Since the coronavirus disease 2019 (COVID-19) pandemic began in 2020, several studies from various countries have described changes in the epidemiology of Guillain-Barré syndrome (GBS); however, it remains unclear whether the incidence and clinical profiles were altered by the pandemic. This study aimed to elucidate the impact of the COVID-19 pandemic on the epidemiology and clinical profile of GBS in Japan. We conducted a nationwide survey on the incidence of GBS between 2017 and 2022, encompassing the pre-pandemic [2017‒2019] and pandemic [2020‒2022] periods. Questionnaires were sent to the neurology and paediatrics departments at hospitals throughout Japan. A primary questionnaire was used to estimate the number of patients and incidence, and a second questionnaire was administered to collect detailed clinical information. The annual number of newly diagnosed GBS cases and their incidence were estimated at 1,885 (95% confidence interval [CI], 1,766‒2,004) and 1.49 (95% CI, 1.40‒1.58) per 100,000 population, respectively, during the pre-pandemic, 1,603 (95% CI, 1,463‒1,743) and 1.28 (95% CI, 1.17‒1.39) per 100,000 population during the pandemic periods; the relative risk for GBS incidence during the pandemic period was 0.91 (95% CI, 0.83‒0.99; 9% reduction). Detailed clinical profiles were available for 2,623 patients (1,420 during the pre-pandemic period and 1,203 during the pandemic period). Compared with patients in the pre-pandemic period, those diagnosed during the pandemic period were older (median age, 56 years vs. 53 years; P = 0.02), had a higher proportion of cases without antecedent infectious episodes (38.2% vs. 24.5%; P < 0.0001), longer time to reach nadir (median, 8 days vs. 7 days; P = 0.0418), and higher frequency of the demyelinating subtype of GBS (37.8% vs. 32.6%; P = 0.0068). No significant differences were observed in the outcomes at 6 months post-onset. The Japanese national registry data showed a markedly reduced number of Campylobacter-related enteritis cases following the pandemic. This study demonstrated a decrease in the overall incidence of GBS during the earlier phase of the COVID-19 pandemic in Japan. The increased number of GBS cases without infectious episodes or demyelinating subtypes during the pandemic period may be caused by reduced exposure to conventional infectious triggers of GBS, such as C. jejuni and increased asymptomatic COVID-19-related demyelinating GBS.

Objectives This study clarified the practical activities undertaken by municipal public health nurses (PHNs) during the coronavirus disease 2019 (COVID-19) pandemic and ethical and emotional conflicts they experienced to derive implications for strengthening community health responses and capacity building during future health crises.Methods This qualitative descriptive study was conducted using focus group interviews with eight municipal PHNs, with an average of 23.88 years of experience. Interview transcripts were transcribed verbatim and analyzed using inductive content analysis to extract themes regarding participants' activities and emotional experiences during the pandemic.Results Under crisis conditions, six categories describing PHNs' activities included (1) coping with rapidly increasing responsibilities under uncertain conditions, (2) supporting vulnerable populations and their caregivers, (3) restoring maternal and child health services, (4) initiating organizational and interagency collaborations to mitigate social deterioration, (5) collecting and sharing information to minimize the negative impacts of restrictions, and (6) working with community leaders and professionals to sustain residents' well-being.Seven categories emerged regarding ethical and psychological conflicts; (1) confusion from expanded roles, (2) frustration at being unable to support those in need, (3) self-doubt about service effectiveness, (4) barriers to collaboration with health centers and other institutions, (5) discrepancies between organizational policies and community realities, (6) re-examination of the meaning of public health nursing during pandemics, and (7) challenges due to insufficient infection control knowledge and systems. A key competency theme was the need to reacknowledge the PHNs' role during health crises.Conclusion During the COVID-19 pandemic, municipal PHNs have experienced limitations in providing individual support and changes in their professional roles. However, they continued to support residents via trust-based relationships with the community and the foundation of public health services, which has been built during normal times. Furthermore, they frequently face ethical dilemmas if prioritizing tasks and responding to residents, which often entails emotional burdens.

Persistent Delays in Diagnostic Evaluation Timeliness After an Abnormal Screening Mammogram in the Years following the Onset of the COVID-19 Pandemic.

BACKGROUND The development of diabetes is linked to the environment, and major lifestyle changes are known to affect the incidence of diabetes. The recent coronavirus disease 2019 (COVID-19) pandemic changed many aspects of daily life and represents a major environmental effect. AIM To investigate whether the COVID-19 pandemic affected the presentation of diabetes in adults. METHODS A retrospective fixed cohort study was performed on the Lombard population, one of the hardest hit by the pandemic in Italy. Records from 57870 adults (40-65 years) with diabetes were extracted from the Lombard healthcare database for pandemic (2020-2021) and control (2018-2019) cohorts. Demographic data and data pertaining to concomitant cardiovascular disorders were analyzed. Cohen’s d and rate ratio with 95% confidence interval (CI) were calculated. RESULTS During the pandemic, the incidence of newly diagnosed diabetes was greater among men aged 40-46 years old (rate ratio = 1.07, 95%CI: 1.01-1.14) and less among older men (59-65 years old; rate ratio = 0.94; 95%CI: 0.90-0.96) compared with the control cohort. The rate of incident diabetic men with hypertension, hyperlipidemia, cardiovascular events, or prescriptions for cardiovascular-acting medications during the pandemic was lower compared with individuals in the control cohort (rate ratio for cardiovascular risk factors = 0.893; 95%CI: 0.87-0.92). A similar pattern was observed among women diagnosed with diabetes during the pandemic (rate ratio for cardiovascular risk factors = 0.899; 95%CI: 0.87-0.93). CONCLUSION The COVID-19 pandemic was associated with greater incident diabetes in younger individuals with fewer cardiovascular comorbidities and suggest that a potent environmental change such as the pandemic can affect the diabetes phenotype in adults.

The pressure of the coronavirus disease 2019 (COVID-19) pandemic on global healthcare systems and societies was unprecedented in the modern era. Social restrictions, containment measures, and disruptions in antimicrobial prescriptions and consumption during the pandemic have been reported to alter the epidemiology of bacterial diseases, although these effects likely differed markedly between locations. Here, we compare the clinical, clonal distribution, and genomic features of Staphylococcus aureus bloodstream isolates before, during, and after COVID-19 in two hospitals on different continents: Parc Taulí University Hospital (Spain) and Dartmouth-Hitchcock Medical Center (USA). We hypothesize that pandemic-related environmental perturbations, such as those due to infection control practices and antimicrobial exposure, may have contributed to shifts in the diversity of circulating bacterial lineages and genomic elements. Our findings revealed changes in the distribution of low-frequency clones, antimicrobial resistance genes, and virulence factors, potentially reflecting changes in selective pressures in clinical environments.

Background: The coronavirus disease 2019 (COVID-19) pandemic is the most significant global health crisis of the past century, with a rapid spread and associated burden of disease and mortality. This study aimed to assess healthcare workers' effective preparedness, leadership support, and experiences in combating the COVID-19 pandemic. Materials and Methods: A qualitative cross-sectional study was conducted among healthcare workers in the Dar es Salaam, Arusha, Dodoma, and Mwanza regions from August 24 to October 3, 2022. The study included 96 participants from 24 healthcare facilities, the qualitative sample size obtained based on the saturation principle. Both purposeful and random selection of participants were used, purposive sampling targeted healthcare workers directly involved in COVID-19 team, while simple random selection was applied to other available healthcare workers in the selected facilities. Interviews were recorded using Kobo Toolbox, while coding and thematic analysis were conducted using NVivo qualitative data analysis software. Results: Most healthcare workers who participated in the interviews reported that preparations were not made in time; preparations started after the first patient was announced in Tanzania. In interviews, all healthcare workers reported that their healthcare facility leaders, including medical officers in-charge and department heads fully supported the fight against COVID-19. However, not all workers felt they had enough experience to combat the virus. Conclusion: Comprehensive support should be provided to Tanzanian healthcare facilities to safeguard the well-being of healthcare providers. Regular and intensive training for all healthcare providers is necessary to promote preparedness and effectiveness in crisis management.

Infective endocarditis (IE) is a life-threatening condition with high mortality. The Coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems, potentially affecting IE management and outcomes. However, its impact in Japan remains unclear. This study aimed to evaluate the impact of the COVID-19 pandemic on in-hospital mortality and the rate of valve surgery among patients with IE in Japan. We conducted a retrospective analysis using the Japanese registry of all Cardiac and Vascular Diseases Diagnostic Procedure Combination (JROAD-DPC) nationwide database, including 19,077 adult patients hospitalized with IE between April 2016 and March 2022. The study period was divided into pre-COVID-19 (n=12,419) and post-COVID-19 (n=6,658) periods. Patient baseline characteristics were well-balanced after 1 : 1 propensity score matching (6,652 pairs). Before matching, crude total in-hospital mortality was higher in the post-COVID-19 period (15.7% vs. 13.9%; P<0.001). However, after matching, there were no significant differences in total in-hospital mortality (15.7% vs. 15.3%, P=0.60). The rate of valve surgery did not differ significantly between the groups after matching (26.4% vs. 25.5%; P=0.22). The incidence of stroke was higher in the post-COVID-19 period (8.3% vs. 7.3%; P=0.049). This nationwide study showed that risk-adjusted in-hospital mortality in patients with IE was not different during the COVID-19 pandemic, although unadjusted mortality was higher in the post-COVID-19 period in Japan.

The coronavirus disease (COVID-19) pandemic has been associated with an increased burden of secondary infections, including fungal infections of the lungs, especially in critically ill patients. However, it is unclear whether this excess risk persisted in the post-pandemic period after infection-control practices and clinical pathways were optimized. This single-center retrospective observational study included 1441 PCR positive COVID-19 patients hospitalized during the COVID-19 pandemic and after the pandemic. Microbiological investigations, fungal cultures, serum galactomannan antigen tests, and Pneumocystis jirovecii PCR tests were performed. The rates of positive test results for fungal infections were calculated as percentages and statistically compared between the 2 periods. Overall, 99 of 1441 patients (6.9%) had at least 1 positive fungal test. The study findings showed that the positive test results for fungal species declined after the pandemic, from 9.15% to 5.13% for all species, 17.36% to 9.29% for Candida species, and 2.22% to 1.00% for Aspergillus species. The decrease in the positive test result rates for all fungal and Candida species was statistically significant (P = .003 and P = .002, respectively). An increased prevalence of pulmonary fungal infections was observed in patients hospitalized during the COVID-19 pandemic. The lower fungal positivity observed in the post-pandemic period may reflect changes in the patient case-mix, diagnostic intensity, and evolving clinical and infection-control practices; however, causal inferences cannot be made from this observational analysis. These findings may inform preparedness, infection-control, and stewardship strategies for preventing and managing pulmonary fungal co-infections during future respiratory virus outbreaks.

Antimicrobial resistance (AMR) is an urgent health threat. Effective communication about AMR and avoiding antibiotics for viral infections is a public health priority. Here, we evaluated whether comparing the AMR crisis to the coronavirus disease 2019 (COVID-19) pandemic could enhance public understanding of AMR and reduce intentions to seek unnecessary antibiotics. In this randomized online survey (March-April 2024), US adults were randomized to receive 1 of 3 messages: (1) written message describing the AMR crisis (control); (2) written message comparing AMR to the COVID-19 pandemic; or (3) a series of poster-like graphics comparing AMR to the COVID-19 pandemic. Respondents then read a scenario describing a viral respiratory infection (where antibiotics are not clinically indicated) and asked to indicate whether they would (1) respond by visiting a primary care clinician and (2) desire to take antibiotics. The final sample (N = 972, completion = 90%) had a mean age of 42 years and 58% identified as female. No statistically significant differences were found between messages for intention to visit a primary care clinician (P = .625) or desire to take antibiotics (P = .157). Across all respondents, older age and independent/third-party political affiliation were associated with lower antibiotic-seeking intentions, whereas medical maximizing, prior antibiotic use, being vaccinated for COVID-19, and pride in that status were associated with higher intentions. Comparing the threat of AMR to the COVID-19 pandemic did not reduce antibiotic-seeking intentions, indicating this analogy may not be an effective messaging strategy. Adults with greater care-seeking behaviors and preferences were more likely to report antibiotic-seeking intentions.

Clostridioides difficile infection (CDI) remains a substantial burden on healthcare systems worldwide. The COVID-19 pandemic has had profound and multifaceted effects on healthcare delivery and infection control practices, potentially influencing the epidemiology of CDI. To assess whether the coronavirus disease 2019 (COVID-19) pandemic has influenced the incidence of CDI and to explore potential contributing factors. This systematic review and meta-analysis was conducted in accordance with the PRISMA guidelines. Seven databases were searched for relevant literature published from December 2019 to October 2025. Study quality was assessed via the Newcastle‒Ottawa Scale (NOS) and the Joanna Briggs Institute (JBI) critical appraisal tools. Random- or fixed-effects models were selected according to heterogeneity. Publication bias was evaluated via funnel plots and Egger's test, and sensitivity analyses were conducted. The primary outcome was the incidence rate of CDI, expressed as cases per 10,000 patient-days. Incidence rate ratios (IRR) were calculated to compare the incidence of CDI between the prepandemic and pandemic periods. Sixteen studies were included. The pooled CDI incidence rate was 4.42 (95% CI: 3.37-5.46) per 10,000 patient-days in the prepandemic period and 3.80 (95% CI: 2.63-4.96) per 10,000 patient-days during the pandemic. The pooled incidence rate ratio was 0.80 (95% CI: 0.67-0.97), indicating a significant reduction in the incidence of CDI. This decline was associated with changes in medical practices (e.g., the suspension of nonurgent and high-risk procedures), antimicrobial stewardship practices, and strengthened infection control measures (e.g., enhanced hand hygiene and environmental disinfection) during the pandemic. Compared with the prepandemic period, the incidence of CDI decreased significantly during the COVID-19 pandemic. This finding suggests that strengthened infection prevention measures, improved antimicrobial stewardship, and adaptations in healthcare delivery may have contributed to reduced CDI transmission. Reinforcing these evidence-based foundational strategies may help mitigate ‌the risk of CDI and other healthcare-associated infections during future public health emergencies.

During the Coronavirus disease 2019 (COVID-19) pandemic, smart technologies have been increasingly adopted in nursing education to reduce infection risk. However, the effectiveness and acceptance of smart glasses in clinical training remain unclear. This study aimed to identify factors influencing ratings of smart glasses and to examine rating correlations between paired nursing students and teachers following one-on-one training. We conducted a paired observational pilot study involving 30 nursing student–teacher pairs from Kaohsiung Armed Forces General Hospital, Taiwan, between November 2021 and December 2022. After completing clinical training using smart glasses, participants evaluated familiarity, satisfaction, time saving, and objectivity using a structured 5-point Likert-scale questionnaire. Group differences were analyzed using chi-square tests, independent t-tests, and 1-way ANOVA. Pearson correlation and linear regression analyses were performed to identify associated factors and inter-pair correlations. The results showed that teachers’ familiarity scores were significantly lower than students (P = .004). The higher time saving scores was significantly showed in teachers compared with students (P = .04). The satisfaction scores of students aged ≥24 years old were significantly lower than those of students aged <24 years old (P = .02). Teachers with ≥15 years of work experience had significantly lower familiarity scores than teachers with < 15 years of work experience (P = .03). Teachers with no experience using other smart technologies had significantly lower familiarity scores than teachers with experience using other smart technologies (P = .03). Among teachers, age (P = .01) and work experience (P = .04) were negatively correlated with familiarity scores. Finally, the familiarity (P = .03) and satisfaction scores (P = .02) of the paired students were positively correlated with the familiarity and satisfaction scores of the paired teachers. Smart glasses were less familiar to senior teachers and those without prior smart technology experience. Age and professional experience significantly influenced acceptance levels. Positive interdependence between paired students and teachers suggests that mutual adaptation may enhance smart technology implementation in clinical nursing education.

To describe trends in pregnancy-related death ratios from 2018 to 2024, assess the contribution of coronavirus disease 2019 (COVID-19) to these trends, and evaluate whether pregnancy-related death ratios have recovered to prepandemic levels. We conducted an observational study that used vital statistics data to calculate the annual pregnancy-related death ratio (the number of pregnancy-related deaths per 100,000 live births) for female individuals aged 15-49 years between 2018 and 2024. We compared the pregnancy-related death ratios across prepandemic (2018-2019) pandemic (2020-2022), and postpandemic (2023-2024) periods; to assess the contribution of COVID-19, we calculated the pregnancy-related death ratio including and excluding COVID-associated deaths (ie, those with ICD-10 U07.1 listed as a cause). Pregnancy-related deaths were identified using International Statistical Classification of Diseases, Tenth Revision codes (A34, O00-O99), and the total pregnancy-related death ratio was decomposed into the early pregnancy-related death ratio (deaths during pregnancy or within 42 days after pregnancy) and the late pregnancy-related death ratio (deaths 43-365 days postpartum). We conducted subgroup analyses by maternal age, race and ethnicity, or geographic region. From 2018 to 2024, there were 8,298 pregnancy-related deaths (32.3/100,000 live births). From the prepandemic period to the pandemic period, the early pregnancy-related death ratio increased by 7.5 deaths per 100,000 live births (95% CI, 6.1-8.8) and the late pregnancy-related death ratio increased by 3.7 deaths per 100,000 live births (95% CI, 2.7-4.6). Most of this increase (76% for the early pregnancy-related death ratio, 50% for the late pregnancy-related death ratio) was COVID-associated deaths. By 2023-2024, the early pregnancy-related death ratio had returned to prepandemic levels, but the late pregnancy-related death ratio remained elevated (1.4 additional deaths/100,000 live births; 95% CI, 0.4-2.4). Most subgroups experienced an increase in early and late pregnancy-related death ratios during the pandemic, but recovery varied. Notably, both early and late pregnancy-related death ratios remained substantially elevated among non-Hispanic Black mothers in 2023-2024 compared with the prepandemic period (early pregnancy-related deaths increased by 7.0/100,000 live births [95% CI, 1.3-12.8]; late pregnancy-related deaths increased by 5.4 /100,000 live births [95% CI, 1.3-9.5]). Pregnancy-related death ratios increased dramatically during the COVID-19 pandemic, and by 2023-2024, recovery differed by the timing of death relative to pregnancy and across sociodemographic subgroups. Additional efforts are needed to identify drivers of differential recovery from the COVID-19 pandemic and inform clinical and policy initiatives to reduce pregnancy-related deaths, improve maternal health, and promote health equity.

Most existing empirical studies conducted on the public regarding the coronavirus disease 2019 (COVID-19) pandemic have categorized depressive symptoms based on average scores. However, few studies have investigated the actual patterns of depressive symptoms for the public in relation to the COVID-19 pandemic. To address this limitation, this study conducted latent profile analysis and analyzed the predictors and outcomes according to the types of depressive symptoms. This study participants were 2,110 adults aged 19 to 71 years who completed the questionnaire for the 5th COVID-19 National Mental Health Survey conducted in March 2021. The three latent profiles were as follows: "overall low-level group" (59.9%), "lethargy and physical symptoms group" (29.8%), and "overall high-level group" (10.3%). Among predictors, younger age, experience of physical and mental health problems of the individual, experience of the indifference of the society/community to the loss and damage, experience of conflict with family members, experience of conflict and distrust with neighbors, experience of fear of personal information disclosure, low level of stress from the trend of media coverage, experience of rows over liability or legal disputes were associated with the likelihood of being classified into the overall high-level group. Analyzing the difference in post-traumatic growth according to the type of depressive symptoms, the overall highlevel group showed the lowest level of post-traumatic growth. Considering the identified predictors, effective strategies need to be established to prevent the aggravation of depressive symptoms and to provide adequate interventions.

The emergence of the coronavirus disease 2019 (COVID-19) pandemic led to numerous changes worldwide. Due to restrictive measures, hospital admission patterns changed in child and adolescent psychiatry, as in all other medical specialties. Although there are studies investigating the impact of the COVID-19 pandemic on mental health, research examining the reasons for hospital admissions and changing trends among children and adolescents remains limited. This study used data from the hospital information system of a university hospital and included patients aged 0-18 years. Data were analyzed across three periods: one year before the pandemic, one year during the pandemic, and one year after the complete lifting of all COVID-19-related restrictions. All 10th revision of the International Classification of Diseases "F" diagnostic codes were included in the analysis. A total of 7,500 unique admissions were included. Diagnostic distributions differed significantly across periods (p<0.001). The leading causes of admission were attention-deficit/hyperactivity disorder (23.5%, n=1,766), psychiatric evaluation (16.3%, n=1,223), and childhood- and adolescent-onset disorders (13.6%, n=1,022). The diagnosis of other childhood- and adolescent-onset behavioral and emotional disorders (F98) showed significant changes in the pre-pandemic period and as a secondary diagnosis post-pandemic. Changes in hospital admissions during the pandemic, especially for neurodevelopmental and severe mental disorders (e.g., autism), suggest stable overall admission rates but a possible increase in externalizing problems. It was suggested that the pandemic did not directly increase psychiatric disorders in children and adolescents but was associated with an increase in externalizing problems.

Orientation: The fundamental recalibration of the psychological contract (PC) for women managers remains under-researched despite the recognised importance of flexible work and well-being. This study focuses on women managers in a South African essential service state-owned enterprise. Research purpose: This study aimed to gain insights into the PC of women managers during and post the coronavirus disease 2019 (COVID-19) pandemic. Motivation for the study: Radical changes impact PCs. This study explores how COVID-19 reshaped this contract for women managers in essential services, who faced unique compounded pressures in balancing leadership, and intensified domestic roles. Research approach/design and method: Using a qualitative approach and purposive sampling, data were collected from 16 participants through semi-structured interviews. Main findings: During the pandemic, participants expected clear communication, support, health measures, and flexible work, but instead faced employer demands for unwavering commitment and constant availability. Post-pandemic, they anticipated guided reintegration but perceived demands for an abrupt return to normalcy. Whilst some participants reported a breach of the PC, citing lack of care and appreciation, others expressed fulfilment regarding job security and flexible work adoption. Consistently, women managers emphasised expectations of equal treatment, professional development, and sensitivity to their unique gendered needs. Practical/managerial implications: The pandemic exposed a crisis of reciprocity, triggering a shift from relational to transactional contractual terms. Organisations must implement concrete interventions: formalising hybrid work, establishing gender-responsive crisis protocols, implementing recognition systems, mandating transparent communication frameworks, and conducting PC audits. Contribution/value-add: Organisational crises reshape the nature of the psychological contract while sustaining core expectations, with implications for long-term leadership engagement in essential services.

During the coronavirus disease 2019 (COVID-19) outbreak, negative-pressure rooms were implemented to isolate high-risk COVID-19 patients. This study compared pneumonia patient outcomes before and after their implementation, focusing on in-hospital mortality as the primary outcome. We conducted a retrospective cohort study of adult pneumonia patients admitted to a tertiary hospital in Northern Thailand, excluding those with trauma-related illness, out-of-hospital cardiac arrest/in-hospital cardiac arrest, or incomplete data. The primary outcome was in-hospital mortality, and the outcomes were door-to-first doctor contact time, door-to-antibiotic time, emergency department (ED) length of stay (LOS), intensive care unit (ICU) admission, and 30-day mortality. Data from 220 pneumonia patients (104 pre-pandemic, 116 pandemic) were analyzed. Of these, 58.6% were elderly males with comorbidities like hypertension and diabetes. Door-to-first doctor contact time was longer during the pandemic (median, 1 vs. 0 minutes; P<0.001), as was ED LOS (median, 5.9 vs. 4.1 hours; P<0.001). Door-to-antibiotic time was also longer in unadjusted comparisons (median, 60.0 vs 36.5 minutes; P<0.001), but the difference was attenuated and not statistically significant after adjustment (adjusted mean difference, 14.2 minutes; P=0.071). No significant differences in in-hospital mortality, 30-day mortality, or ICU admissions were observed. Negative-pressure rooms led to increased door-to-doctor contact time and ED LOS during COVID-19, although without significant differences in mortality. These findings highlight the need to improve ED workflows for future pandemic preparedness.

The coronavirus disease pandemic has raised concerns about a possible link between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and both the development of type 1 diabetes (T1D) and increased rates and severity of diabetic ketoacidosis (DKA) at diagnosis. However, existing evidence is largely retrospective and inconclusive. This prospective multicenter study aimed to evaluate the association between SARS-CoV-2 infection and the rate and severity of DKA in children newly diagnosed with T1D and to assess the prevalence of SARS-CoV-2 exposure in this population. This study included 133 pediatric patients newly diagnosed with T1D across three tertiary centers in Türkiye between April 2021 and April 2022. SARS-CoV-2 status was determined at diagnosis using polymerase chain reaction and serological tests (IgM, IgG); IgG testing was repeated after 21 days. Patients were categorized into three groups: active infection, past infection, and no infection. The prevalence of SARS-CoV-2 exposure was also analyzed. SARS-CoV-2 seropositivity was found in 39% of patients. DKA was present in 76.9% of those with active infection, 66.6% of those with past infection, and 54.3% of those without infection. Although DKA was more frequent in those with SARS-CoV-2 exposure, the difference was not statistically significant (p=0.240). DKA severity also showed no significant variation among groups (p=0.162). DKA was the predominant presentation regardless of SARS-CoV-2 status, with no significant difference in frequency or severity. These findings suggest that increased DKA rates may be more related to healthcare access issues during the pandemic than to direct viral effects.

The coronavirus disease 2019 (COVID-19) pandemic has had unprecedented global impact, with significant effects on mortality and healthcare utilization. This study evaluated the direct and indirect impacts of COVID-19 on mortality and healthcare utilization in South Korea, a country that implemented strict public health measures. We conducted a retrospective analysis using national databases from January 2015 through May 2022. The study compared mortality patterns and intensive care unit (ICU) utilization during the epidemic period (2020-2021) with the reference period (2015-2019). We analyzed excess mortality using a random-coefficient Poisson regression model and examined cause-specific mortality patterns for pneumonia, cardiovascular disease, and cancer. ICU admission trends were assessed using annual percent change (APC) and average annual percent change (AAPC) analyses. The study revealed a distinctive two-phase pattern in COVID-19-related excess mortality: minimal excess deaths until June 2021, followed by a significant increase culminating in 18,068 excess deaths (P-score, 68.39%) during the fifth wave in March 2022. COVID-19 deaths accounted for approximately 45% of excess deaths during this period. Analysis of cause-specific mortality demonstrated temporal shifts in cardiovascular disease and pneumonia deaths from their typical January peaks to March-April 2022. Cardiovascular disease showed significant excess mortality during the fifth wave (z=6.18, P<0.001), while pneumonia mortality was below expected levels when accounting for pre-existing trends. Case fatality rate declined from an initial 9.50% to below 1% by 2022, despite increased case numbers. ICU admissions for non-COVID patients showed a consistent declining trend, with the most substantial decrease (-11.48%) observed in April 2020 during the first epidemic wave. These findings suggest that COVID-19 affected population health through both direct viral infection and indirect effects on healthcare systems and utilization patterns. The study highlights the importance of maintaining critical care capacity for all patient groups during public health emergencies and the need for strategies to balance resource allocation.

BACKGROUNDThe optimal timing of tracheostomy in critically ill patients remains controversial. While early tracheostomy has been associated with reduced ventilator days and intensive care unit length of stay (LOS), survival benefits remain inconsistent. The coronavirus disease 2019 (COVID-19) pandemic changed intensive care unit workflows, airway management strategies, and interdisciplinary decision-making, potentially affecting tracheostomy practices even beyond the pandemic.AIMTo evaluate differences in tracheostomy timing, interdisciplinary consultation patterns, and clinical outcomes before and after the COVID-19 pandemic in critically ill patients without active COVID-19.METHODSThis is a single-center retrospective cohort study of adult patients undergoing tracheostomy at a community hospital in New York during two periods, pre-COVID (October 2012 to February 2020) and post-COVID (June 2022 to July 2024). Patients with active COVID-19 were excluded. Demographics, comorbidities, time-based outcomes (including time to palliative care and surgical consultation, intubation-to-tracheostomy interval, and hospital LOS), and mortality at 2 months and 6 months were analyzed. Multivariable logistic regression was used to identify factors associated with 6-month mortality.RESULTSA total of 314 patients were included (246 pre-COVID, 68 post-COVID). Compared with the pre-COVID cohort, post-COVID patients had a significantly shorter time to palliative care consultation (3 days vs 7 days, P = 0.001), surgical consultation (9.5 days vs 15.0 days, P < 0.001), intubation-to-tracheostomy interval (11.0 days vs 15.5 days, P < 0.001), and hospital LOS (29.5 days vs 34.0 days, P = 0.033). Mortality at 2 months and 6 months did not differ significantly between cohorts. In multivariable analyses, age was the only factor independently associated with mortality.CONCLUSIONThe post-COVID era was associated with earlier interdisciplinary engagement and tracheostomy placement without improvement in short- or long-term mortality. These findings suggest a pandemic-driven change in airway management practices. The COVID-19 pandemic may have sensitized healthcare providers, leading to earlier involvement in tracheostomy decision-making, but long-term effects are yet to be determined.

During the coronavirus disease 2019 (COVID-19) pandemic, the seasonality of Kawasaki disease (KD) in Japan shifted from winter dominance to summer dominance. However, it remains unclear whether this pattern reverted after infection mitigation measures were lifted in 2023. We conducted a population-based retrospective survey among all hospitalized patients with KD in Shiga Prefecture, Japan, from 2015 to 2024. Monthly variations in the KD incidence from 2021 to 2024 were analyzed using the 2015-2019 period as reference. We also examined the seasonality of 10 common pediatric infectious diseases and seasonal influenza during the study period. A total of 2077 patients with KD were identified. The KD incidence remained low during the implementation of public health measures against COVID-19 from 2020 to 2022. Subsequently, the incidence reached the maximum in 2023 (128.2 per 100,000 person-years), coinciding with the lifting of infection mitigation measures; the incidence remained high at 118.9 in 2024. The traditional winter peak in KD incidence disappeared after 2020. Instead, peak incidence was observed in the summer from 2021 to 2022 and in the spring from 2023 to 2024. The number of patients with respiratory syncytial virus infection, which had been highest during the fall and winter from 2015 to 2019, reached the highest levels during the spring and summer from 2021 onward. KD seasonality in Shiga Prefecture did not revert to the traditional winter-dominant pattern after COVID-19 infection mitigation measures were lifted. Continued surveillance is warranted to determine whether the winter-dominant pattern re-emerges.