To determine whether COVID-19 is a risk factor for developing airway stenosis in intubated patients. Retrospective case-control study with planned chart review. Temple University Health Systems hospitals in Philadelphia, PA. Chart review of patients 18 to 90 years old diagnosed with COVID-19 who underwent endotracheal intubation and had a post-extubation CT scan at our institution between February 2020 and December 2022 was performed. Patients without COVID-19 matched for age, sex, and BMI who were intubated within one year served as a control group. Outcome variables included endoscopic and radiographic evidence of airway stenosis. Descriptive statistics were analyzed using Chi-squared and unpaired two-tailed T-test analyses for cohort comparison. One hundred five COVID-positive and 101 COVID-negative met inclusion criteria. The mean age was 58.6 years. Mean endotracheal tube size was 8.05 for COVID-positive and 7.72 for COVID-negative patients (P = .0075). Twenty-six (24.76%) COVID-positive and 45 (44.55%) COVID-negative patients had COPD (P = .0016). Length of intubation was 8.8 days in COVID-positive patients and 3.5 days for COVID-negative patients (P < .0001). Thirty-five (33.98%) COVID-positive and 1 (0.99%) COVID-negative patient were ventilated while prone (P = .0002). Seventy-eight (75%) COVID-positive and 38 (41.76%) COVID-negative patients received intravenous steroids (P = .0001). Mean length of stay was 38.81 days for COVID-positive and 17.16 days for COVID-negative patients (P < .0004). Six (5.77%) COVID-positive and 2 (1.3%) COVID-negative patients developed airway stenosis (P = .202). Patients with COVID-19 infection were not at an increased risk for intubation-related airway stenosis. IV.
Despite availability of safe and effective COVID-19 vaccines for children, uptake of this vaccine remains low in the United States. Caregiver attitudes and behaviors play a key role in child vaccine decisions, yet little is known about the reasons for vaccine refusal within families or the relationship between COVID-19 vaccine and routine childhood immunization refusal. This study examined 1) associations between caregiver and child COVID-19 vaccination status, 2) alignment of reasons for vaccine non-acceptance between the caregiver themselves and for their child, and 3) associations between COVID-19 vaccine non-acceptance and refusal or delay of routine childhood vaccinations. We analyzed data from 6395 families in the NIH ECHO Cohort with self-reported caregiver and child COVID-19 vaccination status between December 2021 and August 2023. Generalized estimating equations were used to assess associations while accounting for cohort clustering. Of the 6395 families, 25% of caregivers had not accepted the COVID-19 vaccine for themselves, and 59% had not accepted the vaccine for any of their children. Children were more likely to be unvaccinated when their caregivers were unvaccinated (OR: 13.2, 95% CI: 10.3-16.9). Among unvaccinated caregiver-child pairs, reasons for vaccine refusal showed strong concordance. The predominant concern among vaccinated caregivers with unvaccinated children was a belief that the COVID-19 vaccine had not been well tested in children (OR: 3.7, 95% CI: 2.3-6.0). Caregivers who refused the COVID-19 vaccination for themselves were more likely to have delayed or refused routine vaccines for their child (child unvaccinated for COVID-19: OR: 1.8, 95% CI: 1.4-2.1); caregiver unvaccinated for COVID-19: OR 2.8, 95% CI: 2.2-3.4). COVID-19 vaccine status among caregivers was strongly associated with child COVID-19 vaccine uptake and broader vaccine behaviors. Addressing shared safety concerns and building caregiver trust in vaccines is essential for improving pediatric vaccination coverage.
Long COVID is increasingly associated with disruption in brain homeostasis, manifesting as severe neurological dysfunction, brain fog and cognitive impairment. This present study investigated localised cognitive deficits in long COVID patients by examining brain blood oxygenation-level-dependent (BOLD) signal activity using ultra-high-field 7 T (7T) task-based functional magnetic resonance imaging (fMRI). Whole-brain BOLD signal differences were assessed across 19 long COVID patients, and 27 healthy controls (HC) including 12 COVID-recovered (Cov-RHC) and 15 COVID-19-naïve HC (nHC). 225 fMRI volumes were acquired during the Stroop colour-word task. Functional and anatomical images were processed using SPM12 to extract the BOLD signal intensity time course from whole-brain voxels for inferences between cohorts during task-fMRI. Significantly low BOLD activation in long COVID patients was observed compared to Cov-RHC in the anterior cingulate cortex (p = 0.002, cluster size=650, Z-value = 4.67), and the precuneus (p = <0.001, cluster size = 1893, Z-value = 4.67). Furthermore, BOLD intensities in precuneus showed a negative association with self-reported pain scores (p = 0.040) and the duration of illness (p = 0.03) in long COVID patients, suggesting significant correlation between BOLD signal and an increase in duration of illness and pain levels. No statistically significant BOLD differences were observed for inter-group comparisons between nHC vs. long COVID, and nHC vs. Cov-RHC. Response times to incongruent (p = 0.002) and congruent task stimuli (p = 0.001) significantly varied between nHC and long COVID cohorts, demonstrating overall faster information processing by nHC. Reduced BOLD signals to 'core' brain regions in long COVID imply reduced cognitive control by intrinsic networks that mediate information processing, cognitive and executive functions due to perturbations linked to cerebral blood flow, oxygenation status, and ongoing neuroinflammation.
The reporting of patient-important outcomes (PIOs) in randomized controlled trials (RCTs) for COVID-19 varies widely, limiting their application in clinical decision-making. We evaluated how often PIOs were reported as primary outcomes in RCTs of COVID-19 treatments and identified trial characteristics associated with their reporting. This meta-epidemiological study analyzed primary outcome data from 102 RCTs evaluating COVID-19 treatments. Mortality outcomes were more frequently reported in trials with 15-28-day follow-up than in trials with ≤ 14-day follow-up (OR: 3.53, 95% CI: 1.10-11.38), and less frequently in trials enrolling participants with moderate-severity COVID-19 compared with trials not enrolling such participants (OR: 0.22, 95% CI: 0.07-0.64). Morbidity outcomes were less frequently reported in trials enrolling severe-COVID-19 participants compared with trials not enrolling them (OR: 0.19, 95% CI: 0.05-0.78), and more frequently reported in trials conducted in Europe (OR: 12.78, 95% CI: 1.01-161.76), Asia (OR: 11.03, 95% CI: 1.50-81.03) and the Americas (OR: 8.92, 95% CI: 1.08-73.89), each compared with multi-continental trials. Trials with more than 200 participants were also more likely to report morbidity outcomes than trials with ≤ 50 participants (OR: 11.43, 95% CI: 1.37-95.55). Quality of life and functional status outcomes were not associated with any of the predictors examined. Reporting of PIOs as primary outcomes in COVID-19 RCTs is inconsistent and influenced by region, disease severity, and sample size. Quality of life and functional recovery remain overlooked. The implementation of Core Outcome Sets (COS) is required to ensure that PIOs are routinely and consistently incorporated into trial designs.
The COVID-19 pandemic worsened well-being and mental health worldwide, but effects have diminished over time. However, prospective national data within representative samples remain scarce. We aimed to examine the change in well-being and psychopathology from pre-pandemic to intra-pandemic times in an Austrian representative general population sample, to identify vulnerable subgroups, and explore most effective coping strategies to mitigate the impact of COVID-19. Data were collected in Austria as part of the Collaborative Outcomes Study on Health and Functioning During Infection Times (COH-FIT) survey, an international, multilingual, anonymous online survey assessing mental health indicators during COVID-19. Adults ≥18 years old participated through nationally representative sampling across three waves from 05/2020-04/2022. Outcomes included the WHO well-being index (WHO-5) and a global psychopathology score ('P-score'), alongside 12 predefined risk factors and 16 coping strategies. Across 4,148 adults, the mean WHO-5 well-being score decreased by 7.5 ± 17.7 points from the pre-pandemic baseline (73.2 ± 19.7) to the intra-pandemic average (65.7 ± 24.1) (p<.001). Participants with female sex, pre-existing mental or physical health conditions, and unemployment experienced greater declines. The proportion of individuals scoring <50, indicating depression, increased from 12.6% pre-pandemic baseline to 25.1% intra-pandemic, and the proportion scoring <29, indicating major depression, increased from 3.3% to 9.7% (both p<.001). The 'P-score' increased by 9.6 ± 15.0 points from 24.1 ± 19.5 pre-pandemic baseline to 33.7 ± 22.4 intra-pandemic (p<.001) with the same risk groups (except female sex). Although the greatest deterioration in both outcomes occurred during the mid-pandemic period (04/2021), neither well-being nor 'P-score' levels returned to pre-pandemic baseline values by 04/2022, nor to values from 05/2020 (Wave 1). Greater deterioration in WHO-5 and the P-score were associated with female sex, unemployment, pre-existing mental or physical disorders, and COVID-19 infection. The most commonly reported helpful coping strategies included internet use, physical activity, media consumption, social media and remote interaction, and meaningful hobbies. COVID-19 had a persistent negative impact on well-being and mental health in Austria. Vulnerable subgroups - including those with prior health conditions and unemployment - were particularly affected. The findings underscore the importance of implementing public health measures together with targeted interventions, preventive measures, and long-term psychosocial support, especially for risk populations.
Exceptional longevity has increasingly been recognized as a distinct biological state associated with unique immune and inflammatory profiles. However, the innate immune characteristics associated with extreme aging, particularly following viral infections, remain incompletely understood. Toll-like receptors (TLRs) play central roles in pathogen sensing and inflammatory signaling, including during SARS-CoV-2 infection, yet their relationship with exceptional longevity has not been clearly defined. Here, we quantified TLR gene expression in peripheral blood from unvaccinated older adults who recovered from COVID-19 prior to vaccination (38 nonagenarians and 8 centenarians). Among the receptors analyzed, TLR2 was the only gene differentially expressed, showing lower expression in COVID-19-recovered centenarians compared with recovered nonagenarians. Importantly, this difference was not associated with COVID-19 severity, suggesting that TLR2 expression in this cohort reflects an age- and recovery-associated immune characteristic rather than clinical outcome. Exploratory comparison with centenarians without prior COVID-19 (n=10) indicated that reduced TLR2 expression was not simply a constitutive hallmark of extreme aging, but may instead reflect a distinct post-infectious innate immune remodeling. Together, these findings identify a distinct TLR2-associated immune signature in centenarians recovered from COVID-19 and suggest that exceptional longevity may be associated with a distinct post-infectious innate immune remodeling following SARS-CoV-2 infection.
Despite widespread favipiravir (FPV) use for coronavirus disease 2019 (COVID-19) in Thailand, pediatric clinical evidence remains limited. This study evaluated FPV's effectiveness and safety for treating COVID-19 in children and adolescents. This multicenter, retrospective, observational cohort study included patients ≤18 years old testing COVID-19 positive between July 2021 and December 2022 across 11 hospitals in Thailand. Patients were divided into those with and without chest X-ray-confirmed pneumonia. Patients who received FPV were treated with 35 mg/kg twice daily on day 1 and 15 mg/kg twice daily on days 2-5. Pharmacokinetic (PK) modeling estimated plasma exposure in children using scaled Thai adult data. Of 2,999 patients, 68.2% had no pneumonia. FPV recipients (n = 1,886) were mostly <5 years old, had a fever, infected during the Omicron wave, had lower mean cycle threshold (Ct) values of SARS-CoV-2 gene at diagnosis, and hospitalized compared to non-recipients. FPV treatment significantly shortened fever duration and hospitalization in both pneumonia and non-pneumonia patients. For non-pneumonia patients, being <5 years old, and receiving FPV were associated with complete recovery at discharge. For pneumonia patients, a history of preterm birth, pulmonary disease, and ICU admission reduced the likelihood of complete recovery at discharge. No serious adverse events were reported. PK models predicted that FPV plasma trough concentrations in children ≥10 kg were above efficacy targets. Early FPV treatment shortened fever duration and hospital stays in children and adolescents with COVID-19, promoting clinical recovery in both pneumonia and non-pneumonia cases.
Concurrent disorders, defined here as co-occurring mental health disorders (MHD) and substance use disorders (SUD), pose challenges for treatment and public health. This study examines the prevalence and characteristics associated with MHD only, SUD only, and concurrent disorders among Canadians aged 15 and older during the COVID-19 pandemic. We analyzed data from the 2022 Mental Health and Access to Care Survey (MHACS), a cross-sectional survey of Canadians aged 15 and older living in the 10 provinces (n = 9861). MHD and SUD were assessed using the WHO Composite International Diagnostic Interview. Respondents were classified into four groups: no disorder, MHD only, SUD only, and concurrent disorders. Multinomial logistic regression identified sociodemographic, health, and pandemic-related characteristics associated with these disorder categories, using survey weights and bootstrap methods. Among respondents, 1.6% had concurrent disorders, 12.2% had a MHD only, and 1.6% had a SUD only. Younger adults, especially those aged 20 to 24, and 2SLGBTQI+ individuals had elevated risk for concurrent disorders. Additional correlates included lower education, rural residence, weak sense of belonging, and functional impairment. Pandemic-related stressors-loneliness, financial hardship, and difficulty accessing care-were strongly associated with concurrent disorders. This study highlights the prevalence and key correlates for MHD, SUD, and concurrent disorders among Canadian adults during the COVID-19 pandemic. Vulnerable populations include younger individuals, sexual and gender minorities, and those facing social isolation or unmet care needs. These findings underscore the importance of ensuring integrated, accessible mental health and substance use services in Canada's postpandemic recovery. Les troubles concomitants, définis ici comme la cooccurrence de troubles de santé mentale (TSM) et de troubles liés à l’usage de substances (TUS), posent des problèmes de traitement et de santé publique. Cette étude se penche sur la prévalence et les caractéristiques associées aux TSM uniquement, aux TUS uniquement et aux troubles concomitants chez les Canadiens de 15 ans et plus pendant la pandémie de COVID-19. Nous avons analysé les données de l’Enquête sur la santé mentale et l’accès aux soins (ESMAS) de 2022, une enquête transversale menée auprès des Canadiens de 15 ans et plus vivant dans les 10 provinces (n = 9 861). Les TSM et les TUS ont été évalués à l’aide de l’Entrevue composite diagnostique internationale de l’OMS. Les répondants ont été classés en quatre groupes : aucun trouble, TSM uniquement, TUS uniquement et troubles concomitants. Une régression logistique multinomiale a permis de déterminer les caractéristiques sociodémographiques, sanitaires et liées à la pandémie associées à ces catégories de troubles, en utilisant les poids de l’enquête et des méthodes bootstrap. Parmi les répondants, 1,6 % présentaient des troubles concomitants, 12,2 % des TSM uniquement et 1,6 % des TUS uniquement. Les jeunes adultes, en particulier ceux de 20 à 24 ans, et les personnes issues de la communauté 2ELGBTQI+ présentaient un risque élevé de troubles concomitants. Les autres corrélats étaient un faible niveau de scolarité, une résidence en milieu rural, un faible sentiment d’appartenance et des déficiences fonctionnelles. Les facteurs de stress liés à la pandémie (solitude, difficultés financières et difficultés d’accès aux soins) ont été fortement associés aux troubles concomitants. Cette étude met en évidence la prévalence et les principaux corrélats des TSM, des TUS et des troubles concomitants chez les adultes canadiens pendant la pandémie de COVID-19. Les populations vulnérables sont les jeunes, les minorités sexuelles et de genre ainsi que les personnes confrontées à l’isolement social ou à des besoins en matière de soins non satisfaits. Ces résultats soulignent l’importance d’assurer des services de santé mentale et de consommation de substances intégrés et accessibles dans le cadre du rétablissement post-pandémique du Canada. The co-occurrence of mental health and substance use disorders (concurrent disorders) rose from 1.2% in 2012 to 1.6% in 2022. The prevalence of mental health disorders alone nearly doubled, from 6.1% in 2012 to 12.2% in 2022, while substance use disorders alone declined from 3.8% to 1.6%. Concurrent disorders are most common among young adults (20–24 years), 2SLGBTQI+ individuals, and those with a weak sense of social belonging. People in rural areas, those with lower education, and those facing unmet care needs had higher rates of these disorders. Pandemic-related stressors, such as loneliness and financial hardship, were strongly linked to the risk of all disorders. La cooccurrence de troubles de la santé mentale et de troubles liés à l’usage de substances (troubles concomitants) est passée de 1,2 % en 2012 à 1,6 % en 2022. La prévalence des troubles en santé mentale uniquement a presque doublé, passant de 6,1 % en 2012 à 12,2 % en 2022, alors que celle des troubles liés à l’usage de substances uniquement a diminué, passant de 3,8 % à 1,6 %. Les troubles concomitants sont plus fréquents chez les jeunes adultes (20 à 24 ans), les personnes issues de la communauté 2ELGBTQI+ et celles qui ont un faible sentiment d’appartenance sociale. Les habitants des zones rurales, les personnes ayant un faible niveau de scolarité et celles dont les besoins en matière de soins n’étaient pas satisfaits présentent des taux plus élevés de ces troubles. Les facteurs de stress liés à la pandémie, tels que la solitude et les difficultés financières, sont fortement liés au risque pour toutes les catégories de troubles.
The mechanisms driving the broad spectrum of Long COVID symptoms-such as fatigue, brain fog, pain, and dysautonomia-remain uncertain. This study investigated central sensitization (CS) as a potential contributor to symptom burden in patients with Long COVID. We aimed to examine its association with symptom severity, as well as objective cerebrovascular, autonomic, and inflammatory markers. A total of 169 consecutive patients with Long COVID referred for evaluation of orthostatic intolerance underwent assessment using the Central Sensitization Inventory, symptom burden surveys (autonomic: COMPASS-31; sensory: NTSS-6; global health: PROMIS), autonomic function testing (deep breathing, the Valsalva maneuver and head-up tilt test with transcranial Doppler and capnography monitoring), and skin biopsies for small-fiber assessment. CS was present in 81% of participants. Patients with CS were more often female (79.6% vs. 53.1%, p = 0.004) and had higher rates of anxiety, depression, fibromyalgia and headaches, as well as a significantly greater autonomic, sensory and global health symptom burden (all p < 0.001). Compared with patients without CS, they also exhibited a greater decline in orthostatic cerebral blood flow velocity (-25.53% ± 11.19 vs. -22.09% ± 10.53, p = 0.038) and higher interleukin-6 levels (p = 0.041). Autonomic failure, most commonly of mild grade, occurred at similar frequency in both groups (84.7% vs. 84.4%, p = 0.999). Skin biopsies demonstrated a comparable prevalence of abnormal findings in both groups (50.8% vs. 52.0%, p = 0.999). Central sensitization appears highly prevalent among patients with Long COVID and may contribute to their multisystem symptomatology. Cerebral hypoperfusion, and neuroinflammation may constitute pathophysiological mechanisms underlying central sensitization in this population.
This study investigates the determinants of vulnerable road user (VRU) crash severity by accounting for unobserved heterogeneity both across and within crash subpopulations. Conventional single-model approaches assume homogeneous effects across all crashes, potentially masking context-dependent severity mechanisms. Crash data for 15,578 pedestrian and 11,433 bicyclist collisions occurring at or near intersections in 20 California cities (2016-2025) were extracted from the Statewide Integrated Traffic Records System (SWITRS). A two-stage analytical framework was employed. First, latent class analysis identified three distinct crash typologies for each VRU mode based on movement patterns, lighting, weather, and collision factors. Second, mixed logit (MXL) models were estimated for each latent class to capture within-cluster heterogeneity through random parameters. Pseudo-elasticity analysis quantified the practical magnitude of variable effects. Temporal stability was assessed by estimating separate models across pre-COVID, during-COVID, and post-COVID periods. Truck involvement, dark conditions without streetlights, and state highway location consistently elevated severe outcome odds across all clusters for both VRU types, while VRU age 65+ shifted injury distributions toward moderate rather than the most severe outcomes. Critically, several factors exhibited context-dependent effects. VRU fault increased severity when drivers traveled straight, but decreased severity in turning-driver crashes for bicyclists, indicating fundamentally different causal mechanisms. State highway effects ranged from the strongest fatal predictor in straight-driver pedestrian crashes to non-significant in other configurations. Different random parameters were identified across clusters, confirming that unobserved heterogeneity operates through distinct mechanisms in different crash contexts. Crash severity determinants are both universally important and context-dependent, with the same variable capable of opposing effects across crash configurations. These findings demonstrate that aggregate models pooling heterogeneous crash types obscure critical variation and support the adoption of context-sensitive approaches to crash modeling.
Conspiracy theories about COVID-19 vaccines circulated widely during the pandemic, yet their prevalence and association with vaccine refusal in sub-Saharan Africa remain poorly quantified. Understanding how global misinformation narratives shape vaccination acceptance in low- and middle-income settings is relevant to future pandemic preparedness. We conducted a cross-sectional survey between October 2023 and April 2024, recruiting 870 adults through convenience sampling across Nigeria's six geopolitical regions. COVID-19 vaccines had been available in the country since 2021, but national uptake remained low throughout this period. Structured face-to-face interviews assessed vaccine intentions, endorsement of specific conspiracy beliefs, information sources, and trust networks. Multivariable logistic regression identified factors independently associated with conspiracy endorsement and vaccine refusal. Of 870 participants, 742 (85.3%) were vaccine-hesitant, and 89.4% of these endorsed at least one conspiracy theory. Microchip or tracking device theories were the most frequently cited concern (32.1%). Overall vaccine acceptance was 14.7%. A graded inverse association was observed: each additional conspiracy theory endorsed was associated with an average 69% lower odds of vaccine acceptance (aOR 0.31, 95% CI 0.25-0.39; p for trend <0.001). In multivariable analysis, conspiracy endorsement was the factor most strongly associated with refusal (aOR 0.11, 95% CI 0.06-0.21). Its inclusion in the model substantially attenuated the coefficients for education and region, which suggests that these sociodemographic associations with refusal may be partly accounted for by differential conspiracy endorsement. COVID-19 vaccine conspiracy theories were widespread in Nigerian communities well into the national vaccination campaign, at a time of persistently low uptake, and represented the factor most strongly associated with refusal. The graded association between conspiracy endorsement and refusal, and the attenuation of sociodemographic predictors after adjustment for conspiracy beliefs, suggest that counter-misinformation strategies could be a high-yield component of future pandemic vaccine campaigns.
to assess the burden of informal caregivers of older adults with post-COVID syndrome and analyze its association with variables regarding older adults and caregivers. a cross-sectional study conducted with 75 older adults with post-COVID syndrome and caregivers. Clinical, functional, cognitive, and psychological measures were used to assess older adults. Psychological and burden measures were used for caregivers using Zarit Burden Interview. Descriptive statistics, Spearman's correlation, and univariate and multiple linear regression were used. most caregivers (67%) reported burden, with 16% experiencing high burden, 31% experiencing moderate, and 20% experiencing mild burden. In multivariate analysis, caregiver burden was associated with frailty (p=0.022), older adult depression (p=0.022), and caregiver depression (p<0.001). Variables explained 37% (p<0.001) of variance in the total Zarit Burden Interview score. caregiver burden for older adults with post-COVID syndrome was associated with factors about older adults and their caregivers, highlighting the need for interdisciplinary support.
The COVID-19 pandemic constituted a public health emergency in Thailand from March 2020 to October 2022, testing the resilience of the health financing system. This study establishes an analytical framework to examine Thailand's public health financing arrangements and their subsequent impacts on public hospital financial reserves during this crisis. This mixed-methods study developed an analytical framework to examine Thailand's public health financing response. The study analyzed COVID-19 public health expenditure data (Fiscal Years (FY) 2020-2022) and financial data from 866 Ministry of Public Health hospitals (FY 2015-2022) using descriptive statistics and trend analysis. These quantitative findings were integrated with a thematic analysis of 21 key informant interviews. Thailand enhanced health financing resilience through adaptive revenue mobilization and flexible resource allocation. Between FY 2020 and 2022, the government expanded fiscal space by mobilizing approximately US$13.78 billion via the Emergency Loan Decrees, Central Budget, and Social Security Fund. Universal Health Coverage (UHC) mechanisms expanded service coverage and expedited provider reimbursement. During delayed loan disbursements, public hospitals used internal financial reserves to bridge funding gaps and maintain service continuity. Consequently, net hospital reserves increased substantially by the pandemic's end compared to pre-pandemic baselines. Thailand strategically leveraged its UHC system and mobilized emergency and pre-existing public funds to secure fiscal space and maintain system resilience. However, temporary funding influxes may mask localized resource strains on hospital financial reserves. To enhance future resilience, Thailand should establish a dedicated health emergency reserve fund, streamline extra-budgetary mechanisms, and adopt flexible procurement regulations.
This paper explores the impact of the COVID-19 pandemic on employee productivity and the future of remote work beyond the pandemic years. Using data collected from 646 remote workers, we examined the influence of interpersonal relations, time management, stress, and skill development on productivity. We validated our model using structural equation modelling (SEM), and the results revealed that the sudden shift to remote work had no significant negative impact on productivity. The results of this study may encourage HR managers to expand remote work opportunities, thereby enhancing talent attraction and retention in a highly competitive job market. Despite prevalent concerns about COVID-19 and the evolving nature of workplaces, employees perceived remote work as offering greater flexibility in task organization and the opportunity to create a healthier work-life balance. Furthermore, our findings suggest that HR managers should consider allowing remote work post-pandemic as a strategic aspect of workplace evolution.
To improve air quality, regulatory actions targeting road traffic and industrial emissions must be implemented. This study determined the effect size (ES, Cohen's δ) and the significance of progressive quarantine restrictions levels national quarantine [NQ+], smart quarantine [SQ++], and focalized quarantine [FQ+++] on air pollution in Bogotá, Colombia, during the COVID-19 pandemic. A natural experiment showed that, during SQ and FQ phases, concentrations of [PM₁₀, 20.0 µg/m3; PM₂.₅, 8.03 µg/m3; SO2, 1.61 µg/m3] and [PM₁₀, 23.2 µg/m3, PM₂.₅, 8.84 µg/m3], respectively, were significantly lower than during equivalent pre-pandemic periods (year 2019; p < 0.001). Effect sizes were larger during FQ (PM₁₀: -1.220, PM₂.₅: -0.605) than during SQ (PM₁₀: -1.180, PM₂.₅: -0.252, SO2: -0.388). Although pollutant concentrations remained below regulatory thresholds (environmentally significance), the ES for [PM₁₀ µg/m3; PM₂.₅ µg/m3] were larger during SQ and FQ. These findings support public health strategies aimed at strengthening the control of emission sources that degrade air quality, particularly those increasing [PM₁₀, PM₂.₅], Moreover, the introduction of the concept of "environmentally significant" effects may further improve decision-making and address environmental problems that affect human well-being.
The COVID-19 pandemic placed junior physicians at the forefront of clinical care under extraordinary conditions, compelling them to navigate overwhelming workloads, and emotionally challenging and ethically complex situations. This qualitative study explores how these experiences shaped their perceptions of self-sacrifice, as interpreted through the lens of the social contract as expressed in foundational frameworks of medical professionalism, such as CanMEDS. Semi-structured interviews were conducted with 17 junior physicians at two emergency hospitals in Sweden, and the data were analyzed using reflexive thematic analysis. The findings reveal that junior physicians experienced significant physical and psychological strain, including fear of infection, exhaustion, and strain on personal well-being and relationships. While participants demonstrated strong dedication to patient care, they also voiced resistance to the implicit expectation of unlimited self-sacrifice embedded in professional ideals. These experiences not only tested their endurance but also re-shaped how they understood the balance between altruism, personal limits, and professional duty. Expectations of self-sacrifice are embedded during medical education, yet our findings suggest that these norms are both reproduced and critically questioned as physicians transition into practice, when they are confronted with the lived realities of clinical work. Importantly, the study indicates a contextual re-negotiation of how altruism and self-sacrifice are perceived, with junior physicians in this material challenging inherited ideals of heroic endurance. The extraordinary pressures of the pandemic appeared to accelerate this process, bringing these reflections to the surface earlier and more forcefully than might otherwise have occurred. The study highlights the need to balance professional commitment with sustainable support structures, and points to the importance of renegotiating the social contract between physicians and society in light of evolving professional realities.
Public health crises exert a disproportionate psychological burden on ethnic minority populations, exacerbating pre-existing health disparities. Drawing upon the COVID-19 pandemic as a focal case, this systematic review synthesizes the coping strategies employed by ethnic minority communities, organized through the lens of ecological systems theory. Adhering to PRISMA guidelines, 65 peer-reviewed studies published between 2020 and 2023 were analyzed. The synthesis identified a multi-tiered coping response: (1) individual-level cognitive-emotional regulation and faith-based practices; (2) microsystem-level familial and communal support and digital mediation; (3) exosystem-level community governance and health policy; and (4) macrosystem-level cultural values and systemic belief structures. The analysis revealed a pronounced research emphasis on individual and microsystemic adaptations, exposing a critical empirical gap concerning structural and policy-driven interventions. While culturally tailored individual support is essential, these findings underscore the need for future research and policy to prioritize integrated, multilevel frameworks capable of effectively mitigating mental health inequities during future public health emergencies.
To characterize the epidemiological patterns of childhood infectious diseases during and after the COVID-19 pandemic and to inform optimization of pediatric prevention and control strategies. A descriptive epidemiological analysis was conducted on reported infectious disease cases among children aged ≤14 years at Qingyang Maternal and Child Health Care Hospital. The pandemic period was defined as 2020-2022, and the post-pandemic period as 2023-2025. Proportions were compared using the chi-square test. From 2020 to 2025, a total of 2,559 cases were reported, yielding an overall reporting rate of 5.28 per 1,000 outpatient visits. Only 53 cases (0.42‰) occurred during the pandemic period, whereas 2,506 cases (6.98‰) occurred post-pandemic. The annual reporting rate ranged from 0.37‰ in 2022 to 10.32‰ in 2025. The male-to-female ratio was 1.30:1. The proportion of cases aged ≤2 years increased from 33.96% during the pandemic to 46.89% post-pandemic, while the 7-14 year age group declined from 28.30% to 15.96%. Nearly all cases (98.94%) resided in Qingyang City. The disease spectrum shifted markedly: varicella (45.28%), pertussis (22.64%), and mumps (11.32%) predominated during the pandemic, whereas influenza (48.72%), other infectious diarrheal diseases (26.94%), and hand-foot-mouth disease (12.01%) dominated the post-pandemic period. Case counts for pertussis, diarrheal diseases, hand-foot-mouth disease, and varicella increased significantly across multiple age strata post-pandemic. Total medical expenditures reached ¥5,623,550.62, with 98.70% incurred post-pandemic; influenza [¥2,746,750.98 (RMB)] and other infectious diarrheal [¥2,455,076.20 (RMB)] constitute the primary economic burden. The pediatric infectious disease spectrum underwent a substantial post-pandemic transformation, with influenza, diarrheal diseases, and hand-foot-mouth disease replacing varicella and pertussis as dominant conditions. Children aged ≤6 years emerged as the primary affected population. The high caseload and economic burden of influenza and diarrheal diseases underscore the need for strengthened surveillance, prioritized protection of younger children, optimized resource allocation, and refined vaccination strategies in the evolving epidemiological landscape.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）