BACKGROUNDGroup A Streptococcus (GAS) commonly causes mild bacterial infections but also deadly invasive disease. An upsurge in paediatric invasive GAS (iGAS) infections was observed during the last quarter of 2022 in the European Union/European Economic Area (EU/EEA) countries.AIMWe aimed to assess iGAS surveillance in the EU/EEA countries and investigate the epidemiology of iGAS infections during the 2022/23 season.METHODSWe conducted a study on GAS and iGAS surveillance to evaluate coverage and surveillance methodology across the EU/EEA countries. We collected and analysed data on paediatric iGAS cases (patients aged ≤ 16 years) occurring in September 2022-June 2023 that resulted in hospitalisation or death. Associations of severe outcome (admission to intensive care unit and/or death) with potential risk factors were estimated by logistic regression in a case-case analysis.RESULTSNineteen countries responded to the questionnaire; eleven had mandated national surveillance for iGAS before 2022. Eight countries submitted data on 1,277 paediatric iGAS cases involving hospitalisation or death: 56% were males and median age was 4 years. Sixty-three (5%) of these cases died. Severe outcome was associated with emm1 type (odds ratio (OR) = 1.73; 95% confidence interval (CI): 1.13-2.67), having a sepsis without a known anatomic source (OR = 1.73; 95% CI: 1.11-2.73) and lower respiratory tract infections (OR = 4.14; 95% CI: 2.70-6.44).CONCLUSIONSurveillance of GAS and iGAS infections varied among the participating countries. We highlight the importance of including emm typing and analysis of clinical data in iGAS surveillance and having international collaboration for effective response to future surges.

BACKGROUNDAdvanced outbreak analytics were instrumental in informing governmental decision-making during the COVID-19 pandemic. However, systematic evaluations of how modelling practices, data use and science-policy interactions evolved during this and previous emergencies remain scarce.AIMThis study assessed the evolution of modelling practices, data usage, gaps, and engagement between modellers and decision-makers to inform future global epidemic intelligence.METHODSWe conducted a two-stage semiquantitative survey among modellers in a large European epidemic intelligence consortium. Responses were analysed descriptively across early, mid- and late-pandemic phases. We used policy citations in Overton to assess policy impact.RESULTSOur sample included 66 modelling contributions from 11 institutions in four European countries. COVID-19 modelling initially prioritised understanding epidemic dynamics; evaluating non-pharmaceutical interventions and vaccination impacts later became equally important. Traditional surveillance data (e.g. case line lists) were widely available in near-real time. Conversely, real-time non-traditional data (notably social contact and behavioural surveys) and serological data were frequently reported as lacking. Gaps included poor stratification and incomplete geographical coverage. Frequent bidirectional engagement with decision-makers shaped modelling scope and recommendations. However, fewer than half of the studies shared open-access code.CONCLUSIONSWe highlight the evolving use and needs of modelling during public health crises. Persistent gaps in the availability of non-traditional data underscore the need to rethink sustainable data collection and sharing practices, including from for-profit providers. Future preparedness should focus on strengthening collaborative platforms, research consortia and modelling networks to foster data and code sharing and effective collaboration between academia, decision-makers and data providers.

Integrating public health functions into national health systems is essential to enhance population health. The Master of Public Health (MPH) degree is an important foundation for public health practice in low-and middle-income countries such as South Africa. However, insufficient evidence on individual motivations for undertaking the MPH and the perceptions of graduates on the utility of the degree at work and in society and its contribution to their leadership skills informed this study.

A consortium of academics from eight South African universities developed a self-administered questionnaire to measure inter alia the socio-demographic characteristics, motivations, career paths, perceptions of the utility of the degree, and its contribution to their professional and personal development. The study population comprised the 2012-2016 cohort of MPH graduates from eight universities. Following informed consent, eligible graduates completed an online survey via REDCap. The data were analyzed using Stata.

A total of 221 graduates completed the survey. The mean age of respondents was 35 years, and the majority were from South Africa (53.2%) or other African countries (43.2%). The majority (91.1%) completed the MPH to improve their skills or to promote their personal development for senior management and leadership roles. Approximately 75% used identified leadership skills at work, but only half these skills were obtained from the MPH. Over 80% of respondents positively impacted on their workplace and in society, using skills mostly derived from the MPH in all domains.

This cohort of MPH graduates exercised leadership in different settings, but many stated that these skills were not obtained from the MPH programs. The COVID-19 pandemic underscored the need for public health leaders skilled in communication, collaboration, and crisis management, amidst considerations of social justice and equity. Hence, leadership skills need to be intentionally included in MPH programs in South Africa.

Pneumoconiosis is recognized as a major occupational health burden worldwide, especially in developing countries where industrial dust exposure is prevalent. This study aims to provide evidence for the development of prevention and control strategies and the strengthening of patient support systems.

Data for this study were sourced from the Jiangsu Province Pneumoconiosis Follow-up Online Reporting System. Survival analysis was performed employing life tables and the Kaplan-Meier method. The Cox proportional hazards regression models were deployed to identify factors influencing pneumoconiosis patients' survival time.

A total of 18,064 patients were diagnosed with pneumoconiosis in Jiangsu Province between 1960 and 2024. Life table analysis revealed an overall cumulative survival rate of 40%. Both mortality and hazard ratios increased with advancing age. Patients with Stage III pneumoconiosis had a significantly lower survival rate compared with those in stages I and II (p < 0.05). The results showed that gender, stage at first diagnosis, age at first diagnosis, and disease progression were significant factors influencing survival time.

Our findings highlight the importance of strengthening prevention and control measures targeting high-risk populations and key industries. Strategies should focus on early detection, timely diagnosis, and active intervention.

This study aimed to evaluate the epidemiological characteristics and long-term trends of bloodborne occupational exposure (BOE) among healthcare workers (HCWs) in a tertiary hospital in China from 2012 to 2022 (11 years) and evaluate BOE-associated factors during COVID-19 pandemic.

A total of 1,725 self-reported cases of BOE were analyzed. The study comprised: (1) Descriptive analysis of demographic and professional variables; (2) Trend analysis of exposure events by season, month, sex, age, professional role, department, exposure source and occupational factors; and (3) Logistic regression analysis, with BOEs during the COVID-19 pandemic as the dependent variable.

BOEs were most prevalent among female, formally employed staff, nurses, 25-year-olds, those with 1-5 years of experience, and junior-title holders. High-risk settings included the neurosurgery department and wards; common exposure types were needlestick injuries (mostly to ungloved hands) and first-time exposures. Hepatitis B virus (HBV) was the primary exposure source, with most exposed individuals having a prior HBV vaccination history. Exposure frequency peaked in December and the fourth quarter of the year. (1) Longitudinal trends showed rising BOE incidence in December, spring, and among specific groups: females, 25-year-olds, hospital doctors (including postgraduate/doctoral trainees), nurses (including interns), and staff with 10-15 years of experience. Syphilis/suspected syphilis-related exposures also demonstrated an upward trend. (2) Logistic regression identified exposure month, occupation, length of service as independent factors associated with BOE during the COVID-19 pandemic (p<0.05).

Targeted prevention and control strategies that focus on high-risk personnel, clinical departments, and specific procedures are essential to reduce the incidence of BOE among healthcare workers. Particular attention is required during public health emergencies (e.g., the COVID-19 pandemic), especially in addressing the January exposure peak, protecting physicians and mid-career staff with 16-20 years of service, and establishing cross-institutional mechanisms for coordinated BOE reporting and follow-up of support staff, in order to further minimize occupational risks. In addition, preventive measures such as targeted training programs, simulation-based exercises, and routine monitoring of HBV immunization status should be systematically implemented for trainees and newly recruited personnel.

Sleep studies (polysomnography) are a diagnostic tool used to monitor various physiological parameters during sleep to diagnose and manage sleep disorders. However, the prognostic utility of sleep measures for the prediction of childhood asthma severe exacerbation (SE) risk is unknown.

Retrospective cohort analysis to identify correlates and quantify the prognostic utility of poor sleep measures for the prediction of SE risk among children with moderate or severe asthma.

The study cohort included 161 patients (36% female, 33% African American, mean (standard deviation [SD]) age of 10 [4] years). A higher sleep arousal index (i.e., sleep fragmentation measured as disruptions in brainwave activity) was associated with increased risk of SE among male (adjusted odds ratio [aOR]: 1.13, 95% CI: 1.04, 1.23) but not female patients (aOR: 0.97, 95% CI: 0.88, 1.07). A history of SE(s) and use of inhaled glucocorticoid plus a long-acting β2-agonists (ICS plus LABA) were associated with higher odds of SE; conversely, a history of sleep latency reducing medication was associated with lower odds of SEs (p < .05). Inclusion of these sleep-related factors in the multivariable model to predict SE had higher prognostic accuracy than a model based on history of SE(s) alone (p < .01).

In addition to prior SE(s), elevated sleep arousal index among male children, use of ICS plus LABA, and history of untreated sleep disturbance can improve the accuracy of SE risk prognosis to inform targeted preventive interventions to reduce excess acute healthcare utilization among children with comorbid sleep problems and moderate/severe asthma.

Primary care computerised medical records (CMR) are used to report the incidence of acute respiratory infections (ARI) for public health surveillance. These systems could increase their utility by also reporting population-level severity of ARI; however, this is rarely done.

To identify candidate markers of ARI severity suitable for use in primary care CMR-based surveillance.

We undertook a systematic review of bibliographic databases and grey literature. Eligible studies reported characteristics for > 500 patients with ARI, severe ARI, influenza-like illness or suspected COVID-19. Studies had to report at least one potential marker of severity. A panel of clinical primary care informaticians reviewed candidate severity markers and assessed each for severity, specificity, relevance to primary care and whether it was likely to be recorded in a CMR.

We included 126 studies from 84 countries. Seventy-seven candidate severity markers were identified across 11 groups. These included four outcome groups (complications, hospital events, intensive care events and death) and seven predictor groups (symptoms, signs, scores, investigations, treatments, absenteeism and treatment-seeking behaviour). Thirty markers were considered most suitable for primary care CMR-based ARI surveillance: 7 outcomes (such as hospital admission, attendance and death) and 23 predictors (such as shortness of breath, oxygen levels, work absence and antibiotics). Predictors were generally considered more timely, as they are likely recorded during the consultation.

This review provides a list of severity markers that could support the development of population-level severity indicators for ARI surveillance in primary care. This could improve real-time situational awareness during respiratory outbreaks.

Cognitive impairments associated with long COVID disrupt daily functioning and psychological well-being. While increasing research has examined prevalence and mechanisms, little is known about patients' treatment experiences, preferences, and expectations. In the absence of validated effective treatments, integrating these perspectives is essential for guiding research priorities and clinical trial design. In China, where long COVID is an emerging public health concern, awareness of cognitive impairments remains limited and access to specialised care is inadequate. Considering potentially substantial differences in baseline health and treatment expectations between young and older adults, this study aimed to explore and compare their perspectives using a qualitative approach.

We adopted constructivist grounded theory to capture participants' lived experiences and develop a theory grounded in their narratives. Semi-structured online interviews were conducted with 23 individuals recruited via Chinese social media long COVID mutual aid groups, including 10 young adults (18-39 years) and 13 older adults (≥ 60 years). Theoretical sampling guided recruitment and iterative analysis through initial, focused, and theoretical coding, leading to the development of a framework explaining treatment preferences and expectations.

All participants reported cognitive impairments based on self-perception, with no formal medical diagnoses. We constructed a theoretical framework of "Individualised and Dynamic Adaptation to Cognitive Challenges". Preferences and expectations could be shaped by age, symptom severity, prior management experiences, lifestyle, doctor-patient interactions, and health literacy. Young adults showed a strong preference for non-pharmacological strategies, including self-directed approaches and emotional support to address stigma. Older adults emphasised a balanced use of pharmacological and non-pharmacological interventions, supported by family and structured routines, while expressing holistic expectations that encompassed cognitive, physical, and emotional well-being. Across both groups, improved sleep and psychological health were consistently emphasised.

Age-specific differences highlighted the heterogeneity of long COVID experiences and underscored the need for dynamic, patient-centred approaches. Tailored interventions that integrate patient perspectives may enhance care quality and outcomes. Holistic care, particularly for older adults who may face additional comorbidities and functional challenges, is essential. In China, increasing awareness among the public and healthcare providers, reducing stigma, and addressing inequalities in care access should be prioritised.

Post-COVID-19 syndrome, defined by persistent symptoms lasting beyond 12 weeks of a SARS-CoV-2 infection, affects both severe and mild COVID-19 cases. Fatigue is the most common symptom, impacting 58% of patients. Other symptoms include mental symptoms, cardiovascular and respiratory issues and autonomic dysfunction. Chronic inflammation and immune dysregulation seem to be associated with post-COVID-19 fatigue. Despite its impact on healthcare and the economy, effective treatments are limited. Yoga and health education have been shown to be effective for fatigue in other related conditions. The aim of this study, therefore, is to investigate the efficacy, safety and cost-effectiveness of yoga and health education on post-COVID-19 persistent fatigue.

A randomised controlled trial with 100 patients with persistent fatigue due to post-COVID-19 syndrome is being conducted at three study centres. Patients are randomised to two interventions, yoga and health education. Both interventions include 12 weeks of 90 min supervised group sessions and 60 min of home practice per week. The primary outcome measure is fatigue on the Chalder Fatigue Scale 12 weeks after randomisation. Secondary outcome measures include postexertional malaise (DePaul Symptom Questionnaire), health-related quality of life (Short Form Health Survey-12 Item Version, EuroQol 5-Dimension 5-Level Questionnaire), anxiety, depression (Hospital Anxiety and Depression Scale), stress (Perceived Stress Scale), sleep quality (Pittsburgh Sleep Quality Index), hand grip strength, laboratory parameters and adverse events. Physical activity analysis over 7 days using a body-worn sensor and 24-hour heart rate variability using a 3-channel ECG recorder are assessed exploratively. All outcome measures will be assessed 12 and 24 weeks after randomisation. In addition, health economic analyses as well as mediator and moderator analyses including self-reported body awareness, self-efficacy, personality traits and treatment credibility/expectations will be conducted. Furthermore, qualitative interviews at week 12 will be carried out.

The trial received ethical approval from the Ethics Committee of the University Hospital Tübingen (approval number: 775/2022BO2). Results will be disseminated via peer-reviewed open-access publications, scientific conferences and targeted communication to patient organisations, healthcare providers and the wider public.

NCT05890599.

Many patients who are extubated after receiving mechanical ventilation for acute respiratory failure experience extubation failure (ie, require reintubation hours to days after extubation). High-quality evidence shows that extubating patients directly to non-invasive ventilation (NIV) or high-flow nasal cannula oxygen (HFNC), rather than conventional low-flow oxygen, can prevent extubation failure. These guideline-recommended interventions, however, require care coordination involving multiple intensive care unit (ICU) team members and are infrequently used. Interprofessional education (IPE), which teaches members of multiple professions together, could effectively address this implementation gap in complex, team-based, critical care settings, particularly when paired with a customisable protocol.

This batched, stepped-wedge, cluster-randomised, type 2 hybrid effectiveness-implementation trial will test three hypotheses: (1) when compared with traditional online education (OE), IPE increases implementation of preventive postextubation respiratory support, (2) the benefits of IPE are increased when paired with a clinical protocol and (3) preventive postextubation NIV for high-risk patients and preventive postextubation HFNC for low-risk patients reduce in-hospital mortality when compared with conventional postextubation oxygen therapy. The trial will recruit 24 clusters made up of one or more ICUs that care for at least 100 mechanically ventilated patients per year in a large multihospital health system in the USA. All clusters will receive OE, IPE and a clinical protocol, with timing determined by randomisation. We will also randomise half of the clusters to education promoting postextubation NIV for patients at high risk of extubation failure and preventive, postextubation HFNC for patients at lower risk, whereas the other half will be randomised to education promoting postextubation HFNC for all eligible patients. We will include all patients who are invasively mechanically ventilated for at least 24 hours. The primary implementation endpoint is the rate of use of postextubation NIV or HFNC among eligible participants. The primary clinical endpoint is in-hospital mortality truncated at 60 days from intubation.

This study was approved by the institutional review board of the University of Pittsburgh and an independent data safety monitoring board. We describe the methods herein using the Standard Protocol Items for Randomised Trials framework and discuss key design decisions. We will disseminate results to participating healthcare providers, through publication in a peer-reviewed medical journal and via presentations at international conferences.

NCT05523479.