Molecular and clinical characterization of respiratory syncytial virus genotypes in a medical centre in Central Taiwan across the COVID-19 era.

The aim of our study was to compare the prevalence, etiology, and outcomes of sepsis and associated AKI in pre- and post-COVID-19 pandemic. We conducted a retrospective observational analysis in 144 patients with sepsis and AKI, in two periods of time, 2 years before and after COVID-19 pandemic, with 2 years' washout period. The comparative analysis between the two periods demonstrated more severe forms of sepsis with septic shock dominating in the post pandemic period (5 (10%) vs 23 (25%), p = 0.037). According AKI staging we found AKI stage 3 more frequently present after pandemic and more patients needed dialysis in the post COVID-19 pandemic (35 (70%) vs 79 (84%), p = 0.04; 31 (62%) vs 78 (54%), p = 0.02; 16 (32%) vs 51% (54%), p = 0.018), respectively. Patients in post COVID-19 era survived less longer (22.66 ± 11.32 vs 17.132 ± 12.66, p = 0.021) with almost doubled risk for mortality HR: 1.977; 95% CI (1.127 ± 3.469), p = 0.018. Regarding causative agents' there was similar distribution in both periods, but the multiple antibiotic resistance index (MAR) was significantly higher in the post COVID-19 period for Staphylococcus coagulase negative (0.48 vs 0.62, p = 0.001). Sepsis and associated AKI occurrence, morbidity and mortality are significantly higher in the post COVID-19 pandemic and the increased MAR of the germs can be one of the main reason for it.

The COVID-19 pandemic severely disrupted healthcare delivery worldwide, including cytopathology services essential for timely diagnosis and management of malignancies. This study evaluated the pandemic's impact on cytopathology specimen trends at the National Health Laboratory Service (NHLS) Universitas Academic Hospital laboratory in central South Africa. A retrospective analysis was conducted on adult non-gynaecological cytology specimens from March 2018 to April 2024, divided into pre-COVID-19, COVID-19, and post-COVID-19 eras. Specimens were categorised into fine needle aspirates (FNAs) and other non-gynaecological specimens, and stratified by anatomical site and diagnosis (benign, malignant, and suspicious for malignancy). Unsatisfactory, paediatric, and inadequate samples were excluded. Time series analysis was used for comparisons. Specimen volumes declined significantly during the COVID-19 era (p < 0.001) and did not recover in the post-pandemic era. Although the proportion of FNAs remained consistent, specific trends were observed, including a marked decline in breast FNAs and benign diagnoses, with a concurrent increase in malignant and cases that were suspicious for malignancy. Respiratory tract FNAs increased during the COVID-19 era, reflecting a shift in clinical priorities. Cytopathology services in central South Africa experienced sustained reductions in the volume of specimens received during and after COVID-19. Increased malignant diagnoses may reflect delayed presentations and diagnostic backlogs created by the lockdown periods. These findings highlight the importance of resilient diagnostic services during health crises, as well as the importance of relying on more cost-effective and faster diagnostic tools, such as cytopathology.

ABSTRACT This article examines how a long-standing, in situ study abroad programme in Greece at a large American public university was transformed into a fully virtual model during the COVID-19 pandemic, and what this shift reveals about the historical relationship between mobility, experiential learning, and academic tourism. Drawing on programme records, instructional materials, and forty-one in-depth interviews conducted with Greek residents by participating students in the programme in August and September 2021, the study analyzes the pedagogical, methodological, and experiential consequences of replacing embodied travel with digital engagement. Placing the case within the scholarship on educational mobility, presence and authenticity in tourism, and mediated forms of travel, the article argues that the virtual programme disrupted long-held assumptions that study abroad depends solely on physical displacement. The findings demonstrate both continuity and rupture: while virtual encounters facilitated rich, often unusually intimate conversations during a period of global crisis, the absence of physical presence also reframed traditional expectations of immersion and cross-cultural contact. This case study contributes to tourism history by showing how global emergencies and technological infrastructures can reshape the forms, meanings, and future trajectories of academic travel.

The aim of our meta-analysis was to determine the global prevalence of burnout among physicians measured by the Copenhagen Burnout Inventory (CBI). A meta-analysis performed following the PRISMA guidelines. PubMed, Scopus, and Web of Science were searched for trials on the prevalence of physician's burnout syndrome. A literature search (October-November 2025) was performed, and pooled prevalence was estimated using a random-effects model. Joanna's Briggs Institute (JBI) quality assessment tool was used to evaluate the risk of bias. Cochrane I-squared test was used to evaluate the heterogeneity among studies. The meta-analysis was performed using IBM SPSS Statistics software (version 29.0.2.0.). Thirty-nine cross-sectional studies containing 17,963 physicians were finally included in the analysis. The global prevalence of burnout was 52% (95% CI: 46%-57%). Pre-pandemic studies from Europe yielded a pooled prevalence of 34% (95% CI: 23%-46%), compared with 47% (95% CI: 34%-61%) during the COVID-19 era. In Asia, the pooled prevalence increased from 55% (95% CI: 46%-64%) before the pandemic to 66% (95% CI: 57%-74%) during the pandemic. A large number of physicians were identified as having moderate-high burnout levels. The findings of this analysis highlight the need for policy measures aimed at enhancing the working environment of healthcare professionals and mitigating burnout. The protocol was registered on PROSPERO (CRD420251177705). Not applicable.

Candidemia is a major healthcare-associated bloodstream infection with high mortality, requiring ongoing surveillance to guide management. This retrospective study analyzed 306 candidemia episodes diagnosed between 2015 and 2024 at a Spanish tertiary-care hospital, comparing two periods (2015-2019 vs. 2020-2024). The overall incidence was 0.79 episodes per 1.000 admissions, with peaks in 2021 and 2024. Candida albicans was the most common species (44.8%), followed by Candida parapsilosis (19.0%) and Nakaseomyces glabrata (15.7%). A significant epidemiological shift occurred in the later period, with increased C. albicans, decreased C. parapsilosis, and emergence of N. glabrata as the second-most frequent species. ICU-related cases rose significantly during the COVID-19 period. Diagnostic turnaround times improved, including faster blood culture positivity and species identification by MALDI-TOF, supported by rapid PCR testing with high sensitivity (91.7%). Antifungal resistance to fluconazole was notable in N. glabrata (48.1%). Empirical echinocandin use increased, alongside greater targeted fluconazole therapy. Antimicrobial stewardship interventions, mainly de-escalation strategies, were widely implemented after 2019. Overall mortality was 40.8%, with a decline observed in 2023-2024. These findings suggest that integrated diagnostic and stewardship strategies may improve outcomes, though causal relationships require further study.

Rationale : The blood service is a bridge between donors and recipients. The third category of participants in the blood collection and transfusion processes are medical personnel and volunteers. The uniqueness of both the social base and processes of the blood service have determined its unique changes in the COVID-19 era. Objective : To identify patterns in the collection and transfusion of donor blood during the COVID-19 pandemic. Methods : A search for reviews, meta-analyses, and randomized clinical trials was conducted using the terms “blood service,” “blood collection,” “blood transfusion,” “SARS-CoV-2,” and “COVID-19” in electronic libraries in Russia (eLibrary.ru) and the United States (pubmed.ncbi.nlm.nih.gov). The obtained data were compared with the results of the Pirogov Center COVID-19 Hospital. A total of 72 publications were selected for analysis. Results : The following topics were structured and discussed: 1) general issues, 2) blood banking issues, 3) blood collection issues, and 4) anti-COVID plasma. Conclusion : When preparing for a possible future pandemic, it is important to consider the following: 1) COVID-19 pandemic warning signs were coronavirus outbreaks in the previous two decades; 2) it will be important to quickly determine whether there is a risk of transmission of a new pandemic virus through blood; 3) blood service professionals must be prepared for changes in work, policies, and procedures; 4) donor health and safety issues will be a key focus; 5) blood handlers may also be involved in new activities; 6) Scenario development, tabletop exercises, and training will allow blood handlers to prepare for the unknowns of the next pandemic.

During the COVID-19 pandemic, human papillomavirus (HPV) vaccination programs and media campaigns promoting HPV literacy were disrupted. As a result, many targeted students remained unvaccinated during that period. This study aimed to evaluate HPV vaccination coverage and health literacy among secondary school students in the recent post-COVID-19 era. A cross-sectional survey was conducted between July and August 2023 among 600 students (grades 7-12) from six Thai schools in Chiang Mai, a province in northern Thailand. The study assessed HPV vaccination status and HPV-related health literacy. Among the participants (mean age 14.9 years; 47.3% female), only 21.5% (n = 120) reported receiving the HPV vaccine, with 58.3% (n = 70) completing the full course. Government supply was the primary source of vaccination, and 92.2% of vaccinated students were female. Significant differences in health literacy were observed between vaccinated and unvaccinated students, particularly in knowledge of HPV's association with cervical cancer, vaccine efficacy, safety, and perceived necessity. Differences were also evident regarding perceived cost, government promotion, awareness of national HPV policies, and the impact of the COVID-19 pandemic on vaccination uptake. This study highlights the persistently low HPV vaccination rate among secondary school students in northern Thailand, accompanied by notable disparities in health literacy. These findings underscore the urgent need for targeted interventions to improve awareness of HPV infection and vaccination, and to strengthen public health initiatives aimed at overcoming barriers and increasing vaccine uptake.

There is paucity of data on recent trends of population-level deaths with Primary Immunodeficiency Diseases (PIDD). To examine the population-based temporal trends in deaths with PIDD in the United States from 2015 to 2022. We performed a retrospective, serial cross-sectional analysis of national death certificate data from 2015 through 2022. We evaluated the changes in the PIDD age-adjusted mortality rate per 1,000,000 (AAMR), overall, then stratified by age, gender, and race/ethnicity. The overall AAMR increased significantly from 2.5 to 3.5 (P<0.01). The AAMR rose significantly from 2.5 in the pre-COVID-19 era (2015-2019) to 3.2 in the COVID-19 era (2020-2022) [P = 0.03]. A similar trend was seen in several subgroups especially those aged ≥65 years. The overall PIDD AAMR increased during the study period, especially in those aged ≥65 years. This data can enhance PIDD awareness and reduce mortality, especially in older patients.

Examining smartphone usage behaviour in the COVID-19 era: Implications for post-pandemic usage and dependence patterns

This study aimed to evaluate national, demographic, and geographic trends in mortality associated with hypertension and ischemic heart disease (IHD) among U.S. adults from 1999 to 2023. Mortality data were extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Adults aged ≥15 years with hypertension (ICD-10: I10-I15) listed as a contributing cause and IHD (ICD-10: I20-I25) as the underlying cause of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percent change (APC) were calculated using Joinpoint regression, stratified by year, sex, race/ethnicity, U.S. Census region, and urban-rural classification. Between 1999 and 2023, 3,575,793 hypertension-associated IHD deaths were recorded. The overall AAMR rose modestly through 2018 (APC = 0.4%; 95% CI, 0.1-0.6), sharply increased from 2018-2021 (APC = 10.3%; 95% CI, 7.7-11.9), and declined thereafter till 2023 (APC = -4.4%; 95% CI, -7.3 to -1.7). Men consistently exhibited nearly twice the mortality rate of women, and Black Americans experienced the highest AAMRs across racial/ethnic groups. Regionally, the South showed the greatest burden, while rural areas had approximately 20% higher mortality than metropolitan regions. Hypertension-associated IHD mortality in the U.S. demonstrates a U-shaped temporal pattern declining until the late 2010s, surging during the COVID-19 era, and only partially improving thereafter. Persistent disparities by sex, race, and geography underscore the urgent need for renewed, equitable prevention strategies targeting hypertension control and cardiovascular risk reduction nationwide.

Congenital craniofacial anomalies represent a critical domain in plastic surgery training, requiring technical expertise, multidisciplinary collaboration, and exposure to specialized congenital cases. Although the Accreditation Council for Graduate Medical Education mandates pediatric plastic surgery experience, variability in training opportunities exists across programs. Understanding how factors such as program size, training pathway, geographic region, resident demographics, and the COVID-19 pandemic impact surgical exposure is essential for ensuring equitable and comprehensive education. A retrospective cohort study was conducted using Accreditation Council for Graduate Medical Education case log data from graduating US plastic surgery residents between 2014/2015 and 2022/2023. All accredited integrated and independent programs were included. Variables assessed included resident gender, underrepresented minority status, training pathway, program size, geographic region, and COVID-19 era. A total of 1902 residents (1043 integrated; 859 independent) were included. The overall mean case volume was 115.3 ± 52.5. Integrated residents logged significantly more cases than independent residents (122.2 ± 57.3 versus 106.8 ± 46.0, P < 0.001). No significant differences were observed by gender or underrepresented minority status. Independent residents from larger programs completed more cases than those from smaller programs (119.5 ± 51.1 versus 102.2 ± 43.0, P < 0.001). Regionally, residents in Western programs performed significantly more cases than peers in other regions (P < 0.001). Case volumes remained stable over time, with no significant impact of COVID-19. Exposure to congenital craniofacial surgery has remained stable nationally, even through the COVID-19 pandemic, although significant differences exist by training pathway, program size, and geography.

Health inequalities and biopolitical state racism in the COVID-19 Era: A Foucauldian perspective on Seine-Saint-Denis, France

HIV cascade, key indicators, and other epidemiological metrics in Australia (2004-2023): a retrospective analysis.

The COVID-19 pandemic accelerated the adoption of digital mental health services (DMHS) in Indonesia as an alternative approach to addressing limited access to conventional psychological services. However, the rapid implementation of these services also revealed various structural, technological, and regulatory challenges within Indonesia’s mental health system. This study aimed to explore stakeholders’ experiences in implementing DMHS during the COVID-19 era, including the challenges encountered, adaptive strategies employed, and recommendations for future service development. This research employed a qualitative exploratory design using semi-structured interviews involving 14 stakeholders, consisting of psychologists, platform managers, founders, and representatives of professional organizations in Indonesia. Data were collected through online interviews and analyzed using inductive thematic analysis supported by NVivo 14 software. The findings identified several major themes, including community and client readiness, service provider readiness, regulatory and legal conditions, technological limitations, service effectiveness and quality challenges, and capacity building and innovation. The study revealed that stigma, digital inequality, unclear regulations, and therapist burnout significantly affected the effectiveness of DMHS implementation. Nevertheless, stakeholders adopted adaptive strategies such as hybrid services, peer learning, structured evaluations, and digital innovation to maintain service quality. In conclusion, strengthening regulations, infrastructure, professional competence, and ethical standards is essential to ensure sustainable and effective digital mental health services in Indonesia.

Ethics Committees (ECs) play a vital role in protecting the rights, safety, and welfare of human participants enrolled in research. In special circumstances such as pandemics, ECs conduct a rapid review of research protocols to respond to a Public Health Emergency (PHE). Globally, many ECs made operational changes to their processes during the COVID-19 era in a bid to continue providing research oversight amidst strict measures to combat the spread of the disease. Little is known about any sustained and/or discontinued EC operational adjustments made during the COVID-19 pandemic. This study explored the EC operational changes that were retained and those that were dropped after the COVID-19 pandemic and any preparedness plans for potential future PHEs. This explorative qualitative study used in-depth interviews to gather data from target population of EC members, chairpersons, secretaries, and research administrators from selected ECs in Kenya that were operational during the pandemic. Data was collected between July and October 2025. We used purposive and snowballing methods until saturation was reached. We developed codes using both inductive and deductive approaches while adopting the five-stage framework analysis method of data familiarization, thematic framework development, code generation, thematic map generation, and examination of data patterns. We used NVIVO version 12 software to analyze the data. A total of 16 participants from the 7 selected ECs in Kenya took part in the study. We generated three (3) broad themes and various sub-themes from the analysis of in-depth interviews: (1) EC operational adjustments retained post-pandemic included technological adoption in protocol submissions and virtual meetings, frameworks for decentralized research, and discussants for protocol review meetings (2) EC operational adjustments dropped in the post-pandemic era included special COVID-19 scientific committees, parallel reviews between ECs and national regulator, quick turnaround reviews, and COVID-19 sensitization sessions during EC meetings (3) EC future directions in preparation for other PHEs included reciprocal approvals, community engagement plans, verbal presentation of protocols, continuous ethics education, and additional EC secretariat support. In Kenya, ECs have retained selective operations that enhance efficiency and have discontinued practices that were directly related to the emergency situation and those that were deemed unsustainable in the long-term.

ObjectivesTo evaluate the value of linked electronic health records (EHRs) for measuring stroke care quality in England before and after the COVID-19 pandemic, focusing on metrics not routinely captured: stroke incidence, dispensing of secondary prevention medications and a proxy of disability—time spent at home after stroke (‘home-time’).DesignProspective cohort study using national linked datasets.SettingEngland-wide health data linkage including the Sentinel Stroke National Audit Programme (SSNAP), primary and secondary care, dispensed medications and mortality records, accessed via National Health Service (NHS) England’s Secure Data Environment.Participants425 675 adults with a first stroke between 1 January 2020 and 31 December 2023; data were available for 304 210 in primary care, 279 825 in hospital admissions, 220 470 in SSNAP and 59 465 in death records.Main outcome measuresAnnual stroke incidence; first-year medication dispensing rates for antiplatelets, anticoagulants, antihypertensives and lipid-lowering agents (with a 1-month washout period) and home-time at 180 days post stroke.ResultsStroke ascertainment was highest when combining all sources, with 10.8% of non-fatal ischaemic strokes recorded exclusively in primary care and 19.4% of fatal strokes identified solely through death records. Standardised annual stroke incidence rose from 227.6 (95% CI 226.1 to 229.0) to 244.8 (95% CI 243.4 to 246.3) per 100 000 over the study period including the COVID-19 pandemic. During the COVID-19 lockdown, non-fatal stroke recordings decreased while stroke-related deaths rose, indicating that recording quality was sensitive to shifts in healthcare-seeking behaviour during the pandemic. Among people with ischaemic stroke, 89.1% received an antiplatelet or anticoagulant, 44.5% an antihypertensive and 80.5% a lipid-lowering therapy. For haemorrhagic stroke, these proportions were: for anticoagulants 13.5%, antiplatelets 13.2%, antihypertensives 46.6% and lipid lowering 41.1%. Medication dispensing for stroke prevention declined with increasing age and comorbidity, but varied little by ethnicity, region or pandemic period. Mean home-time within 180 days of stroke was 166.6 (95% CI 166.4 to 166) days, decreasing with greater age (141.4 days for 90 years or older (95% CI 140.7 to 142.1)), deprivation (166.4 days (95% CI 166.1 to 166.6) for most deprived quintile) and stroke severity (137.4 days for National Institutes of Health Stroke Scale (NIHSS) score on arrival over 22 (95% CI 135.8 to 139.1)) and increasing with years from the COVID-19 pandemic 2023 (169.3 days (95% CI 169.0 to 169.5) vs 2020 164.4 days (95% CI 164.1 to 164.7)).ConclusionsStandardised stroke incidence increased significantly over the study period, highlighting a growing public health burden that persisted despite disruptions due to the pandemic although variation in case ascertainment and stroke coding practices was observed. While secondary prevention coverage for antiplatelets and lipids was high, lower rates of dispensing of antihypertensives, particularly in older and comorbid populations, potentially signal a target for improvement. Home-time represents a sensitive, person-centred outcome that exposes disparities linked to socioeconomic deprivation and clinical severity that can be used to enhance routine stroke audits. These findings justify the expansion of linked EHR infrastructure and the modernisation of governance frameworks to enable the longitudinal evaluation of care quality beyond the COVID-19 era.

Collaboration between local health authorities and community actors is widely recognised as central to effective emergency preparedness and response, particularly in low- and middle-income countries (LMICs), where health systems face persistent resource and governance constraints. However, empirical evidence on how such collaboration is conceptualised, operationalised, and evaluated remains fragmented. This scoping review mapped and synthesised available evidence on collaboration between local health authorities and community leaders (including community-facing actors) during health emergencies, using the COVID-19 pandemic as an illustrative context to inform further research. A scoping review was conducted following the Arksey and O'Malley framework and reported in accordance with the PRISMA-ScR guidelines. Searches were conducted in PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar for studies published between January 2020 and October 2025. Eligible studies were primary empirical research conducted in LMICs that examined collaboration between local health authorities and community-facing actors involved in emergency responses. Data were extracted using a structured charting tool and synthesised using descriptive and narrative approaches. Three qualitative studies from Bangladesh and the Philippines met the inclusion criteria. Collaboration involved partnerships between local health authorities and non-governmental organisations, universities, and community-based actors, often formalised through coordination mechanisms. Reported strategies included joint planning, co-implementation of services, resource and workforce sharing, capacity building, and community outreach. These approaches were associated with enhanced surge capacity, continuity of essential services, strengthened system resilience, and improved access and community engagement. However, community leadership roles were rarely explicitly defined, with leadership functions often embedded within community-facing or intermediary actors. The evidence base on collaboration during health emergencies in LMICs remains limited and conceptually underdeveloped. Available studies suggest that collaboration between local health authorities and community-facing actors may support coordinated and resilient responses. However, important gaps persist in how community leadership is conceptualised, operationalised, and evaluated. Future research should more explicitly define and examine community leadership roles, alongside strengthening institutionalised and sustainable collaborative mechanisms for emergency preparedness and response. Not applicable. This scoping review does not involve a healthcare intervention or human participant enrolment. The review protocol has been published previously and is publicly accessible.

National trends and safety of prophylactic lymphovenous bypass during axillary lymph node dissection: A decade-long analysis of 61,819 patients through the NSQIP database.

Objective:We evaluated how antibiotic use changed after implementation of a multifaceted intervention that sent providers individualized peer-comparison feedback on their antibiotic use for respiratory conditions that do not warrant antibiotics (never-events).Design:An interrupted time-series analysis was performed with a baseline (January 2018–January 2020) and intervention period (November 2021–December 2023), while controlling for COVID-19 era (February 2020–February 2022).Setting:Walk-in ambulatory clinics.Participants:Providers caring for patients in walk-in clinics.Methods:We conducted a mixed-methods study across 7 walk-in clinics in one health system. We included data from visits from 2018–2023 and conducted 17 semi-structured interviews with 10 providers.Results:After intervention implementation, antibiotic use for all visits decreased 8% (RR 0.92, 95% CI 0.86–0.97), then began to increase by 1% per month (RR 1.01, 95% CI 1.00–1.01). Once the intervention started, the use of never-event diagnostic codes decreased by 24% (RR 0.69–0.83) and continued to decrease by 1% per month (RR 0.99, 95% CI 0.98–0.99). Antibiotic use for never-event visits showed no immediate change after the intervention started (RR 0.80, 95% CI 0.61–1.04), then decreased by 3% per month (RR 0.97, 95% CI 0.96–0.98). Some providers valued receiving feedback on the metric; others admitted to shifting their codes.Conclusions:Delivering feedback to walk-in clinic providers was associated with temporary reductions in antibiotic-prescribing across all visits but also changes in diagnostic coding (ie, “gaming”). Antibiotic stewardship programs should monitor for changes in both when implementing new outpatient metrics.