Pulmonary Hypertension (PH) is a chronic condition that leads to progressive functional limitations, making the assessment of functional capacity essential for clinical management. This study aimed to classify PH patients based on the International Classification of Functioning, Disability, and Health (ICF) qualifiers using the Six-Minute Walk Test (6MWT) and compare this classification with the World Health Organization Functional Classification (WHO-FC).

This observational study included 33 individuals with PH. Demographic data, pulmonary function, and 6MWT results were collected. Participants were classified according to ICF qualifiers (ranging from no impairment to complete impairment) and WHO-FC. The association between classifications was tested using Fisher's exact test, considering the conceptual differences between them.

Most participants presented moderate functional impairment, with an average 6MWT distance of 431.5 ± 110 m, equivalent to 68% of the predicted value. Based on ICF qualifiers, 39% of patients had mild impairment, 42% moderate, and 18% severe impairment. However, no significant association was found between ICF qualifiers and WHO-FC, reflecting the distinct conceptual frameworks of these classifications. Unlike WHO-FC, which applies fixed cutoffs, the ICF-based classification provides a more individualized assessment by incorporating the contrast between expected and actual performance in the 6MWT.

The use of ICF qualifiers enabled a more specific evaluation of functional capacity in PH patients, complementing rather than replacing WHO-FC. This approach allows for a more individualized assessment, supporting targeted rehabilitation strategies and improving clinical decision-making in PH management.

Poorly controlled asthma creates a multitude of health, financial, and quality of life difficulties. The potential influences of environmental factors on the stress levels of people living with asthma-including exposure to fine particulate matter and motor vehicle traffic-are often overlooked.

Among a sample of U.S. adults living with poorly controlled asthma, we aimed to determine (1) differences in perceived stress based on self-reported motor vehicle traffic exposure (MVTE), (2) differences in levels of residential indoor fine particulate matter 2.5 microns or less in diameter (PM2.5) based on self-reported MVTE, and (3) associations between residential indoor PM2.5 and perceived stress.

The National Institutes of Health (NIH) Symptom Science Model for Environmental Health served as the theoretical basis for this study, which is a secondary analysis of data from an NIH-funded feasibility study that examined the effects of residential indoor air quality on asthma symptoms and lung function in adults with uncontrolled asthma. This secondary analysis included data from the feasibility study's baseline survey of 40 participants and indoor PM2.5 data collected continuously over 14 days. Baseline survey data included demographic data, responses to the modified four-item version of the Perceived Stress Scale (PSS-4), and self-reported data on MVTE (dichotomized as low versus medium/high).

Participants were primarily female (90%), White (82.5%), college educated (four-year degree or higher, 77.5%), residents of single-family homes (72.5%) in low-MVTE areas (70%), and 26 to 77 years of age. PSS-4 scores ranged from 0 to 14. Participants reporting medium/high MVTE had higher mean PSS-4 scores than those reporting low MVTE, although the difference was not statistically significant (6.5 versus 5.3, respectively; P = 0.305). The median level of indoor PM2.5 concentration (μg/m3) did not differ significantly regardless of whether the MVTE was medium/high or low (3.2 versus 3.6, respectively; P = 0.836). Higher PSS-4 scores were significantly correlated with higher average indoor PM2.5 levels (r = 0.38, P = 0.017).

Indoor PM2.5 reduction has important implications for stress management among adults with asthma. Further research is needed to clarify associations between MVTE and indoor pollution.

Fatigue and cognitive deficits are common and disabling symptoms in patients experiencing post-COVID condition. This randomized parallel study aimed to evaluate the effects of transcranial direct current stimulation (tDCS) over the primary motor cortex combined with cognitive training (M1 + CT), compared to tDCS over the dorsolateral prefrontal cortex with cognitive training (DLPFC + CT), on fatigue, cognition, and other clinical symptoms in post-COVID. Sixty-three patients completed the treatment (n = 32 in the M1 + CT group and n = 31 in the DLPFC + CT group) with a mean age of 47 years and an average symptom duration of 32 months. Both groups underwent comprehensive neuropsychological and clinical evaluations, including ecological momentary assessments of fatigue, at baseline, post-treatment, and one-month follow-up. The Fatigue Severity Scale (FSS) was used as the primary endpoint. Patients were randomly assigned to the M1 + CT or DLPFC + CT groups and received 15 sessions of tDCS administered concurrently with adaptive CT. The M1 + CT group showed a slightly higher efficacy in reducing fatigue and improving sleep quality than the DLPFC + CT group. Both groups demonstrated significant improvements in cognition, anxiety, depression, pain, and sleep quality. These improvements were sustained over time. These findings indicate that tDCS combined with cognitive training is a feasible, safe, and effective approach for reducing fatigue and enhancing cognition in post-COVID patients. The results highlight the potential of brain stimulation and cognitive training to alleviate fatigue and cognitive impairment in post-COVID, warranting further confirmation through additional randomized controlled trials.Trial registration: ClinicalTrials.gov NCT05753202.

Recent evidence suggests that community-wide active case finding (ACF) can reduce tuberculosis (TB) incidence and prevalence. Mass-screening at the community level, supported by mobile digital chest X-ray units, is now being scaled up by programmes across high burden countries. However, there is limited evidence of case-detection yields from programmes conducting ACF at scale in low-resource settings. We retrospectively analysed aggregate data from mobile X-ray screening events (called 'camps') in Pakistan from Q3 2017 to Q2 2021. A total of 11 327 camps were conducted that screened 1 214 289 individuals and detected 7625 cases of All-Forms TB (AF-TB), among whom 3500 (45.9%) were bacteriologically confirmed (B+) and the remaining were treated empirically. The yield for B+ and AF-TB per 100 000 population screened nationally was 289 (95% CI: 279 to 298) and 631 (95% CI: 617 to 646), respectively. Yield of TB detected from screening was highly variable between regions of Pakistan, ranging from 70 to 678 per 100 000 B+ and 76 to 1136 per 100 000 for AF-TB. Our findings have two major lessons for TB programmes. First, there was significant geographical variation in yields of both B+ and AF-TB, supporting targeting of interventions in areas of high prevalence to maximise the intervention's effectiveness. Second, more than half of TB cases were treated empirically, and approaches to improve sample collection, linkage to diagnostics, non-sputum based tests and standardisation of treatment for bacteriologically unconfirmed TB need to be concurrently prioritised by programmes considering scale-up of mobile X-ray-based ACF.

Vaccine hesitancy, particularly among racialized communities, persists due to misinformation, medical mistrust, and systemic barriers. This study examines racial disparities and key determinants related to perceptions of COVID-19 vaccine effectiveness in Canadian parents from Arab, Asian, Black, Indigenous, White and mixed-race communities. A cross-sectional survey was conducted among a representative sample of 2,528 Canadian parents of children aged 0-12 years (57.5% women). Participants completed a survey assessing conspiracy beliefs, health literacy, major experiences of racial discrimination, and perceptions of COVID-19 vaccine effectiveness. The mean COVID-19 vaccine effectiveness perception score was 19.57 (SD = 5.32). ANOVA showed significant differences by race (F = 5.15, p < .001), with Asian (M = 21.41, SD = 4.12) and Indigenous parents (M = 21.42, SD = 4.85) reporting higher scores than White, Black, and Arab ones. Regression analyses indicated that conspiracy beliefs negatively predicted vaccine effectiveness perception (β = -0.05, p < .001), while health literacy had a positive association (β = .19, p < .001). Major racial discrimination was negatively associated but became non-significant after adjusting for conspiracy beliefs. Vaccine effectiveness perception varies across racial groups. Higher health literacy and prior vaccination enhance perceptions, while conspiracy beliefs undermine them. Addressing misinformation and tailoring public health strategies to diverse parental experiences - particularly among younger parents and marginalized groups - will strengthen vaccine confidence.

The online diagnosis and treatment model based on 5th generation mobile communication (5G) technology is one of the important ways to solve the imbalance between supply and demand of medical services.

We systematically summarized Chinese and English literature on the application of 5G technology in the field of wireless medical and conducted a literature feature analysis.

We used bibliometrics to quantitatively analyze the research trends and hot topics and comparatively analyzed the differences between research in China and other countries.

This study analyzed 1344 articles and found that China provided the most funding (531 [75.32%]) and far outnumbered other countries in this field (1014 vs 330), but the quality of articles and effective collaboration between authors need to be improved. The hot topics in this field have gradually shifted from the construction of 5G internet hospitals during the COVID-19 to the construction of smart hospitals based on the Internet of Medical Things, and the research focus has gradually shifted from the data transmission layer such as wearable devices to the application layer of smart medical services.

Researchers can further refine the specific application of 5G technology in the field of wireless medical from the 3 major areas of the smart hospital system.

There is growing interest in integrating technology into clinical clerkship education, particularly in response to disruptions during the COVID-19 pandemic. However, limited synthesis exists on how educational technologies are being used in clerkship settings, what instructional purposes they serve and what outcomes they produce.

A rapid review was conducted to identify empirical studies published between January 2020 and January 2023 that examined educational technology use in undergraduate medical clerkships. We searched Medline, Embase and Web of Science for English-language studies focused on technology use with medical students in clinical learning environments. Data were extracted and synthesized narratively, with studies categorized by technology type, instructional purpose, reported benefits and challenges.

From 1717 screened citations, 35 studies met inclusion criteria. The main technologies used included virtual reality, learning platforms, video conferencing tools and simulation-based systems. These technologies were primarily used for content delivery, interactive instruction and assessment. Reported advantages included enhanced learner engagement, realism, timely feedback and increased accessibility. Common challenges involved limited access to hardware, lack of robust outcome evaluation and concerns about transferability to real-world clinical performance. Most studies reported short-term outcomes, such as satisfaction and knowledge gain, rather than long-term skill development.

Technology integration in clerkship education has accelerated, but implementation remains uneven, and evaluations are often limited in scope. Educators should align technology use with instructional goals and assess its impact beyond immediate learner reactions. Future research should examine long-term outcomes, particularly in under-resourced or distributed clinical training environments.

Recurrent apnoea is common in preterm infants, particularly at very early gestational ages. These episodes of ineffective breathing can lead to hypoxaemia and bradycardia, sometimes severe enough to require resuscitation, including positive pressure ventilation. Various interventions have been used to manage apnoea of prematurity, including methylxanthines and continuous positive airway pressure (CPAP). However, CPAP and methylxanthines remain the most widely studied and utilised treatments due to their greater benefits and lesser harms compared to alternatives like CO₂ inhalation.

To evaluate the benefits and harms of CPAP compared to methylxanthines for apnoea of prematurity in preterm infants.

We searched CENTRAL, MEDLINE, Embase, CINAHL, three clinical trials databases, and conference proceedings. We checked references in included studies and related systematic reviews up to August 2024.

We included all trials using random or quasi-random allocation to CPAP or any methylxanthine in preterm infants with clinical recurrent apnoea with or without bradycardia. We excluded infants with secondary apnoea, defined as apnoea secondary to causes other than prematurity. We excluded cross-over studies since the severity of apnoea of prematurity can change in either direction over time, but most commonly improves with time. We excluded studies that evaluated combined interventions, such as CPAP plus methylxanthines versus either CPAP or methylxanthines alone.

Our critical outcomes were failure of treatment at any time point during hospitalisation, neurodevelopmental outcomes assessed at 18 to 24 months, death in the first year from any cause, bronchopulmonary dysplasia at 36 weeks' postmenstrual age (PMA), and adverse effects such as nasal trauma, tachycardia within the first 24 hours of treatment initiation, feeding intolerance, and pneumothorax.

We used the Cochrane risk of bias tool (RoB 1) to assess the risk of bias in the studies.

We conducted a structured narrative synthesis based on the Synthesis Without Meta-analysis (SWiM) reporting guidelines, as only one eligible study was included. We grouped results by outcome, and extracted absolute and relative effects. No meta-analysis or subgroup analysis was performed.

We included one small randomised controlled trial (RCT) with a total of 32 participants, conducted in a high-resource setting and involving preterm infants. The trial compared CPAP and theophylline.

CPAP compared to theophylline The evidence is very uncertain about whether there is any difference between CPAP and theophylline in failure of treatment during hospitalisation (risk ratio (RR) 2.89, 95% confidence interval (CI) 1.12 to 7.47; risk difference (RD) 0.42, 95% CI 0.11 to 0.74; 1 study, 32 participants; very low-certainty evidence). The evidence is very uncertain about whether there is any difference between CPAP and theophylline in death in the first year (RR 2.57, 95% CI 0.97 to 6.82; 1 study, 32 participants; very low-certainty evidence). In terms of adverse effects, nasal trauma, feeding intolerance, and pneumothorax were not reported. Only tachycardia was reported, but the evidence is very uncertain about whether there is any difference between CPAP and theophylline in tachycardia within the first 24 hours after treatment initiation (RR 0.10, 95% CI 0.01 to 1.60; 1 study, 32 participants; very low-certainty evidence). Bronchopulmonary dysplasia at 36 weeks' PMA and neurodevelopmental outcomes at 18 to 24 months were not reported in the included study. The overall risk of bias is high due to baseline imbalances, lack of blinding, and early trial cessation, which affects the reliability of the findings.

From the single, small included study, performed more than 40 years ago, we are very uncertain whether there is any clinically meaningful difference in the effect of CPAP and theophylline on apnoea of prematurity. Both interventions, CPAP and theophylline, have largely been replaced by nasal prong CPAP and caffeine or aminophylline in modern neonatal care, limiting the applicability of these findings to current practice. However, since caffeine is not readily available in some low- and middle-income countries, and CPAP access remains limited in certain settings, further research may still be relevant. If further trials are conducted, these should use modern CPAP delivery methods and caffeine rather than theophylline. This is the second update of a review first published in 1998.

This Cochrane review had no dedicated funding.

This is an update of the existing review 'Continuous positive airway pressure versus theophylline for apnoea in preterm infants' originally published in The Cochrane Library, Disk 2, 1998 (Henderson-Smart d) and updated on Disk 4, 2001 (Henderson-Smart e). Previous versions are available via DOI: 10.1002/14651858.CD001072. The title was amended from 'Continuous positive airway pressure versus theophylline for apnoea in preterm infants' to 'Continuous positive airway pressure versus methylxanthine for apnoea in preterm infants' in May 2024.

The albumin-bilirubin (ALBI) grade, a validated prognostic tool in cancers such as hepatocellular carcinoma, has not been evaluated in acute respiratory distress syndrome (ARDS). This retrospective cohort study, utilizing data from the MIMIC-IV (v3.0) database, aimed to assess ALBI's predictive value for 28-day all-cause mortality in 338 adult ARDS patients admitted to the ICU. Patients were stratified into survivors (209 cases) and nonsurvivors (129 cases), with a 28-day mortality rate of 38.2%. Multivariable Cox regression identified ALBI as an independent predictor of 28-day mortality (HR = 1.46, 95% CI: 1.09-1.95, p=0.011). Receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 61.1% (95% CI: 54.7%-67.4%) with an optimal ALBI cutoff of -1.681; Kaplan-Meier (KM) survival curves confirmed significantly higher mortality in patients with ALBI ≥-1.681 versus ALBI <-1.681 (p=0.0098). Subgroup analyses revealed no significant interactions between ALBI and clinical variables (interaction p: 0.672-0.85). These findings demonstrate ALBI's utility as a novel, independent prognostic marker for short-term mortality risk in ARDS patients.

The COVID-19 pandemic has profoundly impacted mental health worldwide, particularly within campus environments, where it has heightened issues such as anxiety, depression, and stress. Despite the increasing recognition of these challenges, the role of psychological resilience-defined as personal and external support resources that aid in coping-remains underexplored in relation to mental health outcomes. To address this gap, the present study investigates the relationships between subjective well-being, psychological resilience, and mental health symptoms, measured using the DASS-21 (Depression, Anxiety, and Stress Scale), 3 years after the pandemic's onset. In a cross-sectional survey of Chinese college students (N = 291), we utilized the DASS-21 and the Psychological Resilience Scale, along with multivariate linear regression modeling, to examine these relationships. The results indicated that both personal resilience factors and external support had significant effects on students' subjective well-being. Specifically, emotional regulation, interpersonal support, and family backing had direct positive effects on well-being and indirectly enhanced happiness by reducing anxiety. Notably, goal orientation influenced well-being indirectly by moderating anxiety. Moreover, positive cognitive patterns exhibited a multifaceted impact on subjective well-being, affecting it through both direct and indirect pathways, particularly by reducing anxiety and depression. While anxiety played a central mediating role in these pathways, stress was also found to be a significant predictor of subjective well-being. These findings emphasize the critical importance of psychological resilience and underscore the multidimensional role of the DASS-21 in assessing university students' mental health. The study offers a theoretical foundation for the development of sustainable mental health interventions tailored to the needs of students in the aftermath of global crises.