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Background: The COVID-19 pandemic was associated with an increase in conspiracy theories worldwide. However, in Japan, the prevalence of COVID-19 conspiracy beliefs has remained unclear. This study aimed to estimate the prevalence and correlates of COVID-19 conspiracy beliefs using a survey of 28,175 residents of Japan aged 16-81 years old., Methods: A cross-sectional self-administered survey was conducted from September to October 2021. To assess the number of COVID-19 conspiracy beliefs, we used three questions from the Oxford Coronavirus Explanations, Attitudes, and Narratives Survey. Independent variables included general vaccine conspiracy beliefs, sociodemographic variables, information sources for COVID-19, trust in authorities, and fear of COVID-19., Results: After applying sampling weights and imputation, the estimated prevalence of holding at least one COVID-19 conspiracy belief was 24.4%. From a linear regression model, several factors were independently associated with conspiracy beliefs. Notably, people with the lowest level of education (lower secondary school) endorsed fewer COVID-19 conspiracy beliefs (B -0.089, vs. upper secondary school). Furthermore, higher socioeconomic backgrounds-such as higher income, higher wealth, and regular employment-were associated with endorsing conspiracy beliefs. Only 37.3% of respondents trusted the government of Japan, but paradoxically, trust in the government was positively associated with conspiracy beliefs (B 0.175, vs. distrust)., Conclusions: COVID-19 conspiracy beliefs can be prevalent in about a quarter of the residents of Japan. Certain groups are more likely to endorse conspiracy beliefs, and targeting interventions towards these groups might be efficient in stemming the spread of conspiracy beliefs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sato et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Decentralized COVID-19 testing with antigen rapid diagnostic tests (Ag-RDT) is recommended by the Nigerian Centre for Disease Control for community-level services. These services have been provided in Primary Healthcare Centers, Community Pharmacies, and licensed "Patent Medicine Stores" that serve the least affluent communities. To support quality assurance, we applied an adapted version of SPI-RT (Stepwise Process for Improving the Quality of HIV Rapid and Recency Testing) to sites providing COVID-19-RDTs in Federal Capital Territory of Nigeria., Methods: Between September 2022 and February 2023 community healthcare facilities (48 Community Pharmacies, 21 Patent Medicine Stores, 79 Primary Health Centers) were evaluated using Stepwise Process for Improving the Quality of SARS-CoV-2 Antigen Rapid Diagnostic Testing (SPI-RT) Checklist, tailored to the local implementation context. Evaluated domains included service quality, documents and records, personnel training and certification, safety, physical infrastructure, pre-testing phase, testing phase, and post-testing phase. Each facility received an overall score, expressed as a percentage indicating their performance level., Results: 41/79 (52%) of Primary Health Centers scored at least 90% for service quality, as did 19/48 (40%) of pharmacies, with only 1/21 (4.8%) Patent Medicine Store. Apart from personnel training and certification, Primary Health Centers scored highest across most domains of service quality, followed by Community Pharmacies. The lowest median score in any domain was in the Patent Medicine Stores on testing and safety at 60% for both post-testing phase and safety., Conclusion: Primary Healthcare Centers and Community Pharmacies can provide quality decentralized testing for COVID-19. Patent Medicine Stores may need additional support including monitoring and quality improvement initiatives to ensure the provision of high-quality decentralized COVID-19 rapid testing services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Udoh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Soon after commencement of the SARS-CoV-2 disease outbreak of 2019 (COVID-19), it became evident that the receptor-binding domain of the viral spike protein is the target of neutralizing antibodies that comprise a critical element of protective immunity to the virus. This study addresses the relative lack of information regarding actual antibody concentrations and binding affinities in convalescent plasma (CP) samples from COVID-19 patients and extends these analyses to post-vaccination (PV) samples to estimate protective IgG antibody (Ab) levels. A direct enzyme-linked immunosorbent assay (ELISA) was used to measure IgG anti-spike protein (SP) antibodies (Abs) relative to human chimeric spike S1 Ab standards. Microplate wells were coated with recombinant SP. Affinities of Ab binding to SP were determined by previously described methods. Binding affinities were also determined in an RBD-specific sandwich ELISA. Two indices of protective immunity were determined as permutations of Ab molar concentration divided by affinity as dissociation constant (KD). The range and geometric means of Ab concentrations in 21 CP and 21 PV samples were similar and a protective Ab level of 7.5 μg/ml was determined for the latter population, based on 95% of the normal distribution of the PV population. A population (n = 21) of plasma samples from individuals receiving only one vaccination with the BNT162b2 or mRNA-1273 vaccines (PtV) exhibited a geometric mean Ab concentration significantly (p < 0.03) lower than the PV population. The results of this study have implications for future vaccine development, projection of protective efficacy duration, and understanding of the immune response to SARS-CoV-2 infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Klegerman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

During the COVID-19 pandemic, Nepal rapidly expanded its PCR testing capacity, essential for effective outbreak response. However, many laboratories faced overwhelming test volumes, resulting in delays that may have hindered containment efforts. This study aims to determine whether these challenges stemmed from capacity limitations and/or imbalanced sample distribution due to inadequate coordination. In this retro-perspective simulation of SARS-CoV-2 testing in Nepal during 2021, we evaluate the impact of coordinated sample transfers on reducing laboratory stress and wait times during demand peaks. Our findings reveal that centralized coordination and strategic partnerships for sample transfers significantly enhance diagnostic network performance, even under high demand. These insights offer valuable guidance for policymakers on implementing effective coordination strategies to strengthen diagnostic networks for future pandemics., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bakker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Evidence from clinical research suggests that in the first two waves of COVID-19, the virus spread rapidly through a large number of undocumented asymptomatic infections. These 'silent' infections camouflaged the actual incidence of the disease, leading to downward biases in the rates of transmission, disease prevalence, and fatality. These, in turn, had implications for how people and policymakers responded to changing infection prevalence. This paper posits that in the early stages of the COVID-19 pandemic, a considerable number of SARS-CoV-2 infections spread through asymptomatic infected individuals who lacked economic incentives to test and isolate adequately. The decision to undertake testing and the subsequent possibility of isolation entails a calculus of benefits and costs for an individual. Given that the perceived net benefit of such actions is correlated with the observed risk of infection, the likelihood of an asymptomatic individual choosing to undergo testing increases with the existing infection prevalence rate. This behavior, in turn, influenced disease transmission and mortality dynamics. This study presents an analytical framework that integrates prevalence-dependent testing behavior into a traditional epidemiological model. The model's predictions provide critical policy insights. It reveals that failing to account for testing and isolation behavior results in underestimation of the infection propagation and fatality rates when reported disease prevalence is low, thereby, skewing the containment strategies in the initial and late stages of a pandemic. The findings underscore the necessity of enhancing testing capacity as a crucial countermeasure for future contagions like COVID-19., Competing Interests: The author has declared that no competing interests exist., (Copyright: © 2024 Jayanta Sarkar. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The characteristics of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) related to COVID-19 have remained uncertain. To elucidate the clinical trend of ME/CFS induced by long COVID, we examined data for patients who visited our outpatient clinic established in a university hospital during the period from Feb 2021 to July 2023., Methods: Long COVID patients were classified into two groups, an ME/CFS group and a non-ME/CFS group, based on three diagnostic criteria., Results: The prevalence of ME/CFS in the long COVID patients was 8.4% (62 of 739 cases; female: 51.6%) and factors related to ME/CFS were severe illness, smoking and alcohol drinking habits, and fewer vaccinations. The frequency of ME/CFS decreased from 23.9% in the Preceding period to 13.7% in the Delta-dominant period and to 3.3% in the Omicron-dominant period. Fatigue and headache were commonly frequent complaints in the ME/CFS group, and the frequency of poor concentration in the ME/CFS group was higher in the Omicron period. Serum ferritin levels were significantly higher in female patients in the ME/CFS group infected in the Preceding period. In the ME/CFS group, the proportion of patients complaining of brain fog significantly increased from 22.2% in the Preceding period to 47.9% in the Delta period and to 81.3% in the Omicron period. The percentage of patients who had received vaccination was lower in the ME/CFS group than the non-ME/CFS group over the study period, whereas there were no differences in the vaccination rate between the groups in each period., Conclusion: The proportion of long COVID patients who developed ME/CFS strictly diagnosed by three criteria was lower among patients infected in the Omicron phase than among patients infected in the other phases, while the proportion of patients with brain fog inversely increased. Attention should be paid to the variant-dependent trends of ME/CFS triggered by long COVID (300 words)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Morita et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Simple and easy to use kits for SARS-Cov-2 self-testing during epidemic waves are needed to optimize diagnostic capacity in low- and middle-income countries. SARS-Cov-2 self-testing kits are available, but application of these novel diagnostic technologies is less understood in low and middle-income contexts. We investigated the ability to understand and perform instructions for use (IFUs) for STANDARD Q COVID-19 Ag Test (SD Biosensor) and Panbio COVID-19 Ag Rapid Test Device (Abbott Rapid Diagnostics) for anterior nares (AN) nasal self-sampling and self-testing for COVID-19 in rural and urban Malawi. Qualitative research methods using iterative cognitive interview approach was used to investigate the ability of healthcare providers and lay community members to understand and perform a COVID-19 self-sample or self-test using the manufacturer's instructions for use. A total of 120 iterative cognitive interviews were done with healthcare providers and lay community members for self-sampling (N = 76) and self-testing (N = 44). Cognitive interviews began with the manufacturers version of instructions for use followed by subsequent iterations to refine problematic instructions. Structured interview guide and an observation checklist were used to collect data which was then coded inductively. A framework analysis approach was used to synthesize qualitative data. Study participants were generally proficient at performing a COVID-19 self-sampling and self-testing using the two COVID-19 Rapid Testing Devices. Several of design and content problems within manufacturer's instructions for use made their contextual application sub-optimal. Overall, participants experienced difficulties because of the omission of essential elements within instructions, use of short texts/phrase or lack of a word instruction, the lack of labels on where to open the package; the inconsistencies between word instructions within the instructions for use and the physical contents of the test package; the inability to digest and apply certain technical concepts and the lack of clarity in the phrasing of some text instructions. As expected, healthcare providers experienced fewer problems compared to lay community members. The refinement of these instructions greatly improved comprehension among lay community members. Self-sampling and self-testing for COVID-19 can be performed lay community members with fidelity in a scaled context if the manufacturer's instructions for use have been refined and tailored to the context. In the current study, we have used the study findings to map the optimisation process of manufacturer's IFU'S for self-testing RDT's intended for low literacy contexts including Malawi., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kumwenda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Patients can experience persistent cognitive complaints and deficits in long-COVID. Inflammation and capillary damage may contribute to symptoms by interfering with tissue oxygenation., Methods: This was an exploratory pilot crossover study designed to describe the effects of supplemental oxygen (portable oxygen concentrator, POC) on cognitive performance and peripheral and cerebral oxygen saturation at rest and exercise. Participants with long-COVID (n = 21) were randomized 1:1 to: 1) POC (3h/day) for 2 weeks followed by standard of care (Control) for 2 weeks or 2) Control for 2 weeks then POC (3h/day) for 2 weeks, with a 1-week washout. Cognitive assessment (global cognition [Montreal Cognitive Assessment, MoCA], episodic memory [Hopkins], working memory [Digit Span], executive function [Verbal fluency]) was performed at baseline and after each treatment period. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 were completed. Peripheral and cerebral oxygen saturation were measured at rest and exercise (treadmill) at baseline and after each treatment period. Statistical analyses were descriptive without formal testing., Results: MoCA scores were similar under POC (26.45±2.31) and Control (26.37±2.85); overall POC-Control difference was -0.090 (95% CI [-1.031, 0.850]). Because of a learning effect, post-hoc analyses were performed for Period 1, where the MoCA score difference was 1.705 [0.140, 3.271]. MoCA subscores suggested better performance with POC for Visuospatial/executive (0.618 [-0.106, 1.342]) and Attention (0.975 [0.207, 1.743]). POC trended to have better scores on Digit Span backward (difference: 0.822 [-0.067, 1.711]) and self-reported depressive symptoms (difference: -1.335 [-3.166, 0.495]). For specific PHQ-9 items, POC tended to have lower (better) scores for Q1 (Little interest/pleasure) and Q7 (Trouble concentrating). Cerebral oxygen saturations at end of exercise showed no difference between POC and Control. Peripheral saturations during exercise were similar under POC and Control (difference: 0.519% [-1.675, 2.714])., Conclusion: An advantage of POC over Control was observed for global cognition, attention, visuospatial/executive performance and depressive symptoms. Results need to be validated in a larger study., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Drs Glezer and Kamada are employees of Inogen. Other authors report no competing interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Gagnon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Decision-makers in middle-income countries need evidence on the cost-effectiveness of COVID-19 booster doses and oral antivirals to appropriately prioritise these healthcare interventions., Methods: We used a dynamic transmission model to assess the cost-effectiveness of COVID-19 booster doses and oral antivirals in Fiji, Indonesia, Papua New Guinea, and Timor-Leste. We conducted cost-effectiveness analysis from both healthcare and societal perspectives using data collated from publicly available sources. We developed an interactive R Shiny which allows the user to vary key model assumptions, such as the choice of discounting rate, and view how these assumptions affect model results., Findings: Booster doses were cost saving and therefore cost-effective in all four middle-income settings from both healthcare and societal perspectives using 3% discounting. Providing oral antivirals was cost-effective from a healthcare perspective if procured at a low generic price (US$25) or middle-income reference price (US$250); however, their cost-effectiveness was strongly influenced by rates of wastage or misuse, and the ongoing costs of care for patients hospitalised with COVID-19. The cost or wastage of rapid antigen tests did not appear strongly influential over the cost-effectiveness of oral antivirals in any of the four study settings., Conclusions: Our results support that COVID-19 booster programs are cost-effective in middle-income settings. Oral antivirals demonstrate the potential to be cost-effective if procured at or below a middle-income reference price of US$250 per schedule. Further research should quantify the rates of wastage or misuse of oral COVID-19 antivirals in middle-income settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bilgin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The COVID-19 pandemic has caused over 68.7 million infections and 1.35 million deaths in South America. There are limited data on SARS-CoV-2 seropositivity and its determinants from Andean countries prior to mass vaccinations against COVID-19., Objective: To estimate SARS-CoV-2 seropositivity and its determinants before vaccination in occupational groups of adults presumed to have different levels of exposure and associations with potential symptomatology., Methods: We measured seropositivity of anti-SARS-CoV-2 IgG antibodies in a cross-sectional study of vaccine-naïve adults aged 18 years and older, recruited within three occupational risk groups (defined as low [LR], moderate [MR], and high [HR]) between January and September 2021 in two Andean cities in Ecuador. Associations with risk factors were estimated using logistic regression., Results: In a sample of 882 adults, IgG seropositivity for the three different occupational risk groups was 39.9% (CI 95% 35.3-44.6), 74.6% (CI 95% 66.4-81.4), and 39.0% (CI 95% 34.0-44.4) for the HR, MR, and LR groups, respectively. History of an illness with loss of taste and/or smell was significantly associated with seropositivity in all occupational groups, with adjusted ORs of 14.31 (95%CI, 5.83-35.12; p<0.001), 14.34 (95%CI 3.01-68.42; p<0.001), and 8.79 (95%CI 2.69-28.72; p<0.001), for the HR, MR, and LR groups, respectively; while fever was significant for the LR group with an adjusted OR of 1.24 (95%CI, 1.11-4.57; p = 0.025) and myalgia for the HR group with an adjusted OR of 2.07 (95%CI, 1.13-3.81; p = 0.019)., Conclusion: Notable proportions of seropositivity were seen in all occupational groups between January and September 2021 prior to mass vaccination. Loss of taste and/or smell was strongly associated with presence of anti-SARS-CoV-2 IgG antibodies irrespective of presumed occupational exposure risk., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Leon-Rojas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this research, the ongoing COVID-19 disease by considering the vaccination strategies into mathematical models is discussed. A modified and comprehensive mathematical model that captures the complex relationships between various population compartments, including susceptible (Sα), exposed (Eα), infected (Uα), quarantined (Qα), vaccinated (Vα), and recovered (Rα) individuals. Using conformable derivatives, a system of equations that precisely captures the complex interconnections inside the COVID-19 transmission. The basic reproduction number (R0), which is an essential indicator of disease transmission, is the subject of investigation calculating using the next-generation matrix approach. We also compute the R0 sensitivity indices, which offer important information about the relative influence of various factors on the overall dynamics. Local stability and global stability of R0 have been proved at a disease-free equilibrium point. By designing the finite difference approach of the conformable fractional derivative using the Taylor series. The present methodology provides us highly accurate convergence of the obtained solution. Present research fills research addresses the understanding gap between conceptual frameworks and real-world implementations, demonstrating the vaccination therapy's significant possibilities in the struggle against the COVID-19 pandemic., Competing Interests: NO authors have competing interests., (Copyright: © 2024 Zanib et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Despite the worsening health disparities among youth in detention during the COVID-19 pandemic, there has been minimal exploration into the pandemic experiences of detained youth and opportunities for pandemic mitigation. This paper analyzes the perspectives of youth in detention on the pandemic, including the effect of the pandemic on their detention experience and their perceptions about COVID-19 vaccination. The study used purposive sampling to recruit 16 participants (aged 14-17 years) from two juvenile detention centers in the urban Midwest. We conducted semi-structured interviews and analyzed verbatim transcripts using a hybrid deductive-inductive approach and thematic analysis. Four themes emerged: 1) personal experience influenced youth perceptions of pandemic severity and risk; 2) distrust and misconceptions contributed to youth vaccine hesitancy or refusal; 3) desired opportunities and parental opinion motivated youth to get the COVID-19 vaccine; and 4) pandemic mitigation strategies negatively impacted youths' detention center experience. Study findings identify opportunities for detention centers to minimize the negative impacts of pandemic mitigation strategies on youth in detention, expand vaccination knowledge and uptake, and build trust to positively impact the health and wellbeing of detained youth currently and during future pandemics., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 McNeill-Johnson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The epidemiology of COVID-19 has substantially changed since its emergence given the availability of effective vaccines, circulation of different viral variants, and re-infections. We aimed to develop models to predict 30-day COVID-19 hospitalization and death in the Omicron era for contemporary clinical and research applications., Methods: We used comprehensive electronic health records from a national cohort of patients in the Veterans Health Administration (VHA) who tested positive for SARS-CoV-2 between March 1, 2022, and March 31, 2023. Full models incorporated 84 predictors, including demographics, comorbidities, and receipt of COVID-19 vaccinations and anti-SARS-CoV-2 treatments. Parsimonious models included 19 predictors. We created models for 30-day hospitalization or death, 30-day hospitalization, and 30-day all-cause mortality. We used the Super Learner ensemble machine learning algorithm to fit prediction models. Model performance was assessed with the area under the receiver operating characteristic curve (AUC), Brier scores, and calibration intercepts and slopes in a 20% holdout dataset., Results: Models were trained and tested on 198,174 patients, of whom 8% were hospitalized or died within 30 days of testing positive. AUCs for the full models ranged from 0.80 (hospitalization) to 0.91 (death). Brier scores were close to 0, with the lowest error in the mortality model (Brier score: 0.01). All three models were well calibrated with calibration intercepts <0.23 and slopes <1.05. Parsimonious models performed comparably to full models., Conclusions: We developed prediction models that accurately estimate COVID-19 hospitalization and mortality risk following emergence of the Omicron variant and in the setting of COVID-19 vaccinations and antiviral treatments. These models may be used for risk stratification to inform COVID-19 treatment and to identify high-risk patients for inclusion in clinical trials., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

During the COVID-19 pandemic in Norway, the testing criteria and capacity changed numerous times. In this study, we aim to assess consequences of changes in testing criteria for infectious disease surveillance. We plotted the proportion of positive PCR tests and the total number of PCR tests for different periods of the pandemic in Norway. We fitted regression models for the total number of PCR tests and the probability of positive PCR tests, with time and weekday as explanatory variables. The regression analysis focuses on the time period until 2021, i.e. before Norway started vaccination. There were clear changes in testing criteria and capacity over time. In particular, there was a marked difference in the testing regime before and after the introduction of self-testing, with a drastic increase in the proportion of positive PCR tests after the introduction of self-tests. The probability of a PCR test being positive was higher for weekends and public holidays than for Mondays-Fridays. The probability for a positive PCR test was lowest on Mondays. This implies that there were different testing criteria and/or different test-seeking behaviour on different weekdays. Though the probability of testing positive clearly changed over time, we cannot in general conclude that this occurred as a direct consequence of changes in testing policies. It is natural for the testing criteria to change during a pandemic. Though smaller changes in testing criteria do not seem to have large, abrupt consequences for the disease surveillance, larger changes like the introduction and massive use of self-tests makes the test data less useful for surveillance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Engebretsen, Aldrin. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Corticosteroids can reduce the mortality rate among patients with severe COVID-19 pneumonia. However, opportunistic infections such as Mycobacterium tuberculosis are of concern, especially among those on high doses of corticosteroids. It is unknown whether the risk of developing subsequent TB infection is high or not among COVID-19 patients on high doses of corticosteroids. Hence, this study was conducted to address this gap of knowledge. We conducted a retrospective, cross-sectional study at the King Chulalongkorn Memorial Hospital from October 12, 2022 to June 30, 2023. Two hundred forty-three participants with documented COVID-19 diagnosis on high dose corticosteroids were enrolled into the study. Baseline characteristics and risk factors of developing TB were collected. The prevalence of TB was significantly different among participants with chronic kidney disease (CKD) stages 2-4 and chronic lung diseases. The incidence of TB post 1-year diagnosis of COVID-19 was 4 out of 243 patients (1.6%) or 1,646 cases per 100,000 person-year. The mortality rate among subsequent TB group was significantly much higher than the non-TB group (50% vs 0.4%; p-value = 0.001). COVID-19 participants on high doses of corticosteroids also were co-infected with other infections such as bacteria (37.1%), fungi (5.3%), and Pneumocystis jirovecii (PJP) (1.2%). We found that the incidence of TB in participants with COVID-19 on high doses of corticosteroids was 11 times higher than the general population. Therefore, we recommend screening for latent TB among these patients to prevent/early diagnose TB disease., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Praphakornmano et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

To effectively respond to an emerging infectious disease outbreak, policymakers need timely and accurate measures of disease prevalence in the general population. This paper presents a new methodology to estimate real-time population infection rates from non-random testing data. The approach compares how the observed positivity rate varies with the size of the tested population and applies this gradient to infer total population infections. Applying this methodology to daily testing data across U.S. states during the first wave of the COVID-19 pandemic, we estimated widespread undiagnosed COVID-19 infections. Nationwide, we found that for every identified case, there were 12 population infections. Our prevalence estimates align with results from seroprevalence surveys, alternate approaches to measuring COVID-19 infections, and total excess mortality during the first wave of the pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Benatia et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The complex effects of Long-COVID, a syndrome marked by enduring symptoms after COVID-19 infection, with an emphasis on patients' differing degrees of fibro fatigue (FF). Electrolyte disturbances may affect the severity of FF and may be used as a predictive tool for severe FF in Long-COVID patients., Objective: The aim is to use the electrolyte levels for prediction of the Long-COVID patients with high FF levels., Methods: The electrolyte levels, calcium, and magnesium, as well as albumin and C-reactive protein levels were measured in 120 Long-COVID patients and 60 controls. FF scale was used for scoring the fatigue severity in all subjects. Patients were divided into high-FF (FF score>25) and moderate-FF group (FF score<25)., Results: FF is the major effector on the serum biomarker levels. High-FF group had older people, longer disease durations, lower SpO2, higher CRP, and higher peak temperatures than the control group. High-FF group has a significant decrease in serum total and ionized calcium compared with the controls and low-FF group. After controlling the cofounders, the major factor controlling the levels of the measured biomarkers is the FF value (Partial η2 = 0.468). The ROC-AUC analysis showed that the peak body temperature, Low-SpO2, high-CRP, and low electrolytes can predict the high-FF in a patient with Long-COVID with a moderate sensitivity and specificities (61.6-70%)., Conclusion: Long-COVID patients have an elevation in FF score. The decline in electrolytes can predict the severity of FF with moderate sensitivities and specificities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Al Masoodi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Cognitive difficulties are reported as lasting sequelae within post COVID-19 condition. However, the chronicity of these difficulties and related factors of fatigue, mood, and perceived health have yet to be fully determined. To address this, the current longitudinal study aimed to clarify the trends of cognitive test performance and cognitive domain impairment following COVID-19 onset, and whether hospitalization influences outcomes. 57 participants who reported subjective cognitive difficulties after confirmed COVID-19 infection were assessed at baseline (~6 months post COVID-19) and follow-up (~15 months later) visits. Assessments included measures across multiple cognitive domains and self-report questionnaires of fatigue, mood, and overall health. Analyses were conducted in three stages: at the test score level (raw and adjusted scores), at the cognitive domain level, and stratified by hospitalization status during infection. Results at the test-score level indicate that cognitive performance remains relatively stable across assessments at the group level, with no significant improvements in any adjusted test scores at follow-up. Cognitive domain analyses indicate significant reductions in attention and executive functioning impairment, while memory impairment is slower to resolve. On self-report measures, there was a significant improvement in overall health ratings at follow-up. Finally, those hospitalized during infection performed worse on timed cognitive measures across visits and accounted for a larger proportion of cases with short-term and working memory impairment at follow-up. Overall, our findings indicate that cognitive difficulties persist both at test score and cognitive domain levels in many cases of post COVID-19 condition, but evidence suggests some improvement in global measures of attention, executive functioning and overall self-rated health. Furthermore, an effect of hospitalization on cognitive symptoms post COVID-19 may be more discernible over time., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Grunden et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Long Covid is a chronic disease that affects more than 65 million people worldwide, characterized by a wide range of persistent symptoms following a Covid-19 infection. Previous studies have investigated potential risk factors contributing to elevated vulnerability to Long Covid. However, research on the social traits associated with affected patients is scarce. This study introduces an innovative methodological approach that allows us to extract valuable insights directly from patients' voices. By analyzing written texts shared on social media platforms, we aim to collect information on the psychological aspects of people who report experiencing Long Covid. In particular, we collect texts of patients they wrote BEFORE they were afflicted with Long Covid. We examined the differences in communication style, sentiment, language complexity, and psychological factors of natural language use among the profiles of 6.107 Reddit users, distinguishing between those who claim they have never contracted Covid -19, those who claim to have had it, and those who claim to have experienced Long Covid symptoms. Our findings reveal that people in the Long Covid group frequently discussed health-related topics before the pandemic, indicating a greater focus on health-related concerns. Furthermore, they exhibited a more limited network of connections, lower linguistic complexity, and a greater propensity to employ emotionally charged expressions than the other groups. Using social media data, we can provide a unique opportunity to explore potential risk factors associated with Long Covid, starting from the patient's perspective., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Segneri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The SARS-CoV-2 pandemic has caused unprecedented worldwide infections from persistent mutant variants with various degrees of infectivity and virulence. The elusiveness of a highly penetrant, worldwide vaccination strategy suggests that the complete eradication of SARS-CoV-2 is unlikely. Even with the advent of new antiviral agents, the disease burden worldwide continues to exceed current preventative and therapeutic strategies. Greater interest has been placed towards the development of affordable,broadly effective antiviral therapeutics. Here, we report that the small branched-chain fatty acid Valproic acid (VPA), approved for maintenance of seizure and bipolar disorder, has a novel anti- coronavirus activity that can be augmented with the addition of a long-chain, polyunsaturated omega-3 fatty acid, Docosahexaenoic acid (DHA). An EMR-based epidemiological study of patients tested for COVID-19 demonstrated a correlation exists between a reduced infection rate in patients treated withVPA of up to 25%, as well as a decreased risk of emergency room visits, hospitalization, ICU admission,and use of mechanical ventilation. In vitro studies have demonstrated that VPA modifies gene expression in MRC5 cells. Interestingly, VPA correlates with the inhibition of several SARS-CoV2 interacting genes and the greater inhibition of alpha-coronavirus HCoV-229E (a "common cold" virus) and SARS-CoV2. The VPA-DHA combination activates pre-existing intracellular antiviral mechanisms normally repressed by coronaviruses. Gene expression profiles demonstrate subtle differences in overall gene expression between VPA-treated and VPA-DHA-treated cells. HCoV-229E infection caused an intensely different response with a marked induction of multiple intracellular inflammatory genes. Changes in gene expression took at least 24 hours to manifest and most likely why prior drug screens failed to identify any antiviral VPA activity despite in silico predictions. This report demonstrates an interaction between HDAC inhibition and the potent activation of cellular antiviral responses. A foundation now exists for a low-cost, highly effective antiviral strategy when supplemented with DHA., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Watson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

On the 11th of March 2020, the world faced a new global pandemic, COVID-19 which is a disease caused by the novel coronavirus, it had multiple devastating outcomes on multiple sectors along with significant rates of mortality. These challenges encouraged the development of multiple testing methods, as well as anti-viral medications such as Molnupiravir, as well as evaluating the efficacy of available medications against it, like; Azithromycin, Ritonavir and Hydroxychloroquine. Vaccination against COVID-19 forged into a significant challenge, few months ensuing the first case of SARS-CoV-2, which was diagnosed in December 2019, in Wuhan-China, thus, multiple vaccines were approved for use around the world to combat this pandemic. Our study includes a sample of 556 oncology patients at Augusta Victoria Hospital in Jerusalem, all patients were tested using Panbio rapid antigen test and Allplex PCR Assay. The main objective was to study the sensitivity and specificity of Rapid antigen test, which contributes to a faster isolation call and management of infected patients, thus decreasing the risk on spread to other patients and health care. Patients were categorized based on two factors: Ct range and age group and studying their possible effect on false-negative results. Patients with Ct value less than 20, had the highest detection rate which is consistent with other studies in the literature. The sensitivity and specificity of Panbio Rapid Antigen testing were of 69.9% and 100%, respectively. A correlation between age group and false negative results could not be made, but a correlation between Ct value and false negative result was noticed, Ct value was directly related to false negative results. P-value of 0.007 indicated that results were statistically significant where PCR test is considered more sensitive compared to rapid antigen test., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sabateen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Obesity and COVID-19 are at the top of nowadays health concerns with significant crosstalk between each other. The COVID-19 pandemic negatively affected healthy lifestyles and increased obesity prevalence. Thus, there was a surge in anti-obesity products (AOPs) intake. Herein, we evaluated how the pandemic has affected slimming products' efficacy and safety in patients seeking weight reduction at an urban, weight management centre in Alexandria, Egypt. In addition, the effect of AOPs on COVID-19 infection severity was also appraised to detect whether AOPs can alter COVID-19 host cell entry and infective mechanisms, and thus, affect infection severity., Methods: Patients were invited to complete an anonymous survey. The survey assessed self-reported changes in weight, the use of AOPs during the COVID-19 pandemic, COVID-19 infection severity, AOPs efficacy, and incidence of side effects. Inclusion criteria were obese patients above 18 years old who got infected by COVID-19 while receiving a single-ingredient AOP., Results: A total of 462 participants completed our anonymous validated questionnaire. Most of the participants were females (450; 98.4%) with BMI ranging from 24.98-58.46. Eligible participants were only 234 and the top-administered products were orlistat, liraglutide, metformin, green tea, cinnamon, Garcinia cambogia, and Gymnema Sylvestre. In most cases, AOPs intake was beneficial for COVID-19 infection, and most patients experienced mild-to-moderate COVID-19 symptoms. On the other hand, SARS-CoV-2 significantly interferes with AOPs' mechanisms of action which positively or negatively influences their efficacy and side effects incidence due to predictable pharmacological link., Conclusion: Concurrent AOPs intake with COVID-19 infection is a two-sided weapon; AOPs attenuate COVID-19 infection, while SARS-CoV-2 interferes with efficacy and side effects incidence of AOPs., Competing Interests: NO authors have competing interests, (Copyright: © 2024 El-Mezayen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The diverse manifestations of Long-COVID have become increasingly important due to their significant impact on patients' lives. Telemedicine has emerged as an important tool for post COVID-19 follow-up. This study is part of a large cohort study involving COVID-positive patients monitored by the COD19 telemedicine platform operations center. We recontacted patients who were initially monitored from February 2020 to May 2020 to assess the presence of Long-COVID symptoms at a 2-year follow-up., Methods: We conducted interviews to evaluate Long-COVID symptoms at the 2-year mark and investigated whether patients had contracted a second COVID-19 infection between the 1-year and 2-year follow-ups, and recorded their vaccination status., Results: Out of 165 patients, 139 (84%) reported symptoms at the 1-year follow-up, while only 101 (61%) reported symptoms at the 2-year follow-up. Among patients with Long-COVID symptoms at the 2-year follow-up, the majority (80, 49%) had experienced Long-COVID at the 1-year follow-up, received the SARS-CoV-2 vaccine, and had not experienced a second infection between the two follow-ups. Both having Long-COVID at the 1-year follow-up and contracting a second infection were significant risk factors for presenting with Long-COVID at the 2-year follow-up., Conclusions: To the best of our knowledge, this study stands out as one of the few that includes a 2-year follow-up on Long-COVID symptoms using telemedicine. Telemedicine has proven to be an effective and innovative tool for long-term patient monitoring, early diagnosis, and treatment. Telemedicine represents a significant future challenge for healthcare., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Foppiani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

COVID-19 disproportionately affected minorities, while research barriers to engage underserved communities persist. Serological studies reveal infection and vaccination histories within these communities, however lack of consensus on downstream evaluation methods impede meta-analyses and dampen the broader public health impact. To reveal the impact of COVID-19 and vaccine uptake among diverse communities and to develop rigorous serological downstream evaluation methods, we engaged racial and ethnic minorities in Massachusetts in a cross-sectional study (April-July 2022), screened blood and saliva for SARS-CoV-2 and human endemic coronavirus (hCoV) antibodies by bead-based multiplex assay and point-of-care (POC) test and developed across-plate normalization and classification boundary methods for optimal qualitative serological assessments. Among 290 participants, 91.4% reported receiving at least one dose of a COVID-19 vaccine, while 41.7% reported past SARS-CoV-2 infections, which was confirmed by POC- and multiplex-based saliva and blood IgG seroprevalences. We found significant differences in antigen-specific IgA and IgG antibody outcomes and indication of cross-reactivity with hCoV OC43. Finally, 26.5% of participants reported lingering COVID-19 symptoms, mostly middle-aged Latinas. Hence, prolonged COVID-19 symptoms were common among our underserved population and require public health attention, despite high COVID-19 vaccine uptake. Saliva served as a less-invasive sample-type for IgG-based serosurveys and hCoV cross-reactivity needed to be evaluated for reliable SARS-CoV-2 serosurvey results. The use of the developed rigorous downstream qualitative serological assessment methods will help standardize serosurvey outcomes and meta-analyses for future serosurveys beyond SARS-CoV-2., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Binder et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Mental health and substance use challenges are highly correlated in youth and have been speculated to be associated with COVID-19 vaccine hesitancy. Literature has also suggested that mental health challenges in youth have increased during the COVID-19 pandemic. However, the longitudinal relationship between mental health challenges in youth and COVID-19 vaccine hesitancy is not well established., Objective: We examined the relationship between mental health, substance use and COVID-19 vaccine hesitancy in youth during the COVID-19 pandemic., Methods: Youth ages 14 to 29-years participated in a longitudinal survey study. Participants provided sociodemographic, mental health, and substance use data, as well as qualitative and quantitative information on their vaccine perspectives every two months between February 2021 to August 2021, and on February 2022. Generalized estimating equation logistic regression models were used to analyze the effect of mental health and substance use on vaccine hesitancy over time. Qualitative content area analyses were used to identify trends in vaccine attitudes., Results: Mental health challenges and substance use frequency were associated with vaccine hesitancy, and significantly increased the odds of vaccine hesitancy over time. Additionally, mental health challenges were associated with decreases in vaccine hesitancy (OR: 0.80 (95% CI 0.66, 0.97)) when vaccines first began to emerge, but increases in vaccine hesitancy (OR: 1.72 (95% CI 1.32, 2.26)) one year later. Participants reported perceptions regarding vaccine safety and efficacy were the primary determinants influencing hesitant, uncertain, and acceptant vaccine attitudes. Additionally, changes in vaccine attitudes over time for some participants, were associated with changes in mental health., Conclusions: Increases in mental health challenges and substance use were associated with increases in COVID-19 vaccine hesitancy in youth over the COVID-19 pandemic. Health policy agencies should be aware of the potential impact of mental health challenges and substance use in youth, when developing vaccine policy and programs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Everest et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Ensuring effective access to vaccinations for people experiencing homelessness is crucial to protecting the health of a vulnerable, yet often overlooked population. Reaching this goal takes more than a one size fits all approach. This study evaluates how a dedicated health team collaborated with multiple agencies to register and deliver the COVID-19 vaccine to people experiencing homelessness., Methods: This is a mixed methods study co-designed with the Adult Homeless Integrated Team, a multi-disciplinary team who work with local agencies to provide care to people experiencing homelessness in Cork, Ireland's second largest city. Quantitative data collected at the point of vaccine registration described socio-demographics of the population. To explain the quantitative findings, eleven agencies involved in provision of homeless services were invited to participate in interviews. A manager in each of the agencies acted as a gatekeeper to clients. Interviews explored experiences with the pandemic and the delivery (staff) or receipt (clients) of the COVID-19 vaccine. Interviews were recorded and transcribed, transcriptions were thematically analysed., Results: There were 728 vaccine doses administered to people experiencing homelessness during the first roll-out of vaccines; 401 first doses and 325 second doses. Of those who received a vaccine, the majority were male (76%), and more than half were Irish (55%). Ten semi-structured interviews, seven staff members and three clients, were conducted. There were three themes that provided further insights into the quantitative findings: Adapting to unprecedented times, Misinformation causing vaccine hesitancy and The importance of building relationships., Conclusions: This study provides valuable insights into how a multidisciplinary approach resulted in a successful well received vaccination programme among a traditionally hard to reach group., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Phillips et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: There is a paucity of research regarding COVID-19 vaccines administration errors (VAEs) during the COVID-19 pandemic. This study aimed to investigate the prevalence, types, severity, causes and predictors of VAEs in Jordan during the recent pandemic., Method: This was a 3-day (Sunday, Tuesday and Thursday of the third week of November 2021) prospective, covert observational point prevalence study. It involved direct observation of vaccination administration practices by covert observers who recorded data on a standardized form, documenting the administration process, observed errors, and contextual factors, such as workload, distractions, and interruptions directly after each observation. Univariate and multivariable logistic models were constructed in order to identify predictors of VAEs., Results: The point prevalence of VAEs was 2.4% (209 errors / 8743 vaccine doses). These VAEs were categorized into six types: timing (interval) error (69, 33.0%) dosing error (60, 28.7%), incorrect vaccine product (42, 20.1%), site/route error (17, 8.1%), documentation error (15, 7.2%), and other (6, 2.9%). Most errors were minor (133, 63.6%) and moderate (63, 30.1%). There were 174 (54.9%) healthcare provider-related contributing factors and 102 (32.2%) patient-related factors. Receiving the vaccine in the Southern region compared to Capital region (aOR: 1.92; 95% confidence intervals, 95%CI: 1.41-2.49; p = 0.001) and receiving the vaccine during peak hours compared to regular hours (aOR: 2.18; 95%CI: 1.58-3.86; p = 0.002) were significant predictors of VAEs., Conclusion: Though infrequent, VAEs had prevalence higher than previously reported in the literature, posing serious public health challenges, which might have compromised immunization efficacy and patient safety. Identifying these errors' causes and formulating strategies to reduce them is crucial for enhancing vaccination results., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2025 Abdel-Qader et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: To optimize vaccination strategies, it is useful to detect breakthrough infections and assess vaccine effectiveness in programmatic use. Monitoring emerging SARS-CoV-2 variants and vaccine effectiveness against them is also essential to determine the most effective vaccine options. This study aims to monitor SARS-CoV-2 breakthrough infections, the emergence of new SARS-CoV-2 variants, and host immune response during the peri-infection period of COVID-19. The study will also assess the uptake of the COVID-19 vaccine booster doses, and associated barriers or motivations among healthcare workers (HCWs)., Methods: Leveraging an existing HCW cohort in Bangladesh, HCWs will be enrolled from purposively selected health facilities from four different administrative divisions across Bangladesh. We captured cohort data on HCW's demographic information, clinical information, COVID-19 illness, and exposure, and vaccination histories for COVID-19. However, no biological specimens were collected for testing during the first phase of the cohort. In the current study, we plan to follow enrolled HCWs biweekly for suspected COVID-19 illness and capture relevant data including illness outcomes. Respiratory swab samples from symptomatic and a subset of asymptomatic HCWs will be tested for SARS-CoV-2 by rRT-PCR and positive samples will undergo Sanger sequencing to identify the SARS-CoV-2 variants of concern (VOCs). We will also perform Whole Genome Sequencing on a subset of SARS-CoV-2 positive samples with low CT values (Ct ≤ 30) to identify emerging SARS-CoV-2 variants. To examine the antibody response, we will collect blood samples from the participants at 12-week intervals for one year. We will use the EUROIMMUN kit and will also perform in-house ELISA to assess host immune factors with Luminex platform., Discussion: This proposed study will generate useful data on COVID-19 breakthrough infection and the durability of anti-SARS-CoV-2 antibodies among HCWs following vaccination. The findings on booster vaccination intention and uptake will inform government COVID-19 vaccination strategies. Information on circulating and emerging strains of SARS-CoV-2 and vaccine performance against those strains will help understand population-level risks of COVID-19 infection. The study will generate data on facilitators and barriers to COVID-19 booster uptake among HCWs which can inform health communication messaging to improve booster acceptance in this population., Competing Interests: All the authors report no conflicts of interest., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

To prevent widespread epidemics such as influenza or measles, it is crucial to reach a broad acceptance of vaccinations while addressing vaccine hesitancy and refusal. To gain a deeper understanding of Japan's sharp increase in COVID-19 vaccination coverage, we performed an analysis on the posts of Twitter users to investigate the formation of users' stances toward COVID-19 vaccines and information-sharing actions through the formation. We constructed a dataset of all Japanese posts mentioning vaccines for five months since the beginning of the vaccination campaign in Japan and carried out a stance detection task for all the users who wrote the posts by training an original deep neural network. Investigating the users' stance formations using this large dataset, it became clear that some neutral users became pro-vaccine, while almost no neutral users became anti-vaccine in Japan. Our examination of their information-sharing activities during a period prior to and subsequent to their stance formation clarified that users with certain types and specific types of websites were referred to. We hope that our results contribute to the increase in coverage of 2nd and further doses and following vaccinations in the future., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Cho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Lung cancer, one of the leading causes of death due to neoplasms, requires prompt diagnosis and immediate treatment. The COVID-19 pandemic affected healthcare systems worldwide, having adverse effects on all aspects, particularly on the fate of patients with suspected neoplastic diseases. Limited access to healthcare, disruptions in regular operations (reassigning roles to some wards), postponed hospital admissions, prolonged diagnostic processes, and other factors have collectively led to the phenomenon known as COVID-19 debt., Material and Methods: A retrospective analysis covered statistical data concerning the diagnosis of lung cancer obtained from three centres in northern Poland (Olsztyn, Bydgoszcz, Gdansk) and concerning years 2016 to 2022. Relative risks (RR) with 95% confidence intervals (CI) for cancer event were calculated. Before the pandemic, these centers prioritized the diagnosis of suspected lung cancer cases, which was subsequently disrupted during the pandemic due to various factors., Results: The COVID-19 pandemic led to a decrease in diagnosed lung cancer cases, especially in hospitals repurposed for COVID-19 care. A statistically significant trend in lung cancer incidence per 100,000 inhabitants was observed specifically in healthcare centers that maintained normal operations without disruption., Conclusion: The concept of the COVID debt helps explain changes in lung cancer diagnosis during and post-pandemic, highlighting the need for increased public awareness and intensified diagnostic efforts to facilitate earlier disease detection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Romaszko-Wojtowicz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Developing intranasal vaccines against pandemics and devastating airborne infectious diseases is imperative. The superiority of intranasal vaccines over injectable systemic vaccines is evident, but developing effective intranasal vaccines presents significant challenges. Fusing a protein antigen with the catalytic domain of cholera toxin (CTA1) and the two-domain D of staphylococcal protein A (DD) has significant potential for intranasal vaccines. In this study, we constructed two fusion proteins containing CTA1, tandem repeat linear epitopes of the SARS-CoV-2 spike protein (S14P5 or S21P2), and DD. Structural predictions indicated that each component of the fusion proteins was compatible with its origin. In silico analyses predicted high solubility for both fusion proteins when overexpressed in Escherichia coli. However, contrary to these predictions, the constructs exhibited limited solubility. Lowering the cultivation temperature from 37°C to 18°C did not improve solubility. Inducing expression with IPTG at the early log phase significantly increased soluble CTA1-(S21P2)4-DD but not CTA1-(S14P5)4-DD. Adding non-denaturing detergents (Nonidet P40, Triton X100, or Tween 20) to the extraction buffer significantly enhanced solubility. Despite this, purification experiments yielded low amounts, only 1-2 mg/L of culture, due to substantial losses during the purification stages. These findings highlight the challenges and potential strategies for optimizing soluble expression of CTA1-DD fusion proteins for intranasal vaccines., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tarigan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: COVID-19 infection and vaccination have been reported to confer an elevated risk for cardiovascular events (CVE). We sought to determine whether individuals with an underlying vascular connective tissue disorder including Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS), or vascular Ehlers Danlos syndrome (vEDS) are at increased risk for cardiac events after COVID-19 infection or vaccination., Methods: 325 respondents self-reported data through a cross-sectional, web-based survey available from 22 November 2021, through 15 March 2022 regarding COVID-19 illness and vaccinations, the occurrence of any CVE, and adverse events following vaccination. The data were analyzed using a Cox proportional hazards model with time varying indicators for COVID-19 illness/vaccination in the preceding 30 days., Results: COVID-19 illness was significantly associated with an increased rate of a new abnormal heart rhythm 30 days following infection. No other CVEs were reported in the 90 days after COVID-19 illness. We did not find evidence of an increased rate of any CVE in the 30 days following any COVID-19 vaccination dose., Conclusion: In respondents with MFS, LDS, or vEDS, we uncovered no evidence of an increase in CVEs in the 30 days following COVID-19 illness, with the possible exception of dysrhythmia. In light of the absence of a substantial increase in self-reported CVEs in the 30 days following COVID-19 vaccination, these data are in keeping with the recommendation from the Marfan Foundation Professional Advisory Board that all eligible persons be vaccinated for COVID-19., Competing Interests: NO authors have competing interests, (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

The coronavirus disease (COVID-19) pandemic has spread in the US with more than 100 million human infections and a million deaths since March 2020. A population of concern are high-risk individuals such as adults who are tobacco users, since COVID-19 is a respiratory disease that affects the lungs. Although 79% of the US population ≥ 18 years of age have completed the primary COVID-19 vaccine series; it is imperative to understand the factors associated with receiving or declining the COVID-19 vaccine among high-risk populations to improve vaccination rates. Guided by the diffusion of innovations (DOI) theory, this study identified factors associated with COVID-19 vaccination and the impact on COVID-19 vaccine uptake in adults who use tobacco. We conducted a cross-sectional study using a sample of Pennsylvanian adult tobacco users by sending a unique survey link to 4,081 email addresses in April 2022. Participants were asked about tobacco use, COVID-19 vaccination status, and reasons for receiving/declining the COVID-19 vaccine. Participants (n = 157) were 75% female, 96% White, 74% current tobacco users, and had a mean age of 50.1 (SD = 10.8) years. Nearly 78% (n = 119) received at least one dose of the COVID-19 vaccine (primary series). We categorized all vaccinated tobacco users into adopter categories of the DOI theory; innovators (10%), early adopters (14%), early majority (33%), late majority (11%), and laggards (32%). The major reason that prompted participants to get the COVID-19 vaccine was to ensure they were well protected against COVID-19 infection (77%). Additionally, the only reason for receiving the vaccine that significantly predicted early vaccine uptake (being an innovator or early adopter) was "to loosen restrictions on mask mandates and social/physical distancing" (p = 0.0180). Among the 22% that did not receive a COVID-19 vaccine, the most common major reason they declined the vaccine was because they felt politics played a big role in the vaccine development process (94%). Our findings suggest that major f actors that influenced why adult tobacco users would receive or decline the COVID-19 vaccine included infection control mandates, protection from the COVID-19 infection, and politics. Investigating these factors can help public health professionals design or develop future vaccination programs for high-risk populations in order to scale up vaccination rates., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 D’Souza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The COVID-19 pandemic impacted the world in every aspect. Higher institutions were greatly affected because the outbreak disrupted the teaching and learning structure. Vaccines decrease the rate of infection and transmission of the virus, but the presence of some myths has led to hesitancy towards the vaccine., Objective: The purpose of the survey was to assess the knowledge, perception, and acceptance of the COVID-19 vaccine among undergraduate students in Enugu State, Nigeria., Methods: This was a cross-sectional study carried out among undergraduate students at the University of Nigeria Nsukka (UNN), the Institute of Management and Technology (IMT), and Enugu State University of Technology Enugu state (ESUT), Nigeria between March and November 2023. These institutions were chosen based on their large student populations, diverse academic offerings, and significant geographical coverage within the state. Data collection was done using a 26-item validated self-administered questionnaire. Statistical Product and Service Solutions (SPSS) version 25 with appropriate descriptive (frequency and percentage) and inferential statistics (Chi-square) were used to analyze the data., Results: 1,143 completed questionnaires were obtained. The modal age range was 18-24 years accounting for 814 (71.2%) of the participants. A total of 577 (50.5%) participants demonstrated a good level of knowledge while 685 (59.9%) showed a positive perception of the COVID-19 vaccine. Gender (p = 0.010) and institution (p < 0.001) were associated with their perception of the COVID-19 vaccine. In addition, knowledge and perception of the COVID-19 vaccine were significantly associated with its acceptance at p = 0.038 and < 0.001, respectively., Conclusion: This study reveals that COVID-19 vaccine acceptance among university students in Enugu State, Nigeria, remains low despite moderate knowledge and generally positive attitudes, with perceptions playing a more significant role than knowledge. The findings highlight the need for educational interventions that not only provide accurate information but also actively address misconceptions. To improve vaccine uptake, public health campaigns should focus on shifting perceptions through culturally sensitive, institution-specific strategies., Competing Interests: The authors have no competing interests relevant to this article’s content., (Copyright: © 2024 Mosanya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

COVID-19 prevention measures and vaccine policies have led to substantial polarization across the world. I investigate whether and how vaccination status and vaccination status identification affect the sympathy and prejudice for vaccinated and unvaccinated individuals. Drawing on a preregistered vignette survey experiment in a large representative sample from Germany (n = 6,100) in December 2021, I show that prejudice was greater among the vaccinated towards the unvaccinated than vice versa. Furthermore, I find that differences in sympathy ratings are strongly subject to vaccination status identification. If individuals do not identify with their vaccination status, there are no differences in the evaluation of the in- and outgroups. Stronger vaccination status identification is, however, associated with greater prejudice among the vaccinated towards the unvaccinated but not for the unvaccinated towards the vaccinated. The results therefore show a stronger polarization on the side of the vaccinated that increases with the identification of one's vaccination status., Competing Interests: The author has declared that no competing interests exist., (Copyright: © 2024 Sebastian Jungkunz. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The COVID-19 pandemic has underscored the critical role of observational studies in evaluating the effectiveness of public health strategies. However, although many studies have explored the true impact of vaccination on preventive behavior, their results may be skewed by potential biases and confounding variables. This study examines the application of covariate adjustment and propensity score (PS) estimation, particularly through inverse probability treatment weighting (IPTW), to assess their performance in reducing bias in a framework featuring ordinal outcomes and cumulative logistic regression models, as commonly used in observational studies related to social sciences and psychology. Before applying these methods to the case study, we conducted a simulation study that accounted for the presence or absence of model misspecification in an observational scenario with ordinal outcomes, binary treatment, and a continuous confounder. Our findings demonstrate the effectiveness of combining covariate adjustment with PS methods in reducing bias and improving causal inference. These methods were subsequently applied to an Italian observational study on COVID-19 vaccine hesitancy conducted during the initial phase of the vaccination campaign (April-May 2021). Our analysis revealed that vaccination status had a limited short-term impact on the adoption of preventive measures. This study highlights the importance of employing appropriate adjustment techniques in observational research, particularly when evaluating complex behavioral outcomes. The results support the combined use of covariate adjustment and PS methods to enhance the reliability of findings, ultimately contributing to more informed public health decision-making., Competing Interests: All authors declare that they have no competing interests to be disclosed., (Copyright: © 2024 Sità et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Immune thrombocytopenic purpura (ITP) is a disease characterized by a decrease in platelet count, which can be triggered by various factors, including viral infections and vaccination. With the widespread vaccination against COVID-19, concerns have arisen regarding a possible link between the vaccine and the exacerbation of ITP. This study aims to comprehensively evaluate the impact of COVID-19 vaccination on ITP patients, including associated risks and outcomes., Methods: A comprehensive search will be conducted in multiple electronic databases (including PubMed, Web of Science, EMBASE, Cochrane Library, CNKI, Wan Fang, VIP, and CBM) to identify relevant studies. This study will include randomized controlled trials, cohort studies, case-control studies, and case series evaluating the impact of COVID-19 vaccination on ITP patients. The primary outcome measure is the change in platelet count, while secondary outcome measures include the occurrence of thromboembolic events, bleeding complications, ITP recurrence rate, impact of ITP exacerbation, and adverse events. Data will be summarized and analyzed using Review Manager Software (RevMan) V.5.4. In addition, subgroup analyses will be performed to explore potential sources of heterogeneity., Results: It is anticipated that different types of COVID-19 vaccines may have varying impacts on ITP patients, leading to potential differences in outcomes. This study aims to comprehensively evaluate the potential impact of COVID-19 vaccination on ITP patients and provide reference for clinical decision-making., Conclusions: The results of this systematic review and meta-analysis will provide crucial information on COVID-19 vaccination for ITP patients and clinicians, contributing to guiding vaccination decisions and monitoring potential impacts after vaccination., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Evidence fails to capture disparities amongst African countries in terms of the measure of administered COVID-19 vaccine doses per 100 people. Assessment of data on doses secured, administered, and supplied was undertaken to investigate quantitative measures that impacted COVID-19 vaccine deployment, thereby emphasizing distribution and supply indicators. We employ a full linear regression to identify independent variables that have an impact on vaccination rates, including macroeconomic indicators such as World Bank Income Classification, Gross Domestic Product (GDP) per capita and various indices such as Health Access and Quality Index, Human Development Index, Global Peace Index, Education Index, Political Stability Index and Government Effectiveness. This analysis aims to construct a statistical model utilizing regression analysis to identify key drivers of COVID-19 vaccine deployment in Africa and offer insights into vaccination disparities in the continent. Recognizing the global importance of achieving high vaccination rates, the study sheds light on specific challenges faced by individual countries within Africa, thereby emphasizing the need for tailored efforts. Beyond COVID-19, the research contributes to understanding the relationship between vaccination rates and social indicators that, potentially impact broader public health concerns and global vaccination programs. This study provides a foundation for informed policymaking to enhance vaccine accessibility, inform targeted programs, and improve individual health systems, thereby addressing broader implications for global health., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ezezika et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The aim of this study was to assess the seroconversion rate and percent inhibition of neutralizing antibodies against the wild-type and Omicron variants of SARS-CoV-2 in patients with solid cancer who received two COVID-19 vaccine doses by comparing chemotherapy and nonchemotherapy groups., Methods: This prospective cohort study enrolled 115 cancer patients from Maharaj Nakorn Chiang Mai Hospital, Sriphat Medical Center, Faculty of Medicine, Chiang Mai University, and Chiang Mai Klaimor Hospital, Chiang Mai, Thailand, between August 2021 and February 2022, with data from 91 patients who received two COVID-19 vaccine doses analyzed. Participants received vaccines as part of their personal vaccination programs, including various mRNA and non-mRNA vaccine combinations. Blood samples were collected at baseline, on day 28, and at 6 months post-second dose to assess neutralizing antibodies. The primary outcome was the seroconversion rate against the wild-type and Omicron variants on day 28. Secondary outcomes included seroconversion at 6 months, factors associated with seroconversion, and safety., Results: Among the participants, 45% were receiving chemotherapy. On day 28, seroconversion rates were 77% and 62% for the wild-type and Omicron variants, respectively. Chemotherapy did not significantly affect seroconversion rates (p = 0.789 for wild type, p = 0.597 for Omicron). The vaccine type administered was positively correlated with seroconversion, with an adjusted odds ratio (95% confidence interval) of 25.86 (1.39-478.06) for the wild type and 17.38 (3.65-82.66) for the Omicron variant with the primary heterologous vaccine regimen. Grades 1 and 2 adverse events were observed in 34.0% and 19.7% of participants, respectively., Conclusions: Despite the lower seroconversion rate against the Omicron variant, no significant difference was observed between the chemotherapy and nonchemotherapy groups. COVID-19 vaccinations demonstrated good tolerability in this cohort. These findings highlight the importance of vaccine safety and immunogenicity in cancer patients and can inform tailored vaccination strategies for this vulnerable population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Chewaskulyong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda., Methods: This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The 'chi-square test' and 'modified Poisson regression' were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics., Results: Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1st and 2nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013)., Conclusion: Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nanteza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The unprecedented global impact of the 2019 coronavirus disease (COVID-19) has necessitated a comprehensive understanding of its transmission dynamics and control measures. In this study, we present a detailed analysis of a COVID-19 vaccination model tailored to the context of Bangladesh, incorporating dual-dose vaccination strategies. By employing qualitative and bifurcation analysis techniques, we investigate the equilibrium points, effective reproduction number (R0), and critical thresholds that influence the prevalence and control of COVID-19 in the region. Our findings reveal insights into the effectiveness of vaccination programs and provide a framework for developing targeted control plans. Through a rigorous examination of model parameters and sensitivity analysis, we identify key factors driving COVID-19 transmission dynamics, emphasizing the significance of vaccination rates and other critical parameters. The validation of our model against real-world data underscores its utility in informing evidence-based decision-making for managing the COVID-19 pandemic in Bangladesh and beyond., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Kuddus et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: After initial COVID-19, immune dysregulation may persist and drive post-acute sequelae of COVID-19 (PASC). We described longitudinal trajectories of cytokines in adults up to 6 months following SARS-CoV-2 infection and explored early predictors of PASC., Methods: RECoVERED is a prospective cohort of individuals with laboratory-confirmed SARS-CoV-2 infection between May 2020 and June 2021 in Amsterdam, the Netherlands. Serum was collected at weeks 4, 12 and 24 of follow-up. Monthly symptom questionnaires were completed from month 2 after COVID-19 onset onwards; lung diffusion capacity (DLCO) was tested at 6 months. Cytokine concentrations were analysed by human magnetic Luminex screening assay. We used a linear mixed-effects model to study log-concentrations of cytokines over time, assessing their association with socio-demographic and clinical characteristics that were included in the model as fixed effects., Results: 186/349 (53%) participants had ≥2 serum samples and were included in current analyses. Of these, 101/186 (54%: 45/101[45%] female, median age 55 years [IQR = 45-64]) reported PASC at 12 and 24 weeks after COVID-19 onset. We included 37 reference samples (17/37[46%] female, median age 49 years [IQR = 40-56]). In a multivariate model, PASC was associated with raised CRP and abnormal diffusion capacity with raised IL10, IL17, IL6, IP10 and TNFα at 24 weeks. Early (0-4 week) IL-1β and BMI at COVID-19 onset were predictive of PASC at 24 weeks., Conclusions: Our findings indicate that immune dysregulation plays an important role in PASC pathogenesis, especially among individuals with reduced pulmonary function. Early IL-1β shows promise as a predictor of PASC., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wynberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

We propose a new approach to estimate the vaccination rates required to achieve herd immunity against SARS-COV2 virus at a city level. Based on information obtained from the Israeli Ministry of Health, we estimate two separate quadratic models, one for each dose of the BNT162b2 mRNA Pfizer vaccine. The dependent variable is the scope of morbidity, expressed as the number of cases per 10,000 persons. The independent variables are the first and second vaccination rates and their squares. The outcomes corroborate that herd immunity is achieved in the case that 71 percent of the urban population is vaccinated, and the minimum anticipated scope of morbidity is approximately 5 active COVID-19 cases per 10,000 persons, compared to 53-67 cases per 10,000 persons for zero vaccination rate. Findings emphasize the importance of vaccinations and demonstrate that urban herd immunity may be defined as a situation in which people continue to interact, yet the COVID-19 spread is contained. This, in turn, might prevent the need for lockdowns or other limitations at the city level., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Arbel et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The process of regional economic development is marked by a sustained exposure to external disturbances. In today's unpredictable and tumultuous global environment, such disturbances have become increasingly common, underlining the need to advance a region's economic resilience and foster adaptive mechanisms to handle environmental flux. Comparing the typical provinces in eastern, central, western and northeastern regions during the COVID-19 epidemic period, it found that the economic resilience performance of Henan Province, which is a representative of the central region, has the following characteristics. Henan Province has the lowest total production resilience in the selected regions, but it is in the second position in terms of development potential resistance, while it is in the middle range in terms of resilience performance, and it has a weaker resistance performance in terms of the resilience indicator of the standard of living of the residents. Against this backdrop, this study undertakes an analysis and comparison of the economic resilience indicators of the 18 cities in Henan Province to suggest several refinements. It urges a promotion of the integrated development of the primary, secondary, and tertiary industries through increasing emphasis on the industrial sector, which will enable a transformation of the sectoral structuring. Further, digitization can help the upgrading of industries' intelligence and function as a lever to raise their competitiveness. Innovation in enterprises is also crucial in enhancing industrial competitiveness, by bolstering the technological innovation capabilities of enterprises and simultaneously boosting the wage-based incomes of residents, resulting in an overall improvement in their standard of living. Also, the study emphasizes the establishment of a digital talent platform to construct a sound regional talent ecology system., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Aotian Peng. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The COVID-19 pandemic had a negative effect on population mental health. Medical students may have been particularly affected, whom prevalence of mental health conditions was already high before the pandemic hit, due to the difficult and stressful academic programme. In Northern Ireland specifically, mental well-being levels are the lowest across the UK; however limited research exists examining the medical student cohort. This study explores Northern Irish medical students' perceptions on how the pandemic affected their mental health, their progress within medical education and perceived barriers to accessing support services in Northern Ireland., Methods: A qualitative study of phenomenological design involving 15 in-depth semi-structured interviews. The interviews were conducted amongst individuals who were 1st-4th year medical students when the pandemic was officially declared in Northern Ireland in March 2020. The interviews were transcribed, and thematic analysis was carried out using NVivo V12 qualitative data analysis software., Results: Results demonstrated the COVID-19 pandemic had a considerable negative impact on participants' mental health; a variety of interlinked social, individual and/or psychological and organisational factors led to increased levels of stress, anxiety and depression. This had a secondary negative impact on participants' medical education progress through reducing motivation, causing burnout and impostor syndrome. Unexpectedly; there were some perceived positive outcomes, including improved appreciation for work-life balance and resilience. Participants reported various barriers to seeking help amongst this difficult time period; also categorizable into social, individual and/or psychological and organisational factors, for example; stigmatisation, fear and perfectionistic tendencies., Discussion and Conclusion: There is a pressing demand for heightened support availability, personally tailored mental health assistance and an effort to reduce mental health stigma in Northern Ireland. This study highlights the complex multifactorial nature of mental health. Medical schools must provide additional services to protect well-being during particularly challenging periods and dismantle the barriers preventing individuals from accessing vital support., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Whiteside, Klabbers. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The Coronavirus Disease (COVID-19) is a disease with diverse effects on multiple organ systems, leading to varying presentations and severe complications. As the pandemic progresses, the challenges faced by those who recovered from the disease evolved as various coping strategies were adopted post recovery., Aim: This study investigated the coping strategies used by individuals recovering from COVID-19 to manage the physical, psychological, and social impacts of the disease. It further explored the factors influencing these strategies and their correlation with post-recovery quality of life., Methods: This cross-sectional quantitative study involved 150 participants who attended the Ghana Infectious Disease Centre's post-COVID-19 review clinic between January and June 2021. Coping mechanisms were evaluated using the Brief-COPE questionnaire, which covers 28 strategies across three styles: Problem-focused coping, emotional-focused coping, and avoidant coping. Participants rated their coping strategies on a 4-point Likert scale. Analysis of variance was used to determine differences in use of coping strategies. Quality of life was assessed with the EuroQol Group Association five-domain, five-level questionnaire (EQ-5D-5L) and the EQ-VAS scale. Spearman correlation analyzed the relationship between coping strategies and quality of life., Results: Majority of the study participants used problem-focused (2.71 ± 0.64 SD) type of coping strategy, followed by emotional-focused coping (2.32 ± 0.43 SD). The least strategy used was avoidant coping (1.57 ± 0.39 SD). Older participants, non-healthcare workers, and those with complications or persistent symptoms exhibited higher scores in avoidant and problem-focused coping. Those with persistent symptoms had higher emotional-focused coping scores. Better quality of life was associated with less reliance on all types of coping strategies., Conclusion: Patients recovering from COVID-19 at the Ghana Infectious Disease Centre used positive coping mechanisms effectively. Key predictors of coping strategies included age, persistent symptoms, and complications. Improved quality of life is correlated with reduced use of coping strategies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Amedewonu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The COVID-19 pandemic amplified the risk environment for people who inject drugs (PWID), making continued access to harm reduction services imperative. Research has shown that some harm reduction service providers were able to continue to provide services throughout the pandemic. Most of these studies, however, focused on staff perspectives, not those of PWID. Our study examines changes in perceptions of access to harm reduction services (e.g., participant reported difficulty in accessing syringes and naloxone) among PWID participating in a longitudinal study conducted through the University of Illinois-Chicago's Community Outreach Intervention Projects field sites during the COVID-19 pandemic., Methods: A COIVD-19 survey module was administered from March 2020-February 2022 to participants of an ongoing longitudinal study of PWID ages 18-30, who were English-speaking, and were residing in the Chicago Metropolitan Area. Responses to the COVID-19 survey module were analyzed to understand how study participants' self-reported access to harm reduction services changed throughout the pandemic. Baseline responses to the survey were analyzed to compare participant-reported drug use behaviors and perceived access to harm reduction services across COIVD-19 time periods. Mixed effects logistic regression was used to examine difficulty in syringe access as an outcome of COVID-19 time period., Results: Participants had significantly lower odds (AOR = 0.28; 95% CI 0.12-0.65) of reporting difficulty in accessing syringes later in the pandemic. However, the majority of participants reported access to syringes and naloxone remained the same as before the pandemic., Conclusions: The lack of perceived changes in harm reduction access by PWID and the decrease in those reporting difficulty accessing syringes as the pandemic progressed suggests the efficacy of adaptations to harm reduction service provision (e.g., window and mobile service) during the pandemic. Further research is needed to understand how the COVID-19 pandemic may have impacted PWIDs' engagement with harm reduction services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Kristensen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In this study, we analyzed the potential associations of selected laboratory and anamnestic parameters, as well as 12 genetic polymorphisms (SNPs), with clinical COVID-19 occurrence and severity in 869 hospitalized patients. The SNPs analyzed by qPCR were selected based on population-wide genetic (GWAS) data previously indicating association with the severity of COVID-19, and additional SNPs that have been shown to be important in cellular processes were also examined. We confirmed the associations of COVID-19 with pre-existing diabetes and found an unexpected association between less severe disease and the loss of smell and taste. Regarding the genetic polymorphisms, a higher allele frequency of the LZTFL1 and IFNAR2 minor variants significantly correlated with greater COVID-19 disease susceptibility (hospitalization) and severity, and a similar tendency was observed for the RAVER1 and the MUC5B variants. Interestingly, the ATP2B4 minor haplotype, protecting against malaria, correlated with an increased disease susceptibility, while in diabetic patients disease susceptibility was lower in the presence of a reduced-function ABCG2 transporter variant. Our current results, which should be reinforced by larger studies, indicate that together with laboratory and anamnestic parameters, genetic polymorphisms may have predictive value for the clinical occurrence and severity of COVID-19., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Mózner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Based on nationally representative panel data (N person-years = 40,020; N persons = 18,704; Panel Labour Market and Social Security; PASS) from 2018 to 2022, we investigate how mental health changed during and after the COVID-19 pandemic. We employ time-distributed fixed effects regressions to show that mental health (Mental Health Component Summary Score of the SF-12) decreased from the first COVID-19 wave in 2020 onward, leading to the most pronounced mental health decreases during the Delta wave, which began in August 2021. In the summer of 2022, mental health had not returned to baseline levels. An analysis of the subdomains of the mental health measure indicates that long-term negative mental health changes are mainly driven by declines in psychological well-being and calmness. Furthermore, our results indicate no clear patterns of heterogeneity between age groups, sex, income, education, migrant status, childcare responsibilities or pre-COVID-19 health status. Thus, the COVID-19 pandemic appears to have had a uniform effect on mental health in the German adult population and did not lead to a widening of health inequalities in the long run., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Patzina et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In Spain, the agricultural sector relies heavily on migrant workers, especially during seasonal seasons. However, these workers face significant challenges related to precarious working conditions and structural vulnerability, which have become more acute since the outbreak of the COVID-19 pandemic. This descriptive qualitative study was based on 87 personal interviews with health and social professionals from sectors such as NGOs, social services, trade unions, local institutions, and health services to promote compliance with these measures in four Spanish regions. It explored the difficulties faced by migrant agricultural workers in complying with prevention measures during the COVID-19 pandemic, the measures taken by organizations and public institutions and the health consequences of the pandemic on this group. After a reflexive thematic analysis, the results show how to mitigate the pandemic's impact, both local authorities and NGOs implemented extraordinary measures to care for migrant farm workers. Responses to the pandemic included temporary housing, mass testing, and stricter labor regulations. Working conditions, constant mobility, precarious housing, and language barriers contributed to the difficulty of implementing preventive measures. Covid-19 intensified inequalities and highlighted the lack of preparedness of institutions to deal with this group. The conclusions suggest that intercultural competence in health professional training and the creation of inclusive approaches to health and social care are critical to addressing health disparities and ensuring the well-being of all migrant farm workers, regardless of their migration status or mobility., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Villa-Cordero et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)