Search Results (5,936)

Invasive Mucormycosis (IM) is an extremely rare infection with a high mortality rate, caused by a group of fungi classified as Mucorales moulds. Rhizomucor pusillus is a saprophitic, thermophilic, and angioinvasive microorganism that grows and lives at about 45 °C and is usually found in different environmental spaces such as soil, air, water, food, and other organic matter. These features predispose the infection to wide dissemination, especially in immunocompromised patients and most often in children after chemotherapy for hematological malignancies (HMs). Mucormycosis in patients with hematologic malignancies and neutropenia represents between 0.07% and 4.29% of the concomitant diseases. IM can develop into an infection in different sites, but its most common manifestation is pulmonary, followed by rhino-orbital–cerebral and disseminated forms. In recent years, an increased morbidity rate has been associated with the ongoing COVID-19 pandemic, as cited in the literature. There are many publications with COVID-19-associated mucormycosis (CAM) cases. The present treatment protocol includes extensive and radical surgical debridement and systemic antifungal therapy with Liposomal Amphotericin B (L-AmB), Posaconazole, and Isavuconazole, either combined or as monotherapy. Despite these new treatment modalities, the mortality rate remains over 50%. We present a rare case of a 3-year-old child with acute lymphoblastic leukemia (ALL) and systemic Rhizomucor pusillus infection, diagnosed on the occasion of lung and brain abscesses. The patient underwent lung and brain surgery and is recovering well with no further complications. The two-year follow-up period shows no signs of recurrence of the disease. Full article

This scoping review examines public health communication across nine Eastern European and Central Asian states—Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Russia, Tajikistan, Turkmenistan, and Uzbekistan—highlighting how these systems have transitioned from Soviet-era legacies to contemporary practices. Eligibility criteria included the English- and Russian-language literature published from 1998 onwards, focusing on nine post-Soviet states. Sources of evidence comprised searches in Google Scholar, ScienceDirect, SSRN, Heliyon, MEDLINE/PubMed, and official government websites. Data were charted by three independent reviewers using a standardized form, with discrepancies resolved by senior reviewers. The review identifies persistent gaps in communication during health crises, with a particular focus on the COVID-19 pandemic, where centralized and hierarchical information flows often undermine transparency and responsiveness, as well as further increased health inequalities between rural and urban health outcomes. Despite ongoing reforms, the communication dimension of healthcare systems remains underdeveloped. Findings reveal that centralized and top-down communication remains a dominant feature across the region, hindering timely dissemination of information and limiting the capacity to counter misinformation, as both misinformation and disinformation sometimes emerge from the government. Ultimately, this review contributes a critical analysis of these systematic communication failures and underscores the need to strengthen public health communication and reduce health inequalities. To do it, governments must prioritize transparency, disclose decision-making processes, and rely on evidence-based messaging to build trust. Effective crisis response requires not only government leadership but also the active engagement of the medical and patient communities, supported by civil society and independent media. This review points out the need for more inclusive, transparent, and trust-oriented communication strategies to enhance public health preparedness and resilience in nine Eastern European and Central Asian contexts. Full article

Emergency medicine clinicians face disproportionately high levels of burnout and mental health strain compared to other specialties. This study examined whether perceived resilience predicted reduced mental health strain following the COVID-19 Omicron surge and whether meaningful work mediated this relationship. Participants were 197 emergency medicine professionals at a large hospital system who completed monthly surveys during the pandemic. Perceived resilience and meaningful work were measured pre-Omicron surge, and mental health strain was measured post-surge. Results showed that higher perceived resilience significantly predicted lower mental health strain and that meaningful work explained 40% of this relationship. The findings emphasize that resilience matters and that its benefits are at least partly a function of meaningful work. Broader implications extend to organizations seeking to strengthen workforce well-being. Interventions should integrate resilience-building with practices that enhance purpose and meaning at work. Full article

Background/Objective: The COVID-19 pandemic resulted in unprecedented societal changes globally and negatively impacted the psychosocial health of pregnant women. This study aimed to explore how direct, indirect, and unrelated factors associated with the COVID-19 pandemic influenced stress levels among pregnant women. Methods: This interpretivist qualitative study employed open-ended survey questions to capture the lived experiences of 313 pregnant women in the third trimester residing in Florida between January and March 2022, during the Omicron surge. Thematic analysis was conducted, guided by the Stress and Coping Theory and the Stress Buffering Theory. Results: Participants described a range of stressors directly and indirectly related to the COVID-19 pandemic that affected pregnant women. Themes related to increased stress were (1) fear, worry, and anxiety related to COVID-19 infection, (2) fear, worry, and anxiety related to preparedness for birth/baby due to pandemic restrictions, (3) prevention concerns associated with COVID-19, (4) lack of social support, (5) return to normalcy, (6) health-related social needs, (7) physical health issues, and (8) navigating conflict and grief. Conversely, stress-reducing factors were (1) preventive measures during the pandemic, (2) coping strategies, (3) not having to work, and (4) social support. Conclusions: Pregnant women experienced heightened stress due to a complex interplay of factors related directly or indirectly to the COVID-19 pandemic. It is important that maternity care, mental health and health-related social needs screenings and referrals, and tailored interventions are integrated into public health crises preparedness plans to limit the stress that pregnant women experience and support their well-being. Full article

Background: Clínica Esperanza/Hope Clinic (CEHC), a free clinic for low-income, uninsured, Spanish-speaking patients, located in Providence, RI, piloted an intervention to improve vaccination rates. This program, named “Oportuna Vacuna” (OV) aimed to assess vaccine hesitancy in the post-pandemic period and measure improvements to vaccine uptake after integrating healthcare provider (HCP) and patient education with vaccine workflow adjustments. Methods: OV was initiated in January 2023. Culturally attuned and linguistically appropriate vaccine-focused educational programs were developed and provided to patients and HCPs, while workflow modifications to streamline vaccine administration were implemented during clinic visits. Structured pre- and post-intervention chart reviews were conducted and (oral- and) paper-based knowledge, attitudes, and practices surveys were administered to selected staff and patients to assess knowledge, attitudes, and vaccine confidence before and after the interventions. A total of 816 charts were reviewed prior to the intervention; 709 charts were reviewed post-intervention. A total of 72 patient and 10 HCP pre- and post- intervention surveys were completed. Vaccine uptake was compared to the uptake in 2022. Results: Overall vaccination rates at the clinic increased by more than 400% compared to the prior year. Patients and HCPs demonstrated increased vaccine knowledge and confidence, particularly with respect to COVID-19 and HPV vaccines. In contrast, chart reviews of individual patients revealed only a slight improvement in vaccination completion rates for patients over the 1-year period. Conclusion: Substantial increases in vaccine administration rates across multiple vaccine types highlight the effectiveness of OV, mainly for first time patients, at CEHC. Clinic workflow modifications improved vaccination efficiency and increased vaccine uptake. Educational sessions on vaccines were well received by patients and staff. Overall knowledge about vaccines improved during the intervention among staff and HCPs. Patients reported higher trust in HCPs compared to other sources for vaccine information. Full article

RNA-based vaccination has been broadly applied in the COVID-19 pandemic. A characteristic of the immunization was fast-waning immunity. However, the time scale of this process varied considerably for virus subtypes and among individuals. Understanding the origin of this variability is crucial in order to improve future vaccination strategies. Here, we introduce a mathematical model of RNA-based vaccination and the kinetics of the induced immune response. In the model, antigens produced following vaccination give rise to an immune response leading to germinal center reactions and accordingly B-cell differentiation into memory B-cells and plasma cells. In a negative feedback loop, the antibodies synthesized by newly specified plasma cells shut down the germinal center reaction as well as antigen-induced differentiation of memory B-cell into plasma cells. This limits the build-up of long-lasting immunity and thus is accompanied by fast-waning immunity. The detailed data available on infection with and vaccination against SARS-CoV-2 enabled computational simulation of essential processes of the immune response. Through simulation, we analyzed to what extent a single- or double-dose vaccination provides protection against infection. We find that variability in the immune response in individuals, originating, e.g., in different immune-cell densities, results in a broad log-normal-like distribution of the vaccine-induced protection times that peaks around 100 days. Protection times decrease for virus variants with mutated antibody-binding sites or increased replication rates. Independent of these virus specifics, our simulations suggest optimal timing of a second dose about 5 weeks after the first in agreement with clinical trials. Full article

The ongoing COVID-19 pandemic, caused by SARS-CoV-2, continues to pose major global health challenges despite extensive vaccination efforts. Variant escape, waning immunity, and reduced vaccine efficacy in immunocompromised populations underscore the urgent need for complementary antiviral therapeutics. Here, we report the design, synthesis, and biological evaluation of precision-engineered dermatan sulfate (DS)-mimetic glycopolymers as multi-targeted inhibitors of SARS-CoV-2. Guided by molecular docking and virtual screening, sulfation at the C2 and C4 positions of iduronic acid was identified as critical for binding to the viral spike protein and inhibiting host and viral enzymes, including heparanase (HPSE) and main protease (M^pro). Chemically synthesized DS disaccharides were covalently grafted onto polymer scaffolds via a post-modification strategy, yielding glycopolymers with well-defined assembly that form uniform nanoparticles under physiological conditions. Surface plasmon resonance and pseudovirus assays revealed strong binding to the viral spike protein (K_D ≈ 177 nM), potent viral neutralization, and minimal cytotoxicity. Cellular uptake studies further demonstrated efficient internalization of nanoparticles and intracellular inhibition of HPSE and M^pro. These results establish a modular, non-anticoagulant, and glycosaminoglycan-mimetic platform for the development of broad-spectrum antiviral agents to complement vaccination and enhance preparedness against emerging coronavirus variants. Full article

Social participation is vital for older adults’ well-being. The COVID-19 pandemic disrupted daily activities, but many adapted using SOC (Selection, Optimization, and Compensation) strategies. This study examines how older adults in Hong Kong navigated adversity through strategic decision-making. Twenty-five participants underwent in-depth interviews, with thematic analysis identifying key SOC-related themes: loss-based selection (reducing physical interactions, shifting engagement modes, pursuing solo activities), elective selection (volunteering, exercise, online learning), optimization (adjusting participation methods and timing, taking preventive measures), and compensation (modifying or substituting activities, supporting physical functions). Despite restrictions, older adults actively sought ways to remain socially engaged. Our findings highlight the role of SOC strategies in sustaining participation and enable us to propose a framework for adaptive changes to enhance future well-being. This research deepens discussions on social participation, offering practical insights for fostering resilience among older adults in challenging conditions. Full article

The COVID-19 pandemic has demonstrated that its effects go far beyond the initial respiratory illness, with many survivors experiencing lasting neurological problems. Some patients develop a condition known as Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), which includes current issues such as reduced cognitive function, chronic headaches, depression, neuropathic pain, and sensory disturbances. These symptoms can severely disrupt daily life and overall well-being. In this narrative review, we provide an overview of current understanding regarding the neurological effects of COVID-19, with a focus on Long COVID. We discuss possible underlying mechanisms, including direct viral invasion of the nervous system, immune-related damage, and vascular complications. We also summarize findings from cohort studies and meta-analyses that explore the causes, symptom patterns, and frequency of these neurological issues. Approximately one-third of people who have had COVID-19 report neurological symptoms, especially those who experienced severe illness or were infected with pre-Omicron variants. Emerging research has identified potential biomarkers such as neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) that may help in diagnosis. Treatment approaches under investigation include antiviral medications, nutraceuticals, and comprehensive rehabilitation programs. Factors like older age, existing health conditions, and genetic differences in ACE2 and TMPRSS2 genes may affect an individual’s risk. To effectively address these challenges, current research is essential to improve diagnostic methods, develop targeted treatments, and enhance rehabilitation strategies. Ultimately, a coordinated, multidisciplinary effort is crucial to reduce the neurological impact of Long COVID and support better recovery for patients. Full article

Previous studies have shown that religion and spirituality can provide resources to cope with aging and impact the well-being of older adults. However, whether religiosity and well-being are linked depends on how they are measured. Moreover, the size of statistically significant effects often remains small or even negligible. In Switzerland, two historical religious communities—Catholic and Protestant—have coexisted for centuries, providing an opportunity for exploring potential differences in religious practices of members of these two communities and their effects on well-being. Two populations were targeted: elderly people engaged in organized volunteering and elderly people receiving home care services. A total of 617 volunteers and 614 home care clients returned complete and valid questionnaires. In addition, semi-structured interviews were conducted with 43 volunteers and 35 home care clients to gain deeper insights into their experiences. Since the data were collected during the COVID-19 pandemic, we also explored how participants experienced the semi-lockdown restrictions. The results show that knowing religious affiliation is not sufficient to predict well-being. The degree of identification with the declared affiliation must also be taken into account. Differences between Protestants and Catholics can be highlighted, especially when considering religious practices in more detail. The impact of the pandemic on well-being is only moderately associated with religiosity. Full article

Background: The COVID-19 pandemic has imposed unprecedented stress on healthcare workers (HCWs), potentially affecting their job satisfaction and life satisfaction. This study aimed to examine the role of perceived stress, self-efficacy, and coping strategies as predictors and mediators of well-being among HCWs during the pandemic. Methods: A total of 326 HCWs participated in the study. Perceived stress was assessed using the Perceived Stress Scale (PSS-10), self-efficacy was assessed with the Generalized Self-Efficacy Scale (GSES), life satisfaction was assessed with the Satisfaction with Life Scale (SWLS), job satisfaction was assessed with the Brief Job Satisfaction Scale (BJSS), and coping strategies were assessed with the Mini-COPE. Correlation, regression, and mediation analyses were conducted. Results: HCWs reported elevated stress levels (M ≈ 24), higher than general population norms. Stress was negatively associated with life satisfaction and job satisfaction. Self-efficacy and adaptive coping strategies (acceptance, social support) were positively associated with life and job satisfaction and mediated the relationship between stress and life satisfaction. Helplessness mediated the effect of stress on life satisfaction but not job satisfaction. Conclusions: High self-efficacy and adaptive coping strategies serve as protective factors for HCWs’ well-being during the COVID-19 pandemic. Interventions enhancing self-efficacy and promoting acceptance and social support may mitigate stress and improve life and job satisfaction. Full article

Through a series of over 100 bilingual interviews with Hispanic San Antonians, the COVID-19 Oral Historias Project documents the Latino/a/e community’s experiences through the pandemic by sharing individual stories, amplifying local voices, and creating compassion in a fragmented time. The present article documents the project itself, contextualizing its creation, detailing its methodology, highlighting the most common themes across interviews, and pointing out its novel contributions. While the interviewees’ experiences are inarguably diverse, narrative threads were found throughout the corpus, united by the duality of the narrators’ experiences; throughout this period, they simultaneously negotiated community norms and official health directives, local and international anxieties, and hopelessness and hope. The project is unique in (1) its language use, privileging minoritized ways of speaking (Spanish and Spanglish); (2) its size, with over 100 interviews; and (3) its clearly delimited scope, with all respondents living in San Antonio. This massive, unified resource creates a public collection of bilingual stories, highlighting non-hegemonic voices that are of value to the community itself, as well as to the recorded history of the pandemic, filling in historical gaps and providing real, lived accounts of this period that might otherwise be lost over time. Full article

Delays caused by motor vehicle traffic, accidents, and environmental pollution present considerable challenges to sustainable urban mobility. To address these issues, transportation system users are encouraged to adopt active transportation methods, micromobility options, and public transit. Electric scooters have become a notably popular micromobility choice, especially following the emergence of vehicle-sharing companies in 2018, a trend that gained further momentum during the COVID-19 pandemic. This study explored the demographic characteristics, attitudes, and behaviors of e-scooter users in Istanbul through an online survey conducted from 1 September 2023 to 1 May 2024. A total of 462 e-scooter users participated, providing valuable insights into their preferred modes of transportation across 24 different scenarios specifically designed for this research. The responses were analyzed using various machine learning techniques, including Artificial Neural Networks, Decision Trees, Random Forest, and Gradient Boosting methods. Among the models developed, the Decision Tree model exhibited the highest overall performance, demonstrating strong accuracy and predictive capabilities across all classifications. Notably, all models significantly surpassed the accuracy of discrete choice models reported in existing literature, underscoring the effectiveness of machine learning approaches in modeling transportation mode choices. The models created in this study can serve various purposes for researchers, central and local authorities, as well as e-scooter service providers, supporting their strategic and operational decision-making processes. Future research could explore different machine learning methodologies to create a model that more accurately reflects individual preferences across diverse urban environments. These models can assist in developing sustainable mobility policies and reducing the environmental footprint of urban transportation systems. 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: Ecological momentary assessment (EMA) is a methodology that offers a real-time approach to monitoring clinician well-being, but its utility during high-intensity operational periods remains underexplored. This study examines the feasibility and performance of an EMA-based system for tracking clinical responsibilities and burnout among healthcare workers during the first year of the COVID-19 pandemic. Methods: Utilizing an intensive longitudinal design, 398 healthcare workers, including physicians, physician assistants, nurses, and trainees, completed brief EMA surveys every five days from April 2020 to March 2021. Burnout was assessed with a validated single-item measure and analyzed in relation to redeployment status and hospital caseloads. Results: The EMA approach successfully captured meaningful temporal fluctuations in burnout. Redeployment was associated with higher burnout levels (b = 0.125; p = 0.01), and rising caseloads amplified this effect (interaction b = 0.169; p = 0.001). Nurses showed the strongest caseload-related increases in burnout (b = 0.359; p < 0.001). These patterns persisted even after individuals returned to their usual roles. Conclusions: This study demonstrates that EMA is a scalable and sensitive approach for continuous burnout surveillance, capable of detecting role-specific and context-dependent stress responses in real time. EMA-based monitoring can support early identification of at-risk groups, guide staffing and redeployment decisions, and inform timely organizational interventions during crises and other periods of operational strain. Full article