Search Results (3,784)

Rotavirus alphagastroenteritidis remains the leading cause of severe gastroenteritis in children under five years, despite widespread vaccine use. The COVID-19 pandemic disrupted healthcare and vaccination delivery, while non-pharmacological interventions may have influenced R. alphagastroenteritidis transmission. We conducted hospital-based surveillance of R. alphagastroenteritidis gastroenteritis at Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, from October 2019 to October 2024. Children under five presenting with acute gastroenteritis were enrolled; 99.1% of vaccine-eligible participants had received at least one R. alphagastroenteritidis vaccine dose. Stool samples were tested for R. alphagastroenteritidis by enzyme immunoassay (EIA) and genotyped using RT-PCR. Among 1135 enrolled children, 29.1% (330/1135) were R. alphagastroenteritidis-positive. Cases occurred year-round except for December 2020–January 2021, when no R. alphagastroenteritidis infections were detected, and February–March 2023, when no samples were collected. The prevalence varied significantly by age group between children greater than 23 months of age to the rest of the age groups (<6 months, 6–11 months, and 12–22 months) (p = 0.0046). The most common R. alphagastroenteritidis G-genotypes were G3 (38.7%), G2 (25.4%), and G12 (17.2%), with G2 emerging as the predominant strain from June 2023. G3P[8] was the most frequent G–P combination (25%). Its overall prevalence did not change during the pandemic; however, genotype distribution shifted compared to pre-COVID-19 patterns. Sustained surveillance and genomic analyses are essential to monitor evolving strain dynamics and inform vaccine policy. Full article

The COVID-19 pandemic was responsible for an unprecedented increase in psychological problems among post-secondary students worldwide. Drawing on data from a repeated cross-sectional (RCS) project, this study investigated changes in psychological symptoms, emotional regulation (cognitive reappraisal and emotional suppression), and academic, social, and personal–emotional college adjustment, and associations between these variables among students in two countries during the phases of lockdown (2021), lifting of restrictions (2022), and the endemic phase (2023). University students in Canada (n = 1014) and Spain (n = 447) completed online surveys during these periods. Students in both countries reported significant declines in perceived COVID-19 stress across the pandemic phases. In comparison with pre-pandemic rates, elevated psychological symptoms remained constant. There were some country differences, but sex differences were consistent. Psychological symptoms mediated the association between cognitive reappraisal and the adjustment measures among Canadian students during each pandemic period. Alternatively, they mediated the linkages of maladaptive emotional suppression with academic, social, and personal–emotional functioning of Spanish students at every phase, but only during the lifting of restrictions and the endemic phase for Canadian students. The results indicate the complexity of country and context in the role of emotional regulation during uncontrollable conditions and provide directions for intervention in stressful situations, including adjustment to university and future disastrous environmental events. Full article

Background/Objectives: Following the COVID-19 pandemic, the influenza season returned to its typical pre-pandemic circulation patterns. The category of people most vulnerable to severe influenza was older adults, and frail individuals, confirming their central role as a priority group for vaccination. The objective of this study was to evaluate the impact of an active influenza vaccination program in an area with low influenza vaccination rates and propensity to vaccine co-administration. Methods: People recruited were hospitalized frail individuals, patients over the age of 60, and those with chronic illnesses or comorbidities. It was administered a questionnaire to investigate adherence to influenza vaccination and the Health Action Process Approach was used to evaluate the propensity to co-administration. Results: A total of 418 hospitalized patients were enrolled in the study, of whom 58.4% (n = 244) received the influenza vaccine and 17.9% (n = 75) had a higher propensity to have co-administration of influenza and other recommended vaccines. The factors associated with influenza vaccination acceptance were received advice from hospital healthcare workers (aOR = 10.6 p < 0.001) and previous influenza vaccination (aOR = 18.1; p < 0.001). Propensity to vaccine co-administration was associated with a higher educational level (aOR = 4.21; p = 0.002), receiving vaccination advice from hospital healthcare workers (aOR = 2.80; p = 0.03), perceived positive outcome (aOR = 1.29; p = 0.02) and perceived self-efficacy (aOR = 1.48; p < 0.001). Conslusions: This study explored the impact on influenza vaccination coverage in implementing in hospital vaccination offer. The reliability of this strategy, together with the standard vaccination offer, could allow reaching the recommended vaccination coverage, particularly among at-risk people. Full article

Acinetobacter baumanni (A. baumannii) is a well-known pathogen associated with antimicrobial-resistant infections. It is a major cause of nosocomial infections and is frequently associated with polymicrobial and antibiotic-resistant infections. This study investigates the frequency of A. baumannii infections, its antimicrobial resistance profile and the main co-pathogens isolated in respiratory samples at the San Giovanni di Dio e Ruggi d’Aragona Hospital in 2015–2019 (pre-COVID-19 pandemic) and 2020–2023 (during/post-COVID-19 pandemic). Bacterial identification and antibiotic susceptibility testing were performed using the VITEK^® 2 system (2015–2019), while identification was carried out with MALDI-TOF MS starting from 2020. A total of 1679 strains were isolated between 2015 and 2019, and 1186 between 2020 and 2023, with significantly higher frequencies in males 61–80 and females 71–80. A. baumannii was isolated predominantly from respiratory specimens, derived predominantly in intensive care units (ICUs). The antimicrobial resistance rates of A. baumannii were above 90% for gentamicin, trimethoprim/sulfamethoxazole, imipenem and ciprofloxacin, while colistin resistance was less than 1% (0.95%) in pre-pandemic and alarmingly increased during/post pandemic period (6.1%). A. baumannii was most frequently associated with Klebsiella pneumoniae, Staphylococcus aureus and Pseudomonas aeruginosa in respiratory tract infections. A. baumannii represents a serious global health threat due to its extensive antimicrobial resistance, highlighting the need for continuous surveillance, detailed strain characterization, and development of new antimicrobial agents. Full article

Background and Objectives: Heart failure (HF) represents a clinical syndrome characterized by symptoms and signs such as fatigue, dyspnea, edema of the lower limb, or pulmonary rales. It usually occurs in elderly individuals due to decreased cardiac pumping function and/or increased diastolic ventricular filling pressures. The COVID-19 pandemic deeply altered many daily life habits, and one of the most affected groups of people were those with chronic diseases because of their need for regular medical follow-up. Furthermore, SARS-CoV-2 infection itself has been shown to exacerbate cardiovascular diseases (CVDs). Materials and Methods: This retrospective, observational, and comparative study aimed to characterize and compare patients with chronic heart failure hospitalized in the Cardiology Department of Medical Clinic II, Mureș County Emergency Clinical Hospital, in Târgu Mureș, Romania, between January and December 2019 (pre-pandemic), January and December 2021 (pandemic), and January and December 2023 (post-pandemic). Results: A total of 406 patients were analyzed: 202 patients hospitalized in 2019, 101 patients hospitalized in 2021, and 103 patients hospitalized in 2023. Women with HF were significantly older (median age 72 years) than men (median age 65 years; p < 0.001). During the pandemic, the median length of hospitalization increased (8 days vs. 7 days in the other periods). The pandemic period was also associated with a decrease in left ventricular ejection fraction (LVEF), as reflected by a higher incidence of patients with HF with reduced ejection fraction (42% during the pandemic; p < 0.01). Conclusions: During and after the pandemic, men exhibited significantly higher rates of right and left bundle branch blocks, as well as chronic obliterating artery disease of the lower limb. Left ventricular function declined during the pandemic in both men and women. Throughout the years, we observed distinct patterns between male and female patients regarding associated diseases or behaviours, suggesting lifestyle and psychological changes due to the COVID-19 pandemic. Full article

Background: The duration of protection that COVID-19 vaccination provides against severe outcomes remains uncertain. Accurately defining this timeframe is critical for informing effective vaccination policies and booster strategies. This investigation aimed to quantify the length and durability of vaccine-conferred protection against severe disease, delivering evidence to guide public health decision-making. Methods: We conducted a multi-site cohort study to evaluate the relationship between time since last COVID-19 vaccination and the risk of severe infection among emergency department (ED) patients with a principal diagnosis of COVID-19. Vaccination status was categorized by time since the last documented dose: unvaccinated, 0–6 months, 7–12 months, 13–18 months, and 19–24 months. The primary outcome was severe COVID-19, defined as ICU admission, mechanical ventilation, or in-hospital death. Inverse Probability of Treatment Weighting (IPTW) was used to adjust for baseline confounding based on age group, sex, race, comorbidity burden, immunocompromised status, and calendar time period (pre-2023 vs. post-2023). Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for each vaccination interval compared to unvaccinated patients. Results: Between 1 December 2021, and 20 July 2024, 42,124 ED encounters were included in the analysis. In IPTW-weighted models, vaccination within 0–6 months (aHR 0.73, 95% CI 0.64–0.83), 7–12 months (aHR 0.72, 95% CI 0.64–0.82), and 13–18 months (aHR 0.67, 95% CI 0.57–0.79) was associated with a significantly reduced risk of severe outcomes. However, no significant protection was observed at 19–24 months (aHR 0.95, 95% CI 0.80–1.14). In age-stratified analyses, protection persisted longer in individuals aged ≥65 years than in those aged 50–64. Older age, male sex, comorbidities, and immunocompromised status were also associated with increased risk. Conclusions: COVID-19 vaccination provides sustained protection against severe outcomes for up to 18 months, after which effectiveness declines substantially. These findings support booster dose strategies based on time since last vaccination and targeted prioritization for high-risk populations. Full article

Background: The COVID-19 pandemic has imposed significant changes on daily life. It negatively impacts children’s physical activity and lifestyle behaviors, which may cause accelerated weight gain during the COVID-19 pandemic. This study aims to evaluate children’s longitudinal age- and sex-adjusted body mass index (BMI) percentile changes during and after the COVID-19 pandemic. Methods: Height and weight data were obtained from electronic medical records for children (ages 2–18) visiting outpatient clinics during three periods: pre-COVID-19 lockdown, during COVID-19 lockdown, and post-COVID-19 lockdown. According to the availability of anthropometric information, three partially overlapping cohorts were formed: Cohort 1 (N = 934, pre- and during lockdown), Cohort 2 (N = 1129, during and post-lockdown), and Cohort 3 (N = 203, data from all three periods). Results: During the lockdown, the mean changes in percentiles of age- and sex-adjusted BMI were 6% ± 0.23, while after the lockdown, there were smaller mean changes in BMI percentiles (1% ± 0.19). There were significant associations of age and the baseline BMI categories with the change in the means of the adjusted BMI percentile of children during and after the COVID-19 pandemic (p-value < 0.001). In addition, there were significant associations of gender and the baseline BMI categories with the change in the means of the adjusted BMI percentile of children over a three-time series (p-value: <0.04, <0.001, respectively). Conclusions: In conclusion, children experienced increased BMI during and after the COVID-19 lockdown. This result highlights the importance of structured interventions to mitigate the consequences during challenging times on children’s health. Full article

Introduction: The COVID-19 pandemic posed additional challenges for this vulnerable population, such as Sjögren’s disease (SjD), underscoring the need for effective and safe vaccination strategies. Objective: To evaluate the immunogenicity and safety of COVID-19 vaccines in patients with SjD. Methods: This prospective, observational, longitudinal study included SjD patients from the SAFER cohort. Immunogenicity was assessed via anti-spike IgG (IgG-S) titers using chemiluminescence reported as geometric mean titers (GMT) and fold increase in GMT (FI-GMT). Disease activity was evaluated using the ESSDAI score. Adverse events and COVID-19 infections were also monitored. Assessments were conducted at four time points: pre-first dose (T1), pre-second dose (T2), pre-booster (T3), and four weeks post-booster (T4). Primary vaccination involved ChAdOx1 nCoV-19 or inactivated vaccine (CoronaVac), and boosters were either homologous (ChAdOx1 nCoV-19) or heterologous (BNT162b2). Results: Among 51 participants (mean age 46 years; 90% female), 41% had comorbidities and 27% (n = 14/51) were highly immunosuppressed. Among those 73% (n = 37/51) under low immunosuppression, n = 8/51 (13%) were not using any medication. At baseline, 11% (n = 4/35) showed moderate/high disease activity, which decreased to 6.5% (n = 2/31) at T4. Primary vaccination was ChAdOx1 in 94% (n = 48/51) and CoronaVac in 6% (n = 3/51); 73% (n = 37/51) received heterologous and 27% (n = 14/51) homologous boosters. COVID-19 infection post-booster occurred in 20% (n = 10/51). Seroconversion rates reached nearly 100% across all medication subgroups except for biologic users, who showed delayed but stable seroconversion by T4. IgG-S titers increased progressively through T4. Primary immunization induced an ascending GMT in both vaccine types. At T4, the GMT was significantly higher in the BNT162b2 group (2148.03 [1452.05–3155.84]; p < 0.001; 95% CI) than in the ChAdOx1 group (324.29 [107.92–974.48]; p < 0.001; 95% CI); the fold-increase in immune response was six times greater with BNT162b2 (5.98 [2.97–12.03]; p = 0.001; 95% CI). Seroconversion was 100% in the heterologous group versus 83% in the homologous group (p > 0.01). Those with prior infection showed significantly higher titers, particularly at T2 and T3 (p < 0.001 for T1–T3). Adverse events were mild and not statistically significant. Multivariate regression confirmed BNT162b2 as an independent factor for higher antibody titers. Conclusion: COVID-19 vaccination in patients with SjD was safe and induced high anti-spike antibody titers and seropositivity. Heterologous boosting, particularly with BNT162b2, demonstrated superior immunogenicity. No association was found between vaccination and SjD disease flares or worsening activity. Full article

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder characterized by recurrent nodules, abscesses, and sinus tracts in apocrine gland-bearing areas. Surgery plays a key role in moderate-to-severe disease. As patients increasingly rely on the internet for decision-making, the quality of online information on HS surgery requires critical evaluation. Previous studies have shown poor quality and limited coverage of surgical aspects. This study systematically assesses publicly available websites on the surgical and reconstructive management of HS, quantifies their quality using the modified Ensuring Quality Information for Patients (mEQIP) tool, and identifies areas needing improvement to support informed decisions. Methods: Google, Bing, and Yahoo were searched using five HS surgery-related keywords. The first 50 results per keyword and engine were collected (n = 750), and 214 websites met the inclusion criteria. Sites were categorized by provenance (practitioners, hospitals, healthcare portals, professional societies, encyclopedias) and assessed using the 36-item mEQIP checklist. High quality was defined as ≥23/36 (75th percentile). Comparisons were made by publication era (pre-/post-COVID-19) and source type. Results: The mean mEQIP score was 21.7; only 51 websites (23.8%) met the high-quality threshold. No significant difference emerged between pre- and post-COVID publications. Healthcare portals scored highest (22.8), followed by practitioners (21.5) and hospital sites (21.2); professional societies (19.7) and encyclopedias (17.3) performed worst. Major deficiencies included limited discussion of surgical risks, quality-of-life outcomes, and postoperative care. Conclusions: Online resources on HS surgery are frequently incomplete and omit essential details on risks, recurrence, and reconstructive options. Surgeons should direct patients toward vetted sources, and professional societies should develop accessible, evidence-based patient guidelines. Full article

Background/Objective: The SARS-CoV-2 pandemic, emerging in late 2019, led to a global health crisis, with many patients developing prolonged symptoms after infection known as sequelae of COVID-19. This condition is theorized to be driven by systemic inflammation and immune dysregulation and presents with diverse symptoms from cardiovascular, pulmonary, and neurological systems. This study investigates the prevalence, risk factors, and long-term impacts of sequelae of COVID-19. Method: Using Denmark’s healthcare databases, this population-based cohort study included 1,034,093 individuals over 40 years who tested positive for COVID-19 between 1 March 2020 and 28 February 2022. Participants were divided into two age groups: 40–59 years and 60 years or older. Part A examined the risk of sequelae of COVID-19 diagnoses (ICD-10 code B94.8A) based on the Charlson Comorbidity Index (CCI). Part B assessed two-year outcomes for patients diagnosed with sequelae of COVID-19. Results: Results showed a 0.55% prevalence of sequelae of COVID-19 in both age groups. Higher CCI scores correlated with an increased risk of sequelae of COVID-19. During the two-year follow-up, patients with sequelae of COVID-19 faced significantly elevated risks of thromboembolic events, chronic lung diseases, and infections. Adjusted hazard ratios were notably high: 14.50 (7.54–27.86) and 12.50 (6.95–22.49) for thromboembolic events in adults and older adults, respectively; 33.81 (13.30–85.96) and 9.83 (6.09–15.87) for chronic lung disease; and 8.40 (4.49–15.70) and 15.44 (10.47–22.78) for infections. Conclusions: While the overall prevalence of sequelae of COVID-19 was low among individuals over 40, those with higher comorbidity burdens were at greater risk of severe sequelae and subsequent health complications. These findings underscore the need for clinical monitoring, especially for patients with pre-existing comorbidities, to mitigate long-term health risks associated with COVID-19 sequelae. Full article

Background/Objectives: The COVID-19 pandemic significantly disrupted healthcare systems and blood supply chains. This study aimed to analyze blood transfusion trends across three distinct clinical departments in a Hungarian tertiary care clinical center and to examine the relationship between these trends and the pandemic waves. Methods: A retrospective analysis of hospitalization and transfusion data from the Departments of Anesthesiology and Intensive Therapy, Surgery, and the Division of Hematology at the University of Pécs Clinical Centre was performed between 1 January 2020, and 31 December 2023. Generalized additive models were employed to assess the association between available predictors and the odds and volume of red blood cell transfusions. Results: At the Department of Anesthesiology and Intensive Therapy, the median weekly ratio of transfused patients fell from 50% (pre-pandemic) to 9.76% (third wave of pandemic). COVID-19 diagnosis was associated with lower odds of receiving transfusion (OR: 0.23) and with a lower incidence rate ratio of transfused red blood cells (IRR: 0.22). At the Department of Surgery, the median weekly ratio of transfused patients was consistently low and stable (9–10%) throughout the study period. The number of patients remained relatively stable at the Division of Hematology during the study period, expressing a higher odds of receiving transfusion during the second (OR: 2.63) and fourth (OR: 1.52) pandemic waves. Conclusions: The pandemic’s impact on transfusion practice, driven by indirect various consequences of patient redirection and protocol modifications, was most expressed at the Department of Anesthesiology and Intensive Therapy. Similar changes in transfusion practice may be anticipated in the event of another pandemic outbreak. Full article

The COVID-19 pandemic has profoundly influenced healthcare systems and infection control worldwide, with important implications for the epidemiology of antimicrobial resistance. This study examined the prevalence and characteristics of carbapenem-resistant Enterobacterales (CRE) isolates in Southeastern Austria from 2018 to 2022 to assess potential pandemic-related effects. A total of 63 isolates were analyzed using phenotypic and molecular methods, including carbapenemase detection, genotyping, and multilocus sequence typing. The number of CRE isolates appeared to decline during the pandemic years (2021–2022) compared to the pre-pandemic period, with Enterobacter cloacae notably detected in both full pandemic years. Carbapenemase-producing CRE accounted for 44 out of the 63 isolates (69.8%), with metallo-beta-lactamases (VIM-1 and NDM-1) and OXA-48-like carbapenemases predominating. Resistance mechanisms not based on carbapenemase production were more common before the pandemic but rarely detected thereafter. To our knowledge, this is the first report of dual-carbapenemase-producing CRE isolates in Austria. Multi-locus-sequence typing indicated limited nosocomial transmission, with most isolates representing independent introductions linked to external sources. The decline in CRE prevalence may reflect reduced international travel and healthcare access during the pandemic, which could have limited the importation of resistant strains. These findings reflect the potential role of global mobility in the spread of CRE and illustrate how public health interventions can shape antimicrobial resistance trends. Full article

Retention in pre-exposure prophylaxis (PrEP) care—defined as receiving a fourth PrEP prescription within 12 months of initiation—remains a major challenge for young adults and individuals minoritized by race and ethnicity in the United States (U.S.), particularly after disruptions in care from the Coronavirus Disease 2019 (COVID-19) pandemic. This study examined changes in PrEP retention before and after COVID-19 among clients ages 18–29 years at AIDS Healthcare Foundation (AHF) Wellness Center clinics across the U.S. We conducted a retrospective analysis of electronic health record (EHR) data from 6047 clients who initiated PrEP between 1 January 2018 and 15 March 2023. Retention was defined as receiving a fourth PrEP prescription within 12 months of initiation. Overall, PrEP initiation increased threefold post-COVID-19, but retention by the fourth prescription declined from 86.2% pre-COVID-19 to 62.6% post-COVID-19 (p < 0.001). Clients initiating PrEP post-COVID-19 had significantly lower odds of retention (odds ratio [OR] = 0.13; p < 0.001), suggesting these systemic disruptions reduced continuity of care. Additionally, clients who identify as non-White had lower retention odds compared to clients who identify as White post-COVID-19 (OR = 0.80; p = 0.003), indicating that racial/ethnic disparities in PrEP care persist beyond the pandemic’s impact. These findings highlight the need for targeted interventions to strengthen retention in PrEP care post-COVID-19. Full article

The COVID-19 pandemic has reshaped the global understanding of airborne disease transmission, particularly in healthcare environments. This literature review examines how building ventilation and indoor air quality strategies have evolved in response to SARS-CoV-2, with a specific focus on healthcare settings. A systematic review of 163 post-pandemic studies, alongside a selective review of pre-COVID-19 literature, was conducted to assess how scientific knowledge, practical recommendations, and HVAC-related interventions have changed. The review categorizes studies across detection methods, simulation models, observational analyses, and policy recommendations, drawing attention to novel findings and evidence-supported practices. While the body of research reaffirms the critical role of ventilation, many recommendations remain unevaluated through empirical methods. This study identifies the gaps in evidence and highlights the most impactful advances that can inform future design, maintenance, and operational protocols in healthcare facilities to mitigate airborne infection risks. Full article

Background/Objectives: Healthcare and social workers were at increased risk of infection during the COVID-19 pandemic, and were therefore also at increased risk of long-term physical and mental health consequences due to infection. This study aimed to investigate the course of health-related quality of life (HRQoL) and mental health, in terms of depression and anxiety. Methods: A longitudinal study surveyed employees in health and social services diagnosed with SARS-CoV-2 in 2020 over a period of three years. Results: A total of 834 individuals participated in all four surveys. The mean age was 50.2 years (SD 5.8), with 82.3% of the participants being female. Mixed-model analyses were performed to examine the development over time. The results showed significant impairments in physical and mental HRQoL, as well as in mental health. Factors influencing physical HRQoL were gender, age, and pre-existing conditions. Pre-existing mental health conditions and self-reported health prior to infection were found to be predictors of mental HRQoL and symptoms of depression and anxiety. Those with persistent symptoms reported a significantly lower quality of life than those who had recovered. The mean physical HRQoL among participants with ongoing symptoms was 38.6, compared with 50.0 for those without symptoms, and the mean mental HRQoL was 40.4 versus 50.1 (p < 0.001). Conclusions: These findings suggest that health-related quality of life and mental health should continue to be monitored to prevent long-term psychological distress. Full article