Search Results (3,898)

Background: Bordetella pertussis causes pertussis, a respiratory infection with whooping cough. Despite a high vaccine coverage, pertussis resurged post-COVID-19 pandemic. Meanwhile, isolates resistant to macrolides—the first-line therapy—have increased in several countries, including Japan. Culturing B. pertussis and detecting resistance are difficult; reports remain limited in Japan. Methods: From March to August 2025, we collected nasopharyngeal samples from children aged 0–15 years with suspected pertussis at six Japanese clinics. Pediatricians obtained swabs and tested them using gene-amplification kits (e.g., BioFire^® SpotFire^® in four clinics, LAMP Pertussis Detection^® in two clinics). B. pertussis was confirmed by PCR; isolates were sequenced to identify macrolide-resistant mutations. Results: Samples were taken from 54 children, the number of boys and girls was 34 and 20, and their median age was 12 years old. Among 54 B. pertussis isolates, 43/52 (82.7%) sequenced strains harbored the A2047G mutation associated with macrolide resistance. Resistance rates at each clinic varied from 40% to 96%. Conclusions: These findings indicate a post-pandemic rise in macrolide-resistant B. pertussis in Japan. Ongoing resistance surveillance is essential, and repurposing residual clinical samples after routine testing is useful given culture and detection challenges. Full article

Urban heat islands pose intensifying threats to public health, equity, and urban livability as climate change amplifies temperature extremes. This systematic review synthesizes evidence from 33 primary studies (2021–2025) examining health impacts, mitigation strategies, and policy integration. The analysis focuses on interaction mechanisms, specifically how mitigation strategies differentially reduce health burdens across vulnerable populations, to advance systems-level understanding of urban heat dynamics. Following PRISMA guidelines, the review examined these mechanisms across three interconnected domains: health burdens, physical mitigation effectiveness, and post-pandemic policy synergies. Findings reveal profound inequities in heat exposure and associated health outcomes, with disadvantaged populations experiencing 26–45% higher heat-related mortality risk and 3–4 °C greater exposure than affluent communities, even after controlling for income. Physical mitigation strategies show measurable effectiveness, providing 1–6 °C cooling from green infrastructure and 2–22 °C from cool surfaces. Optimal interventions vary by socioeconomic context, with urban trees being more effective in disadvantaged areas, while cool roofs are better suited to affluent zones. COVID-19 natural experiments demonstrated 30–50% anthropogenic heat reductions, revealing strategic opportunities for integrating heat mitigation with 15-Minute City planning and work-from-home normalization. Effective implementation requires moving beyond isolated interventions toward spatially differentiated, equity-centered strategies aligned across planning, transportation, and governance domains. The post-pandemic period presents a critical window for embedding heat mitigation into broader urban transformation agendas. Full article

Lower respiratory infections (LRIs) are responsible for significant morbidity and mortality in Ecuador; however, evidence to support prevention strategies is limited. This study aimed to identify age-specific trends, spatial patterns, and sociodemographic risk factors of LRI mortality in Ecuador between 2012–2022, utilizing national mortality data sourced from the Ecuadorian National Institute for Statistics and Censuses (INEC). Age-sex-specific trend analysis was performed using Joinpoint regression. LRI age-standardized mortality rates (ASMRs) were mapped by province of death, and percentage change was calculated between 2012 and 2019. Multivariable logistic regression was performed to assess risk factors pre- and post-2020. A change in trend in LRI mortality rate, from a decreasing trend to a marginal increasing trend, was identified for both genders in children aged 0–4 and 5–15 years. There were significant increasing trends for males (2014–2019 APC: 2.21%, 95% CI: 0.57, 6.70) and females (2016–2019 APC: 4.62%, 95% CI: 0.84, 10.58) aged ≥ 70 years. From 2012 to 2019, the highest average LRI ASMR was in Guayas (30.90 deaths per 100,000 inhabitants), and the greatest percentage increase was observed in Orellana (419.54%). Before 2020, LRI mortality, compared to deaths of other causes, was significantly associated with sex, age, education, ethnicity, place of death and climate region, with major shifts post COVID-19 pandemic. Full article

The COVID-19 pandemic highlighted critical issues in health services and public policy, particularly in long-term care facilities across Canada. Failures in these facilities revolving around chronic underfunding, staffing shortages, inadequate infection control, and inconsistent regulatory oversight, underscore the need to rethink health service interventions, especially considering varying implementation contexts among provinces. The Ontario Long-Term Care COVID-19 Commission Final Report pointed to long-standing systemic issues as the primary causes of the sector’s failures. To explore this issue, a narrative review was conducted with findings indicating that the long-term care crisis in Canada cannot be solved by more privatization, regulation or efficiency measures, as these have contributed to the problem’s root causes. Ontario’s long-term care crisis stems from systemic misalignments in policy, structure and stakeholder dynamics, requiring a shift toward systems thinking and resident-centered care to build an equitable and sustainable long-term care sector. Ultimately, governments must lead a policy redesign that reflects shared responsibility, stakeholder interdependence, and public involvement, offering a model for broader healthcare reform. Full article

Background/Objectives: Alcohol-based handrub (ABHR) consumption is commonly used as an indirect proxy for hand hygiene practices. Hand hygiene compliance increased significantly during COVID-19, but sustainability remains uncertain. This study assessed ABHR consumption trends from 2022 to 2024 and compared them with pre-pandemic and pandemic-era rates. Methods: We conducted a follow-up observational study tracking quarterly ABHR consumption in a surgical department and hospital-wide (2022–2024). Consumption was normalized as mL per patient-day and compared with 2019–2020 data. Time-series regression with Newey–West standard errors assessed temporal trends. Results: Surgical department consumption declined 27.5% (55.9 to 40.5 mL/patient-day), returning to 2019 pre-pandemic levels. Hospital-wide consumption increased 36% (36.4 to 49.6 mL/patient-day). Neither trend reached statistical significance (p > 0.05). The 2024 surgical rate remained substantially below the 2020 pandemic peak (320 mL/patient-day). Conclusions: Pandemic-era ABHR consumption gains were not sustained in the surgical department despite maintained educational infrastructure, accessible dispensers, and consistent staffing. The critical missing element was systematic monitoring and feedback. Institutions relying solely on passive education may experience erosion of hand hygiene compliance post-crisis, highlighting the need for active surveillance programs to maintain behavioral gains. Full article

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8. Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic’s peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH’s potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement. Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review. Full article

The Coronavirus Disease 2019 (COVID-19) pandemic and its prolonged effects have been widely discussed on social media, and these discussions have been analyzed in various studies. A long-term analysis of Twitter (now “X”) posts regarding COVID-19 vaccination is essential for informing policy and improving public health communication strategies. In addition, to prevent the spread of infectious diseases, it is crucial to rapidly promote vaccination while mitigating the impact of negative sentiment toward vaccination on social media platforms. Therefore, identifying the key factors behind negative discussions is important for guiding policy decisions and shaping responses. In this study, we collected Japanese tweets (posts) containing the words “Corona” and “vaccine” that were posted from February 2021 to December 2022. The results indicate that negative sentiment was primarily driven by concerns about adverse reactions and general fear and anxiety, which were particularly prominent before vaccination for the general public began, as well as mentions of pain during and after vaccination. While concerns about adverse reactions persisted throughout the analysis period, their prominence decreased over time as positive reactions became more frequent. Our findings provide insights into the characteristics and key factors behind negative discussions on COVID-19 vaccination in the Japanese context and may help improve public health communication strategies. Full article

Pseudomonas aeruginosa bloodstream infections (PABSIs) are a major clinical challenge due to their association with significant mortality and antimicrobial resistance mechanisms. The COVID-19 pandemic changed antimicrobial practices, intensive care management, and patient risk profiles, potentially influencing the epidemiology and outcomes of PABSIs. In the post-pandemic period, practices were expected to revert to normal. The objective of this scoping review was to identify and summarize reported mortality rates and risk factors for PABSIs in studies published between 2023 and 2025. Literature searches were conducted across PubMed, Web of Science, Embase, and Scopus. Screening was performed in accordance with PRISMA-ScR guidelines. Twenty-two eligible studies were included. Mortality rates varied across the study setting and populations; however, several consistent predictors were consistently identified, including carbapenem exposure, multidrug-resistant Pseudomonas aeruginosa, hematologic disease or malignancy, corticosteroid therapy, sepsis or septic shock, mechanical ventilation, and higher severity-of-illness scores. Few studies have linked molecular mechanisms to patient outcomes, highlighting important gaps in knowledge. Notably, only a small number of studies included the post-pandemic period but did not analyze the data separately. Despite limited available evidence, critically ill and immunocompromised patients remain at greatest risk of death from PABSIs. This review highlights the need for a broader comparative analysis in future. Full article

This study evaluates the early impact of Central Bank Digital Currencies (CBDCs) on key financial indicators in The Bahamas, focusing on the introduction of the SandDollar—the world’s first fully implemented retail CBDC. Using the Synthetic Control Method (SCM), the analysis constructs counterfactual scenarios to assess the effects of CBDCs on three dependent variables: outstanding loans from commercial banks as a percentage of GDP, outstanding deposits as a percentage of GDP, and the number of deposit accounts per 1000 adults. Three separate SCM models were estimated for the period 2014–2024, incorporating a broad set of control variables reflecting financial infrastructure, economic performance, demographic characteristics, and digital readiness. The findings consistently show that the SandDollar’s implementation is associated with reductions in loan issuance, deposit levels, and deposit account ownership compared to their synthetic counterparts. These results support the hypothesis that direct CBDC models may amplify “deposit substitution” and increase liquidity risks by shifting financial activity away from commercial banks. Although the SCM provides a structured causal framework, the short post-treatment period and potential pandemic-related disruptions limit the scope of a long-term understanding. The study underscores the importance of careful CBDC design, particularly the role of intermediated models in mitigating unintended financial stability risks. Full article

Vulnerable populations experience higher mortality and readmission after hospital discharge. We sought to evaluate the impact of the Transitions Of Care Bundle (TOCB™) on COVID-19 patient outcomes post-discharge compared to a control cohort. This retrospective study used electronic health record data collected for 243 COVID-19 patients (65 TOCB™, 178 control) during the initial pandemic months at a large academic facility in Northeast New Jersey (NJ). Data included demographics, comorbidities, readmissions, mortality, and payor. The TOCB™ cohort had proportionally more Hispanic patients (56.92% vs. 48.3%, p = 0.0885). All TOCB™ patients were discharged home without needing additional services, compared to only 36% of the control group. The implementation of TOCB™ was associated with shorter hospital stays, a potential decrease in readmission rates, and fewer emergency department visits. These results imply that well-coordinated post-discharge services are linked to a diminished risk of mortality, possible hospital readmission, and other adverse health outcomes. Full article

Background/Objectives: Speech and language delay (SLD) is one of the most prevalent developmental conditions in childhood, with post-pandemic data indicating a notable increase in identified cases. Within this group, expressive language disorder (ELD) frequently appears alongside neurodevelopmental disorders such as autism spectrum disorder (ASD), epilepsy, and intellectual disability. Although awareness of ELD has grown, the role of genetic testing in its evaluation remains unclear, as such testing is not routinely pursued for isolated expressive language concerns. This gap highlights the need to better define the diagnostic value of genetic analysis and to examine the interval between an ELD diagnosis and the return of genetic testing results. Methods: This study investigated genetic contributions to ELD using the National Brain Gene Registry (BGR), a multisite database of rare neurodevelopmental disorders. Participants with ICD-10 code F80.1 were identified through electronic health records; demographic data, comorbidities, genetic variants, inheritance patterns, age at diagnosis, and timing of interventions were analyzed. Results: Of 687 BGR participants, 32 (4.7%) had documented ELD. The cohort, aged 3–19 years, presented with common comorbidities like developmental delays, ASD, epilepsy, and hypotonia. Across 42 genes, 49 unique variants were identified: 26 pathogenic or likely pathogenic, 22 variants of uncertain significance, and one benign variant. Seventeen variants were de novo, and 10 participants carried multiple variants. Most children (80%) received an expressive language diagnosis prior to genetic testing, with reports returned an average of 1.5 years following the diagnosis. Conclusions: Overall, children with ELD commonly carry genetic variants and neurodevelopmental comorbidities, yet genetic testing is typically pursued well after diagnosis and does not currently alter early management. These findings underscore the need for clearer, evidence-based guidelines to define when genetic testing adds diagnostic or prognostic value in the evaluation of ELD. Full article

Background: Psychological services within hospitals are essential to delivering integrated, patient-centred care, yet in many health systems they remain fragmented, variably organised, or confined to specific medical specialties. The Clinical Psychology Unit of the Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), represents one of the few examples of a hospital-wide psychological governance model in Italy, but its organisational structure and longitudinal activity have not previously been systematically described. Objective: This study (I) describes the organisational design and operational components of the Gemelli Unit; (II) compares it with international organisational models using a typological framework; and (III) examines its resilience and adaptive capacity during the coronavirus disease 2019 (COVID-19) pandemic. Methods: A descriptive–narrative approach was adopted, integrating institutional documentation, routinely collected service data (2019–2024), anonymised case vignettes, and a structured comparison with national and international psychological care structures. The analysis was informed by theoretical models of integrated health-care delivery and by Donabedian’s structure–process–outcome framework. Results: Between 2019 and 2024, psychological interventions increased from 28,878 to 47,076 (+63%), with a post-pandemic average of 41,868 annual interventions. In 2024, the Unit supported 2150 patients and 340 healthcare professionals, with psycho-oncology accounting for approximately one-third of all activities. The model integrates clinical activity, staff support, conflict management, research, and training under a centralised governance structure, ensuring hospital-wide coverage and coordinated referral pathways. The comparative analysis identified four international organisational types—department-based, liaison/specialty-based, structured health-system, and academic–clinical hybrid—highlighting the hybrid and transversal nature of the Gemelli Unit and its capacity to maintain and adapt services during the COVID-19 emergency. Conclusions: The Gemelli Unit represents a distinctive hospital-wide organisational model that combines centralised governance, transversal deployment, personalised care, and structured support for healthcare professionals. These characteristics position it as a potentially transferable benchmark for health systems seeking to integrate psychological care into core organisational and clinical processes. Future work should prioritise the development of standardised outcome indicators and national frameworks to support the evaluation and harmonisation of hospital-based psychological services. Full article

The COVID-19 pandemic has posed significant challenges to mental health worldwide, raising the need to identify stable psychological resources that promote sustainable well-being. This longitudinal study examined whether character strengths predict well-being, post-traumatic growth, and mental health over a 13-month period. Participants (N = 146) completed online measures of character strengths, mental health, life satisfaction, affect, and post-traumatic growth at two time points. First, we tested whether a single general factor of character predicted later mental health and whether life satisfaction, affect, and post-traumatic growth mediated this relationship. Then, we repeated this model but with five different character strengths factors as predictors. Results showed that character predicted all mediators and mental health over time, but only the affective components of well-being mediated the relationship between character and mental health, especially positive affect. When looking at the five character strengths factors, although the majority predicted higher well-being and better mental health over time, goodness and interpersonal and fortitude strengths yielded the strongest effects. These findings suggest that character strengths contribute to sustainable well-being by fostering affective resilience in the face of adversity, aligning with the goals of Sustainable Development Goal 3 (Good Health and Well-being). Full article

Background and Objectives: The onset of the COVID-19 pandemic posed a new challenge to hospital infection prevention measures and to the antimicrobial therapies adopted. The present study aimed to assess the influence of the COVID-19 pandemic on the dynamics of surgical site infection (SSI) rates and the variations in the microbiological profiles of the SSI. Materials and Methods: A retrospective, single-center study was conducted to examine data from patients who underwent conventional surgical procedures and developed SSI. The study was conducted at the First Surgery Clinic of the “Pius Brinzeu” Clinical Emergency Hospital, Timisoara, Romania. Data from 173 patients were analyzed over six years (from 26 February 2018 to 25 February 2024). The selected time interval was divided into three periods: pre-pandemic, pandemic, and post-pandemic. Results: During the pandemic, the average patient age was significantly lower than in the other periods. The average length of stay decreased consistently over the six-year study period. Among the 173 patients included in the study, 71.1% had a monobacterial infection, while the remaining 28.9% had infections involving at least two different bacteria. The two most commonly identified bacteria in more than 50% of the cases were Pseudomonas aeruginosa and Enterococcus spp. There was a significant decrease in bacterial resistance to levofloxacin and ciprofloxacin over the study period, with resistance dropping from 50% (pre-pandemic) and 53.3% (pandemic) to just 9.1% (post-pandemic). Conclusions: The COVID-19 pandemic substantially altered the SSI profile in our institution. The temporary increase in SSI frequency during the pandemic was likely related to shifts in surgical case mix and care delivery, rather than decreased infection control performance. Post-pandemic restoration of surgical flow coincided with improved antimicrobial susceptibility patterns, particularly for fluoroquinolones. Microbiological surveillance, the use of infection prevention measures, and robust stewardship initiatives remain essential to maintain these favorable trends and mitigate the emergence of future resistance. Full article

Background: Non-Hodgkin lymphoma (NHL) is a malignancy of the immune system that includes several subtypes, most commonly diffuse large B-cell lymphoma and follicular lymphoma. Its etiology is multifactorial, with risk factors such as immunosuppressive therapy, infections, chemical exposure, and advanced age. A key aspect is the bidirectional relationship between lymphoma and immunodeficiency, which increases susceptibility to recurrent infections and complicates disease management. Case presentation: One particularly challenging case during the COVID-19 pandemic involved a patient with a personal history of diffuse B-cell non-Hodgkin lymphoma, diagnosed 5 years earlier, who had undergone eight cycles of rituximab-based chemotherapy. The patient tested positive for SARS-CoV-2 for three consecutive months and experienced repeated urinary tract infections warranting more in-depth investigations. The uniqueness of this case lies in the rare association of non-Hodgkin lymphoma, suspected post-rituximab immunodeficiency, severe COVID-19 infection, and recurrent urinary tract infections, which complicated clinical management. Despite appropriate treatment for both respiratory and urinary infections, as well as eight cycles of chemotherapy, the patient’s condition continued to deteriorate significantly, ultimately requiring intravenous immunoglobulin replacement therapy. Following the treatment, the patient presented a remarkable clinical improvement, with resolution of the signs and symptoms, and an absence of further recurrent infections. The patient remained clinically stable under regular immunoglobulin replacement therapy, with sustained infection control and improved quality of life. Conclusions: This case highlights the importance of assessing immune status in patients with a hematological malignancy, especially when recurrent infections persist. Full article