Maternal health has made important gains globally over the past decades, but it remains a pressing health priority that is facing diminishing returns from conventional policy instruments. Community engagement approaches hold great promise through their focus on social and contextual determinants of maternal health. This study explores the short-term effects of a relational community engagement intervention which foregrounded trust and relationships between communities and local healthcare providers as important social determinants: the Community Network Engagement for Essential Healthcare and COVID-19 Responses Through Trust (CONNECT) Initiative in Lao People's Democratic Republic (PDR).

We studied the short-term effects of the CONNECT Initiative on health-centre-provided maternal healthcare attitudes, practices, and experiences. An evaluative study using a quasi-experimental study without control design was implemented from 10/2022 to 12/2023 among 14 diverse case study communities in four provinces across Lao PDR. Data collection involved two rounds of complete census surveys before and at least three months after village-based CONNECT activities (3,161 survey observations), 50 semi-structured interviews with villagers, and 50 contextualizing key informant interviews.

Among others, attitudes among women to recommend health centres for ante-natal care and delivery were 7.3 and 14.6 percentage points higher at endline (p < 0.01), and practices of giving birth at their local health centre were 14.3 percentage points higher at endline (p = 0.095). No statistically significant effect for maternal healthcare experiences was detected. Compared to the changes across survey periods, changes were similarly pronounced at endline among women who were exposed to CONNECT relative to unexposed villagers. We also observed a proportionate counter-reaction of reduced indicators of attitudes and practices involving hospital-provided maternal healthcare services.

CONNECT addressed communities' trust and relationships towards local healthcare providers. The Initiative responded effectively to social determinants of maternal health in Lao PDR, with the positive side-effect of strengthening the gatekeeping functions of primary care facilities in the broader health system. This provides strong support for further operational and evaluation research into the opportunities of relational community engagement activities to complement supply-sided interventions in the attainment of global maternal health goals and low- and middle-income country health services provision more broadly.

The COVID-19 pandemic revealed significant gaps in healthcare access for migrants, including Vietnamese migrants in Japan who are young and growing. This study aimed to clarify the accessibility and difficulties related to COVID-19 healthcare services (vaccination, testing, and medical care) and identify factors associated with these difficulties.

A cross-sectional online survey was conducted from March to April 2023 through a Vietnamese social media platform with 1.5 million followers. Data from 418 respondents were analysed descriptively, and multivariate logistic regression was used to identify factors associated with experienced difficulties. Independent variables included age, education, residential status, length of stay in Japan, Japanese language proficiency, underlying diseases, and health insurance.

Among 418 participants, 47.1% were Technical Intern Trainees, and 93.3% were under 30. Over 95% of the participants perceived that COVID-19 vaccination, testing, and medical care were accessible if needed; however, 26.6% had unmet healthcare needs. The self-reported uptake rate was 90.4% for vaccination and 84.4% for testing among all 418 participants, and 84.0% of 97 participants who tested positive accessed medical care. Among those who received services, 18.8% experienced difficulties with vaccination, 24.1% with testing, and 69.1% with medical care. Major difficulties included cost, administrative requirements, and long waiting times. Factors such as age, education, length of time living in Japan, and underlying diseases were associated with greater difficulties. Japanese language proficiency specifically reduced the odds of difficulties in accessing medical care (adjusted odds ratio [AOR] = 0.008, confidence interval [CI] = 0.001-0.117, p <.001) but not for vaccination (AOR = 0.481, CI = 0.186-1.247, p =.132) or testing (AOR = 0.559, CI = 0.230-1.356, p =.198).

Despite high self-reported accessibility to COVID-19-related healthcare services, unmet needs for general healthcare persisted among one-fourth of the participants. These challenges were influenced by individual and structural factors, particularly language, education, and system navigation. Tailored interventions such as multilingual support, simplified administrative processes, and enhanced community outreach are essential to address disparities for Vietnamese migrants. These findings underscore the importance of integrating migrants into health systems and preparedness frameworks to ensure equitable healthcare access during future health emergencies.

Despite intimate partner violence (IPV) having increased significantly during the COVID-19 pandemic in Canada, it remains under-documented in the Quebec province. To partially fill this gap, this study sought to investigate IPV experienced by women in the perinatal period in Quebec and health and social care providers' response in caring for both victims and their fetuses/children at the time of health restrictions.

The study adopted a qualitative exploratory descriptive design and involved eleven perinatal victims and eleven health and social care providers (HSCPs). Semi-structured interviews were conducted using in-depth interview guides. Data was analyzed using thematic analysis.

The study showed the multifaceted dimensions of perinatal IPV during COVID-19. Spatial, psychological, physical, economic and sexual violence were reported by the perinatal victims. Further, we found that the type and magnitude of perinatal IPV varied greatly with the periods of restrictions. The study also indicated that perinatal victims faced spatial, institutional, cultural, geographical and perpetrator-related barriers to seeking help. For accessing formal and informal support resources, and escaping IPV, perinatal victims used diverse coping strategies. Additionally, we found that a wide range of barriers limited the ability of HSCPs to operate during the pandemic. However, to enable continued client engagement, they used several coping strategies such as remote working, hybrid IPV care (in-person and virtual services), close collaboration with other community organizations and pharmacies, food or gift card distributions; which reflects their ability to adapt and be creative to address challenges presented by the COVID-19 pandemic.

This study shed light on the necessity to improve the provision of health and social services to better prevent IPV and meet the needs of perinatal victims and their fetuses/children.

High-frequency oscillatory ventilation (HFOV) is widely used in neonates with respiratory distress syndrome (RDS) to optimize lung recruitment while minimizing ventilator-induced lung injury. Sigh breaths have been incorporated into HFOV to improve alveolar recruitment in cases of atelectasis. However, the safety of this approach, particularly in extremely preterm neonates, remains unclear. This study aimed to evaluate whether the use of sigh breaths during HFOV increased the risk of developing tension pneumothorax within the first 96 h after birth in neonates born at 22-25 weeks of gestation with RDS.

This retrospective cohort study included neonates born at 22-25 weeks of gestation between 2014 and 2023 who required rescue HFOV within 4 h of birth due to respiratory acidosis. Among 66 eligible neonates, 2 were excluded due to congenital anomalies, leaving 64 included for analysis. The study population was categorized into three groups: (1) neonates with atelectasis who received sigh breaths (n = 16), (2) neonates with atelectasis who did not receive sigh breaths (n = 3), and (3) neonates without atelectasis who did not receive sigh breaths (n = 45). The primary outcome was the incidence of tension pneumothorax within 12-96 h post-birth.

Tension pneumothorax occurred in 10 neonates (15.6%). Bivariable analysis revealed a significant association between the use of sigh breaths and tension pneumothorax (p = 0.007). Firth's penalized logistic regression demonstrated that neonates with atelectasis who received sigh breaths had a significantly higher risk of developing tension pneumothorax (odds ratio = 5.5, 95% confidence interval: 1.2-23.9, p = 0.02) compared to those without atelectasis who did not receive sigh breaths. In contrast, no significant difference was observed between neonates with and without atelectasis who did not receive sigh breaths.

While sigh breaths during HFOV may facilitate alveolar recruitment in preterm neonates with atelectasis, their use appears to significantly increase the risk of tension pneumothorax. Given the vulnerability of extremely preterm lungs, caution is required when implementing sigh breaths in this population. Further prospective studies are needed to refine ventilation strategies and minimize complications in extremely preterm neonates.

To explore the factors affecting patient outcomes in pulmonary artery thromboendarterectomy (PTE) under deep hypothermic circulatory arrest (DHCA) and cardiopulmonary bypass (CPB) support and to provide a reference for further improving the effect of PTE.

Eighty-five patients with chronic thromboembolic pulmonary hypertension (CTEPH) who underwent PTE under DHCA and CPB support at Beijing Anzhen Hospital from January 2015 to October 2023 were enrolled, including 56 males (65.88%) and 29 females (31.42%), aged 23-75 years (mean 57.05 ± 15.03 years). The diagnostic criteria for the patients with CTEPH met with the diagnostic criteria described in the 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Based on whether major adverse events (MAE) occurred during the hospitalization after PTE (MAE was defined as all-cause death and major complications related to surgery), patients were divided into the MAE group (n = 36) and the non-MAE group (Control group, n = 49). The differences in the preoperative and intraoperative indicators were compared between the two groups. A logistic regression analysis, receiver operating characteristic (ROC) curve and area under the curve (AUC) analysis were performed to identify risk factors affecting the outcomes of PTE.

PTE under DHCA and CPB support was performed in 85 cases. Duration of CPB was 214.84 ± 49.08 min. The duration of aortic cross-clamping (ACC) was 125.88 ± 24.22 min. The duration of DHCA was 24.36 ± 7.25 min, and the number of DHCA episodes was 3.14 ± 1.52. After the PTE 36 patients (42.35%) experienced one or more MAEs, including 7 all-cause deaths (8.24%), 14 cases (16.47%) with reperfusion pulmonary edema, 20 cases (23.53%) with residual pulmonary hypertension (defined as mPAP > 25 mmHg), 6 cases (7.06%) with pulmonary hemorrhage syndrome, 12 cases (14.12%) with pneumonia, 12 cases (14.12%) with delirium, 6 cases (7.06%) with pericardial tamponade, 12 cases (14.12%) with pleural effusion, and 6 cases (7.06%) with acute kidney injury. When compared with the factors affecting the patient outcomes between two groups, significant differences (P < 0.05) were observed in the preoperative factors including gender (female), body mass index, heart failure with New York Heart Association (NYHA) class Ⅲ-Ⅳ, tricuspid valve pressure gradient value, B-type natriuretic peptide (BNP) value, left ventricular ejection fraction (LVEF), 6-minute walking distance, mean pulmonary arterial pressure (mPAP), systolic pulmonary artery pressure (sPAP), pulmonary vascular resistance (PVR), pulmonary artery wedge pressure (PAWP), and cardiac index. Significant intraoperative differences (P < 0.05) were also found in the parameters including CPB time, ACC time, DHCA time, the longest single DHCA time, maximum temperature difference between nasopharynx and bladder, and peak value of lactic acid. However, logistic regression analysis, receiver operating characteristic (ROC) curve, and area under the curve (AUC) analysis revealed that among these factors, only sPAP, PVR, PAWP, CPB time, DHCA time, and the longest single DHCA time were independent risk factors for MAE.

The results of this study indicate that preoperative right heart catheterization parameters-including mPAP, PAWP, and PVR-and intraoperative parameters-such as prolonged CPB time, DHCA time, and the longest single DHCA time-are independent predictors of MAE after PTE. Therefore, careful management of these parameters may further improve patient outcomes.

Acquired subglottic stenosis (ASGS) is a significant cause of pediatric airway obstruction and presents various anesthetic challenges due to the complexities of altered airway anatomy. While balloon dilation serves as a first-line minimally invasive intervention, shared airway management between surgeons and anesthesiologists requires meticulous coordination. This case report demonstrates the successful implementation of nasopharyngeal airway-assisted positive pressure ventilation during balloon dilation in a critically ill infant with grade III ASGS. This approach proposes a new ventilation strategy for complex airway procedures.

A 3.2 kg, 3-month-old male infant presented with progressive respiratory failure secondary to Cotton-Myer grade III ASGS. Following multidisciplinary consensus, emergency balloon dilation was performed under general anesthesia with tracheostomy contingency planning. Initial ventilation attempts using a laryngeal mask proved inadequate, causing surgical field obstruction. Transitioning to a nasopharyngeal airway connected to the anesthesia machine in pressure-controlled ventilation mode successfully maintained adequate gas exchange (SpO₂ 95 ~ 100%).The procedure was completed successfully without hemodynamic compromise or airway reflexes, ultimately avoiding tracheostomy. Postoperative recovery was uneventful, with the patient returning to pediatric respiratory intensive care unit for continued respiratory support.

Using a nasopharyngeal airway assisted positive pressure ventilation can effectively maintain oxygenation and surgical access during pediatric ASGS interventions, proposing a novel ventilation strategy for complex airway procedures. While demonstrating procedural feasibility in this critical scenario, larger-scale prospective studies are required to validate its efficacy and safety profile across varying stenosis severities.

Acute respiratory distress syndrome (ARDS) caused by SARS-CoV-2 infection is associated with high mortality rates and respiratory compromise in which excessive neutrophil extracellular trap (NET) production may amplify alveolar inflammation and injury. Dornase alfa, a recombinant DNAse 1, has been proposed to attenuate these effects by degrading extracellular DNA and enhancing alveolar clearance of NETs. In this multicenter, open-label, randomized in two parallel arms (1:1) controlled trial, intubated COVID-19 ARDS patients received either standard-of-care (SOC) alone or SOC plus aerosolized dornase alfa (2500 IU twice daily for 7 days). The primary endpoint was the proportion of patients with ARDS severity improvement at Day 7, defined by at least one-grade improvement on the Berlin criteria scale. Secondary outcomes included 28-day mortality, ventilator-free days, ICU-free days, and changes in key ventilatory parameters. Biological samples were analyzed to assess NET related markers, DNAse drug activity and indicate possible bioavailability issues associated with aerosolization of dornase alfa. Seventy-seven patients were enrolled (dornase alfa group, n = 39; SOC group, n = 38). At Day 7, ARDS severity improved in 18% of patients receiving dornase alfa compared with 29% in the SOC group (adjusted OR: 0.33; 95% CI 0.09-1.14; p = 0.11). Secondary endpoints, including 28-day mortality, ventilator-free days, and ICU-free days, showed no significant differences between groups. Adverse events occurred in 38.5% of patients in the dornase alfa arm versus 31.6% in the SOC arm, indicating comparable safety profiles. Despite early increases in NET plasmatic levels observed in both groups and successful ex vivo NET degradation, aerosolized dornase alfa failed to significantly enhance DNAse activity or reduce NET-related markers in patients' plasma and mucus, suggesting potential bioavailability limitations with this delivery method. In patients with COVID-19-related ARDS, dornase alfa did neither significantly reduce ARDS severity nor improve clinical outcomes over SOC. Although well tolerated, analysis of biological samples suggests that aerosol administration may have compromised drug bioavailability. Further trials are needed to determine whether specific patient subgroups could benefit more from dornase alfa or if alternative drug delivery methods might enhance treatment efficacy. ClinicalTrials.gov, NCT04355364. Registered on 21/04/2020.

Saliva is a promising non-invasive alternative to nasopharyngeal swabs (NPS) for SARS-CoV-2 diagnosis, yet its longitudinal performance remains underexplored. This longitudinal study evaluated saliva's diagnostic accuracy against NPS in 72 symptomatic individuals across six visits (July 2021-May 2022), analyzing 285 paired RT-qPCR samples in Rio de Janeiro, Brazil. Using NPS as the reference standard, saliva demonstrated high specificity (96.6%; 95% CI 92.9-98.7%), substantial agreement (91.6%; κ = 0.78; 95% CI 70-86% ; P < 0.001), and variable sensitivity (69.2% overall; 95% CI 57.2-79.5%), ranging from 40% during mid-phase infection (visit 3) to 82% during early infection (visit 1). Cycle threshold (Ct) values revealed slightly higher viral loads in NPS (mean Ct = 26.75) than in saliva (mean Ct = 28.75), with a mean difference of 0.79 cycles. Discordant results (8.4%) revealed saliva's utility in detecting late-stage infections missed by NPS. No significant associations were found between diagnostic agreement and participant characteristics or Ct values. In conclusion, our longitudinal data demonstrate that saliva testing achieves 69.2% sensitivity (ranging from 40 to 82% across infection phases), 96.6% specificity, and 91.6% overall agreement with NPS. The 8.4% discordant results included 1.7% of cases where saliva-detected infections were missed by NPS, highlighting its complementary value in late-stage monitoring. These results, coupled with saliva's stability over time, support its implementation as a scalable, cost-effective diagnostic tool-particularly in resource-limited settings-where its high specificity makes it particularly valuable for rule-out testing despite temporal variations in sensitivity.

Rapid and accurate diagnosis of emerging inflammatory illnesses is challenging due to overlapping clinical features with existing conditions. We demonstrate an approach that integrates proteomic analysis with machine learning to identify diagnostic protein signatures, using the example of SARS-CoV-2-induced multisystem inflammatory syndrome in children (MIS-C). We used plasma samples collected from subjects diagnosed with MIS-C and compared them first to controls with asymptomatic/mild SARS-CoV-2 infection and then to controls with pneumonia or Kawasaki disease. We used mass spectrometry to identify proteins and support vector machine (SVM) algorithm-based classification schemes to identify protein signatures. Diagnostic accuracy was assessed by calculating sensitivity, specificity, and area under the ROC curve (AUC), and corrected for overfitting by cross-validation. Proteomic analysis of a training dataset containing MIS-C (N = 17), and asymptomatic/mild SARS-CoV-2 infected control samples (N = 20) identified 643 proteins, of which 101 were differentially expressed. Plasma proteins associated with inflammation increased, and those associated with metabolism and coagulation decreased in MIS-C relative to controls. The SVM machine learning algorithm identified a three-protein model (ORM1, AZGP1, SERPINA3) that achieved 90.0% specificity, 88.2% sensitivity, and 93.5% AUC, distinguishing MIS-C from controls in the training set. Performance was retained in the validation dataset utilizing MIS-C (N = 19) and asymptomatic/mild SARS-CoV-2 infected control samples (N = 10) (90.0% specificity, 84.2% sensitivity, 87.4% AUC). We next replicated our approach to compare MIS-C with similarly presenting syndromes, such as pneumonia (N = 17) and Kawasaki disease (N = 13), and found a distinct three-protein signature (VWF, FCGBP, and SERPINA3) that accurately distinguished MIS-C from the other conditions (97.5% specificity, 89.5% sensitivity, 95.6% AUC). A software tool was also developed that may be used to evaluate other protein signatures using our data. These results demonstrate that the use of mass spectrometry to identify candidate plasma proteins followed by machine learning, specifically SVM, is an efficient strategy for identifying and evaluating biomarker signatures for disease classification.

Despite Spain's > 2 million COVID-19 paediatric cases before 2024, few required hospitalisations (8900). We aimed to estimate the effectiveness of two-dose COVID-19 vaccinations against hospitalisation 'with' and 'for' COVID-19 in paediatrics.

All individuals aged 5-14 years between January 2021 and February 2022 in two databases in Spain (SIDIAP and BIFAP) vaccinated against COVID-19 (two doses) were matched 1:1 to unvaccinated controls with the same age, sex, region and comorbidities on the dates of vaccination. Individuals with previous SARS-CoV-2 infections were excluded. COVID-19 was identified as the main reason (hospitalisation 'for' COVID-19; SIDIAP) or as one of the reasons (hospitalisation 'with' COVID-19; BIFAP) for hospitalisation with a positive SARS-CoV-2 test ±30 days. Incidence rate differences and vaccine effectiveness (VE; 95% CI; controlled by inverse probability weights) against hospitalisations 'for' and 'with' COVID-19 were calculated.

The cohorts included 75 361 (SIDIAP) and 178 589 (BIFAP) pairs. Among vaccinated individuals (99.99% with mRNA vaccines) and controls, < 5 and 15 hospitalisations 'for' COVID-19 were identified (SIDIAP), whereas 21 and 32 hospitalisations 'with' COVID-19 (BIFAP), all aged 12-14 years old. Vaccination prevented 2.5 hospitalisations 'for' and 0.5 'with' COVID-19 during the Delta period, and 0.8 hospitalisations 'with' COVID-19 during Omicron predominance per 10⁶ person-days. The VE was 94% (95% CI: 52%-99%; SIDIAP) and 53% (95% CI: 18%-74%; BIFAP).

Given the low incidence of hospitalised COVID-19, two-dose series mRNA vaccination showed moderate-high effectiveness with few averted cases. Including hospitalisation 'with' COVID-19 underestimated the effectiveness. If paediatric severe COVID-19 remains rare, larger databases are required to understand precisely the effectiveness and impact of new vaccines.

EU PAS Register number: EUPAS47725.