To examine how perceived changes in stress among adults during the COVID-19 pandemic are associated with changes in self-rated health (SRH) in Puerto Rico.

This cross-sectional analysis used data from the Puerto Rico Community Engagement Alliance (Puerto Rico-CEAL). Adults aged ≥ 18 years (n = 654) completed an online survey from December 2021 through February 2022. One item assessed perceived changes in psychological stress throughout the pandemic. Two separate items assessed SRH (rated from poor to excellent) before and during the pandemic; changes in SRH ratings were calculated. Adjusted Poisson regression models were used to estimate prevalence ratios (PRs) of decreased SRH.

Overall, 72.8% of the sample perceived an increase in psychological stress during the pandemic and 39.6% experienced decreased SRH. In adjusted models, participants reporting perceived increases in stress were more likely to experience decreases in SRH (PR = 2.44; 95% CI, 1.71-3.45) during the pandemic compared with those reporting no change in stress.

Perceived increases in psychological stress during the pandemic were associated with decreased SRH among participants in this Puerto Rico-based sample. Studies are needed to identify stress management strategies during public health emergencies.

The COVID-19 pandemic disrupted HIV prevention services, including reductions in pre-exposure prophylaxis (PrEP) prescription and HIV testing. However, evidence on the association between the pandemic with PrEP use, as well as HIV and sexually transmitted infection (STI) rates among PrEP users remained limited.

To compare patterns of PrEP adherence, HIV incidence, and STI rates among adult men newly initiating PrEP before vs during the COVID-19 pandemic.

We conducted a new-user retrospective cohort analysis of commercially insured PrEP users using the 2018-2021 MarketScan administrative claims database. Adult men aged 18-49 years in the MarketScan administrative claims database prescribed tenofovir disoproxil fumarate with emtricitabine or tenofovir alafenamide with emtricitabine for PrEP were included. Group-based trajectory modeling was used to identify PrEP adherence patterns. After balancing group demographic and clinical characteristics with inverse probability treatment weighting, time-varying Cox proportional hazards models were used to evaluate HIV risk and Poisson regression was used to assess STI rates.

Of 8,683 adult men (43% aged 25 to 34 years), 5,957 initiated PrEP before the pandemic and 2,726 during the pandemic. Prepandemic adherence trajectories included nonadherence (11.8% of the cohort) and rapidly declining (20.8%), gradually declining (21.1%), and consistently high (46.3%) adherence. Pandemic adherence trajectories included early discontinuation (35.7%) and rapidly declining (19.5%), gradually declining (14.8%), and consistently high (29.9%) adherence. Initiating PrEP during the pandemic was associated with higher risk of HIV acquisition (adjusted hazard ratio = 2.20 [95% CI = 1.08-4.47]). STI rates did not differ between groups (adjusted incidence rate ratio = 1.04 [95% CI = 0.88-1.23]).

Individuals initiating PrEP during the pandemic were associated with reduced PrEP adherence and higher HIV incidence. Targeted strategies to maintain access and continuity of HIV prevention services during public health emergencies are needed.

The COVID-19 vaccine saved millions of lives during the pandemic. Clinical trials at the time of authorization and approval showed remarkable effectiveness. However, the effectiveness of the COVID-19 vaccine has changed now that people are no longer naive to the virus. The benefit of vaccination is incrementally lower for some people, raising questions about who should receive the vaccine, what the vaccines should cost, and which subpopulations would be cost-effective to vaccinate. The Institute for Clinical and Economic Review (ICER) recently released its assessment of the COVID-19 vaccine. It was ICER's first vaccine assessment, presumably because of the uncertainty of future coverage policies for the COVID-19 vaccine. ICER found that the COVID-19 vaccine is most beneficial for the very young, the very old, and those in between with risk factors. Cost-effectiveness models mirror effectiveness assessments. Limiting vaccine access to people with risk factors in specific age bands would require a prior authorization, adding complexity and administrative costs for payers. Coverage restrictions may further reduce population vaccinations rates, resulting in higher virus community load and prolonged circulation. Although the US regulatory framework requires insurers to cover vaccines included on the Centers for Disease Control and Prevention (CDC) Immunization Schedules without cost sharing, the future placement of COVID-19 vaccines on these schedules is uncertain. Given the evidence and population benefits, we support ICER's recommendation for private payers to cover COVID-19 vaccines with no patient cost sharing. We further recommend no restrictions on coverage based on risk factors, regardless of CDC Immunization Schedules, which have recently been subject to considerable uncertainty.

BackgroundHepatic dysfunction is increasingly recognized as a contributor to adverse outcomes in patients with pulmonary arterial hypertension (PAH). However, current prognostic models for PAH do not incorporate hepatic function parameters.ObjectivesTo develop and validate a novel risk prediction model that integrates hepatic function indicators with established PAH severity markers, and to compare its performance against the COMPERA 2.0 model.DesignProspective cohort study.MethodsThree liver fibrosis scores (LFSs)-FIB-4, NFS, and HUI-were evaluated for their prognostic significance. A total of 715 PAH patients from Fuwai Hospital were used to develop the FW-HP model. The model's predictive performance was assessed and compared with COMPERA 2.0. Risk stratification of the PAH cohort was subsequently conducted based on model scores.ResultsAll three LFSs were independently associated with mortality in PAH. The FW-HP model, incorporating albumin, total bilirubin, N-terminal pro-B-type natriuretic peptide, and World Health Organization functional class, provided superior risk prediction with area under the receiver operating characteristic curve of 0.86, 0.89, and 0.83 at 1-, 2-, and 3-year intervals, respectively-markedly exceeding COMPERA 2.0. The FW-HP score demonstrated higher net clinical benefit and enabled earlier identification of non-low-risk patients requiring more aggressive management.ConclusionsThe FW-HP model offers improved prognostic accuracy by incorporating hepatic function into PAH risk stratification. It represents a practical tool for early risk identification with potential to guide clinical decision-making in PAH patients.

ObjectivesThis study quantified trends in the burden of lower respiratory infections from 1990 to 2023 in five East Asian countries, projected disease trajectories from 2024 to 2033 using machine learning, and identified key risk factors and their associations with the sociodemographic index.MethodsBased on the Global Burden of Disease Study (2023) estimates, we calculated the age-standardized incidence, prevalence, mortality, and disability-adjusted life year rates of lower respiratory infections for five East Asian countries. A multistage machine learning framework with Shapley additive explanations was used to screen exposure-related risk factors, and machine learning time-series models were used to project the future burden of lower respiratory infections.ResultsLower respiratory infection incidence and prevalence declined universally; however, mortality trends were heterogeneous (rising in South Korea and falling in others). China demonstrated the largest reduction in incidence. Mongolia demonstrated the steepest decline in prevalence; however, it continued to have a high burden of disability-adjusted life years in 2023. Exposure to secondhand smoke was the most important risk factor, whereas zinc/iron deficiency prevailed in low sociodemographic index settings; the lower respiratory infections burden had a nonlinear inverse association with the sociodemographic index, with population aging as a key driver. Projections demonstrated a continued decline in the overall burden of lower respiratory infections, although mortality rates were projected to increase in South Korea.ConclusionThe burden of lower respiratory infections has reduced substantially in East Asia over three decades; however, population aging has resulted in divergent mortality trends. High-sociodemographic index regions require age-responsive, integrated strategies targeting both exposure reduction and host vulnerability to sustain declines in mortality rates.

Early targeted antibiotic therapy is critical for improving outcomes in ICU patients with pneumonia unresponsive to initial treatment. Metagenomic next-generation sequencing (mNGS) is a unique diagnostic tool; however, its effectiveness for high-risk populations remains unclear.

This retrospective study included 642 ICU patients with pneumonia unresponsive to initial treatment, categorized into single- or repeat-test groups based on mNGS testing frequency. We analyzed the results of mNGS and conventional microbiological tests (CMTs), compared microbial detection characteristics between patients with different immune statuses, assessed the impact of repeat testing on microbial detection and treatment adjustments and evaluated its association with patient prognosis using multivariable logistic regression and propensity score matching.

Among 642 patients, patient-level agreement between mNGS and CMTs was low (κ = 0.180, p < 0.001). First bronchoalveolar lavage fluid (BALF)-mNGS results showed a higher microbial detection rate in immunocompromised than immunocompetent patients. Among patients undergoing repeat BALF-mNGS testing, partial concordance between first and second tests was most common pattern. Antibiotic treatments were modified in 67.6% of cases based on mNGS results, with a higher adjustment rate in the repeat-test group. Although ICU mortality was higher in the repeat-test group, multivariate logistic regression analysis revealed no significant association between repeat testing and mortality risk (adjusted odds ratio = 1.15, 95% CI: 0.64-2.06, p = 0.630). After propensity score matching, no significant difference was observed between two groups (absolute risk difference: 1.12%, 95% CI: -7.43% to 9.67%, p = 0.798).

mNGS is a valuable microbial detection tool for ICU patients with pneumonia unresponsive to initial treatment and can support early antimicrobial adjustment. Repeat testing can provide information on dynamic changes in the microbial spectrum during disease but was not associated with improved patient outcomes, suggesting that repeat testing frequency should be carefully considered to avoid unnecessary testing. mNGS results should be interpreted in conjunction with CMTs, host immune status and inflammatory biomarkers to optimise its clinical value in ICU pneumonia.

To explore the value of real-time three-dimensional echocardiography (RT-3DE) in evaluating right ventricular (RV) structure and function in patients with pulmonary hypertension (PH) across different echocardiographic pulmonary artery systolic pressure (PASP) strata.

A total of 150 patients with PH and 84 healthy controls were included. Patients with PH were stratified into mild, moderate and severe echocardiographic PASP strata. Conventional two-dimensional (2D) echocardiographic parameters and RT-3DE-derived RV parameters were compared among groups. Correlations between echocardiographic parameters and pulmonary pressure burden were analyzed. Cross-validated receiver operating characteristic analyses were performed to evaluate the diagnostic performance of 2D parameters, RT-3DE parameters and combined 2D plus RT-3DE models.

PH etiologies included Group 1 pulmonary arterial hypertension (31.3%), Group 2 PH due to left heart disease (51.3%), Group 3 PH due to lung disease and/or hypoxia (11.3%), Group 4 PH associated with pulmonary artery obstruction (1.4%), and Group 5 PH with unclear and/or multifactorial mechanisms (4.7%). RV-TD, RV/LV ratio, RAEA, and RV-FW increased across echocardiographic PASP strata, whereas S', TAPSE, RVFAC, and RVEF decreased. RT-3DE-derived RV volume and functional parameters differed significantly among groups; within the PH cohort, RVEDV, RVESV, RVSV, and RV cardiac output increased across PASP strata, while RVEF progressively decreased. The combined 2D plus RT-3DE model showed high cross-validated discrimination for moderate-to-severe PH and severe PH, with AUCs of 0.956 and 0.998, respectively.

Combined 2D echocardiography and RT-3DE provide complementary noninvasive information for evaluating RV remodeling and systolic dysfunction in patients with PH across different echocardiographic PASP strata.

BackgroundIdiopathic pulmonary fibrosis (IPF) represents a chronic and irreversible progressive disease, while acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) represents a catastrophic event in the course of the disease with high mortality. So far, there is no known accurate biomarker with a diagnostic or prognostic role in IPF. Matrix metalloproteases (MMPs), belonging to the family of zinc-containing metallopeptidases, play an active role in extracellular matrix remodeling and in regulating fibrogenesis.ObjectivesThe study's aim was to assess the potential diagnostic and prognostic role of plasma MMP-1 and MMP-9 in IPF and their association to disease progression, acute exacerbation development, and death.DesignConsecutive stable and exacerbated patients referred to our department from October 2013 until December 2017 were enrolled in the study.MethodsDemographic, clinical, and laboratory data were collected. MMP-1 and MMP-9 plasma concentrations were measured. All patients were followed-up until death or until 1^st July 2020. We analyzed data using tobit regression analysis, Kaplan-Meier analysis, Cox regression analysis, and fractional polynomials.ResultsOne hundred twenty-eight patients were included in the study [74 stable IPF patients, mean age (SD) 71.5 years (8.05) and 54 exacerbated, mean age (SD) 71.8 years (10.15)] as well as 26 healthy controls, mean age (SD) 61.4 years (10.4). At baseline, both stable IPF and exacerbated patients presented higher concentrations of MMP-9 in plasma compared to healthy controls independently of age, sex, and smoking (p=0.006 and p=0.002, respectively). In stable IPF, each 1 µg/L increase in plasma MMP-1 concentration at baseline was associated with an increase in the hazard rate of death by 20% (95%CI: 2% to 42%; adjusted for age, sex, smoking and FVC).ConclusionIn our patients with stable IPF, MMP-1 concentration is prognostic for death, whereas MMP-9 has diagnostic value for IPF. These results may lead to better patient stratification and personalized therapeutic approaches.

IgA nephropathy (IgAN), or Berger's disease, is a common primary glomerulonephritis that presents a variety of clinical manifestations. The most typical presentation consists of episodes of gross hematuria in young adults, often occurring concurrently with upper respiratory tract infections. However, it may also present microscopic hematuria, varying degrees of proteinuria, renal insufficiency, or hypertension of varying severity. The diagnosis is based on kidney biopsy, which reveals IgA mesangial deposits. This condition may be associated with other systemic diseases that should be investigated. The course is heterogeneous, ranging from spontaneous remission to rapidly progressive forms. Prognostic factors - both clinical and biological (hypertension, proteinuria, renal function) and histopathological (Oxford classification criteria) - help guide therapeutic management. The cornerstone of treatment remains nephroprotection. The indication for immunomodulatory therapies should be assessed on a case-by-case basis. Numerous studies are currently underway to evaluate the effectiveness of promising new treatments targeting the production of pathogenic IgA or their inflammatory consequences within the glomeruli.

Pertussis incidence increased substantially in Ireland in 2024. This study examined the relationship between pertussis incidence and area-level socioeconomic deprivation in the HSE Dublin and Midlands region in 2024.

All 121 confirmed cases in the HSE Dublin and Midlands region in 2024 were collated, alongside demographic and clinical information. Each case was assigned the deprivation score of its residential Small Area using the Pobal HP Deprivation Index. Denominator population data from Health Atlas were used to calculate cumulative incidence and Poisson regression was used to assess the association with deprivation.

Incidence rose from 1.2 cases per 100,000 in the most affluent areas to 15.4 cases per 100,000 in the most deprived. Every one-step increase in deprivation category was associated with a 16% increase in pertussis incidence (IRR 1.16, 95% CI 1.03-1.31, p = 0.016). Pairwise comparisons showed that deprived areas had a pertussis incidence up to 13 times higher than in the most affluent communities.

Pertussis incidence increased progressively with area-level socioeconomic deprivation, with the highest incidence observed in the most disadvantaged communities. These results highlight major inequalities in pertussis burden and show the need for targeted vaccination campaigns in deprived areas.