Search Results (1,261)

Background: The COVID-19 pandemic substantially disrupted healthcare systems worldwide, raising concerns regarding delays in diagnosis, alterations in treatment pathways, and oncological outcomes for women with advanced ovarian cancer (AOC). This study evaluated the impact of the pandemic on the management and survival of patients with AOC treated at a high-volume ESGO-accredited tertiary gynaecological oncology centre. Methods: A retrospective cohort study was conducted using a prospectively maintained database of consecutive women diagnosed with FIGO stage III–IV epithelial ovarian, fallopian tube or primary peritoneal cancer between January 2017 and December 2022. Patients were divided into pre-pandemic and pandemic cohorts. Demographic characteristics, FIGO stage, treatment pathways, surgical outcomes, and overall survival were compared. Survival was analysed using Kaplan–Meier methodology and multivariable Cox proportional hazards regression was performed to evaluate the independent association between the pandemic period and overall survival after adjustment for age, FIGO stage, ECOG performance status and treatment modality. Results: A total of 700 patients were included, 406 patients treated before the pandemic and 294 during the pandemic. Patients diagnosed during the pandemic had a better ECOG performance status, but 51.3% presented with FIGO stage IV disease. Overall treatment rates were maintained (84.4% vs. 87.4% pre-pandemic), although treatment strategies shifted towards increased use of neoadjuvant chemotherapy (55% vs. 42.4%, p < 001), with a greater proportion of patients subsequently undergoing interval debulking surgery. Complete cytoreduction following interval debulking surgery was preserved throughout the study period, despite more advanced disease at presentation. One-year overall survival was similar between cohorts (69% vs. 72.2% pre-pandemic), whereas three-year overall survival was significantly lower among patients treated during the pandemic (36.1% vs. 45.1%). On multivariable Cox regression analysis, treatment during the pandemic remained independently associated with poorer overall survival after adjustment for clinically relevant baseline factors. Conclusions: Despite unprecedented disruption to healthcare services, specialist gynaecological oncology care has maintained access to multimodality treatment and preserved maximal effort cytoreductive surgery. Nevertheless, patients diagnosed during the pandemic experienced inferior long-term survival independent of baseline disease characteristics and treatment allocation, highlighting the broader indirect consequences of the pandemic on cancer outcomes. These findings emphasise the importance of protecting diagnostic pathways, multidisciplinary cancer services and surgical capacity during future healthcare crises. Full article

The risk of healthcare associated infections (HAIs) among hospitalized patients increased with the severity of COVID-19 disease and duration of hospitalization, especially in intensive care units (ICUs). This study retrospectively investigated HAI trends between March 2020 and December 2022 in patients with a COVID-19 diagnosis admitted to the exclusive ICU for the management of severe COVID-19 patients in the Molise region, central Italy. The clinical records of patients were anonymously coded and examined for the number of HAIs and microbiological isolations. Only infections that occurred after 48 h of ICU admission were included for descriptive, univariate and multivariate statistical analysis. Over the three-year period, 185 patients with a COVID-19 diagnosis (69.7% male, mean age 66.1 ± 10.6 years) were admitted to the hospital ICU: 50 (27.0%) in 2020, 94 (50.8%) in 2021, and 41 (22.2%) in 2022. During ICU stays, a high proportion of patients required at least one invasive device and died (97.2% and 88.1%, respectively). Death outcome was significantly associated with pre-existing comorbidities and related treatment, sex, and devices. During ICU stays, 80% received antimicrobial therapy, which was further related to death. At least one microbiological HAI was detected in 103 (55.9%) patients (76.6% male, mean age 65.4 ± 9.6 years). HAI incidence differed by year (p < 0.001), occurring in 36 (35.0%) patients in 2020, 54 (52.4%) in 2021, and 13 (12.6%) in 2022, respectively, and 80.6%, 96.0%, and 92.3% of patients died. A total of 268 isolations were observed: 99 (36.9%), 139 (51.9%) and 30 (11.2) in 2020, 2021 and 2022, respectively, and were mostly fungi in 2020 and 2022 (46.5% and 36.7%, respectively), while Gram-negative bacteria predominated in 2021 (36.7%). The study revealed higher HAI rates among patients in 2021 according to the increasing number of COVID-19 cases and related hospitalizations due to the Alpha variant at the local level, but also reflected the national epidemiology, while the decline in 2022 could be likely associated with the pandemic evolution and improvements in the management of COVID-19 patients. These findings further underline a high rate of lethality, more likely attributed to severe COVID-19 in patients with advanced age and underlying diseases, to which HAI onset could have undoubtedly contributed. The study provides useful epidemiological data regarding HAIs among critically ill COVID-19 patients during different phases of the pandemic across three years. Full article

Background: Notifiable infectious diseases impose a substantial, evolving burden on public health systems. This study characterized long-term epidemiological trends, inter-class associations, and age-stratified patterns of notifiable infectious diseases in South Korea and projected future burden through 2028. Methods: We analyzed aggregate national surveillance data (2001–2024) from the Korea Disease Control and Prevention Agency (KDCA) via the Korean Statistical Information Service (KOSIS). Because the statutory classification changed in 2020 from a four-group (Class 1–4, gun) to a four-grade (geup) system, all inferential trend, correlation, and forecasting analyses were restricted to the internally consistent 2001–2019 group-system period, and 2020–2024 grade-system data were used descriptively. Secular trends were estimated with ordinary least squares and, for count-specific inference, negative-binomial log-linear models (annual percent change, APC); residual autocorrelation was assessed (Durbin–Watson, Ljung–Box). Structural breaks were estimated objectively (Bai–Perron least-squares). Inter-class associations were tested with Pearson/Spearman correlations and re-evaluated with partial correlation (controlling for calendar year) and first-difference detrending to guard against spurious co-trending. Forecasts used a random-walk ARIMA (identified by ADF stationarity testing, ACF/PACF, and AICc) and a damped Holt–Winters model on the H1N1-adjusted series, combined into an ensemble; performance was validated by rolling-origin cross-validation (RMSE, MAE, MAPE). Results: After handling the 2009 H1N1 pandemic outlier, total notifications rose significantly over 2001–2019 (slope = 8344 cases/year; 95% CI 6603–10,084; R² = 0.866; p < 0.001). Class 2 (respiratory/vaccine-preventable) diseases showed the strongest trend (APC = 17.2%/year; 95% CI 8.0–27.3), with an objectively estimated structural break at 2004 (supF = 10.5) separating an early variable phase from sustained growth (2005–2019: +7418 cases/year; R² = 0.94). Raw Class 1–Class 2 correlation (Pearson r = 0.569, p = 0.011) did not survive temporal adjustment (partial r = 0.13, p = 0.59; detrended r = −0.31, p = 0.21), indicating shared secular co-trending rather than a direct epidemiological association; only Class 2–Class 3 remained associated after detrending (r = 0.52, p = 0.03). Young working-age adults (30–49 years) showed the steepest Class 1 increases. Ensemble projections for the pre-COVID trajectory were 238,000 (2025) to 269,000 (2028) annual notifications, with wide prediction intervals reflecting substantial uncertainty. Conclusions: South Korean notifiable-disease epidemiology was dominated by a genuine upward Class 2 respiratory trend; several previously reported inter-class correlations were attributable to common temporal trends rather than shared transmission. Post-COVID normalization monitoring and respiratory-disease surveillance investment are priority actions. Full article

Background: Unplanned paediatric hospital readmissions are key indicators of healthcare quality, often reflecting issues in discharge planning and continuity of care. The COVID-19 pandemic significantly disrupted healthcare delivery and utilisation, yet its impact on paediatric readmission patterns in Australia remains unclear. Methods: A 5-year single-centre retrospective cohort study of 21,262 paediatric admissions and unplanned readmissions at a non-tertiary metropolitan Australian hospital between 21 March 2017 and 20 March 2023 was conducted. Admissions up to 20 March 2020 were classified as pre-pandemic, and those from 21 March 2020 as during the COVID-19 pandemic. We analysed patient characteristics, including gender, age, First Nations status, primary diagnosis, and socio-economic status, to identify UHR trends. Results: During the COVID-19 period, total paediatric admissions declined by nearly 30%, and the readmission rate decreased from 7.5% to 4.6% compared with the pre-pandemic period. Across both cohorts, higher readmission rates were observed among male patients, infants aged 0–12 months, and children from more socio-economically advantaged areas. Readmissions among First Nations children and those with communicable diseases declined during the pandemic period. Conclusions: A higher proportion of males and patients under 12 months of age had higher readmission rates across both periods. These findings highlight the need for targeted early intervention, age-specific discharge planning, and strengthened follow-up care for high-risk groups. Further research should extend the study period beyond the pandemic and include larger cohorts to better characterise long-term trends and improve generalisability. Full article

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

Background: The COVID-19 pandemic profoundly disrupted healthcare utilization patterns at both primary care (PC) and hospital emergency department (ED) levels. This study aimed to assess the impact of the pandemic on referral patterns from PC to a hospital ED and on the resource consumption associated with those referrals. Methods: A descriptive, retrospective, longitudinal comparative study with multivariable sensitivity analyses was conducted at a first-level hospital of Madrid (Spain). All consecutive PC-to-ED referrals received during two observation windows were included: a pre-pandemic period (1 June–31 December 2019; $n=946$) and a Later-Pandemic period (1 January–30 June 2022; $n=1797$). Sociodemographic characteristics, referral form quality, diagnostic specialty, and in-ED resource utilization variables were collected and compared using ${\chi }^2$, Student’s t-test, and Mann–Whitney U tests as appropriate. To assess seasonal confounding, multivariable logistic and ordinal regression models adjusting for calendar season, age, and sex were performed for the primary resource-utilization outcomes. Results: A total of 2743 referrals were analyzed. The monthly referral rate increased by approximately 122% between periods (135/month vs. 300/month). A statistically significant but clinically negligible difference in mean age was observed ($53.1\pm 18.3$ vs. $54.9\pm 19.0$ years; $p=0.015$); no significant sex differences were found. Referral form completion improved significantly for clinical history (94.5% vs. 98.2%; $p<0.001$). Orthopedics referrals nearly tripled (5.8% vs. 18.4%), while respiratory/COVID-19-related referrals represented 22.0% of the 2022 caseload. ED length of stay between 3 and 6 h increased from 13.0% to 42.8% ($p<0.001$), while the need for urgent blood tests fell from 68.9% to 56.0% ($p<0.001$), hospital admission from 68.4% to 10.9% ($p<0.001$), and referral to another center from 12.3% to 0.9% ($p<0.001$). In multivariable sensitivity analyses, the period effect remained statistically significant after adjustment for calendar season, age, and sex for hospital admission (adjusted OR $=0.062$; 95% CI: 0.037–0.106; $p<0.001$) and urgent blood test utilization (adjusted OR $=0.470$; 95% CI: 0.326–0.678; $p<0.001$), although study period and season remain partly confounded by the non-overlapping design. Conclusions: During the later-pandemic period, PC-to-ED referrals increased substantially while being associated with fewer complementary investigations and fewer hospital admissions. This study documents between-period differences in referral patterns and ED resource utilization rather than causal effects; the differences persisted after adjustment for seasonality but cannot be definitively attributed to the pandemic. Future multi-center longitudinal studies are needed to confirm these trends and clarify their underlying mechanisms. Full article

Ensuring a high quality of life for citizens is a fundamental objective for every city, with public safety representing one of the most critical challenges to social sustainability and equitable urban development. This study analyzes the spatiotemporal dynamics of violent crime in Mexico City across pre-pandemic, pandemic, and post-pandemic periods (2019–2023) to evaluate how COVID-19 mobility restrictions were associated with changes in crime patterns. Using publicly available crime reports, we applied Seasonal-Trend decomposition using Loess (STL) and Moran’s I to examine four violent crimes: homicide, robbery, kidnapping, and rape. The results reveal crime-specific pandemic-related patterns. While robbery showed a sustained decline, its spatial clustering intensified significantly, with Moran’s I increasing from 0.22 to 0.59, indicating highly localized risk zones. Conversely, rape exhibited a steady increase that appeared unaffected by lockdown measures, while maintaining significant spatial autocorrelation. Likewise, Cuauhtémoc borough persisted as the main urban hotspot across all phases. Overall, crime did not decline uniformly during the pandemic; instead, mobility restrictions reshaped the geographic distribution and concentration of specific offenses. This research contributes to the understanding of crime dynamics during and after a public health emergency. Full article

Introduction: The Trauma Medical Home (TMH) randomized clinical trial tested the efficacy of a collaborative care intervention on the biopsychosocial recovery of older injured adults compared to usual care. Study enrollment occurred between 11 October 2017 and 13 October 2021 and study operations were impacted by the COVID-19 pandemic. It is important to measure the potential effects of COVID-19 on research study participants to ensure accurate reporting of results. The purpose of this secondary analysis was to compare depression and anxiety symptoms and health-related quality of life in older adults at TMH study enrollment pre-COVID-19 and during COVID-19. We hypothesized that those enrolled during COVID-19 would have worse symptoms and quality of life. Methods: This study was a secondary analysis of data from a multicenter randomized clinical trial (R01AG052493-01A1) TMH, that examined the ability of a collaborative care model to enhance the recovery of older injured adults compared to usual care. It was hypothesized that the TMH intervention would improve biopsychosocial recovery for injured older adults compared to usual care. The enrollment periods pre-COVID-19 and during COVID-19 were compared. Chi-square tests and Wilcoxon Rank Sum tests, then multivariable linear and logistic regressions were completed with SF-36 component scores and depression (PHQ-9) and anxiety (GAD-7) scores as the dependent variables, respectively. Results: A total of 429 participants were analyzed. There was no significant difference in anxiety and depression symptoms between the pre-COVID-19 and during-COVID-19 enrollment periods. Perceived limitations due to physical health problems were worse for those enrolled during COVID-19 (adjusted β = −9.8, 95% CI −18.3 to −1.4), but other health-related quality of life measures were similar between the two groups. Conclusions: These findings support the conclusion that the negative psychological impacts of the pandemic are likely due to individual factors other than age or COVID-19. These results suggest a high degree of psychological resiliency in older adults under stress. Future research should focus on the potential effects of socioeconomic status, demographic background, and level of physical functioning on psychological outcomes. Full article

The COVID-19 pandemic transformed online and distance learning from a supplementary educational option into a central component of education systems, bringing anxiety, stress, and psychological well-being to the forefront of digital learning research. This study traces the two-decade evolution of research on anxiety and stress in online and distance learning between 2005 and February 2026 and examines the thematic reorientation associated with the COVID-19 period. Bibliometric mapping of 243 Web of Science (WoS) records was used to identify publication trends, intellectual structures, international collaboration patterns, and thematic developments. Piecewise analysis indicated a significant post-2020 break in annual scientific output, with the growth rate increasing nearly eightfold (p = 0.0015). Thematic evolution showed that pre-pandemic studies mainly focused on technology acceptance, computer anxiety, and learner adaptation, whereas pandemic and post-pandemic research shifted toward mental health, psychological well-being, social isolation, technostress, and resilience. China and the United States dominated scientific production, while Australia and Saudi Arabia showed notable mobility in collaboration networks. Overall, the findings suggest that the COVID-19 period was associated with a field-level reorientation toward an interdisciplinary psychosocial agenda for future online education. Full article

This study investigated the perceptions and practices of disinfectant use among students at the City University of New York (CUNY) before, during, and after the peak of the COVID-19 pandemic, with a focus on behaviors observed following a controversial statement made by President Donald Trump in April 2020 suggesting the potential use of disinfectants as a treatment for a SARS-CoV-2 infection. Utilizing an online survey of 441 CUNY students, data was collected on cleaning and disinfection behaviors during four distinct periods: pre-pandemic (January–February 2020), during the pandemic’s height (March–April 2020), after the pandemic’s height (June–August 2020), and following the aforementioned presidential statement. Data patterns illustrate an increase in cleaning frequency and disinfectant use during the peak of the pandemic, followed by a notable decrease after the presidential statement. The data also illustrated potentially dangerous practices, such as misting the body with cleaning sprays and using household cleaners on bare skin, though these behaviors generally decreased after the peak of the pandemic. The study highlights the impact of public health communication and the role of misinformation in shaping hygiene practices during a crisis. It underscores the need for clear, evidence-based messaging to promote safe and effective disinfectant use and to counter misinformation that may lead to harmful behaviors. This novel research contributes to the understanding of how a specific student population responded to the pandemic and provides insights for future public health interventions. Full article

Educational resilience commonly refers to better-than-expected academic outcomes among socioeconomically disadvantaged students or schools. However, little is known about its temporal stability, particularly in highly stratified and selective education systems such as Hungary’s, especially following major disruptions like the COVID-19 pandemic. This study investigates the prevalence and stability of resilient and vulnerable elementary school profiles in Hungary using data from the National Assessment of Basic Competencies (NABC). School-level pedagogical value-added (PVA) indicators were estimated separately for mathematics and reading comprehension and aggregated across two three-year periods: the pre-pandemic period (2017–2019) and the post-pandemic recovery period (2023–2025). Schools were categorized into resilient and vulnerable groups based on the intersection of social disadvantage and performance. The profile analyses included 2048 schools; regression models included 192–201 cases depending on data completeness. Results show that resilient schools are rare and only partially stable, with fewer than one-quarter maintaining this status after the pandemic. Logistic regression analyses show that prior resilience, lower levels of disciplinary problems, and maintainer type were associated with a higher likelihood of post-pandemic resilience, while school size, regional location, disadvantage level, and teacher shortages lost explanatory power. Overall, the findings support a dynamic, context-dependent interpretation of school resilience. Full article

Background: Vaccinations are highly effective in preventing infectious diseases, which otherwise present a serious challenge to the health of individuals and public health. To identify potential gaps in vaccination coverage, we examined childhood vaccination levels in Frankfurt am Main (FFM) and the Rhein Neckar district (including Heidelberg city, RNHD) prior to, during and following the COVID-19 pandemic. Moreover, we explored various factors that appear to contribute to lower vaccination levels in specific communities in either or both locations. The results are intended to guide strategies for designing and improving vaccination services for specific groups in local health settings. Methods: A retrospective analysis was conducted to examine the vaccination rates of children in Frankfurt am Main and the Rhein Neckar district (including Heidelberg city) by using anonymized data from school entry examinations spanning the years 2017 to 2024. Data pre-processing, analysis, and visualization were performed using R (5.4.2). Frequencies and percentages were calculated for sociodemographic and vaccination rates (the completeness of the vaccination schedule recommended by STIKO for children). Multivariate logistic regression was performed to determine factors with a significant impact on vaccination uptake. Results: Multinomial logistic regression with ‘measles-only’ (Measles) as the reference category revealed distinct predictor patterns across vaccination levels. In both regions, children who completed preventive medical check-ups had higher odds of completing the schedule of vaccination plus at least one additional vaccine (ScheduledPlus) versus, measles-only vaccination. In RNHD, children from Eastern European language families and low- and medium-social-status backgrounds showed higher odds of completing the scheduled vaccinations without the recently introduced rotavirus vaccination (ScheduledNotRota), versus measles-only vaccination. In FFM, strong interaction effects were observed between medical examination completion and migration background, with children from non-German birthplaces showing dramatically reduced odds of complete vaccination when preventive care was incomplete. Discussion: The proportion of children with a complete vaccination status remained stable over the study period in both locations, with no evidence of post-pandemic decline. Nevertheless, this stability masks important heterogeneity in vaccine coverage patterns across sociodemographic groups. Systematic identification and modeling of interactions between nationality, parental employment, and healthcare utilization tell a compelling “double jeopardy” story that the effects of these risk factors are not additive but synergistic. Regular medical check-ups remain an important factor in ensuring high vaccination coverage among children until they start school and underscore the justification for such established preventive care programs. A nuanced understanding, however, is crucial for moving beyond simplistic, one-size-fits-all public health messaging. Full article

Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the CFTR gene. The sequential approval of CFTR modulators ivacaftor (2012), lumacaftor/ivacaftor (2015), tezacaftor/ivacaftor (2018), and elexacaftor/tezacaftor/ivacaftor (2019) has transformed CF care, but population-level mortality trends across therapeutic periods have not been comprehensively assessed. We conducted a retrospective analysis of CF mortality in the United States from 1999 to 2024 using CDC WONDER Underlying Cause of Death data (ICD-10 codes E84.0–E84.9). Age-adjusted mortality rates (AAMR) per 100,000 were calculated using the 2000 U.S. standard population. The study period was divided into three periods: pre-modulator (1999–2011), early modulator (2012–2018), and elexacaftor/tezacaftor/ivacaftor (2019–2024). Annual mortality trends were evaluated using segmented log-linear Poisson regression, with annual death counts as the outcome and the corresponding U.S. population as an offset. Candidate models with multiple change points were compared to identify distinct temporal segments. Annual percent changes (APCs) and 95% confidence intervals (CIs) were estimated for each segment. Prespecified therapeutic periods, including pre-modulator (1999–2011), early modulator (2012–2018), and ETI period (2019–2024), were retained for descriptive analyses. Trends were stratified by sex and U.S. Census Region. A total of 10,959 CF deaths were recorded over 26 years. In the pre-modulator period, mortality was stable at a mean of 478 deaths/year (AAMR 0.14–0.17). The early modulator period showed a modest 5.4% reduction in mean annual deaths (452/year). The period following ETI availability was associated with a decline to 263/year, a 47% reduction from the pre-modulator period (AAPC −8.6%/year). The AAMR declined from 0.17 (1999) to 0.07 (2024). The female-to-male death count ratio shifted from 1.05 to 0.97 across periods, though age-adjusted rates were identical between sexes within each period, and this finding should be interpreted cautiously. Regionally, the South’s share of CF deaths grew from 37.2% to 41.6% despite absolute declines in all regions, suggesting potential geographic disparities that warrant further investigation with individual-level data. Segmented regression identified change points in 2005 and 2015. Mortality declined significantly from 1999 through 2005 (APC, −2.70%; 95% CI, −4.01% to −1.37%), remained stable from 2006 through 2015 (APC, +0.21%; 95% CI, −0.47% to +0.90%), and declined sharply from 2016 through 2024 (APC, −9.76%; 95% CI, −10.66% to −8.84%). CF mortality in the United States has declined by more than half since the introduction of CFTR modulators. The shift in the sex-based death count ratio and the concentration of remaining deaths in the South are hypothesis-generating observations that require confirmation with individual-level data. These ecological findings cannot establish causation, as concurrent changes in supportive care, lung transplantation practices, and COVID-19 pandemic effects may have contributed to the observed trends. Full article

Background: The COVID-19 pandemic and related containment measures profoundly affected child and adolescent mental health, with increasing evidence of a rise in psychiatric symptomatology and healthcare burden. This study aimed to evaluate temporal changes in neuropsychiatric presentations before, during, and after the COVID-19 pandemic in a pediatric clinical population. Methods: In this retrospective single-center study, 505 children and adolescents referred to a pediatric neuropsychiatry service were included and stratified into three periods: pre-pandemic (n = 112), pandemic (n = 231), and post-pandemic (n = 162). Clinical and healthcare-related variables were retrospectively collected, including reasons for referral, psychiatric diagnoses, premorbid conditions, and pharmacological treatments. Comparative analyses were performed to identify temporal variations in psychopathological profiles and clinical management. Results: A significant increase in psychiatric symptomatology emerged in the post-pandemic period compared with the pre-pandemic period. In particular, eating disorders, mood disturbances, self-harm, and somatic symptom presentations showed a marked increase over time, presenting as recurrent and associated phenotypes that peaked or consolidated after the acute emergency. The pandemic period was primarily characterized by a greater need for psychopharmacological intervention, specifically driven by the clinical need to manage acute behavioral crises. Overall, findings indicated a persistent increase in the complexity and severity of neuropsychiatric presentations beyond the acute phase of the pandemic. Conclusions: The COVID-19 pandemic was associated with substantial changes in pediatric neuropsychiatric presentations and treatment needs. The persistence of the increased psychopathological burden in the post-pandemic period highlights long-term mental health trajectories associated with the pandemic era. These emerging patterns of phenotypic complexity demonstrate that child and adolescent psychiatric services must transition from single-diagnosis models toward integrated care networks. Practically, strengthening community-based early intervention and creating rapid-access crisis support are essential to manage severe emotional dysregulation in the community and reduce acute psychiatric hospitalizations. Full article

Introduction: The COVID-19 pandemic profoundly disrupted healthcare, prompting adaptations in oncological practices. This systematic review evaluates the pandemic’s impact on the management of non-melanoma skin cancer (NMSC) of the head and neck (H&N) region. Methods: The review was reported according to PRISMA guidelines. Eligible studies compared pre-pandemic and pandemic periods in adult patients treated for head and neck NMSC reporting outcomes related to histological distribution, time to treatment initiation, reconstructive method, and surgical margin status. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analyses were performed for outcomes with sufficient extractable data. Results: The review comprised five studies involving 1318 cases. The relative distribution of basal cell carcinoma and squamous cell carcinoma did not differ significantly between pre-pandemic and pandemic periods. Time to treatment initiation showed no significant overall change, although heterogeneity was high, indicating substantial variability among healthcare settings. Reconstruction shifted significantly toward primary closure compared with flap reconstruction during the pandemic period (OR 1.90; 95% CI: 1.46–2.47; p < 0.0001). Negative surgical margins were reported in 1119 of 1266 excisions/cases with available data (88.4%), with no significant difference between pre-pandemic and pandemic periods (OR 0.77; 95% CI: 0.46–1.32; p = 0.34). Conclusions: The pandemic was associated with a shift toward simpler reconstructive strategies, particularly increased use of primary closure, likely reflecting attempts to reduce operative complexity and resource use. While short-term oncologic outcomes appeared broadly preserved, long-term functional, aesthetic, and patient-reported outcomes remain insufficiently characterized. Future studies should evaluate these outcomes to better inform crisis-adapted oncologic and reconstructive care pathways. Full article