Delayed school enrolment can be an important marker for developmental delays and be associated with adverse health events. Analysing enrolment delays on an epidemiological level provides valuable insights in social, rural, socioeconomic or temporal variations. Using data from the EMOTIKON study, the influence of gender, rural and temporal variation was assessed on the frequency of children older than the key age (OTK) in a sample of 292,181 third-grade children in the Federal State of Brandenburg in Germany from 2009 to 2025. Temporal variation was analysed considering interference from significant events, specifically a change in regulation incorporating parental preferences and the onset of the SARS-CoV-2 pandemic. A generalised linear mixed model (GLMM) approach with a regression discontinuity design (RDD) revealed a substantial increase in the frequency of OTK children initiated by the change in regulation which persisted through the onset of the pandemic. The analysis further identified high regional socioeconomic deprivation, living far from metropolitan areas, living in midsize centres and being a boy as correlates of delayed school enrolment. These patterns suggests delays in school enrolment as a proxy for developmental delays to be heavily influenced by regulatory and social contexts, and at the same time highlights the importance of regional and gendered factors for school readiness assessments.

Objective: To analyze the pathogen distribution and antimicrobial resistance profiles of severe community-acquired bacterial pneumonia (SCABP) in children admitted to the pediatric intensive care unit (PICU). Methods: This retrospective cohort study included 308 children with SCABP treated at the PICU of Children's Hospital of Shanghai Jiao Tong University between January 2018 and December 2024. A total of 426 non-duplicate pathogenic bacteria were isolated from bronchoalveolar lavage fluid and sputum specimens. Antimicrobial susceptibility testing was performed for all isolates. Patients were stratified by admission year and the trends in isolation rates were tested using the Cochran-Armitage trend test. Results: A total of 426 non-duplicate pathogens were isolated from the 308 pediatric patients (178 males, 130 females), comprising 330 strains (77.5%) Gram-negative and 96 strains (22.5%) Gram-positive bacteria. The 5 most common organisms were: Acinetobacter baumannii (AB, 84 strains, 19.7%), Haemophilus influenzae (HI, 76 strains, 17.8%), Streptococcus pneumoniae (SP, 49 strains, 11.5%), Staphylococcus aureus (SA, 47 strains, 11.0%), and Pseudomonas aeruginosa (PA, 39 strains, 9.2%). Over the study period, HI emerged as the leading pathogen in 2024, with its isolation rate rising significantly from 8.3% (6/72) in 2018 to 36.1% (22/61) in 2024. In contrast, the isolation rates of AB and SP declined significantly from 33.3% (24/72) and 16.7% (12/72) in 2018 to 4.9% (3/61) and 1.6% (1/61) in 2024, respectively (χ² for trend=18.75, 27.50, 9.50, all P<0.05). The overall resistance rates of HI to ampicillin, trimethoprim-sulfamethoxazole (TMP-SMZ), azithromycin, and cefuroxime were 72.4% (55/76), 71.1% (54/76), 63.2% (48/76), and 60.5% (46/76), respectively, while it remained fully susceptible to ceftriaxone. No PA isolates exhibited resistance to amikacin or piperacillin-tazobactam throughout the study. SP was universally resistant to erythromycin and clindamycin, with 71.4% (35/49) resistance to TMP-SMZ, while remaining fully susceptible to amoxicillin-clavulanate. SA had an 85.1% (40/47) resistance rate to penicillin, but retained complete susceptibility to vancomycin, linezolid, minocycline, tigecycline, TMP-SMZ, and rifampicin. Conclusions: Gram-negative bacteria predominate in SCABP among PICU patients. The pathogen spectrum has shifted significantly over time, with HI emerging as the predominant causative agent and exhibiting high resistance to multiple antibiotics. Ongoing surveillance and susceptibility-guided antibiotics selection are essential in clinical management.

Objective: To delineate the pathogen spectrum and epidemiological features of acute respiratory infections (ARI) among pediatric patients in Beijing during 2024-2025. Methods: In this cross-sectional study, 1 435 children diagnosed with ARI were enrolled from outpatient, emergency, respiratory medicine, and critical care medicine department of Capital Center for Children's Health, Capital Medical University between July 2024 and June 2025. Respiratory specimens were collected and screened for 28 respiratory pathogens using multiplex real-time quantitative PCR. Specimens positive for influenza virus, respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and human rhinovirus were further subtyped. Patients were categorized into influenza-like illness (ILI) and severe acute respiratory infection (SARI) groups. Positivity rates across different sources, visit periods, and age groups were compared using the chi-square test and Wilcoxon rank-sum test. Results: Among the 1 435 children, there were 770 males and 665 females, with an age at presentation was 6.7 (4.4, 12.6) years. The total positive rate for the 28 pathogens was 80.5% (1 155/1 435). The ILI group comprised 1 040 cases (549 males, 491 females) with age at presentation was 6.8 (4.5, 12.8) years and the positive rate of 76.6% (797/1 040). Common viral pathogens included human rhinovirus 15.7% (163/1 040), human parainfluenza-virus (HPIV) 10.3% (107/1 040), and Influenza virus 7.1% (74/1 040), while common bacterial and atypical pathogens included Mycoplasma pneumoniae (MP) 18.7% (194/1 040), Haemophilus influenzae (HI) 18.4% (191/1 040), and Streptococcus pneumonia (SP) 17.1% (178/1 040). The SARI group comprised 395 cases (221 males, 174 females) with age at presentation was 6.5 (4.0, 12.3) years and the positive rate of 90.6% (358/395). Common viral pathogens included human rhinovirus 17.2% (68/395), RSV 9.9% (39/395), and HPIV 7.1% (28/395), while common bacterial and atypical pathogens included MP 51.4% (203/395), SP 15.4% (61/395), and HI 13.4% (53/395). Co-detections of multiple pathogens accounted for 43.0% (497/1 155) of all positive cases. The positivity rates of RSV and MP in the SARI group were significantly higher than those in the ILI group (both P<0.001). RSV positive rate was the highest in children under 1 year of age, accounting for 15.3% (13/85), while MP positive rate was the highest in children aged 7 to 18 years, accounting for 38.1% (205/538). Typing results revealed that 96.5% (83/86) were typed to H1N1 among influenza virus A cases, while 58.3% (42/72) were genotyped as RSV-A ON1 among RSV cases, 86.3% (63/73) were subtyped to B2 among HMPV cases, and 45.0% (104/231) were typed to human rhinovirus-A among human rhinovirus cases. Conclusion: The pathogen spectrum of pediatric patients with ARI in Beijing from 2024 to 2025 was characterized by the alternation or co-circulation of multiple bacteria and viruses, a high rate of co-detection of multiple pathogens, and different between SARI and ILI groups. Influenza virus was dominated by H1N1, RSV by RSV-A, HMPV by HMPV-B2, and human rhinovirus by human rhinovirus-A.

Objective: To analyze the clinical characteristics, causative pathogens, complications, and treatment outcomes of orbital cellulitis in children. Methods: A retrospective cohort study was performed. Clinical data including clinical characteristics, laboratory tests, pathogen profiles, and treatment were analyzed for 175 pediatric patients with orbital cellulitis admitted to Beijing Children's Hospital, Capital Medical University from January 2016 to December 2023. Patients were categorized by lesion location into periorbital cellulitis (PC) and orbital cellulitis (OC) groups; by complication status into with and without complications. Intergroup comparisons were performed using the chi-square test and Mann-Whitney U test. Logistic regression analysis was used to identify risk factors for complications. Results: Of the 175 patients, 116 were male and 59 were female, with an age at presentation of 3.6 (2.1, 6.7) years. There were 81 patients in the PC group and 94 in the OC group. All patients presented with eyelid and periorbital erythema and edema. The OC group demonstrated higher proportions of males, sinusitis, proptosis, ocular motility disorders, bulbar conjunctival edema, and decreased visual acuity compared to the PC group, C-reactive protein levels, neutrophil counts, and platelet counts in the acute phase were also significantly higher in the OC group (all P<0.05). A definitive microbiological diagnosis was established in 74 cases (42.3%), and a total of 76 pathogenic strains were isolated. The most common pathogen was Staphylococcus aureus, accounting for 47 strains (61.8%), including 33 strains (43.4%) of methicillin-susceptible Staphylococcus aureus, and 14 strains (18.4%) of methicillin-resistant Staphylococcus aureus, followed by Streptococcus intermedius and Streptococcus constellatus with 6 strains each (7.9%), and Streptococcus pneumoniae and Pseudomonas aeruginosa with 4 strainss each (5.3%). Complications developed in 47 cases (26.8%), most commonly orbital abscesses in 29 cases (16.6%), followed by purulent meningitis in 14 cases (8.0%). Multivariate logistic regression analysis identified proptosis (OR=3.56, 95%CI 1.49-8.49), decreased visual acuity (OR=4.45, 95%CI 1.27-15.66), and headache (OR=2.76, 95%CI 1.01-7.57) as independent risk factors for complications (all P<0.05). Conclusions: Orbital cellulitis in children commonly presents with eyelid and periorbital redness and swelling. Male sex, sinusitis, proptosis, ocular motility disorders, bulbar conjunctival edema, and decreased vision acuity serve as high-risk indicators for orbital cellulitis. Elevated C-reactive protein, neutrophil count, and platelet counts in the acute phase are laboratory makers closely associated with orbital cellulitis. Staphylococcus aureus is the most common causative pathogen. Decreased vision acuity, proptosis, and headache suggest the presence of complications.

The increasing prevalence of chronic diseases, combined with healthcare professional shortage, makes a reorganization of the healthcare system essential. This qualitative study compares the practices of sixteen nurses (ten registered nurses [RNs] and six advanced practice nurses [APNs]) in the context of chronic disease management. Results reveal two parallel trajectories: that of the RNs, who develop empirical expertise, and that of the APNs, who possess regulatory authority. Long COVID has highlighted this.

Breathlessness has functional, psychological and social impacts. Loneliness is a health priority under-researched in relation to breathlessness, despite breathlessness impacting social interactions.

We estimated the prevalence of loneliness and associated characteristics in adults (≥50 years) with breathlessness in the English Longitudinal Study of Ageing (ELSA, 2010-11). Breathlessness was assessed using the adapted modified Medical Research Council Dyspnoea Scale from grade 0 (none) to 3 (stops on level due to breathlessness). Grade 4 was not assessed in ELSA. Loneliness was measured using the 3-Item University of California, Los Angeles Loneliness Scale (scores ≥6 = lonely). Logistic regression was adjusted for age, sex and ethnicity.

Of the 8195 participants, 28.4% reported breathlessness and 19.3% were lonely. Greater breathlessness was associated with older age, female sex and lower wealth (p<0.001). Those with greater breathlessness were more likely to be lonely (16.3% for no breathlessness vs 34.9% for grade 3), live alone (18.2% vs 36.6%) and be unmarried (26.7% vs 45.7%) (all p<0.001). Greater breathlessness was associated with depressive symptoms, limiting longstanding illness, mobility issues (all p<0.001) and social isolation (p=0.012). Of those with worse breathlessness (graded 2-3, n=1149), 32.8% were lonely. Characteristics associated with loneliness in those with grade 2-3 breathlessness were female sex (OR 1.32, 95% CI 1.02 to 1.71), lower wealth (OR 2.75, 95% CI 1.63 to 4.64), no qualifications versus having a degree (OR 1.65, 95% CI 1.03 to 2.66), being unmarried (OR 3.45, 95% CI 2.64 to 4.52), living alone (OR 3.71, 95% CI 2.80 to 4.91), depressive symptoms (OR 1.58, 95% CI 1.47 to 1.69), limiting longstanding illness (OR 1.76, 95% CI 1.30 to 2.38), smoking (OR 1.42, 95% CI 1.04 to 1.97), difficulties with activities of daily living (OR 1.34, 95% CI 1.21 to 1.47) or mobility (OR 1.15, 95% CI 1.10 to 1.21). Age, ethnicity or social isolation was not significantly associated with loneliness in adults with breathlessness.

Adults with breathlessness are more likely to be lonely, especially those with lower socio-economic status, who are unmarried or live alone or who have poorer physical function. Findings highlight priority groups for loneliness interventions among adults with breathlessness.

Postoperative respiratory complications, particularly in patients with poor oral hygiene, contribute significantly to morbidity and healthcare burden. The oral cavity serves as a reservoir of pathogenic micro-organisms that, when aspirated during or after surgery, can lead to respiratory infections. While chlorhexidine mouthwash has shown promise in high-risk surgeries, its role in short-duration elective abdominal surgeries remains unexplored, especially in low-resource settings.

This double-blind, randomised controlledrial included 228 patients (American Society of Anaesthesiologists I/II, aged 18-65 years, Oral Hygiene Index (OHI) >6) undergoing elective abdominal surgery under general anaesthesia lasting <4 hours. Patients were randomised to receive either 0.2% chlorhexidine (group A) or normal saline (group B) mouthwash two times before surgery. Outcomes measured included postoperative sore throat, fever, pneumonia, surgical site infections (SSI) and length of hospital stay. Microbiological cultures, complete blood count, C-reactive protein (CRP) and chest X-rays were evaluated on postoperative days 1, 3 and 7.

Chlorhexidine significantly reduced sore throat (18.42% vs 47.37%, p<0.001), positive bacterial cultures (21.05% vs 62.28%, p<0.001), CRP elevation and SSI (4.39% vs 21.93%, p<0.001). Length of hospital stay was also shorter in the chlorhexidine group (p<0.001). Pneumonia rates were low and comparable.

This double-blind randomised controlled trial demonstrates that preoperative use of chlorhexidine mouthwash significantly reduces postoperative sore throat, bacterial colonisation, SSI and length of hospital stay in patients with poor oral hygiene undergoing short-duration elective abdominal surgeries. These findings highlight the utility of a simple, low-cost oral hygiene intervention in improving surgical outcomes, particularly in low-resource settings and support its incorporation into standard perioperative protocols, even for lower risk procedures.

CTRI/2024/06/069511).

Cardiovascular disease is a major comorbidity in chronic obstructive pulmonary disease (COPD). Previous studies evaluating the association between inhaled corticosteroids (ICS) and cardiovascular events (CVEs) in COPD have yielded conflicting results and a potential dose-response relationship remains unclear.

To determine the association between ICS exposure and risk of CVE in COPD patients.

In this nationwide, retrospective register-based cohort study, we included patients with a specialist-verified COPD diagnosis between January 2008 and January 2022. ICS exposure was quantified as mean daily budesonide-equivalent dose redeemed in the year prior to index and categorised as none, low (>0 µg/day and <400 µg/day), moderate (400-800 µg/day) or high (>800 µg/day). We assessed CVE risk using adjusted cause-specific Cox proportional hazards models, with additional sensitivity analyses including a complete-case analysis, time-varying Cox regression, Fine-Gray competing risk model, and a negative control outcome analysis.

Among 82 327 patients, 8948 (10.9 %) experienced a CVE during a 1-year follow-up. In the primary analysis, low- and moderate-dose ICS was associated with a significantly reduced CVE rate compared with no ICS use. A modest decrease in CVE rate was observed for moderate-dose ICS largely across all sensitivity analyses.

ICS use in COPD was not associated with an increased risk of CVE at any dose level. A modest association with reduction in CVE risk was confined to moderate-dose ICS. These findings support the cardiovascular safety of ICS and reinforce that ICS prescribing should be guided by exacerbation risk and symptom burden rather than cardiovascular concern.

To determine whether patterns of asthma and/or chronic obstructive pulmonary disease (COPD) medicine dispensed in pharmacy dispense records (PDRs) associated with high risk of asthma and COPD exacerbation can be identified in long-term PDRs.

Retrospective cohort study.

NostraData between 2011 and 2019.

Deidentified PDRs containing respiratory medicines, with a minimum of three dispensing events across at least 5 years.

The primary outcome measures were to describe the frequency, duration and dosage of medicines such as short-acting beta-agonist (SABA), oral corticosteroids (OCS) and inhaled corticosteroids (ICS), dispensed within PDRs containing respiratory medicines.

Of 26 055 926 PDRs explored, 14.7% were eligible for inclusion (n=3 837 950) and represented people with a median age of 48 years who visited an average of five different pharmacies over a range of 5-8 years. The most common medicine dispensed was SABA (72.7%), and 35.2% were dispensed ≥3 in a year. Almost half the PDRs dispensed with OCS (49.2%) were dispensed ≥1 g cumulatively. Asthma and asthma/COPD PDRs were most commonly dispensed Global Initiative for Asthma (GINA) Step 4 medications (36%), and only 7.5% of PDRs demonstrated ≥60% adherence to preventer/controller inhalers.

Patterns of medication dispensing associated with high risk of asthma and COPD exacerbation, such as the overuse of SABA and OCS and inadequate adherence to preventer/controller inhalers, can be identified in long-term PDRs. This real-time information in PDRs should be further researched to support identification of people at risk of exacerbation in primary care, to optimise management in primary care and deliver targeted intervention.

Understanding how sentiment toward COVID-19 mitigation measures evolves on social networks can help to inform infectious disease models and policymakers. Even though numerous studies have described social media interactions during the pandemic, few have modeled the underlying dynamics of sentiment contagion and polarization.

This study aimed to investigate topic emergence and sentiment evolution in COVID-19 mitigation discussions on r/Belgium, focusing on (1) whether discussion topics exhibited social contagion, (2) whether expressed sentiment displayed homophily, and (3) how this homophily formation can be captured by a mechanistic model.

We classified posts created on r/Belgium between January 1, 2020, and June 30, 2022, into lockdowns, masks, and vaccination, using a pretrained bidirectional encoder representations from transformers (BERT) topic model, and assigned English posts a sentiment, using a robustly optimized BERT pretraining approach (RoBERTa)-based sentiment classifier. We then examined temporal patterns of post volume and tested for social contagion in topic initiation. Sentiment homophily was quantified by comparing observed comment-parent sentiment pairs to null distributions. The novel smooth latent-expressed bounded confidence (SLEBC) model dynamically captured sentiment evolution, distinguishing between latent sentiment trajectories and noisy expressed sentiment. We tested the model against 2 alternatives, one with a linear update and one without the latent state, using the Watanabe-Akaike information criterion.

Analysis of 655,642 posts made by 28,559 users revealed that post volume was associated with external events such as policy announcements and media reports. There was no evidence of within-Reddit social contagion in topic initiation. However, sentiment exhibited significant homophily, with comment sentiment correlating with parent comment sentiment. The SLEBC model reproduced observed sentiment patterns (Watanabe-Akaike information criterion: -28.5 to -18.4 across topics), outperforming both alternatives (-21.1 to -17.4 for the linear model and 6.8 to 692 for the one without the latent state). It slightly underestimated sentiment homophily but still outperformed the alternatives in this regard. In the SLEBC model, expressed sentiment adapts more strongly to the immediate parent comment than the user's latent state updates based on their interaction history (proportions of users showing this pattern: 0.74, 0.70, and 0.51 for lockdowns, masks, and vaccination).

Discussion topics on r/Belgium are not associated with social contagion within the platform, but sentiment dynamics are shaped by within-thread interactions. The SLEBC model suggests that users adapt their expressed sentiment to match the post they reply to, highlighting that expressed sentiment may poorly reflect underlying latent sentiment. Infodemic models for Reddit-like platforms could benefit from incorporating external information sources for topic seeding and from using bounded confidence rather than linear contagion mechanisms for sentiment spread.