Why did notifiable intestinal diseases persist while respiratory infections plummeted? Unraveling the divergent environmental drivers across the COVID-19 pandemic.

During the first wave of the COVID-19 pandemic, several studies - including our own - demonstrated a significant decrease in emergency surgical presentations, including acute appendicitis (AA). While these early findings are well documented, little is known about how presentation patterns and clinical outcomes evolved across subsequent pandemic waves. This study examines longer-term trends in AA care across three distinct pandemic phases, highlighting how healthcare systems and patient responses adapted over time within a tertiary surgical setting. We conducted a retrospective single-center cohort study. Patients undergoing appendectomy between March 2020 and December 2021 were assigned to distinct pandemic phases based on national SARS-CoV-2 incidence (wave 2, wave 3, and wave 4). These were each compared separately to a pre-pandemic reference cohort treated between January 2019 and February 2020. Demographic data, clinical presentation, laboratory values, histological findings, and postoperative outcomes were analyzed. Throughout the pandemic period, the number of appendectomies remained lower than in the pre-pandemic reference group, particularly during high-incidence phases. Patients in wave 2 presented with more advanced disease, including significantly higher rates of perforation and peritonitis. In waves 3 and 4, disease severity and postoperative outcomes were comparable to the pre-pandemic reference period. This long-term analysis suggests that the initial shift toward more advanced disease among patients undergoing appendectomy was not sustained, with presentation patterns and outcomes tending toward pre-pandemic levels during later pandemic waves. These findings may reflect adaptive processes within the healthcare system, despite ongoing external stress.

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.

Shifts in pediatric orthopedic injury patterns in the emergency department before, during, and after the COVID-19 pandemic.

The COVID-19 pandemic has profoundly disrupted global tourism, yet the cognitive mechanisms underlying tourists' behavioral responses during health crises remain insufficiently understood. Drawing on an extended Theory of Planned Behavior (TPB) framework, this study investigates how epidemic perception, non-pharmaceutical interventions (NPIs), and moral norms shape tourists' decision-making processes. Survey data were collected from 360 respondents with pre-existing travel plans in China during the early pandemic phase. Structural equation modeling (Amos and Smart-PLS) reveals that epidemic perception functions as a foundational cognitive anchor, significantly influencing NPIs, moral norms, subjective norms, and attitudes. Moral norms emerge as a pivotal mediator, directly shaping attitudes, perceived behavioral control, and behavioral intentions. Counterintuitively, NPIs exhibit a negative relationship with intention to cancel travel, suggesting that protective measures effectively mitigate perceived risks and enable tourists to reconcile travel desires with health concerns. Subjective norms exert both direct and indirect effects through moral pathways, underscoring the amplified role of social expectations during crises. Notably, perceived behavioral control does not significantly influence attitudes or intentions, indicating that moral and social imperatives temporarily overshadow resource-based considerations during public health emergencies. These findings advance theoretical understanding of pandemic-era travel behavior. Practically, they suggest that destinations should leverage epidemic perception through authoritative communication to activate moral and social norms, promote NPIs to rebuild traveler confidence, cultivate collective responsibility via social endorsement, and address practical barriers at the implementation stage to transform intentions into actual travel behavior.

Nonpharmaceutical interventions such as social distancing and face mask use were central to controlling infectious disease transmission during the early phases of the COVID-19 pandemic, particularly when vaccines and treatments were limited or unevenly available. Although public health strategies emphasized individual compliance, adherence varied widely. Empirical evidence remains limited regarding how individuals integrate influences across individual, interpersonal, and community levels when assessing their ability and readiness to socially distance. This study examined how residents evaluated, prioritized, and experienced multi-level factors shaping perceived ability and readiness to practice social distancing during the early phase of the COVID-19 epidemic. We conducted a cross-sectional online survey of adults (≥18 years) residing in St. Louis City and St. Louis County, Missouri, between April and July 2020. Participants selected and ranked individual/interpersonal and community-level factors influencing social distancing and provided open-ended explanations of their choices. Quantitative data were analyzed descriptively to assess selection frequency and ranking priority. Qualitative responses were analyzed using iterative thematic coding to examine how participants interpreted and combined these factors. The analytic sample included 1692 respondents. At the individual/interpersonal level, family and friends' distancing behavior (58.9%), desire for in-person interaction (52.4%), and personal risk of COVID-19 (48.9%) were frequently selected, while personal risk, caring for others, and ability to work from home were most often ranked as the highest priority. At the community level, others' distancing in public spaces (66.2%), availability of COVID-19 testing (58.9%), and businesses' ability to ensure distancing and sanitation (57.2%) were most frequently selected, with epidemic severity, testing availability, and treatment availability ranked as most influential. Qualitative findings indicated that respondents experienced these influences as interconnected, integrating personal and relational risk, local epidemic conditions, healthcare access, visible community norms, and employer policies. Perceived ability and readiness to practice social distancing emerge from interdependent social and structural conditions rather than isolated individual motivations. Public health responses to emerging infectious diseases may be more effective when individual-level guidance is complemented by accessible testing and treatment, supportive workplace policies, and community environments that visibly reinforce protective behaviors.

Community-acquired respiratory viruses (CARV) can cause severe infections in patients with cancer. To characterize epidemiology and outcome, the multicenter registry OncoReVir was established in November 2018. From November 2018 to October 2024, 2080 patients with cancer and CARV infection were enrolled. Only patients with a single CARV infection were analyzed (n = 1975). Data included demographics, cancer characteristics, and clinical course. A subgroup (n = 381) compared epidemiology and outcome across pre-, peri-, and postpandemic periods. Predefined endpoints were pneumonia, ICU admission, and infection-related mortality. Median age was 61 years (interquartile range 52-69), 42.5% were female, and 85.5% had hematological diseases. Most frequent CARVs were severe acute respiratory coronavirus 2 (SARS-CoV-2) (36%), influenza (22.5%), human parainfluenza virus (hPIV, 12.5%), and respiratory syncytial virus (RSV, 12%). Epidemiology (excluding SARS-CoV-2) shifted by period: prepandemic, influenza predominated (70.5%); pandemic, RSV (31%); postpandemic, RSV (27.5%), and hPIV (25.5%). Overall, 53% patients were hospitalized, 7% required ICU care, pneumonia occurred in 22.5%, and infection-related mortality was 4% (overall mortality 28%). Endpoint occurrence varied minimally across phases. Influenza drove prepandemic severity, whereas other CARVs became relevant during/after the pandemic. CARV epidemiology in patients with cancer changed substantially across pandemic phases, while clinical severity and infection-related mortality remained largely unchanged.

The Coronavirus Disease 2019 (COVID-19) pandemic has raised concerns regarding its potential to induce autoimmune responses. Antinuclear antibodies (ANA) are hallmarks of systemic autoimmunity, and emerging evidence suggests their increased prevalence post-infection. This study aimed to assess ANA positivity rates and patterns of distribution before and after the onset of the pandemic in Lombardy, Italy. We conducted a historical analysis of 1879 matched Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) - Reverse Transcription Polymerase Chain Reaction (RT-PCR) and ANA records performed between March 2020 and December 2023. ANA positivity was assessed using indirect immunofluorescence (IIF) on Human Epithelial type 2 (HEp-2) cells and classified according to the International Consensus on ANA Patterns (ICAP). The extracted data were compared to the pre-pandemic period (2019). Cumulative risk analysis and Cox regression were used to evaluate associations among ANA and SARS-CoV-2 exposure, hospitalization, sex, and age. ANA positivity increased during the pandemic (42.4%) compared to 2019 (29.9%, p < 0.00001). Among SARS-CoV-2 positive individuals, ANA positivity was more frequent (12.9% vs 6%, OR: 2.31, p < 0.001). Cox regression confirmed that SARS-CoV-2 infection (HR:1.397), female sex (HR:1.458), hospitalization (HR 5.369) and age (HR:1.003) were independently associated with the risk of ANA positivity. Time-to-event analysis revealed that ANA positivity risk was higher in the first pandemic phases, following original and alfa variants of SARS-CoV-2 infections compared to delta and omicron variants. Nuclear anti-topo I-like [anti-cell (AC)-29] pattern was more prevalent in SARS-CoV-2 positive individuals. SARS-CoV-2 infection is associated with an increased cumulative risk of ANA positivity in the Lombardy population, especially in the earlier phases of the pandemic.

This study evaluated the quality and analytic utility of occupational data in coronavirus disease 2019 (COVID-19) case investigation records from Busan, South Korea, during the period of comprehensive surveillance in 2020-2021, when occupation was inconsistently integrated into routine case reporting despite its importance for infection-risk assessment. We analyzed 25 283 confirmed COVID-19 cases reported between February 21, 2020, and December 31, 2021. Occupational information was extracted from investigation forms, epidemiological reports, and electronic medical records. We assessed completeness, internal inconsistencies, and codability to the Korean Standard Classification of Occupations (KSCO), and examined temporal trends across pandemic phases. Descriptive statistics and manual reviews of free-text entries were conducted. Occupational information was recorded for nearly all investigated cases in 2020-2021 (>99%), but entries were often vague ("unemployed," "other") or institutional ("school," "hospital"), which limited their utility. A minority of entries could be standardized to KSCO 1-3-digit categories because of ambiguous wording or contradictions between occupation and workplace. Although data collection virtually ceased in 2022 and 2023 after individual-level investigations were discontinued, patterns in the 2020-2021 dataset already showed that design flaws in the occupation field reduced analytic value. Busan's early COVID-19 surveillance system recorded occupation for nearly all cases but produced limited analyzable information. The disconnect between data entry and analytic usefulness highlights the need for structured, dual occupation-industry coding, searchable picklists, and real-time quality checks so that occupational risk can be systematically identified and incorporated into future pandemic preparedness and response.

Although the emergency phase of the COVID-19 pandemic is over, attention has remained focused towards ongoing vaccination programs and the protection of high risk populations. The DS-5670 lipid nanoparticle-mRNA vaccine platform contains SARS-CoV-2 spike protein receptor-binding domain (RBD)-derived antigen(s). We conducted studies to provide supporting evidence for DS-5670 as a source of seasonal boosters using RBD antigens from variant strains and different valency compositions. Randomized, active-comparator, non-inferiority studies evaluated monovalent DS-5670a (original strain RBD; Study 146 in 4518 adults ≥18 years) or bivalent DS-5670a/b (original and omicron BA.4-5 RBDs; Study 212 in 701 participants ≥12 years) as boosters. Primary efficacy endpoints were the GMFR in serum neutralization titers against SARS-CoV-2 (original strain) at 4 weeks (day 29) after study drug administration (Study 146), and the GMT and seroresponse rate of anti-SARS-CoV-2 (omicron BA.5 strain) serum neutralization titers on day 29 (Study 212). We show that both studies exceed non-inferiority margins. In Study 146, day 29 adjusted geometric mean fold-rise ratios for DS-5670a are 1.464 (97.5% confidence intervals 1.112, 1.927) vs BNT162b2 and 1.772 (1.335, 2.353) vs mRNA-1273. In Study 212, day 29 adjusted geometric mean titer ratio (DS-5670a/b vs bivalent BNT162b2) is 1.712 (95% confidence intervals, 1.509, 1.944); the between-group difference in seroresponse is 21.4% (13.8, 28.6). Both DS-5670 compositions are effective against symptomatic COVID-19, with broad neutralization activity across omicron sub-lineages. No serious adverse events are associated with DS-5670 in either study. This platform can be utilized to produce new vaccines against future SARS-CoV-2 variants.

Background While the promotion and optimization of tele-mental health (TMH) is increasingly recognized as essential, empirical research on public perceptions of this emerging support modality remains limited. Aims This study aims to investigate public attention, sentiment, and thematic concerns related to TMH in China across different phases of the COVID-19 pandemic, offering demand-side insights to support the development of digital mental health systems. Methods Drawing on 41,820 Weibo posts spanning the periods before, during, and after COVID-19 in China, this study employed sentiment analysis and topic modeling to capture dynamic public attitudes toward TMH. Results (1) Sentiment patterns revealed a mixture of emotions across all periods, with a slight predominance of positive sentiment; (2) Seven core discussion topics emerged, including TMH during COVID-19, campus-based applications, industrial development, emotional support, interpersonal relationships, mental disorders, and mental health promotion; (3) Public focus and emotional tone regarding these topics shifted significantly across pandemic phases. Conclusions The findings offer critical demand-side insights for advancing TMH initiatives in China and provide evidence to inform the global development of digital mental health systems.

The COVID-19 pandemic has broadly disrupted healthcare utilization, potentially affecting the diagnosis and treatment of hypertension. While most reports focus on countries with strict lockdowns, the impact on care in countries like South Korea that did not impose lockdowns remains unclear. This study aimed to investigate the changes in trends of new diagnosis and treatment initiation of hypertension in Korea during the pandemic. Using Korean nationwide claims data from 2015 to 2020, we identified new diagnosis and treatment initiation of hypertension. New diagnosis was defined as a claim for essential hypertension (International Classification of Diseases-10 code: I10), and treatment initiation was defined as a hypertension claim with antihypertensive prescription. Age-standardized rates were calculated using the 2020 insured population. Monthly trends in 2020 were compared with 2019 and with projected rates estimated using autoregressive integrated moving average (ARIMA) models based on pre-pandemic trends from 2015 to 2019. Analyses were conducted at the national and subnational levels. From 2015 to 2019, the rates of new diagnosis and treatment initiation of hypertension increased steadily, but both decreased in 2020. The most pronounced monthly decrease occurred in March 2020, with the largest regional declines observed in Daegu and Gyeongbuk. In the ARIMA model analysis, the observed rates in March 2020 were approximately 21% lower than expected rates for new diagnosis and 18% lower for treatment initiation. A substantial decline in new diagnosis and treatment initiation of hypertension was observed during the early phase of the COVID-19 pandemic in Korea.

The coronavirus disease 19 pandemic disrupted pediatric respiratory infections through non-pharmaceutical interventions and altered contact patterns. Long-term comparisons across the pandemic timeline in children remain limited. In this study, we analyzed 15,657 respiratory specimens from patients ≤ 18 years at Dankook University Hospital (2007-2023) using multiplex polymerase chain reaction assays targeting 15 viruses. Age-stratified positivity rates were compared across pandemic phases. Children ≤ 6 years comprised 88.61% of the study population. Human rhinovirus showed the highest detection rate (24.06%), followed by adenovirus (12.33%), respiratory syncytial virus-subtypes A and B (RSV-A: 11.13%; RSV-B: 8.65%), human parainfluenza virus-type 3 (HPIV-3; 6.21%), human metapneumovirus (HMPV; 5.33%), and enterovirus (2018-2023; EV; 10.96%). Monthly distributions differed (p < 0.001). RSV peaked in late autumn and winter; influenza and seasonal coronaviruses in winter and spring; HMPV, HPIV-3, EV, and human bocavirus in summer and fall. Positivity declined during the pandemic, rebounding in 2023, most prominently among children aged 1-6 years (84.91%). HPIV-3 and EV increased (p < 0.001). RSV-A predominated pre-pandemic, whereas RSV-B showed a non-significant relative increase post-pandemic; no subtype differences occurred during the pandemic. Findings demonstrate pathogen-specific shifts in predominance and seasonality and support ongoing surveillance and pediatric care planning.

Sentiment analysis is a cornerstone of social media–based public opinion monitoring, yet the optimal approach for pandemic-related discourse remains contested. This study conducts a comparative evaluation of two dominant paradigms: lexicon-based sentiment analysis and transformer-based deep learning models. The proliferation of user-generated content on social media platforms during global crises has catalyzed the use of sentiment analysis as a tool for understanding public perceptions and behaviours. However, the choice of sentiment analysis tools significantly influences the accuracy, interpretability, and applicability of results. This study conducts a comparative evaluation of three widely used sentiment analysis tools—VADER (Valence Aware Dictionary for Sentiment Reasoning), TextBlob, Orange Data Mining’s integrated sentiment classifier and transformer-based deep learning (BERT) —in analysing COVID-19–related Twitter data. Using a dataset of approximately 57,000 tweets collected during multiple pandemic phases, the tools’ performance in terms of classification accuracy, precision, recall, F1-score, computational efficiency, and alignment are assessed with human-labelled ground truth data. The findings reveal that while VADER outperforms in capturing nuanced sentiment in short, informal texts, TextBlob demonstrates strengths in polarity scoring but suffers from over-generalization, and Orange’s classifier provides strong baseline performance with enhanced usability for non-programmers. The study offers practical guidelines for selecting sentiment analysis tools in pandemic-related social media research, balancing accuracy with accessibility for multidisciplinary research teams.

The COVID-19 pandemic exposed structural vulnerabilities in the global health emergency workforce. Sustained monitoring of response competence dynamics is critical for maintaining health system resilience during protracted outbreaks. This study aimed to investigate trends and structural transitions in nurses' infectious disease emergency response competence during different phases of the COVID-19 pandemic. Using the Healthcare Workers' Infectious Disease Emergency Response Competence Questionnaire, 3 repeated cross-sectional surveys were conducted in February 2020, August 2021, and February 2023. The participants were matched in a 1:1:1 ratio by their demographic characteristics via propensity scores. Temporal trends were analyzed using ANOVA, and competence structure transitions were examined via network analysis. Three-wave analyses (n=2525 per wave) demonstrated a sustained decline in competence, from 4.05 (SD 0.63) in February 2020 to 3.81 (SD 0.66) in August 2021 and further to 3.70 (SD 0.66) in February 2023. All pairwise comparisons were statistically significant (all P<.001). Network analysis identified critical structural shifts in competence architecture: in February 2020, the core network node was T24 (emergency management of body fluid exposure; strength=1.764), whereas in August 2021 and February 2023, the core network node was T19 (acquisition of key information on emerging infectious diseases; strength=1.759 and 1.852, respectively). Network structure comparisons revealed significant differences between February 2020 and August 2021 (P=.01) and between February 2020 and February 2023 (P=.01), whereas the difference between August 2021 and February 2023 was not significant (P=.07). Despite accumulated pandemic experience, nurses' infectious disease response competence declined substantially, indicating systemic fragility during prolonged crises. However, this experience reshaped competence architecture, evolving from technical infection prevention toward higher-order competence in information integration and clinical decision-making under uncertainty. To rebuild resilience, phase-specific training programs are essential: early-phase training emphasizes infection prevention, whereas prolonged outbreaks focus on information identification and decision support. Additionally, standardized information platforms and psychological support are essential to manage ongoing pandemic pressures.

BackgroundThe COVID-19 pandemic has profoundly impacted healthcare systems worldwide, with China presenting a unique case. As the first country to report COVID-19 cases and the last to lift its stringent Zero-COVID policy, China presents a distinctive context for understanding the long-term effects of the pandemic on healthcare utilization. This study provides a comprehensive analysis of healthcare utilization trends in China over more than four years of the pandemic, focusing on how different phases, including the Zero-COVID policy and its cessation.Methods and findingsWe conducted an interrupted time-series analysis of monthly healthcare utilization data from January 2015 to April 2024, including outpatient visits and inpatient discharges, across Mainland China, controlling for underlying secular trends and patterns. Hospital-based healthcare utilization data were sourced from the National Health Commission of China, and daily Policy Stringency Indices (higher values indicating stricter control policies) were obtained from Oxford’s COVID-19 Government Response Tracker. We modeled changes in healthcare utilization using negative binomial regression, comparing actual outcomes with counterfactual estimates based on pre-COVID trends. We assessed healthcare utilization during key pandemic phases, including the post-Zero-COVID period. Healthcare utilization in China experienced substantial declines during the pandemic, with an estimated reduction of 1.21 billion (7%) outpatient visits and 140.9 million (13%) inpatient discharges compared to expected levels from January 2020 to April 2024. The most pronounced declines occurred during the initial pandemic waves and coincided with periods of stringent Zero-COVID measures. Negative associations between the Policy Stringency Index and healthcare utilizations were observed. Before the lifting of the Zero-COVID policy, a 10-point increase in the Policy Stringency Index was associated with a 7.2 percentage point decrease in outpatient visits and a 6.2 percentage point decrease in hospitalizations. Although healthcare utilization gradually rebounded following the cessation of the Zero-COVID policy, as of April 2024, utilization remained below expected levels in 20 (65%) of the 31 regions for outpatient visits and in 23 (74%) for inpatient discharges. Regional disparities were evident, with more developed areas, such as Shanghai and Beijing, experiencing the largest absolute reductions after adjusting for population size. In Shanghai, outpatient visits declined by 4,997 and hospitalizations by 241 per 1,000 people. In contrast, the largest relative reductions occurred in less developed regions, where outpatient visits dropped by 16% in Guizhou and hospitalizations declined by 27% in Shanxi. Use of aggregated routine health system data limited individual-level analyses, assessment of care quality, and disentangling of causal pathways.ConclusionsThe COVID-19 pandemic and Zero-COVID policies were associated with substantial and enduring disruptions to healthcare utilization in China, characterized by slow recovery and regional disparities in access. These findings underscore the importance of strengthening healthcare systems to enhance resilience and better balance public health interventions with the maintenance of essential healthcare services in anticipation of future public health crises. Continued targeted efforts are needed to address the delayed recovery, particularly in regions with already strained healthcare infrastructure, and to ensure equitable healthcare access across the country.

Introduction: Quality care is very much important in case of COVID19 and it mainly access in terms of patients satisfaction. To measure the satisfaction of the health systems not only clinical but nonclinical outcomes of care which influence the patient satisfaction.Aims and Objective: (1) To study satisfaction of patients admitted in COVID19 hospital, GMERS Medical College & Hospital, Patan, regarding behaviour of medical, nursing and supportive staff working in hospital. (2) To study satisfaction of admitted patients regarding cleanliness in the hospital as well as food and drinking water facility available in the hospital (3) To study satisfaction of the patients regarding services (treatment) provided in the hospital.Materials and Methods: Hospital based cross sectional study. Total 170 patients admitted in covid hospital was taken in study by using sample size calculation formula [n=4pq/L2], Simple random sampling technique was use for sample collection.Results: More than 98% patients felt that they were attended timely and prompt treatment given. During their admission in COVID 19 hospital 99.4 % felt the wards and ICU were clean. More than 95% patients are satisfied by health staff behavior. More than 96% patients responded that they will suggest COVID 19 Hospital. More than 99% patients were satisfied with the Covid19 Hospital services. Patients gave 8.7/10 rating for Covid19 Hospital services.Conclusion: This study demonstrates exceptionally high patient satisfaction with services at the designated COVID-19 hospital during the early pandemic phase, with a mean overall rating of 8.7/10 and strong willingness to recommend the facility. High ratings across timeliness of care, staff behavior, cleanliness, and communication suggest that structured infection control, effective interpersonal practices, and minimal financial burden can maintain excellent patient experiences even in crisis settings. These findings highlight the value of responsive healthcare delivery in building trust during public health emergencies, though single-center and telephonic methods limit generalizability.

(1) Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue, with survival largely determined by the initial rhythm and timeliness of resuscitation. Comprehensive population-based data are essential for guiding prevention, emergency medical services (EMS) planning, and improving outcomes. (2) Methods: We performed a retrospective observational study of all adult OHCA cases managed by EMS in Lecce (Italy) between January 2013 and March 2025. Demographics, arrest circumstances, initial rhythm, time intervals, and return of spontaneous circulation (ROSC) were analyzed across age, sex, temporal, and pandemic-related strata. Rhythm classification followed European Resuscitation Council guidelines. (3) Results: A total of 11,653 cases were analyzed (mean age 76.8 ± 15.5 years, 56.6% male). Asystole (AS) was the predominant rhythm (88.7%), followed by ventricular fibrillation (VF, 7.6%), pulseless electrical activity (PEA, 1.3%), and pulseless ventricular tachycardia (pVT, 0.08%). VF was more common in younger and male patients, while AS increased with age. Hour-level analysis revealed circadian peaks: VF in late afternoon and AS in early morning. Pandemic analysis showed reduced VF and increased AS during COVID-19, with partial recovery post-pandemic. ROSC occurred in 3.47% overall, strongly associated with shockable rhythms. EMS response times were stable across day-night and pandemic phases. (4) Conclusions: AS dominates OHCA presentations, especially among the elderly, whereas VF remains the strongest predictor of ROSC. Circadian variation at the hourly level suggests potential for EMS optimization. Pandemic-related shifts in rhythm highlight the vulnerability of the chain of survival to societal disruptions. Strengthening bystander CPR, expanding AED availability, and tailoring EMS strategies remain key priorities for improving OHCA outcomes.

Background/Objectives: The COVID-19 pandemic substantially disrupted routine childhood vaccination practices across the United States. Oklahoma, a state characterized by lower socioeconomic indicators and higher levels of vaccine hesitancy, may have been particularly vulnerable to these disruptions. This study aimed to assess the impact of the COVID-19 pandemic on routine childhood vaccination in Oklahoma. Methods: Data were obtained from the Oklahoma State Immunization Information System to examine changes in the administration of DTaP and MMR vaccines before and during the COVID-19 pandemic, stratified by pandemic phase. Percentage changes in vaccine doses administered were calculated across time periods. Log-binomial regression models were used to evaluate the association between pandemic timing and receipt of subsequent DTaP doses among children under one year of age. Results: Administration of both DTaP and MMR vaccines declined during the COVID-19 pandemic across all pandemic phases examined. Compared with the pre-pandemic period, fewer children returned for subsequent DTaP doses during the pandemic. Regression analyses indicated a reduced likelihood of completing age-appropriate DTaP dosing among infants during the pandemic. Conclusions: Routine childhood vaccination in Oklahoma declined during the COVID-19 pandemic, with persistent reductions observed across pandemic phases. These findings highlight vulnerabilities in vaccination delivery during public health emergencies and underscore the need for targeted state-level strategies to sustain routine immunization services during future crises.

The early phase of the COVID-19 pandemic posed severe psychological challenges to health care workers (HCWs). This study examines the acute psychological symptoms, coping responses, and posttraumatic growth among HCWs in Southern Turkey during the first wave of the outbreak. It aims to establish a baseline understanding of the initial psychological impact that preceded the development of chronic conditions documented in later pandemic phases. A cross-sectional, web-based survey was conducted between April 30, 2020 and May 15, 2020, among 639 HCWs from two COVID-19 referral hospitals in Kahramanmaraş, Turkey. Recruitment was conducted through internal hospital email lists and secure messaging groups. The survey was anonymous, and no incentives were offered. Participants completed the Turkish versions of the Depression, Anxiety and Stress Scale-21, Coping Responses Inventory, and Posttraumatic Growth Inventory. Ethical approval was obtained, and informed consent was provided electronically. The completion rate was 93.8%. Elevated psychological distress was observed, with scores indicating symptoms of depression in 60.0% of participants, anxiety in 54.4%, and stress in 41.8%. Female HCWs, nurses, and those with chronic conditions showed significantly higher Depression, Anxiety and Stress Scale-21 scores. Passive coping styles-particularly helplessness and submissiveness-were more frequently used by women. Simultaneously, participants reported moderate to high levels of posttraumatic growth, especially in dimensions of self-perception and life philosophy. As this was a cross-sectional study conducted in two hospitals, the findings have limited generalizability and do not permit causal inferences. This study provides a critical snapshot of HCWs' psychological state during the earliest and most chaotic stage of the pandemic. The co-occurrence of distress and posttraumatic growth suggests a complex response to trauma. The prominence of passive coping strategies may contribute to long-term psychological sequelae, such as burnout. These findings highlight the urgent need for early institutional interventions that promote adaptive coping and support personal growth during public health emergencies. (PsycInfo Database Record (c) 2026 APA, all rights reserved).