China experienced a catastrophic haze episode in January 2013 (2013JHE), no study has compared the prevalence of acute respiratory symptoms between smokers and non-smokers in 2013JHE. A rapid cross-sectional assessment of perceived air pollution and the prevalence of coughing, phlegm, and wheezing was conducted among 4303 adults sampled from three cities in Liaoning. Odds ratios (ORs) were calculated for the prevalence of coughing, phlegm, and wheezing. A path analysis was performed to test the relationships between number of cigarettes smoked daily, perceived air pollution score (PAPS), protective behavior score (PBS), and irritating feeling score (IFS). Among the participants, 26.3% felt irritated; 26.9% had acute respiratory symptoms; 22.9% had coughing; 20.2% had throat pain. The ORs for coughing, phlegm, and wheezing were all significantly increased among individuals with a history of respiratory disease, PAPS, PBS, and IFS. However, the ORs for coughing and wheezing were borderline significantly decreased among smokers, and the number of cigarettes smoked daily was negatively associated with PAPS and PBS in the path model. The 2013JHE had a serious impact local residents and significantly increased the prevalence of acute respiratory symptoms. Non-smokers and residents with a history of respiratory disease appear to be more susceptible sub-populations.

To estimate the impact of COVID-19 infection on the requirement for social care services among adults aged ≥50 years in North-West London.

Population-based matched cohort study using linked routinely collected electronic social care, primary care and hospital records (the Discover dataset).

Approximately 4.7 million people with a general practitioner record in North-West London.

150 654 adults aged ≥50 years with a first diagnosis of COVID-19 between January 2020 and February 2023 and 547 704 propensity score matched comparators without a COVID-19 diagnosis during the same period.

Social care use and associated costs overall and by specific type (care home, domiciliary care, respite care, social care assessments) stratified by age group, index year, diagnosis setting, severe COVID-19 risk status, frailty and care home admission prior to index. Overall survival was also assessed.

A total of 9174 (6.09%) individuals with COVID-19 required social care use (of any type) during follow-up, 2.54 times (95% CI 2.48 to 2.61; p<0.0001) higher than matched comparators (n=13 126, 2.40%). The difference was largest for care home admission; individuals with COVID-19 had 4.10 (95% CI 3.87 to 4.36; p<0.0001) times the risk of a care home admission and nearly twice the risk (risk ratio 1.94; 95% CI 1.86 to 2.02; p<0.0001) of domiciliary care during follow-up compared with matched comparators. Individuals with COVID-19 experienced higher mortality, with 9.30% (14 005/547 704) dying during follow-up compared with 3.76% (20 608/547 704) deaths among matched comparators.This increase in social care utilisation was observed for all age groups. Adults with COVID-19 had over four times higher social care costs than matched comparators (£1276 per person per year (pppy) vs £276 pppy; mean difference +£1000, 95% CI £947 to £1054, p<0.0001), with most of the costs due to care home admissions. Higher social care costs in individuals with COVID-19 compared with matched comparators were strongly age related, rising from a mean difference of £130 pppy (95% CI £99 to £161) in those aged 50-64 to £6108 pppy (95% CI £5613 to £6603) higher costs in those aged ≥85.

COVID-19 infection is associated with meaningfully higher social care requirements in the ≥50 years population. Reducing the need for social care use and the associated costs of care should be one of the goals of interventions to reduce the risk and severity of COVID-19 infection.

The internet is one of the essential tools today, and its impact is particularly felt among university students. Internet addiction (IA) has become a serious public health issue worldwide. This multi-class classification study aimed to identify the potential predictors of IA by four severity levels among university students in Bangladesh. We used cross-sectional survey data from 424 university students from different universities in Bangladesh. Data was collected using a self-reported questionnaire, along with an IA test to assess addiction levels. We identified the important features related to IA using the Boruta algorithm. Predictions were made using different machine learning (ML) (decision tree (DT), random forest (RF), support vector machines (SVMs), and logistic regression (LR)) models. Their performance was assessed using confusion matrix parameters, receiver operating characteristics (ROC) curves, and k-fold cross-validation techniques for multi-class classification problems. The prevalence of severe IA was 3.77% among the participating university students in Bangladesh from July 15 to July 22, 2024. University students' backgrounds, depression, anxiety, stress, participation in physical activity, misbehaving with family members, memory loss symptoms, and being COVID-19-positive were selected as significant features for predicting IA. Overall, the RF (accuracy = 0.531, sensitivity = 0.200, specificity = 0.986, precision = 1.00, k-fold accuracy = 0.4858, micro-average area under curve (AUC) = 0.7798) more accurately predicted IA compared to other ML techniques. The ML framework for multi-class classification study can reveal significant risk factors and predict this behavioral addiction more precisely. It can help policymakers, stakeholders, and families better understand the situation and prevent this severe crisis by improving policy-making strategies, promoting mental health, and establishing effective university counseling services. Therefore, raising awareness among the younger generation and their parents about the predictors of IA is important.

Deployment to Afghanistan and Southwest Asia has been associated with adverse respiratory health outcomes. However, the impact of inhalational exposures (eg, vapor, dust, gas, fumes), which are known correlates of reduced lung function and future chronic lung disease, during military service time outside this deployment period has not been assessed.

To assess military inhalational exposures during nonwartime routine activities and their associations with chronic respiratory symptoms.

This cross-sectional study used data from the US Department of Veterans Affairs Service and Health Among Deployed Veterans study. US veterans who served between October 7, 2001, and February 28, 2017; deployed to Afghanistan or Southwest Asia; and living near 6 Veterans Affairs sites were randomly selected from Defense Manpower Data Center records. Participants completed interviewer-administered multi-item questionnaires about 29 exposures related to active duty military service time when not deployed. Onsite visits occurred between April 27, 2018, and March 13, 2020, and analyses were performed between April 1, 2023, and February 10, 2025.

Inhalation exposures during active duty military service time.

The main outcomes were chronic respiratory symptoms of dyspnea, wheeze in the previous 12 months, and chronic bronchitis. Using factor analysis, the 29 exposures were reduced to 20 items and categorized into 5 factors. Responses were scored ordinally (0, 1, 2) according to exposure prevalence and duration. Generalized linear modeling was used to explore associations between exposures and chronic respiratory symptoms.

The sample included 1712 veterans (median [IQR] age, 37 [33-45] years; 1522 male [88.9%]) who had military service other than during their deployment to Afghanistan or Southwest Asia. The median (IQR) total active duty military service duration was 77 (57-128) months, with 82.8% of their service time spent outside the theater of conflict. The prevalence of dyspnea, chronic bronchitis, and wheeze was 7.0% (117 participants), 7.1% (121 participants), and 15.2% (260 participants), respectively. The most commonly reported exposure categories were combustion and ground dust (1014 participants [59.2%]), aircraft maintenance (812 participants [47.4%]), and heavy equipment maintenance (783 participants [45.7%]). Adjusted multivariable analyses identified significant associations between heavy equipment maintenance exposures and dyspnea (odds ratio [OR], 1.33; 95% CI, 1.06-1.68) and wheeze (OR, 1.29; 95% CI, 1.10-1.52). Aircraft maintenance exposures were significantly associated with wheeze (OR, 1.22; 95% CI, 1.01-1.47). No statistically significant associations were found between these exposures and chronic bronchitis.

This cross-sectional study shows significant associations between heavy equipment maintenance and aircraft maintenance inhalation exposures outside of deployment with chronic respiratory symptoms among US veterans. These findings suggest that certain military inhalational exposures may contribute to the development of chronic lung disease and that policy interventions to reduce such exposures may protect the long-term respiratory health of military personnel.

Chronic rhinitis, including the specific condition of inferior turbinate hypertrophy, represents a significant challenge within the field of otolaryngology. This condition, characterized by the hyperplastic enlargement of the turbinates, severely impacts nasal airflow and overall quality of life.

This study aims to address this gap by evaluating the effectiveness of endoscopic inferior turbinectomy using a microdebrider in treating chronic rhinitis in a Vietnamese hospital setting.

This prospective case series was conducted at Viet-Tiep Hospital, involving 31 patients with chronic rhinitis and inferior turbinate hypertrophy who underwent endoscopic inferior turbinectomy using a microdebrider from 2017 to 2019. Preoperative, intraoperative, and postoperative variables were analyzed, including nasal airflow, surgical duration, and symptom improvement. Key outcomes, such as pain, nasal crusting, and airflow changes, were assessed using the Visual Analog Scale and Glatzel scale, alongside endoscopic findings and CT imaging for turbinate morphology.

This study included 31 patients (mean age: 42 years, 64.5% male) undergoing endoscopic inferior turbinectomy using a microdebrider. All patients had nasal congestion, with 83.9% experiencing bilateral symptoms. Preoperatively, 80.6% had severe nasal obstruction, and 87.1% showed no response to vasoconstrictors. Common symptoms included rhinorrhea (64.5%), snoring (67.7%), and headache (71%). Postoperative outcomes were favorable, with 90.3% reporting good results. Mild nasal obstruction persisted in 12.9% after one month. Nasal crusting was minimal in 51.6%, and 93.3% showed turbinate reduction. Mild postoperative bleeding occurred in 6.5%, and pain levels were mostly mild.

Endoscopic inferior turbinectomy with a microdebrider is an effective, minimally invasive option for chronic rhinitis, offering significant symptom relief and low complication rates. Its short operative time and minimal postoperative pain support its broader adoption.

Sex-biased differences in COVID-19 outcomes in relation to individual SARS-CoV-2 variants are not well understood. In this study, lungs and nasal cavities of age-matched female and male K18-hACE2 transgenic mice were collected for dissecting sex-specific differences in pathology after infection of SARS-CoV-2 614 G, Delta, or Omicron variant. Overall, Delta infection induced the most severe inflammation and pathology in nasal cavity and lung followed by the 614 G, then Omicron variant. Sex differences in host responses to SARS-CoV-2 infection were variant-specific. Delta-infected males showed increased pulmonary infiltration of CD163+ "M2" macrophages, Ly6G+ neutrophils, and NKR-P1C + NK cells during early onset of infection, and elevated lung inflammatory cytokines such as IL-10, IL-6, and IP-10 than Delta-infected females. Conversely, females had increased lung CD4 + T cell recruitment after Omicron infection and significantly elevated lung MCP-1 secretion after Delta infection than males. Lung spatial transcriptomics data revealed that Delta-infected females had enriched gene pathways related to humoral immune response and interferon signaling, while males had enriched pathways associated with extracellular matrix production, chemokine signaling, and cell chemotaxis. Taken together, this study highlights the complex infection dynamics with respect to individual SARS-CoV-2 variants and underscores the importance of sex as a confounding factor for COVID-19 pathology.

Hypertension is a leading cause of death and disability in the United States, but national trends in hypertension after the COVID-19 pandemic remain unknown. We analyzed NHANES data from pre-pandemic (2017-March 2020) and post-pandemic (August 2021-August 2023) surveys to determine nationwide prevalence, awareness, and control of hypertension. Weighted, age-standardized prevalence estimates were compared using Poisson regression with prevalence ratios (PRs). Among 14 449 participants representing 237 million US adults, hypertension prevalence was 49.5% pre-pandemic versus 47.7% post-pandemic (PR 0.96; p = 0.15). Overall, hypertension awareness was unchanged (57.7% vs. 53.7%; PR 0.96; p = 0.14) but declined among adults aged 18-39 years (PR 0.78; p = 0.02). Blood pressure control remained low (25.9% vs. 22.3%; PR 0.91; p = 0.06) and worsened in men (PR 0.83; p = 0.01). In conclusion, hypertension prevalence, awareness, and control did not significantly improve post-pandemic. More aggressive public health efforts are needed to reduce the adverse impacts of hypertension in the United States.

To evaluate and rank the efficacy and safety of different acupuncture (AP) therapies in treating sleep apnea syndrome (SAS).

We searched PubMed, Web of Science, Cochrane Library, Embase, Wanfang Data, CNKI, CBM, and VIP for randomized controlled trials (RCTs) studying AP for SAS until April 25, 2024. Effectiveness required a >25% decrease in apnea-hypopnea index (AHI) and a >1/3 reduction in symptom scores after treatment. Secondary outcomes included AHI, lowest oxygen saturation (LSaO₂), longest apnea time (LAT), Epworth Sleepiness Scale (ESS) score, and adverse events (AEs). We performed standard pairwise meta-analyses and network meta-analyses (NMA) using Stata15.1 and RStudio4.2.3, assessed evidence quality (GRADE), and ranked treatments using SUCRA values.

Network meta-analysis of 43 randomized trials (3402 SAS patients) revealed distinct efficacy profiles: Electroacupuncture (EA) was the best intervention for reducing apnea-hypopnea index (AHI) (SUCRA=86.0%), while acupoint catgut embedding (ACE) ranked highest for both shortening longest apnea time (LAT) (SUCRA=98.7%) and improving lowest oxygen saturation (LSaO₂) (SUCRA = 89.7%). For reducing daytime sleepiness (ESS), manual acupuncture combined with Chinese herbal decoction (MA+OCHD) was most effective (SUCRA = 87.6%). In terms of overall clinical effectiveness rate, manual acupuncture plus Western medicine (MA+WM) performed best (SUCRA = 79.8%). Safety analysis showed Chinese herbal decoction (OCHD) alone was associated with the fewest adverse events (SUCRA = 93.4%).

AP therapies are effective and safe for SAS. EA or ACE best improves breathing parameters, MA+OCHD best reduces sleepiness, and MA+WM yields the highest overall effectiveness. These findings guide SAS treatment selection.

Post-COVID-19 syndrome (PCS) presents in a multitude of ways, with fatigue, physical constraints, and diminished quality of life being common symptoms. It is becoming increasingly clear that unimodal behavioral interventions do benefit all PCS patients. Adherence to and response to isolated psychotherapy or physical activity interventions vary greatly, with certain patients benefit more from one form of therapy, or even a combination, than others do. The study aims to compare the effects of a single exercise therapy, psychotherapy, and a combination of both therapies.

The study will be conducted as a prospective, randomized controlled, open-label trial with 3 treatment arms (exercise therapy, psychotherapy, and combined therapy). According to the sample size calculation, 65 participants will be enrolled in each group. The primary outcome is the change of PCS fatigue symptoms from baseline to 3 months, estimated by the Fatigue Assessment Scale. Secondary endpoints include changes in further measures of fatigue (Chalder Fatigue Skala, Multidimensional Fatigue Inventory, Post-exertional Malaise Scale, Bell Scale), health-related quality of life (Short Form-36 and Brief Illness Perception Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and work ability (Work Ability Index). The intervention lasts for 3 months and includes online therapy sessions of 50 min every 2 weeks or in case of lack of concentration or fatigue this could be split to two 25-min sessions (all equating to a total of 300 min of specialist care). The psychotherapy adopts a short-term and coping-oriented approach based on the unique requirements of each patient from a psychotherapeutic perspective. Exercise therapy involves a personalized physical activity plan customized to suit the patient's requirements, with tracking day-to-day physical activity along with daily moderate endurance and strengthening workouts. An ANCOVA model, including the stratification factors sex and BMI, will be used for the primary analysis of Fatigue Assessment Scale. Significance tests will be based on the group differences in least square means and corresponding 95% CIs.

Due to the current relevance of the issue, the unclear evidence so far, and the lack of appropriately powered randomized studies, it is crucial to assess potentially effective concepts for treating patients with PCS. Future therapy decisions will benefit from answering the question of whether combined therapies hold a significant advantage over unimodal therapeutic approaches, as well as identifying predictors that indicate an advantage of certain therapies for particular patients.

ClinicalTrials.gov NCT06042751 . Registered on 21 September 2023.

The COVID-19 pandemic caused widespread global disruptions to healthcare systems. There has been no assessment of this on dialysis practice at a binational level.

A multi-centre retrospective observational cohort study using data from the ANZDATA Registry was performed, with adult incident dialysis patients (1 January 2018 to 31 December 2022). Patients commencing dialysis during 2020-2022 were compared to 2018-2019 for the primary outcome of dialysis incidence rate. Secondary outcomes included estimated glomerular filtration rate (eGFR) at dialysis start, initial treatment location (home vs. facility), modality (haemodialysis vs. peritoneal dialysis), haemodialysis access, frequency, and duration. Commencement during lockdown in 2020-2021 was also analysed.

11 690 patients commenced dialysis during 2020-2022 and 7366 commenced during 2018-2019, with no differences in incidence rate across the pandemic years (2020: p = 0.163, 2021: p = 0.139, 2022: p = 0.190). Compared to pre-pandemic years, uptake of home-based therapies was higher in 2020 (OR = 1.16, 95% CI 1.06-1.27, p = 0.002) with no difference in 2021 and 2022. Peritoneal dialysis uptake was higher in 2020 (OR = 1.15, 95% CI 1.04-1.26, p = 0.005) and 2021 (OR = 1.11, 95% CI 1.01-1.21, p = 0.037) with no difference in 2022. Haemodialysis patients were less likely to commence with an arteriovenous fistula or graft in 2022, compared to pre-pandemic years (OR = 0.87, 95% CI 0.78-0.96, p = 0.005). Odds of commencing haemodialysis with an arteriovenous fistula or graft were reduced during lockdown (OR = 0.79, 95% CI 0.65-0.95, p = 0.014).

There was no change in the incidence rate of dialysis patients during 2020-2022, although there were differences in home dialysis uptake and starting access type.