Highland Health Sciences Library

Elife. 2025 May 8;12:RP88387. doi: 10.7554/eLife.88387.

ABSTRACT

Intranasal vaccination is an attractive strategy for preventing COVID-19 disease as it stimulates the production of multimeric secretory immunoglobulin A (IgA), the predominant antibody isotype in the mucosal immune system, at the target site of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry. Currently, intranasal vaccine efficacy is evaluated based on the measurement of polyclonal antibody titers in nasal lavage fluid. However, how individual multimeric secretory IgA protects the mucosa from SARS-CoV-2 infection remains to be elucidated. To understand the precise contribution and molecular nature of multimeric secretory IgA induced by intranasal vaccines, we developed 99 monoclonal IgA clones from nasal mucosa and 114 monoclonal IgA or IgG clones from nonmucosal tissues of mice that were intranasally immunized with the SARS-CoV-2 spike protein. The nonmucosal IgA clones exhibited shared origins and common and unique somatic mutations with the related nasal IgA clones, indicating that the antigen-specific plasma cells in the nonmucosal tissues originated from B cells stimulated at the nasal mucosa. Comparing the spike protein binding reactivity, angiotensin-converting enzyme-2-blocking, and in vitro SARS-CoV-2 virus neutralization of monomeric and multimeric secretory IgA pairs recognizing different epitopes showed that even non-neutralizing monomeric IgAs, which represent 70% of the nasal IgA repertoire, can protect against SARS-CoV-2 infection when expressed as multimeric secretory IgAs. We also demonstrated that the intranasal administration of multimeric secretory IgA delivered as prophylaxis in the hamster model reduced infection-induced weight loss. Our investigation is the first to demonstrate the function of nasal IgA at the monoclonal level, showing that nasal immunization can provide effective immunity against SARS-CoV-2 by inducing multimeric secretory IgAs at the target site of the virus infection.

PMID:40338637 | DOI:10.7554/eLife.88387

Respir Care. 2025 May 8. doi: 10.1089/respcare.12661. Online ahead of print.

ABSTRACT

Background: The implications of splitting medical management and advanced procedural care are unique to critical care medicine. As tele-critical care adoption accelerates, examining the equivalence between in-person intensivist care and tele-intensivist staffing is needed. We sought to examine the equivalence of patient outcomes associated with tele-intensivist and in-person intensivist care of critically ill patients with COVID-19. Methods: In this retrospective multi-center cohort study, 1,885 consecutive critical care hospitalizations of subjects with COVID-19 receiving tele-intensivist or in-person intensivist care at 5 hospitals in Texas participating in the Society of Critical Care Medicine Discovery Viral Respiratory Illness Universal Study COVID-19 registry were included. The main outcomes were mortality, length of stay, and duration of invasive ventilation. Results: Of the 1,885 ICU admissions, 491 (26%) were managed in 4 hospitals with tele-intensivist staffing and compared with 1,394 (74%) ICU admissions managed by the same intensivists via in-person staffing (1 hospital). Propensity score matching for controlled comparison of tele-intensivist and in-person intensivist groups revealed no difference in ICU or in-hospital mortality, length of stay, or duration of invasive ventilation. Conclusions: Mortality, length of stay, and duration of invasive ventilation of subjects receiving tele-intensivist care were similar to subjects in the same healthcare system receiving in-person intensivist care.

PMID:40338617 | DOI:10.1089/respcare.12661

Am J Orthopsychiatry. 2025 May 8. doi: 10.1037/ort0000855. Online ahead of print.

ABSTRACT

People with disabilities (PWD) have reported higher major depression (MD) and generalized anxiety disorder (GAD) symptoms during the COVID-19 pandemic than others in the general population, with social isolation and disability stigma as key predictors of heightened symptomatology. However, the nature and predictors of PWD's MD and GAD symptom trajectories during the pandemic and after other potentially traumatic events remain largely unknown. The present study aimed to (a) document PWD's MD and GAD symptom trajectories during the pandemic and (b) examine social isolation and disability stigma as predictors of trajectory membership. A convenience sample of PWD recruited from disability-focused social media groups and Listserv (N = 200) completed a longitudinal study, with surveys in October-December 2020 (Time 1), November-December 2021 (Time 2), and October-December 2022 (Time 3). Participants reported on social isolation, disability stigma, demographic and disability characteristics, and pandemic-related stressors at Time 1, and MD and GAD symptoms at each wave. Latent class growth analysis detected three MD symptom trajectories (Mild-Decreasing: 40.5%; Moderate-Decreasing: 43.0%; Moderately Severe-Stable: 16.5%), and three GAD trajectories (Mild-Decreasing: 40.5%; Moderate-Decreasing: 41.5%; Severe-Stable: 18.0%). In adjusted models, higher social isolation was associated with higher odds of membership in the Moderately Severe-Stable MD trajectory versus the Mild- and Moderate-Decreasing MD trajectories, and higher odds of membership in the Moderate-Decreasing GAD trajectory versus the Mild-Decreasing GAD trajectory. The results demonstrate the persistent MD and GAD symptoms experienced by many PWD during the pandemic and the importance of interventions to address PWD's social isolation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40338598 | DOI:10.1037/ort0000855

Adv Ther. 2025 May 8. doi: 10.1007/s12325-025-03218-3. Online ahead of print.

ABSTRACT

The coronavirus disease 2019 (COVID-19) global health crisis, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented unprecedented challenges to global healthcare systems, leading to rapid advances in treatment development. This review comprehensively examines the current therapeutic approaches for managing COVID-19, including direct-acting antivirals, immunomodulators, anticoagulants, and adjuvant therapies, as well as emerging and experimental approaches. Direct-acting antivirals target various stages of the viral life cycle, offering specific intervention points, while immunomodulators aim to modulate the host's immune response, reducing disease severity. Anticoagulant therapies address the coagulopathy frequently observed in severe cases, and adjuvant treatments provide supportive care to improve overall outcomes. We also explore the challenges and limitations of implementing these treatments, such as drug resistance, variable patient responses, and access to therapies, especially in resource-limited settings. The review also discusses future perspectives, including the potential of next-generation vaccines, personalized medicine, and global collaboration in shaping future COVID-19 treatment paradigms. Continuous innovation, combined with an integrated and adaptable approach, will be crucial to effectively managing COVID-19 and mitigating the impact of future pandemics.

PMID:40338485 | DOI:10.1007/s12325-025-03218-3

Support Care Cancer. 2025 May 8;33(6):458. doi: 10.1007/s00520-025-09496-5.

ABSTRACT

PURPOSE: Surgery remains the primary treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. However, it can lead to postoperative complications and reduced functionality. Prehabilitation aims to improve functional reserves before surgery. We aimed to evaluate the implementation of a multimodal prehabilitation program in "real-world" patients undergoing gastrointestinal cancer surgery.

METHODS: An implementation study evaluating prehabilitation in patients undergoing gastrointestinal (colorectal or UGI) cancer surgery at Concord Hospital. The prehabilitation program included supervised exercise, nutrition and nursing support delivered face-to-face or by telehealth (COVID-19 adaptations).

ASSESSMENTS: baseline, pre-surgery and 30 days after surgery.

PRIMARY OUTCOME: implementation using the RE-AIM (Reach/Effectiveness/Adoption/Implementation/Maintenance) framework.

SECONDARY OUTCOMES: functional, nutritional and surgical outcomes, with comparisons to historical controls.

RESULTS: Between January 2020 and December 2021, 181 patients were screened; 91 (50%) were eligible. Reach: 77/91 recruited (63 colorectal, 14 UGI). Median age, 70 years (IQR, 59-79); 60% were males. Median intervention duration, 16 days (IQR, 12.25-19.75).

EFFECTIVENESS: quality of life, anxiety and functional capacity improved from baseline to pre-surgery (6-min walk test (+16.1 m, p=0.038) and 2-min step test (+10.0 steps, p<0.001)). Compared to historical controls, hospital length of stay was reduced by 2.1 days (p=0.010), with no differences in complications. Adoption: 91% of referrals came directly from surgeons.

IMPLEMENTATION: 94% completed the intervention, with high adherence and satisfaction levels. Maintenance: after study completion, the program was incorporated into standard care with some modifications.

CONCLUSIONS: Prehabilitation can be implemented in a real-world setting, with a trend towards improving functional and surgical outcomes, but dedicated resources are necessary to implement and maintain the program.

PMID:40338380 | DOI:10.1007/s00520-025-09496-5

J Clin Psychiatry. 2025 May 5;86(2):24m15387. doi: 10.4088/JCP.24m15387.

ABSTRACT

Objective: To compare the effectiveness of vortioxetine versus escitalopram and sertraline as a treatment in individuals with major depressive disorder (MDD) and post-COVID syndrome (PCS).

Methods: This is a prospective, open-label, comparative effectiveness study in individuals with new-onset MDD as PCS outcome. The study was carried out in 1 clinical site. Individuals who had a history of confirmed SARS-CoV 2 infection, who met World Health Organization-defined criteria for PCS, and who met new-onset of MDD criteria according to DSM-5-TR were included. Participants that were eligible were assigned to receive vortioxetine at 10-20 mg/d, escitalopram 10-20 mg/d, or sertraline 50-200 mg/d over 8 weeks. The primary and secondary outcomes were changes from baseline to end point in Digital Symbol Substitution Test (DSST) and Montgomery-Asberg Depression Rating Scale (MADRS) or Patient Reported Outcome Measurement Information System Fatigue Short Form 7a (PROMIS 7a), respectively. Data were collected during January 2022 and December 2023.

Results: 140 participants were assigned to received vortioxetine (n = 70), escitalopram (n = 36), or sertraline (n = 34). Participants assigned to vortioxetine exhibited significant changes in DSST scores from baseline to end point compared to escitalopram or sertraline (least squares [LS] mean differences, 8.25; 95% CI, 6.25-10.25; P < .001; LS mean differences, 8.00; 95% CI, 5.95-10.06; P < .001, respectively). Participants in the vortioxetine treatment group reported significantly greater changes in total MADRS scores from baseline to end point compared to escitalopram or sertraline (LS mean differences, -4.06; 95% CI, -4.92 to -3.20; P < .001; LS mean differences, -3.94; 95% CI, -4.83 to -3.06; P < .001, respectively).

Conclusion: Vortioxetine has a significant procognitive effect. Antidepressant effects and improvement in fatigue symptoms (PROMIS 7a) also were observed.

PMID:40338259 | DOI:10.4088/JCP.24m15387

Vaccines (Basel). 2025 Feb 24;13(3):228. doi: 10.3390/vaccines13030228.

ABSTRACT

The World Health Organization (WHO) defines vaccine hesitancy as reluctance or refusal to vaccinate despite availability. Contributing factors in visible minority populations include vaccine safety, effectiveness, mistrust, socioeconomic characteristics, vaccine development, information circulation, knowledge, perceived risk of COVID-19, and perceived benefit. Objectives: This study aimed to examine vaccine hesitancy in visible minority populations across Canadian regions. Methods: A survey was conducted among visible minority populations in Canadian regions, using 21 questions from the available literature via the Delphi method. The Canadian Hub for Applied and Social Research (CHASR) administered the survey to individuals 18 years or older who resided in Canada at the time of the survey and identified as visible minorities such as Asian, Black, and Latin American. After recruiting 511 participants, data analysis used Chi-square tests of association and 95% confidence intervals (CIs) to identify regional differences in vaccine choices, side effects, information sources, and reasons for vaccination. A weighted analysis extended the results to represent the visible minorities across provinces. Results: Higher rates of Pfizer were administered to participants in Ontario (73%), the Prairies (72%), British Columbia (71%), and Quebec (70%). British Columbia had the highest Moderna rate (59%). The most common side effect was pain at the injection site in Quebec (62%), Ontario (62%), BC (62%), and in the Atlantic (61%). Healthcare professionals and government sources were the most trusted information sources, with healthcare professionals trusted particularly in the Prairies (70%) and government sources similarly trusted in Quebec (65%) and Ontario (65%). In the Atlantic, 86% of refusals were due to side effects and 69% were due to prior negative vaccine experiences. Conclusions: Leveraging healthcare professionals' trust, community engagement, and flexible policies can help policymakers improve pandemic preparedness and boost vaccine acceptance.

PMID:40338240 | DOI:10.3390/vaccines13030228

Hum Vaccin Immunother. 2025 Dec;21(1):2493027. doi: 10.1080/21645515.2025.2493027. Epub 2025 May 8.

ABSTRACT

Healthcare workers (HCWs) are essential in preventing and managing infectious diseases. Despite their critical role, vaccination coverage among HCWs remains suboptimal, endangering not only patient safety and healthcare system efficiency, but also HCWs' own health due to their frequent exposure to infectious agents. This study examines a decade of influenza vaccination trends and recent COVID-19 vaccine co-administration patterns at a major Italian hospital, aiming to identify factors affecting vaccine acceptance and evaluate organizational strategies to enhance vaccination uptake. A retrospective cohort study analyzed vaccination data from 6,341 hCWs between 2015 and 2023, examining acceptance rates across different vaccination delivery models. Mixed effects logistic regression models evaluated the impact of sociodemographic and professional factors and organizational approaches on vaccine acceptance. Results showed influenza vaccination peaked at 46% during the first COVID-19 year, before declining to pre-pandemic levels. Co-administration rates increased significantly, with a 118.94% rise between 2021 and 2022. Different delivery models significantly influenced vaccine acceptance: "open-day" events significantly boosted influenza vaccine acceptance (OR 22.29, 95% CI [18.22; 27.27]), while the hospital outpatient service proved optimal for co-administration (OR 61.03, 95% CI [30.97; 120.25]). This study reveals important patterns in vaccination behavior and organizational effectiveness. The observed decline in influenza vaccination after the COVID-19 peak suggests vaccine fatigue and reduced risk perception due to widespread preventive measures. The success of different delivery models indicates that healthcare institutions should implement multiple, complementary vaccination strategies tailored to specific contexts and workforce preferences, while maintaining continuous educational support to ensure sustained vaccine coverage.

PMID:40338231 | DOI:10.1080/21645515.2025.2493027

Int J Geriatr Psychiatry. 2025 May;40(5):e70093. doi: 10.1002/gps.70093.

ABSTRACT

BACKGROUND AND OBJECTIVES: Loneliness is common among nursing home residents, and it is also thought to be a problem in assisted living (AL). However, we lack research on loneliness in AL. Our objectives were to assess changes in risk-adjusted prevalence of loneliness in AL, and facility-level variations in loneliness before and during the COVID-19 pandemic, and facility-level factors associated with AL resident loneliness during the pandemic.

RESEARCH DESIGN AND METHODS: This population-based, repeated cross-sectional study used Resident Assessment Instrument-Home Care (RAI-HC) data (01/2017-12/2021) from Alberta, Canada. On a system-level, we estimated quarterly, risk-adjusted loneliness prevalence, and used segmented regressions to assess whether loneliness changed after the start of the pandemic. For risk adjustment, we used resident-covariates known to be associated with loneliness, but out the health system's or AL home's control (e.g., age or cognitive impairment) to enable fair comparisons over time. Linking AL home surveys, collected in COVID-19 waves 1 (March-June 2020) and 2 (October 2020-February 2021) to RAI-HC records, we used covariate-adjusted general estimating equations (GEE) to assess AL home factors (e.g., staffing shortages, social distancing measures) associated with resident-level loneliness during the pandemic.

RESULTS: Quarterly samples included 2026-2721 residents. Loneliness [95% confidence interval] fluctuated between 13.6% [11.5%-15.7%], and 16.8% [14.4%-19.2%], with no statistically significant increase during the pandemic. Facility-level median [inter-quartile range] loneliness prevalence varied considerably before (14.9% [8.3%-21.1%) and during the pandemic (13.5% [6.9%-21.3%]). GEEs included 985 residents in 41 facilities (wave 1), and 1134 residents in 42 facilities (wave 2). Facility-factors associated with decreased odds of loneliness included: facilitating caregiver involvement (odds ratio = 0.531 [95% confidence interval: 0.286-0.986]), essential visitor policies (0.672 [0.454-0.994]), and video calls with volunteers or religious/spiritual leaders (0.603 [0.435-0.836]). Facilitating outdoor activities/visits (2.486 [1.561-3.961], and providing hallway-based activities (1.645 [1.183-2.288]) were associated with increased odds of loneliness.

DISCUSSION AND IMPLICATIONS: Loneliness did not change during COVID-19 in AL on a health system level, but varied considerably between facilities before and during the pandemic. Modifiable facility-level factors explained variations in loneliness within facilities, suggesting important targets for policies and improvement interventions.

PMID:40338173 | DOI:10.1002/gps.70093

Int J Geriatr Psychiatry. 2025 May;40(5):e70097. doi: 10.1002/gps.70097.

ABSTRACT

BACKGROUND: The COVID-19 pandemic increased social isolation in older adults, promoting mental and cognitive decline. The impact of social media on these effects remains unclear.

AIM: To investigate the long-term association of social isolation with mental and cognitive health in older adults and whether social media use mitigated this association.

METHOD: Data from the Norwegian Trøndelag Health Study before (2017-2019), during (January 2021), and after the pandemic (2021-2023) were analysed (N = 4844, 53% women, mean age 80 years). Multi-adjusted mixed-effects linear regression estimated differences in changes in mental (CONOR-MHI) and cognitive (MoCA) health related to self-reported social isolation and social media use. Beta (β) represents differences in change in z-score of CONOR-MHI or MoCA.

RESULTS: Social isolation was associated with a steeper decline in mental health than no social isolation (β = 0.07, 95% CI 0.01, 0.13) but was not associated with change in cognitive health. Daily social media use was not related to change in mental health, whereas it was associated with a less steep cognitive decline than no social media use (< 1 h: β = 0.13, 95% CI 0.05, 0.20; ≥ 1 h: β = 0.10, 95% CI 0.01, 0.15). Stratified by social isolation, daily social media use < 1 h was related to a less steep cognitive decline than no social media use in both isolated (β = 0.15, 95% CI 0.02, 0.28) and non-isolated individuals (β = 0.13, 95% CI 0.03, 0.22).

CONCLUSION: Individuals experiencing social isolation during the pandemic had a steeper decline in mental, but not cognitive health, compared to those not isolated. Social media use did not buffer the decline in mental health but was associated with less steep cognitive decline. The pandemic showed limits of relying solely on digital solutions for social contact.

TRIAL REGISTRATION: The study is registered in ClinicalTrials.gov 18.02.2021, with the identification number NCT04792086.

PMID:40338168 | DOI:10.1002/gps.70097

Influenza Other Respir Viruses. 2025 May;19(5):e70110. doi: 10.1111/irv.70110.

ABSTRACT

Madagascar has maintained an influenza surveillance program for decades. Following the emergence of SARS-CoV-2 in 2020, the country implemented strict nonpharmaceutical interventions (NPIs) that disrupted influenza circulation. We studied the evolutionary dynamics of influenza viruses in Madagascar over a 5-year period, spanning both the pre-pandemic and COVID-19 pandemic periods: 2019-2023. We showed that global genetic evolution profiles for A(H1N1)pdm09, A(H3N2), and B/Victoria viruses occurred from the pre-pandemic to the pandemic period of COVID-19 in Madagascar. In addition, we observed distinct patterns of viral re-emergence following the relaxation of COVID-19 containment measures. This study underscores the importance of sustaining continuous surveillance of influenza virus circulation to monitor the emergence of new variants and identify clade-specific isolates. In addition, these results suggest that targeted NPIs could complement vaccination strategies in reducing influenza transmission and should be integrated into a comprehensive approach for effective influenza control.

PMID:40338114 | DOI:10.1111/irv.70110

J Assoc Nurses AIDS Care. 2025 May 7. doi: 10.1097/JNC.0000000000000556. Online ahead of print.

ABSTRACT

Parents living with HIV (PLWH) are often affected by co-occurring trauma, substance use, and mental health concerns. These complex challenges may contribute to intergenerational transmission of health risk, yet few studies have examined how these challenges affect family well-being in HIV-affected families. HIV care providers' insights can inform prevention efforts. Our study used qualitative focus group methods in two Southeast US cities to explore providers' perceptions of PLWH's challenges navigating parenting and HIV-related concerns and strengths supporting positive adaptation. Six themes emerged: PLWH's challenges; strengths; COVID-19 impacts; impact of trauma, mental health, and substance use; supports needed; and engagement strategies. Providers highlighted trade-offs between parents' self-care and parenting and that parents often draw strength from their children. Challenges identified were both common to parenting and unique to living with HIV. Results underscore the need for multilevel prevention, including addressing basic needs; integration of mental health and medical services; and increased family services.

PMID:40338078 | DOI:10.1097/JNC.0000000000000556

Curr Med Chem. 2025 May 7. doi: 10.2174/0109298673367163250417065816. Online ahead of print.

ABSTRACT

BACKGROUND: Developing new COVID-19 antivirals requires understanding viral proteins, oxidative stress, and drug repositioning. Safety assessments of organochalcogen molecules derived from AZT in Caenorhabditis elegans offer promising prospects for new treatments.

OBJECTIVE: In this work, we evaluated the safety and antioxidant effect of eight organochalcogen AZT-derivatives using the free-living nematode C. elegans through chronic exposure [48h]. In addition, we used in silico computational modelling analyses to predict protein targets for these compounds.

METHODS: This study used survival, litter size, brood size as toxicological and safety parameters, subcellular localization of DAF-16, expression of SOD-3 and GST-4, and ROS levels to evaluate the antioxidant effects and target prediction by similarity set approach [SEA], protein-protein interaction [PPI] network analysis, and comparative phylogenetic analysis to predict protein targets for these compounds.

RESULTS: The molecules were safe at concentrations of 1-500 μM. AZT, R3a, and R3f promoted DAF-16 nuclear translocation without affecting SOD-3 levels. R3f reduced GST-4 levels, while R3a increased ROS levels. In silico analyses identified 16 human protein targets of AZT and its derivatives, linked to nucleotide metabolism, DNA replication, and anti-inflammatory pathways, showing high homology to C. elegans.

CONCLUSION: We hypothesize that Se and Te atom insertion may alter pharmacological properties by modulating DAF-16, GST-4, and ROS-related pathways. in silico data suggest these derivatives are promising for antiviral activity, targeting nucleotide metabolism and DNA replication while also potentially modulating the anti-inflammatory response, an appealing feature for COVID-19 treatment.

PMID:40337965 | DOI:10.2174/0109298673367163250417065816

Vaccines (Basel). 2025 May 8;13(5):499. doi: 10.3390/vaccines13050499.

ABSTRACT

The journal retracts the article, titled "COVID-19 Vaccine Hesitancy and Resistance in India Explored through a Population-Based Longitudinal Survey" [...].

PMID:40337927 | DOI:10.3390/vaccines13050499

Health Secur. 2025 May 8. doi: 10.1089/hs.2024.0077. Online ahead of print.

ABSTRACT

New York City has been the epicenter of multiple recent infectious disease outbreaks, including COVID-19 and mpox, due to its position as one of the largest international travel hubs in the United States. In response to the imperative need to transport patients to specialized biocontainment units during high-consequence infectious disease outbreaks, the Health and Human Services Region 2 Regional Emerging Special Pathogen Treatment Center at New York City Health + Hospitals/Bellevue and the NYC Department of Health and Mental Hygiene spearheaded a comprehensive patient transport system. Informed by real-world experiences, quarterly drills, and regional partner engagement, the updated Region 2 patient transport concept of operations (CONOPS) ensures safe and seamless patient transfers. This article elucidates key components of the patient transport CONOPS, the multifaceted partner engagement approach used to develop it, and the collaborative workshop that fine-tuned the plan. Organizational skills, partner engagement, and adaptability were all necessary for refining and operationalizing a robust patient transport CONOPS. The finalization of this plan speaks to the collaborative spirit and commitment of regional leaders to ensure the effective management of high-consequence infectious disease outbreaks and the safeguarding of public health within Region 2 and beyond.

PMID:40337828 | DOI:10.1089/hs.2024.0077

Work. 2025 Apr;80(4):1900-1912. doi: 10.1177/10519815251320037. Epub 2025 Feb 28.

ABSTRACT

Background: The world has rapidly experienced a shift in the work environment due to a global need brought about by the COVID-19 pandemic and the recognition of the advantages that remote work presents for companies engaged in processes and customer service. However, not all employees exhibit the same level of adaptation and performance while carrying out their tasks outside the organization's premises. In this scenario, multicriteria decision analysis emerges as a tool to support the decision-making process in prioritizing employees with the best profile for carrying out telecommuting activities. Objective: To create a multicriteria decision model for ranking in the selection of employees for a call center company based in the state of Rio Grande do Norte, Brazil, for remote work from home. Methods: A case study was conducted, incorporating the application of Value-Focused Thinking (VFT), a questionnaire, and the development of the decision model using the FITradeoff method. The choice is based on the concepts of flexible elicitation from the FITradeoff method (Flexible and Interactive Tradeoff). FITradeoff is a method for eliciting scale constants created in accordance with the scope of the Multi-Attribute Value Theory (MAVT). Results: The model was able to provide support information for ranking employees with the best profiles for transitioning from on-site work to remote work, based on consistent prioritization criteria, aiding decision-makers in justifying the chosen selection. Conclusions: It was possible to rank the best profiles for transitioning work arrangements and gain an understanding of how employees perceive remote work.

PMID:40337811 | DOI:10.1177/10519815251320037

Front Public Health. 2025 Apr 23;13:1579851. doi: 10.3389/fpubh.2025.1579851. eCollection 2025.

ABSTRACT

BACKGROUND: Pneumoconiosis, a group of occupational lung diseases caused by prolonged inhalation of mineral dust, remains a critical global health threat due to persistent workplace exposures in high-risk industries such as mining, construction, and artificial stone processing. These occupational hazards are exacerbated by inadequate dust control measures, insufficient use of personal protective equipment (PPE), and underreporting in low-and middle-income countries (LMICs). Emerging industries, including engineered stone fabrication, have introduced new risks, leading to accelerated silicosis among younger workers. Despite global efforts to improve occupational safety, socio-economic disparities, regulatory gaps, and public health crises such as the COVID-19 pandemic have further complicated disease management. This study analyzes trends in the global burden of pneumoconiosis from 1990 to 2021, providing evidence to inform post-pandemic strategies for occupational health equity and dust exposure mitigation.

METHODS: The data for this study were sourced from the Global Burden of Disease (GBD) 2021 database, utilizing age-standardized incidence rates (ASIR), prevalence rates (ASPR), mortality rates (ASDR), and disability-adjusted life years (DALYs) as the primary assessment indicators. Dynamic changes in the burden of pneumoconiosis were analyzed by estimating the annual percentage changes (EAPCs). The correlation between the Socio-Demographic Index (SDI) and the burden of pneumoconiosis was examined using Pearson correlation tests. Additionally, we conducted decomposition and inequality analyses and Bayesian Age-Period-Cohort (BAPC) to assess trends and distribution related to the pneumoconiosis burden.

RESULTS: The global incidence of pneumoconiosis increased from 42,187.99 cases in 1990 to 62,866.45 cases in 2021, accompanied by a rise in mortality rates. Notably, the burden of pneumoconiosis remains disproportionately higher among men than women across nearly all regions. The highest incidence and mortality rates were recorded in the age group of 80 years and older, with a pronounced gender disparity, particularly in East Asia and High-income North America. These rates were generally elevated in low-income and lower-middle-income regions, where males exhibited significantly higher ASIR and ASDR compared to females. No correlation was found between the SDI values and the pneumoconiosis burden. Additionally, absolute inequality among SDI countries decreased from 1990 to 2021, whereas relative inequality demonstrated an upward trend during the same period.

PMID:40337738 | PMC:PMC12055836 | DOI:10.3389/fpubh.2025.1579851

Front Public Health. 2025 Apr 23;13:1499628. doi: 10.3389/fpubh.2025.1499628. eCollection 2025.

NO ABSTRACT

PMID:40337732 | PMC:PMC12055835 | DOI:10.3389/fpubh.2025.1499628

Front Public Health. 2025 Apr 23;13:1461436. doi: 10.3389/fpubh.2025.1461436. eCollection 2025.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic was a global health emergency that significantly affected both the wellbeing of individuals and the global economy.

OBJECTIVE: The aim of this study was to evaluate the degree of SARS-CoV-2 involvement, viral load, and immunological response in adults aged 18-65 who performed essential tasks in the municipality of Andratx (Balearic Islands, Spain) compared to those who did not. Additionally, the study examined these factors in children aged 2-18 years from both groups, if there were any.

MATERIALS: Both groups were monitored between July 2020 and February 2021, in which the degree of involvement, the viral load, and the immunological response to the SARS-CoV-2 were analyzed using questionnaires, polymerase chain reaction (PCR) tests, and ELISA serology tests.

RESULTS: A positive case of RT-PCR test was found in screening the general population. The highest 2019-nCoV(N)-Ig antibody levels in plasma were measured from 1 to 17 February 2021, with the following percentage of positives: 6.8% of essential workers, 9.5% of essential workers' sons, 7.3% of non-essential workers, and 2.2% of non-essential workers' sons. However, an increase in levels of anti-SARS-CoV-2 (N) immunoglobulin G (IgG) and anti-SARS-CoV-2 (N) immunoglobulin M (IgM) were produced in session 3, from 9 to 25 November 2020, in both cases in non-essential workers, with a mean of 218.1 ng/mL of anti-SARS-CoV-2 (N) IgG and 31.3 ng/mL of anti-SARS-CoV-2 (N) IgM.

CONCLUSION: The control measures taken to manage the COVID-19 pandemic in the municipality of Andratx, Mallorca, Spain, were effective.

PMID:40337727 | PMC:PMC12055839 | DOI:10.3389/fpubh.2025.1461436

Open Forum Infect Dis. 2025 Apr 10;12(5):ofaf214. doi: 10.1093/ofid/ofaf214. eCollection 2025 May.

NO ABSTRACT

PMID:40337724 | PMC:PMC12056933 | DOI:10.1093/ofid/ofaf214

Iran J Microbiol. 2025 Apr;17(2):194-203. doi: 10.18502/ijm.v17i2.18380.

ABSTRACT

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic was mitigated by the rapid development and deployment of vaccines. While vaccines reduce infection severity, breakthrough infections (BTIs) still occur. The CDC defines BTI as a positive SARS-CoV-2 test ≥14 days post-vaccination. This study investigates the occurrence of COVID-19 BTIs at a tertiary care hospital in Puducherry, South India.

MATERIALS AND METHODS: This retrospective study analysed hospital tested qRT-PCR data of individuals from the ICMR portal (March 2021-March 2022). Demographic and vaccination details were extracted.

RESULTS: Among 8001 tested individuals, 1452 were vaccinated. The BTI rate decreased from 16.6% to 1.2% after the first dose and from 58% to 40% after the second one. Odds ratio indicated a 74% reduction in infection risk for vaccinated individuals compared to unvaccinated. Males had higher infection rates than females, regardless of vaccination status.

CONCLUSION: Our study demonstrates a higher BTI rate after one vaccine dose compared to two doses. The BTI rate also increased four months post-vaccination, even with two doses, potentially due to waning immunity and the emergence of new variants. Therefore, continued adherence to preventive measures in conjunction with vaccination is crucial for minimizing COVID-19 transmission.

PMID:40337707 | PMC:PMC12053422 | DOI:10.18502/ijm.v17i2.18380

Iran J Microbiol. 2025 Apr;17(2):194-203. doi: 10.18502/ijm.v17i2.18380.

ABSTRACT

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic was mitigated by the rapid development and deployment of vaccines. While vaccines reduce infection severity, breakthrough infections (BTIs) still occur. The CDC defines BTI as a positive SARS-CoV-2 test ≥14 days post-vaccination. This study investigates the occurrence of COVID-19 BTIs at a tertiary care hospital in Puducherry, South India.

MATERIALS AND METHODS: This retrospective study analysed hospital tested qRT-PCR data of individuals from the ICMR portal (March 2021-March 2022). Demographic and vaccination details were extracted.

RESULTS: Among 8001 tested individuals, 1452 were vaccinated. The BTI rate decreased from 16.6% to 1.2% after the first dose and from 58% to 40% after the second one. Odds ratio indicated a 74% reduction in infection risk for vaccinated individuals compared to unvaccinated. Males had higher infection rates than females, regardless of vaccination status.

CONCLUSION: Our study demonstrates a higher BTI rate after one vaccine dose compared to two doses. The BTI rate also increased four months post-vaccination, even with two doses, potentially due to waning immunity and the emergence of new variants. Therefore, continued adherence to preventive measures in conjunction with vaccination is crucial for minimizing COVID-19 transmission.

PMID:40337699 | PMC:PMC12053401 | DOI:10.18502/ijm.v17i2.18380

Iran J Microbiol. 2025 Apr;17(2):204-210. doi: 10.18502/ijm.v17i2.18381.

ABSTRACT

BACKGROUND AND OBJECTIVES: Viral infections of the respiratory system are a major public problem due to their ease of spread, pandemic potential, and significant rate of death. Diagnosing these infections requires laboratory testing, as clinical symptoms alone are often insufficient. Influenza A, Influenza B, and COVID-19 are common infections that burden the population, especially during winter. We developed a multiplex real-time PCR method to simultaneously detect Influenza A and B, as well as COVID-19. Compared to existing detection kits, it offers higher accuracy, lower costs, and faster results, making it an efficient diagnostic tool.

MATERIALS AND METHODS: We designed primer/TaqMan probes for the M2 gene of Influenza A, N gene of SARS-CoV-2, and NS1 gene of Influenza B. Reaction components were optimized and functional parameters were tested using standard samples with known viral copy numbers.

RESULTS: The method's detection limit is 10 copies for Influenza A and B, and 60 for SARS-CoV-2. Sensitivity and specificity for Influenza A are 88% and 100%, for Influenza B, 95.6% and 100%, and for SARS-CoV-2, 90.4% and 100%.

CONCLUSION: This multiplex real-time PCR method can accurately detect and distinguish SARS-CoV-2, Influenza B, and Influenza A infections.

PMID:40337683 | PMC:PMC12053393 | DOI:10.18502/ijm.v17i2.18381

Iran J Microbiol. 2025 Apr;17(2):204-210. doi: 10.18502/ijm.v17i2.18381.

ABSTRACT

BACKGROUND AND OBJECTIVES: Viral infections of the respiratory system are a major public problem due to their ease of spread, pandemic potential, and significant rate of death. Diagnosing these infections requires laboratory testing, as clinical symptoms alone are often insufficient. Influenza A, Influenza B, and COVID-19 are common infections that burden the population, especially during winter. We developed a multiplex real-time PCR method to simultaneously detect Influenza A and B, as well as COVID-19. Compared to existing detection kits, it offers higher accuracy, lower costs, and faster results, making it an efficient diagnostic tool.

MATERIALS AND METHODS: We designed primer/TaqMan probes for the M2 gene of Influenza A, N gene of SARS-CoV-2, and NS1 gene of Influenza B. Reaction components were optimized and functional parameters were tested using standard samples with known viral copy numbers.

RESULTS: The method's detection limit is 10 copies for Influenza A and B, and 60 for SARS-CoV-2. Sensitivity and specificity for Influenza A are 88% and 100%, for Influenza B, 95.6% and 100%, and for SARS-CoV-2, 90.4% and 100%.

CONCLUSION: This multiplex real-time PCR method can accurately detect and distinguish SARS-CoV-2, Influenza B, and Influenza A infections.

PMID:40337675 | PMC:PMC12053414 | DOI:10.18502/ijm.v17i2.18381

J Nurs Manag. 2025 Apr 30;2025:4285361. doi: 10.1155/jonm/4285361. eCollection 2025.

ABSTRACT

Aim: To conduct a bibliometric analysis of the nurses' job satisfaction from 2004 to 2023. Design: The bibliometric and visual analysis was performed in January 2024. Methods: Bibliometric approaches were applied to analyse 11,993 articles, utilising R and VOSviewer software. Results: Articles published by 24,155 authors from 1735 distinct sources between 2004 and 2023 were retrieved from the Web of Science and incorporated into the research's purview. The most productive nation and institution correspondingly were the United States and the University of Toronto. The leading scholars in this sphere were Spence Laschinger, Heather K, Labrague, Leodoro J, and Rodwell, John according to Price's Law, author co-citation and bibliographic-coupling network analysis. 14,152 keywords about nurses' job satisfaction study were discovered in this research. The most common keywords encompassed "job satisfaction," "nurses," "burnout," "turnover," and "intention" It was also observed that while trend topics like "work engagement" "COVID-19" and "grit" have gained popularity recently, the most commonly employed trend topics in earlier years included "empirical research report" "longitudinal study," and "organizational characteristics." Conclusion: Research on nurses' job satisfaction remains relatively limited and requires more attention, especially in developing countries. Developed countries, especially the United Kingdom and the United States, are the main contributors to nurse job satisfaction research. In the early days, nurse job satisfaction research mainly focused on the current status and influencing factors of nurse job satisfaction in different medical organizations, nurse groups or departments, while more researchers have recently paid more attention to research on specific issues emerging in this field, such as the impact of COVID-19 on nurse job satisfaction and turnover. In addition, scholars in the field of nurse job satisfaction focus on finding the real determinants of job satisfaction of adult practicing nurses, such as interpersonal value consistency, human resource management, and the impact of job satisfaction of adult nurses in different medical environments. Topics such as "perseverance," "COVID-19" and "work engagement" may be potential focuses for future research. Furthermore, transnational research should be given greater emphasis to investigate whether the major factors and effective interferences of nurses' job satisfaction differ between cultures and more multicenter as well as big sample studies should be conducted to efficiently improve nurses' job satisfaction. Impact: This study used bibliometric analysis to examine the most contributing nations, institutions, authors, trend topics, and research focus. Data on the present state of nurses' job satisfaction research, including its knowledge maps, study emphasis, and thematic trends are few. The findings of this research can lay a strong basis for future research and offer direction. No Patient or Public Contribution: There were no humankind subjects in the bibliometric analysis of published papers.

PMID:40337624 | PMC:PMC12058320 | DOI:10.1155/jonm/4285361

Lancet Reg Health Southeast Asia. 2025 Apr 26;36:100584. doi: 10.1016/j.lansea.2025.100584. eCollection 2025 May.

ABSTRACT

BACKGROUND: COVID-19 has challenged entire health systems, including laboratories. To address the increasing demand for tests to inform the epidemiology of the disease and for case management purposes, many countries made significant investments to rapidly expand laboratory capacity for detecting SARS-CoV-2. In this study, we used a simulated laboratory environment, based on a model of operating laboratories in Nepal, to identify opportunities for improvement.

METHODS: We developed a discrete event simulation (DES) model, based on data from and in collaboration with Nepali health authorities, to analyse laboratory operations in Nepal. We used a series of "what-if" scenarios under different levels of testing demand and staffing to investigate bottlenecks in the processing of COVID-19 samples in a simulated laboratory environment, assess the impact of potential reagent shortages and increased automation, and more generally, explore the key factors that drive the performance and resilience of the testing system.

FINDINGS: Suboptimal staff allocation and scheduling can limit the timely return of laboratory results; however, better staff allocation can mitigate bottlenecks and reduce the impact of reagent shortages. For example, when the demand is 720 samples per day and seven staff members are on duty, adding one additional staff member improves reporting time (reduction from 48 h to approximately 32 h). However, changes in scheduling can increase the average time to return the results to over 200 h. A one-day reagent shortage appears to have minimal impact, but a delay of five days significantly increases the reporting time, reaching nearly 150 h. Increasing automation or better process coordination for sample registration can also lead to better performance, reducing the average reporting time from over 60 h to just under 24 h.

INTERPRETATION: Our findings identify important bottlenecks and challenges, along with ways to address them, and thus provide important lessons for improving disease testing operations for this and future pandemics.

FUNDING: WHO Special Programme for Research and Training in Tropical Diseases (TDR).

PMID:40337599 | PMC:PMC12056959 | DOI:10.1016/j.lansea.2025.100584

Cureus. 2025 Apr 7;17(4):e81816. doi: 10.7759/cureus.81816. eCollection 2025 Apr.

ABSTRACT

Spinal osteomyelitis (SO) is a rare but serious infection of the vertebrae with occasional epidural involvement. Diagnosis is complicated by nonspecific findings that oftentimes mimic malignancy or tuberculosis, with typical methods of diagnosis such as blood culture and image-guided biopsy possessing varying levels of sensitivity. In this report, we present a rare case of SO that highlights these diagnostic difficulties. SO should be considered in a patient who presents with non-specific back pain. In such cases, non-diagnostic image-guided biopsy attempts do not rule out SO. Further investigations into additional diagnostic techniques to reduce false negatives are required to limit delays in diagnosis.

PMID:40337591 | PMC:PMC12056565 | DOI:10.7759/cureus.81816

Cureus. 2025 Apr 7;17(4):e81840. doi: 10.7759/cureus.81840. eCollection 2025 Apr.

ABSTRACT

The COVID-19 pandemic has significantly impacted the mental health and well-being of children and adolescents globally. This comprehensive narrative review synthesizes current research on the pandemic's psychological effects on young people, examining emotional distress, behavioral changes, sleep disturbances, educational disruptions, and the exacerbation of pre-existing mental health conditions. A systematic literature search was conducted using PubMed, MEDLINE, PsycINFO, CINAHL, and Web of Science, covering articles published from January 2020 to December 2024. Studies focusing on children and adolescents (aged 0-18 years) that examined mental health outcomes related to the COVID-19 pandemic were included. Data extraction was performed using a standardized form, and a narrative synthesis approach was employed to analyze and integrate the findings. Key findings reveal a substantial increase in anxiety, depression, and post-traumatic stress disorder among children and adolescents during the pandemic. School closures, social isolation, and disrupted routines have contributed to these mental health challenges. Sleep patterns have been notably affected, with delayed bedtimes, increased sleep disturbances, and a higher prevalence of insomnia and nightmares. The pandemic has widened educational disparities, particularly affecting children from disadvantaged backgrounds. Individuals with pre-existing mental health conditions have experienced exacerbated symptoms and faced challenges in accessing care. Various interventions, including cognitive behavioral therapy, social-emotional learning programs, and digital mental health support, have shown promise in mitigating the pandemic's psychological impact on young people. Children were more affected, as they faced a global crisis for the first time with limited coping skills. Disruptions in routine, social isolation, and family stressors heightened anxiety, depression, and behavioral issues, making them more affected. This review emphasizes the need for continued research, targeted interventions, and policy development to address the long-term mental health consequences of the COVID-19 pandemic on children and adolescents.

PMID:40337590 | PMC:PMC12056868 | DOI:10.7759/cureus.81840

Ann Med Surg (Lond). 2025 Mar 28;87(5):2645-2652. doi: 10.1097/MS9.0000000000003197. eCollection 2025 May.

ABSTRACT

BACKGROUND: Various comorbidities are known to exacerbate the risk of surgical mortality with COVID-19 infection. The effect of HIV infection on surgical mortality in the context of COVID-19 has also not been investigated. The aim of our study was to investigate the influence of HIV status on mortality in surgical patients admitted during the COVID-19 pandemic in Johannesburg, South Africa.

MATERIAL AND METHODS: We reviewed records of patients who were admitted and underwent surgery during the COVID-19 pandemic and died. Data regarding perioperative COVID-19 infection, risk factors, comorbidities, mortality preventability, and contributing factors were extracted. Logistic regression was used to analyze comorbidities associated with COVID-19 infection among surgical mortalities.

RESULTS: A total of 404 records of mortalities were found and 25% (82/404) tested positive for COVID-19. 40% Of the mortalities were either potentially preventable or preventable. Comorbidities in patients who were COVID-19-positive surgical mortalities compared to their negative counterparts included smoking in 35% versus 4%, chronic obstructive pulmonary disease (COPD) in 20% versus 3%, and diabetes mellitus in 23% versus 13%, respectively. The odds of being COVID-19 positive in surgical mortalities with hypertension, smoking, and COPD were 1.96 times [OR = 1.96, 95% CI (1.06, 3.59)], 7.78 times [OR = 7.78, 95% CI (3.45, 18.35)], and 3.09 times [OR = 3.09, 95% CI (1.08, 8.95)], respectively. 55% of COVID-19-positive patients who died were HIV positive compared to 31% among the COVID-19-negative group. 26% of HIV-positive patients were on anti-retroviral treatment (ART). 22% of HIV-/COVID-19-coinfected surgical mortalities were not on antiretroviral treatment compared to 9% in the HIV-positive and COVID-19-negative groups. The odds of COVID-19 infection in surgical mortalities who were HIV positive and not on ART was 3.10 [95% CI (1.55, 6.11)].

CONCLUSION: The rate of COVID-19 infection was higher in HIV-positive patients who died, especially if they were not on ART. Smoking, COPD, and hypertension imparted the largest risk on COVID-19 infection in cases of surgical mortality. These comorbidities likely superimpose the pathological effects of COVID-19 infection, worsening surgical prognosis.

PMID:40337390 | PMC:PMC12055160 | DOI:10.1097/MS9.0000000000003197

Respirol Case Rep. 2025 May 6;13(5):e70197. doi: 10.1002/rcr2.70197. eCollection 2025 May.

ABSTRACT

This case report describes an 80-year-old woman with systemic sclerosis (SSc), complicated by interstitial lung disease (ILD) and new-onset pulmonary hypertension (PH), likely triggered by an atypical SARS-CoV-2 infection. Diagnosed with SSc in 2016 and previously stable ILD, she experienced clinical deterioration in 2023 with worsening respiratory failure and PH. Despite negative PCR and antigen tests, high anti-SARS-CoV-2 IgG levels and CT findings were consistent with COVID-19-related organising pneumonia. Intravenous glucocorticoids led to partial symptom improvement, although ILD progression continued. The patient died in December 2023 from pneumococcal pneumonia. This case highlights the complex interaction between SSc and COVID-19, where overlapping mechanisms of endothelial injury and fibrosis may exacerbate pre-existing organ damage. It underscores the need for a multidisciplinary approach and timely interventions, including vaccination, early clinical assessment and appropriate immunosuppressive or antiviral treatments, to prevent severe infectious complications and halt disease progression in this high-risk patient population.

PMID:40337292 | PMC:PMC12055518 | DOI:10.1002/rcr2.70197

Front Neurol. 2025 Apr 23;16:1534352. doi: 10.3389/fneur.2025.1534352. eCollection 2025.

ABSTRACT

BACKGROUND: Post-exertional malaise (PEM) is a central feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and has emerged as a prominent feature of Long COVID. The optimal clinical approach to PEM is inconclusive, and studies of the impact of exercise have yielded contradictory results.

OBJECTIVE: The objective of this study was to examine PEM in Long COVID by assessing the prevalence of self-reported PEM across study cohorts and symptom responses of Long COVID patients to a standardized exercise stressor. Secondarily, Long COVID symptom responses to exercise were compared to those of ME/CFS and healthy volunteers.

METHODS: Data from three registered clinical trials comprised four cohorts in this study: Long COVID Questionnaire Cohort (QC; n = 244), Long COVID Exercise Cohort (EC; n = 34), ME/CFS cohort (n = 9), and healthy volunteers (HV; n = 9). All cohorts completed questionnaires related to physical function, fatigue, and/or PEM symptoms. EC also performed a standardized exercise test (cardiopulmonary exercise test, CPET), and the PEM response to CPET was assessed using visual analog scales and qualitative interviews (QIs) administered serially over 72 h. EC PEM measures were compared to ME/CFS and HV cohorts. A secondary analysis of QI explored positive responses to CPET among EC, ME/CFS and HV.

RESULTS: Self-reported PEM was 67% in QC and estimated at 27% in EC. Only 2 of 34 EC patients (5.9%) were observed to develop PEM after a CPET. In addition, PEM responses after CPET in Long COVID were not as severe and prolonged as those assessed in ME/CFS. Twenty-two of 34 EC patients (64.7%) expressed at least one of 7 positive themes after the CPET.

CONCLUSION: Self-report of PEM is common in Long COVID. However, observable PEM following an exercise stressor was not frequent in this small cohort. When present, PEM descriptions during QI were less severe in Long COVID than in ME/CFS. Positive responses after an exercise stressor were common in Long COVID. Exercise testing to determine the presence of PEM may have utility for guiding clinical management of Long COVID.

PMID:40337174 | PMC:PMC12055772 | DOI:10.3389/fneur.2025.1534352

JIMD Rep. 2025 May 6;66(3):e70021. doi: 10.1002/jmd2.70021. eCollection 2025 May.

ABSTRACT

SARS-CoV-2 infection and Long COVID (LC) might lead to a significant deterioration of physical and mental health. Wilson disease (WD) patients have a chronic liver and/or neuropsychiatric disease, making it particularly interesting to investigate LC in WD. 51 WD patients were retrospectively examined, evaluating physical and mental health by a survey and neuropsychological tests (SF-12, PSQI, ISI, Epworth, Chalder-fatigue scale, PHQ-9, GAD-7, PSS, FLei) before and ~11 months after SARS-CoV-2 infection. LC was defined as the development of new, at least moderately severe symptoms (shortness of breath, chest pain, fatigue, brain fog, exercise capacity, concentration disturbances) and/or worsening of pre-existing symptoms. 70.6% had predominant hepatic and 29.4% had neuropsychiatric symptoms at WD diagnosis. Median age was 39 years; 56.1% were female. Patients were in stable maintenance phase with a median treatment duration of 23 years. When compared to before COVID-19, WD patients had significantly worse physical life quality, sleeping quality, and fatigue. After COVID-19, a high percentage of WD patients reported concentration disorders (60%), fatigue (55%), reduced exercise capacity (50%), shortness of breath (40%), chest pain (20%) and feeling of brain fog (15%). 39.2% (n = 20) of the WD patients were classified as LC. This LC-WD subgroup showed significantly impaired quality of life, a high stress level, and sleeping disturbances, fatigue, depression, anxiety, and cognitive impairment. A large proportion of WD patients experience LC symptoms, reduced life quality, and sleeping disorders after SARS-CoV-2 infection. WD patients post-infection should be well monitored and supported if they develop persisting symptoms or neuro-psychological problems.

PMID:40337099 | PMC:PMC12055521 | DOI:10.1002/jmd2.70021

Kidney Dial. 2025;5(2):12. doi: 10.3390/kidneydial5020012. Epub 2025 Apr 3.

ABSTRACT

BACKGROUND: We observed a COVID-19 survivor with a ventriculoperitoneal shunt who developed increased intracranial pressure during hemodialysis. We hypothesized that post-SARS-CoV-2 infection, patients may have altered cerebral perfusion pressure regulation in response to intracranial pressure changes.

METHODS: From April to July 2021, we recruited dialysis patients with prior COVID-19 from two Madrid nephrology departments. We also recruited age- and sex-matched dialysis patients without prior SARS-CoV-2 infection. Transcranial Doppler ultrasound was used to measure the middle cerebral artery velocity before dialysis and 30, 60, and 90 min after the initiation of dialysis.

RESULTS: The final sample included 37 patients (16 post-COVID-19 and 21 without). The COVID-19 survivors showed a significant pulsatility index increase between 30 and 60 min compared to those without COVID-19. They also had lower heart rates.

CONCLUSIONS: We propose two mechanisms: an increase in intracranial pressure or a decreased arterial elasticity. A lower heart rate was also observed in the COVID-19 survivors. This study highlights SARS-CoV-2's multifaceted effects, including potential long-term vascular and cerebral repercussions.

PMID:40336917 | PMC:PMC12056549 | DOI:10.3390/kidneydial5020012

Br J Occup Ther. 2024 Jul;87(7):452-460. doi: 10.1177/03080226241233112. Epub 2024 Mar 19.

ABSTRACT

INTRODUCTION: Parent/carers of disabled children want timely and personalized support. Research suggests that technology may address some limitations associated with traditional methods of communication with therapists (e.g. letter, telephone). This exploratory study examined United Kingdom (UK) parents and carers views on the use of digital technology (i.e. computers/phones) in supporting their child and the potential for its greater use in the care of children with complex needs.

METHODS: An online survey was distributed via special schools and support forums/networks. Questions explored use of and attitudes to digital technology in the care of children with complex needs. Descriptive statistical analyses and content analyses were undertaken on the data.

RESULTS: Respondents were 43 parents/carers whose children used rehabilitation services prior to the COVID-19 pandemic. The majority used digital technology frequently to support their child and saw the potential for greater use in rehabilitation services - provided this was not at the expense of in-person therapist contact.

CONCLUSION: Parents and carers held positive views of digital technology as a tool to support their child and enhance rehabilitation services. Recommendations include regular service consultation on parental/child attitudes to digital service delivery and longitudinal studies to assess related health outcomes.

PMID:40336719 | PMC:PMC11887867 | DOI:10.1177/03080226241233112

Contemp Clin Trials Commun. 2025 Apr 21;45:101489. doi: 10.1016/j.conctc.2025.101489. eCollection 2025 Jun.

ABSTRACT

BACKGROUND: Mental health disorders, including stress, anxiety, and depression, are the most common complications during pregnancy, with significant racial disparities in prevalence and access to care. Low-income Black/African American/of African descent (Black) individuals are at greater risk for perinatal mental health issues and face more obstacles to care due to a variety of barriers, including poor implementation of screening protocols, stigma, adverse experiences of social determinants of health, and distrust of healthcare systems. These disparities are particularly striking in Washington, DC, and worsened during the COVID-19 pandemic.

METHODS: This study has two aims: (1) to refine an individualized plan to integrate patient navigation and a culturally adapted cognitive-behavioral (CBT) prevention and treatment intervention for low-income Black pregnant women; and (2) to determine the effectiveness of multiple interventions: patient navigation, culturally adapted CBT, and/or peer support groups versus usual care for pregnant individuals at subthreshold and threshold risk for prenatal stress, depression and/or anxiety in a two-arm prospective longitudinal randomized controlled study. Outcomes will be tracked from pregnancy through 12 months postpartum, assessing maternal mental health, engagement with the intervention, healthcare experiences and utilization, and infant outcomes.

CONCLUSIONS: If found to be efficacious, results will help develop scalable, culturally relevant interventions aimed at reducing racial disparities in maternal mental health care and improving health outcomes for both mothers and infants. Trial registration: ClinicalTrials.gov ID NCT05345834.

PMID:40336702 | PMC:PMC12056800 | DOI:10.1016/j.conctc.2025.101489

Lancet Reg Health West Pac. 2025 Apr 23;58:101554. doi: 10.1016/j.lanwpc.2025.101554. eCollection 2025 May.

ABSTRACT

BACKGROUND: As the COVID-19 pandemic shifted into the post-pandemic period in early 2023, following the COVID-19 normalization with relaxation of stringent control measures and high vaccination coverage in Hong Kong, its long-term impact on mortality remains challenging with necessary needs of data-driven insights. This study examined the pattern of post-pandemic excess mortality in Hong Kong.

METHODS: We analyzed weekly inpatient death data from public hospitals from January 1, 2013, to June 1, 2024, using a mixed model with over-dispersed Poisson regression. Expected mortality was estimated as the difference between observed mortality and baseline derived from pre-pandemic data. Age-stratified analyses of overall and cause-specific mortality were conducted across the pre-Omicron pandemic, Omicron, and post-pandemic periods.

FINDINGS: In the post-pandemic period, the excess mortality declined but remained six-fold higher (37.66 [95% CI: 32.72-42.60] per 100,000) than pre-Omicron level, maintaining significance after adjusting for age (32.79 [95% CI: 28.13-37.46] per 100,000). The older population experienced sustained excess mortality, with crude estimates of 100.51 and 586.74 per 100,000 among those aged 65-79 years and ≥80 years, respectively, primarily due to respiratory diseases. Younger population showed near-zero overall excess mortality, whereas increased excess mortality among them occurred in heart disease, cerebrovascular disease, and injuries.

INTERPRETATION: Our findings highlight the lasting mortality impact of pandemic among vulnerable populations, specifically the older population, possibly due to the post-COVID conditions and circulating COVID-19, suggesting the need for targeted interventions for this group.

FUNDING: Health and Medical Research Fund.

PMID:40336577 | PMC:PMC12054014 | DOI:10.1016/j.lanwpc.2025.101554

Mol Ther Nucleic Acids. 2025 Apr 8;36(2):102536. doi: 10.1016/j.omtn.2025.102536. eCollection 2025 Jun 10.

ABSTRACT

The COVID-19 pandemic underscored the urgency of developing effective vaccines to combat infectious diseases, especially in vulnerable populations such as the elderly and immunocompromised. While recombinant protein vaccines offer safety, their poor immunogenicity highlights the need for advanced vaccination platforms. New genetic/nucleic acid vaccine formulations like plasmid DNA and mRNA showed efficiency and safety in preclinical and clinical studies; however, they demand innovative adjuvants because their mechanism of action differs from traditional protein vaccines. Genetic adjuvants-encoded by nucleic acids within DNA, RNA, or viral vectors-emerge as a promising solution by targeting and modulating specific immune pathways, including antigen presentation, T cell activation, and memory formation. These innovative adjuvants enhance vaccine efficacy by fine-tuning innate and adaptive immune responses, overcoming immune senescence, and addressing the challenges of CD8⁺ T cell activation in immunocompromised populations. This review explores the potential of genetically encoded adjuvants, including cytokines, chemokines, and other immune modulators. By comparing these adjuvants to traditional formulations, we highlight their capacity to address the limitations of modern vaccines while discussing their integration with emerging technologies like RNA-based vaccines. As genetic adjuvants advance toward clinical application, understanding their mechanisms and optimizing their delivery is pivotal to unlocking next-generation immunization strategies.

PMID:40336572 | PMC:PMC12056970 | DOI:10.1016/j.omtn.2025.102536

Int J Popul Data Sci. 2025 May 7;10(1):2703. doi: 10.23889/ijpds.v10i1.2703. eCollection 2025.

ABSTRACT

Source and contact tracing (SCT) is a core public health measure that is used to contain the spread of infectious diseases. It aims to identify a source of infection, and to advise those who have been exposed to this source. Due to the rapid increases in incidence of COVID-19 in the Netherlands, the capacity to conduct a full SCT quickly became insufficient. Therefore, the public health services (PHS) might benefit from a restricted strategy targeted to geographical regions where (predicted) case-to-case transmission is high. In this study, we set out to develop a prediction model for the number of COVID-19 cases per postal code within the Netherlands using geographic and demographic features. The study population consists of individuals residing in one of the participating nine Dutch PHS regions who tested positive for SARS-CoV-2 between 1 June 2020 and 27 February 2021. Using a machine learning random forest regression model, we predicted the top 100 postal codes with the highest number of cases with an accuracy of 49% for the current week, 42% for next week, and 44% for two weeks from present. In addition, the age groups of 20-39 and 40-64 years had a higher prediction accuracy than groups outside these age ranges. The developed model provides a starting point for targeted preventive SCT efforts that incorporate geospatial and demographic characteristics of a neighbourhood. It should nonetheless be noted that during the early stages of the outbreak, the number of available datapoints needed to inform such models are likely insufficient. Given the accuracy and data requirements of the developed model, it is unlikely that this class of models can play a pivotal role in informing policy during the early phases of a future epidemic.

PMID:40336504 | PMC:PMC12058245 | DOI:10.23889/ijpds.v10i1.2703

Ann Lab Med. 2025 May 8. doi: 10.3343/alm.2024.0458. Online ahead of print.

ABSTRACT

BACKGROUND: Sapovirus is an increasingly recognized cause of acute gastroenteritis (AGE). Despite its significance, data on sapovirus epidemiology and genetic diversity in Korea are limited. Therefore, we examined sapovirus positivity rates over a 6.5-yr period and analyzed the genetic diversity of strains detected in 2022 in Korea.

METHODS: We retrospectively analyzed 204,563 sapovirus multiplex PCR test results from suspected AGE cases collected between 2017 and 2023 at two institutions. Monthly and age-specific positive rates were evaluated. Forty sapovirus-positive samples from 2022 were genotyped using reverse transcription PCR and sequencing. The sequences were compared with those in the National Center for Biotechnology Information Virus database, and a phylogenetic tree was constructed to assess genetic relationships among sapovirus strains.

RESULTS: The overall sapovirus positivity rate from 2017 to 2023 was 2.2%, with an increasing trend in summer and autumn, except during the coronavirus disease 2019 (COVID-19) pandemic in 2020 and 2021, when sapovirus was rarely detected. Positivity markedly increased in the summer and autumn of 2022 and 2023 following the COVID-19 pandemic. The predominant genotypes in 2022 were GI.1 and GII.3. Phylogenetic analysis revealed genetic diversity among circulating strains.

CONCLUSIONS: This study highlights the rising incidence of sapovirus in Korea, particularly after the COVID-19 pandemic. Despite focusing on genotyping data from a single year, these findings emphasize the need for ongoing surveillance to monitor sapovirus evolution and its public health impact. Additionally, our findings provide essential baseline data for future research into the epidemiology and genetics of sapovirus.

PMID:40336393 | DOI:10.3343/alm.2024.0458

Curationis. 2025 May 7;48(1):e1-e9. doi: 10.4102/curationis.v48i1.2735.

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has severely impacted nursing services, with thousands of ICU nurses infected with potentially fatal respiratory infections. Saudi Arabian studies suggest psychological implications, with loneliness and social isolation linked to higher depression and anxiety levels. Pandemic preparedness should focus on workforce protection and mental well-being promotion.

OBJECTIVES: This study aimed to understand the experiences of critical care nurses in Saudi Arabia who contracted COVID-19, with the goal of formulating recommendations to empower them, increase resilience, and help the profession thrive post-pandemic.

METHOD: This study used an exploratory, descriptive, and contextual approach, conducting unstructured interviews with 11 Critical Care Unit (CCU) Registered Nurse (RN) who contracted COVID-19, and analysing the data using Colaizzi's seven-step method.

RESULTS: Three themes emerged from the data: (1) physical isolation led to loneliness and psychological separation, lacking emotional support and freedom of choice; (2) reintegration into the work environment increased stress and loneliness and (3) Coronavirus disease 2019 exposure provided essential insight into patient care and increased awareness of adaptive skills. These themes highlight the challenges participants faced during the pandemic.

CONCLUSION: This research study indicated the experiences of ICU nurses who contracted COVID-19, revealing feelings of loneliness, depression and stress. Despite reintegration into their work environment, these feelings persist.Contribution: The study indicates that nurses in social isolation or quarantine also require open communication, social interaction, personal autonomy and emotional support to boost their resilience and mental health, and to increase their job satisfaction.

PMID:40336382 | DOI:10.4102/curationis.v48i1.2735

Curationis. 2025 May 6;48(1):e1-e12. doi: 10.4102/curationis.v48i1.2698.

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic strained the healthcare sector and workers. Nurses experienced stress and burnout because of strain in resources, limited staff and exposure risk. Resultant lower back pain was prevalent. Nurses were poorly equipped to manage these conditions physically and psychologically.

OBJECTIVES: The study aims to investigate lower back pain and stress levels during COVID-19. It also aims to provide data describing any association between both.

METHOD: Pain and stress were determined using questionnaires. Quantitative, descriptive design and convenient sampling were used. The Chi-square goodness-of-fit-test tests significant Back Pain Functional Scale (BPFS) responses (12 daily activities lower back pain) and determines the relationship between pain and stress before and during COVID-19 related to the current time. Chi-square test of independence is used on cross-tabulations to determine the relationship between stress and lower back pain. Fisher's exact test was used for conditions not met. The Binomial test was used for the significance check of yes/no response to medication use. A questionnaire was provided on exercise levels and provision by workplace.

RESULTS: Higher pain and stress were noted during versus prior to COVID-19. Back Pain Functional Scale showed no difficulty performing the majority of activities. A small percentage used medication, showing no significant change. Majority did not perform exercise for reducing lower back pain prior to or during COVID-19. Exercise intervention was not provided by workplaces for the majority, during or prior to COVID-19.

CONCLUSION: Lower back pain and perceived stress levels increased during the COVID-19 pandemic. Provision of lower back pain education and exercise intervention in preventing and managing lower back pain in hospital nurses was needed. This study adds to the stress and lower back pain knowledge base in South Africa.Contribution: The findings assist in understanding the effects of Covid-19 on stress and lower back pain in nurses, linkage of the two, and possible interventions to reduce these effects using knowledge enhancement and prescribed exercise interventions.

PMID:40336381 | DOI:10.4102/curationis.v48i1.2698

Curationis. 2025 Apr 30;48(1):e1-e11. doi: 10.4102/curationis.v48i1.2718.

ABSTRACT

BACKGROUND: Staff shortages, the coronavirus disease 2019 pandemic, increased patient acuity and fiscal restraints contributed to basic nursing students being assigned to intensive care units (ICU). These students, expected to step up and function within the team, were confronted with expectations and situations beyond their clinical preparation for practice. How can we better prepare these students for practice?

OBJECTIVES: To develop recommendations that promote transition programmes that prepare student nurses to become practice-ready novice general nurses to work in the ICU.

METHOD: The study adopted a sequential explanatory mixed-method. Quantitative data collection was achieved through census sampling and the utilisation of the Casey Fink Practice Readiness Survey. Statistical analyses used IBM SPSS (version 25, IBM Corporation) to identify predictive relationships between practice readiness and identified variables through multi-linear regression. Qualitative data collected through purposive selection and semi-structured focus group discussions were transcribed, coded and analysed through domain analysis.

RESULTS: Four factors affecting nursing students' perceived readiness for practice in the ICU were identified: (1) Support for new general nurses, (2) their need for professional socialisation and belonging, (3) orientation and skill development and (4) rotation and exposure to the ICU.

CONCLUSION: Multifaceted innovative introduction programmes may assist in preparing the novice general nurse to become practice-ready.Contribution: This article contributes towards a possible solution to bridge the theory-practice gap and positively influence students' transition into the workplace to facilitate retention of novice practitioners beyond their first year of practice in a specialised unit.

PMID:40336380 | DOI:10.4102/curationis.v48i1.2718

Virulence. 2025 May 8:2502551. doi: 10.1080/21505594.2025.2502551. Online ahead of print.

ABSTRACT

Considering that bat ecology alterations may be linked with pathogen spillover, research on bat coronaviruses, particularly on the infection and transmission pattern among bats in relation with their ecology, is essential. We captured bats distributed in Korea from 2021 to 2022, examined coronaviruses in oral swabs, faeces, urine, and ectoparasites, and were able to detect alphacoronavirus. We investigated coronaviruses, but noted no substantial differences in the body condition index in the coronavirus-positive bats. Binary logistic regression analysis revealed that bat ecological factors that were significantly associated with coronavirus-positive were roost type, sample type, and bat species. Coronavirus-positive ectoparasite cases suggested additional study on the potential role of them as the viral transmission vectors or fomites. Reinfection of a different coronavirus in recaptured bats was evident, suggesting the possibility that coronavirus circulation can evade the potential protective immunity acquired from previous coronavirus infections. The present findings provide comprehensive information on the coronaviruses transmission dynamics within bat populations linked with bat ecology.

PMID:40336345 | DOI:10.1080/21505594.2025.2502551

New Solut. 2025 May 8:10482911251334843. doi: 10.1177/10482911251334843. Online ahead of print.

ABSTRACT

Mask shortages during COVID-19 led to the adoption of reusable textile masks; research into their performance and optimal washing conditions can guide domestic laundering to encourage their use, decreasing plastic pollution. The study tested four washing methods for cleaning artificially contaminated facepieces. These conditions included nonbiological detergent at 30°C, Reference Detergent 3 (RD3) at 40°C and 60°C, and fortified RD3 (sodium perborate + tetraacetylethylenediamine) at 40°C. After washing, the facepieces were tumble- or air-dried. The effectiveness was determined by measuring bacteria reduction by standard plate count, achieving a target reduction of ≥99.99% and a benchmark cleanliness requirement (for surgical masks) of ≤ 30 CFU/g (EN 14683: 2019). All met the benchmark except 30°C nonbiological detergent washes with air drying. Oxidative bleach reduced RD3 performance. This research demonstrates that heavily contaminated reusable masks can be effectively decontaminated using domestic machines on a normal wash cycle (40 degrees).

PMID:40336319 | DOI:10.1177/10482911251334843

Int J Hyperthermia. 2025 Dec;42(1):2488792. doi: 10.1080/02656736.2025.2488792. Epub 2025 May 7.

ABSTRACT

BACKGROUND: Post-Covid syndrome (PCS) has been an ongoing challenge since the COVID-19 pandemic. Relatively little is known about the effect of whole-body hyperthermia (WBH) in the treatment of PCS.

METHODS: We retrospectively analyzed the data of patients with PCS who were treated as inpatients with a multimodal integrative therapy approach including WBH. The primary outcome comprised changes in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) between T0 (at hospital admission) and T2 (four weeks after discharge), secondary outcomes were changes in Fatigue Impact Scale (FIS-D), Multidimensional Dyspnea Profile (MDP) and Covid-Associated Symptoms (CAS) between T0-T1 (at discharge) and T0-T2.

RESULTS: FACIT-F yielded a significant increase (p < 0.001) between T0 (19.1 ± 8.4) and T2 (29.9 ± 13.0) (primary outcome), indicating an improved health status. While FIS-D and CAS scores improved significantly between T0 and T2, dyspnea parameters improved only between T0 and T1. 63% of respondents identified WBH as an effective treatment.

CONCLUSIONS: Study results provide preliminary evidence for potentially positive effects of WBH in the setting of this study, in which it is embedded in a multimodal therapy approach. The results should be substantiated by future RCTs to identify specific effects of individual therapy components.

PMID:40336247 | DOI:10.1080/02656736.2025.2488792

Mol Ther. 2025 May 6:S1525-0016(25)00363-6. doi: 10.1016/j.ymthe.2025.04.043. Online ahead of print.

ABSTRACT

Hypokalemia is a prevalent complication of COVID-19 patients with acute kidney injury (AKI), however, mechanisms have yet to be fully understood. By single-nucleus RNA sequencing, we found that COVID-19 patients with AKI were associated with a marked upregulation of the epithelial sodium channel (ENaC) in the renal tubular epithelial cells (TECs). By using a mouse model of AKI induced by kidney-specifically overexpressing SARS-CoV-2 N protein, we detected that overexpression of renal SARS-CoV-2 N protein could induce hypokalemia and AKI, which was associated with upregulation of ENaC, ROMK and BK proteins. Functionally, patch-clamp study revealed that overexpression of SARS-CoV-2 N protein largely increased the ENaC current in the TECs. Mechanically, we uncovered that kidney-specifically overexpressing SARS-CoV-2 N protein could activate ENaC to cause hypokalemia and AKI directly by binding to the ENaCα and ENaCγ subunits and indirectly by activating the p38 MAPK pathway. Importantly, treatment with an ENaC specific inhibitor could protect against SARS-CoV-2 N-induced hypokalemia and AKI, revealing a regulatory role and therapeutic target of ENaC in SARS-CoV-2 N-induced hypokalemia and AKI. In conclusion, hypokalemia in COVID-19 AKI is induced by SARS-CoV-2 N protein via the ENaC-dependent mechanism. Targeting ENaC may offer a novel therapy for COVID-19 patients with AKI.

PMID:40336195 | DOI:10.1016/j.ymthe.2025.04.043

J Med Econ. 2025 May 7:1-11. doi: 10.1080/13696998.2025.2500825. Online ahead of print.

ABSTRACT

OBJECTIVE: Global fertility has halved since its 1960s peak to be little above the replacement rate, and lower in many developed countries. In addition it has been suggested that excess deaths since onset of the Covid pandemic may have influenced fertility. Given the economic and social interest in declining fertility, this study seeks an explanation.

METHODS: We developed a sample for 18 mid-large industrialized countries of 30 variables covering vital statistics and health, social and economic data, and determined excess deaths during 2020-2022 and unexpected births during 2022-2024. Analysis estimated the link between Covid excess deaths and subsequent unexpected births; and estimated links between excess deaths and unexpected births and national parameters.

RESULTS: Countries' average birth rate during 2022-2023 was 5-6 percent below that expected from their trend and mean prior to spread of Covid in 2020. Birth rates were higher than expected after 2022 in countries which had high excess deaths during 2020-2022. Regression against national parameters traced reductions in post-Covid births to countries' strong economic measures (low unemployment, high GDP per capita), indicators of women's high economic capacity (years at school, female workforce participation), and weak religiosity. Similar analysis identified higher excess deaths in less wealthy countries, and those with weaker social measures and women's opportunities, and poor pre-existing health outcomes (high infant mortality, low life expectancy, fewer physicians).

CONCLUSION: The association between unexpected births and excess deaths this decade is largely spurious because lower wealth and poor previous health outcomes drove excess deaths, while the opportunity cost of childbearing has accelerated declining births in wealthier countries post-Covid.Better understanding population effects of the pandemic is of broad social and economic interest given declining fertility rates; and change in trajectory of births could prove the pandemic's most serious socio-economic consequences.

PMID:40336191 | DOI:10.1080/13696998.2025.2500825

Arch Public Health. 2025 May 7;83(1):122. doi: 10.1186/s13690-025-01609-0.

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused profound and rapid changes in patient care and healthcare system organization. There is a compelling need for insight into the challenges that confronted physicians during the early phase of the pandemic to identify successful adaptations and strategies that minimize disruption to patient care and protect clinician wellbeing. The purpose of this study was to understand physicians' lived experiences of providing patient care during the early COVID-19 pandemic.

METHODS: This qualitative, descriptive study used a thematic analysis approach. The sample included 17 physicians from five specialties with direct care experience of COVID-19 patients (infectious disease, primary care, emergency medicine, critical care, and hospitalists). Participants were identified through snowball sampling. Data were collected through focus groups and interviews in May and June 2020 and analyzed with an inductive and deductive approach using thematic analysis.

RESULTS: Three overarching themes relating to patient care delivery during the ongoing COVID-19 pandemic were identified: facilitators, barriers, and acute stressors. Facilitator subthemes included: organizational logistical and operational support, organizational support for self-care and wellness, and peer and family support/debriefing. Barrier subthemes included: lack of clear and consistent governmental guidelines and organizational support, uncertainty resulting from poor communication or lack of information, and interpersonal barriers to physician self-care and wellbeing. Stressor subthemes included: concern about exposure, feeling unprepared, and anticipating the worst.

CONCLUSIONS: Physicians reported that both patient care and their own wellbeing were greatly impacted by organizational and systems level facilitators and barriers. Findings from this study can inform the creation of best practices, tools, and strategies that can assist with future emergency preparedness and pandemic response planning efforts.

PMID:40336105 | DOI:10.1186/s13690-025-01609-0

J Med Case Rep. 2025 May 7;19(1):213. doi: 10.1186/s13256-025-05254-7.

ABSTRACT

BACKGROUND: Chilblains have emerged as a cutaneous manifestation following coronavirus disease 2019 vaccination. While there are many case reports on chilblain-like lesions, documentation from tropical countries remains limited. In this context, we report a case detailing chilblain-like lesions associated with coronavirus disease 2019 vaccination in Thailand.

CASE PRESENTATION: A 35-year-old Thai female patient presented with several painful, red papules on the fingers and toes 9 days after receiving the mRNA-1273 vaccination. Skin biopsy was performed, and the results were consistent with chilblains. Laboratory workup revealed positive result for lupus anticoagulant. The rash completely resolved without any treatment but reappeared following the second vaccine dose.

CONCLUSION: Chilblain-like lesion following coronavirus disease 2019 vaccination is frequently observed in temperate countries, with few reports from tropical areas. The presence of lupus anticoagulant may contribute to the development of chilblains after coronavirus disease 2019 vaccination.

PMID:40336095 | DOI:10.1186/s13256-025-05254-7

Int J Equity Health. 2025 May 7;24(1):127. doi: 10.1186/s12939-025-02497-0.

ABSTRACT

BACKGROUND: Despite increasing vaccine availability and evidence and expert recommendations to support administration, some countries maintained restrictive policies regarding COVID-19 vaccination in pregnancy throughout the pandemic. This global analysis explores the role of gender equity, country income level, and vaccine availability in predicting national policies on COVID-19 vaccine administration in pregnancy.

METHODS: Policies were collected from May 2021 to January 2023 from 224 countries/territories using publicly available information posted on national public health authority web pages. Policies were categorized into 6 types, representing different levels of permissiveness, from recommended for some or all to not recommended, and changes in national policies were captured over time. Outcomes were defined as: 1) prevalence of restrictive policies at a specific time point; 2) country-level change from restrictive policy/no position at an earlier time point to a permissive policy at a later timepoint. Simple and multivariable logistic regressions were performed to explore the association between the outcomes and potential policy predictors, including income level, mRNA vaccine availability, and the Global Gender Gap Index (GGGI).

RESULTS: Complete cross-sectional data were available for 114 countries as of June 2021, 137 countries as of October 2021, and 142 countries as of March 2022. The number of maternal immunization policies increased and became steadily more permissive between 2021 and 2022. Availability of mRNA vaccines and higher income level were associated with reduced odds of a restrictive policy at the 2021 timepoints, and higher GGGI scores were associated with reduced odds of restrictive policies at all timepoints. After adjusting for income level and mRNA vaccine availability, higher GGGI scores reduced the relative odds of a restrictive COVID-19 vaccine policy by 10% (aOR: 0.90, 95CI: 0.81, 0.99) in October 2021 and 14% (aOR: 0.86, 95%CI: 0.76, 0.97) in March 2021. Higher GGGI scores were also associated with increased odds of a policy switch from restrictive/no position in June 2021 to permissive in October 2021 (aOR: 1.12, 95%CI: 1.00, 1.24).

CONCLUSIONS: Gender inequity was associated with greater odds of a restrictive policy for use of COVID-19 vaccines in pregnancy, suggesting that gender biases may influence fair policymaking for pregnant people in pandemic preparedness and response.

PMID:40336086 | DOI:10.1186/s12939-025-02497-0