Integration of mental health screening and treatment into cystic fibrosis (CF) care has been driven by the finding of elevated rates of depression and anxiety in The International Depression/Anxiety Epidemiological Study (TIDES), international mental health guidelines and CF Foundation support to screen adolescents and adults in all US CF care centres. Benefits of screening include earlier identification, greater access to care, reduced stigma and positive uptake from the CF community. However, TIDES did not include children under 12 years. Depression and anxiety have increased dramatically in young children, and new guidelines recommend mental health screening of children in primary care. Given the paediatric mental health crisis and the widespread adoption of CF transmembrane conductance regulator (CFTR) modulators, which have been associated with adverse events (AEs), there is an urgent need to gather mental health data in young children with CF.

TIDES 2.0 is a longitudinal cohort study designed to evaluate the prevalence of depression, anxiety and behaviour problems in US children with CF 18 months through 11 years, evaluate and compare the performance of two widely used instruments to identify the optimal screening measures for this population and characterise neuropsychiatric AEs associated with CFTR modulator therapy. Purposive randomised sampling is used to recruit 600 children at 16 CF centres across 4 regions of the US, with oversampling of minoritised patients to ensure national representation. We will estimate the prevalence of children above the clinical cut-score on each symptom domain and evaluate their longitudinal course and predictors. Rigorous mixed-methods approaches will be used to describe potential AEs associated with modulator use.

This study is a timely step in understanding the mental health of young children with CF. It will provide the groundwork to extend mental health screening and care to younger children with CF and inform updates to the mental healthcare guidelines. These results will be distributed at international CF meetings and submitted to peer-reviewed journals. The University at Buffalo Institutional Review Board approved the study (STUDY00008868).

NCT07048574.

Observational studies are central to assessing vaccine effectiveness and informing public health policy. The two most common designs are test-negative case-control and cohort studies, yet direct comparisons of their performance using the same population, data sources, and analytic strategies remain rare. This study compares these two designs within a national population using harmonized analytic approaches.

Nationwide, matched test-negative case-control and retrospective cohort studies were conducted in Qatar between 1 January 2021 and 18 December 2021 to assess the effectiveness of the coronavirus disease (COVID-19) primary series of BNT162b2 and mRNA-1273 against any severe acute respiratory syndrome coronavirus 2 infection, symptomatic infection, and severe COVID-19.

In the test-negative design, BNT162b2 effectiveness was 71.0% [95% confidence interval (CI): 70.1-71.9] against any infection, 75.6% (95% CI: 74.2-77.0) against symptomatic infection, and 96.3% (95% CI: 95.2-97.2) against severe COVID-19. In the cohort design, after adjustment for testing rate, corresponding effectiveness was 78.0% (95% CI: 77.1-78.9), 81.2% (95% CI: 79.8-82.5), and 98.0% (95% CI: 96.6-98.8), respectively. Both designs demonstrated similar, rapid, and largely linear waning of effectiveness in both magnitude and pattern. Test-negative design estimates lay between cohort estimates with and without adjustment for testing rate. Similar results were observed for mRNA-1273.

Both designs yielded consistent effectiveness estimates across vaccines and clinically relevant outcomes, with only modest differences related to handling of health-seeking behavior. These findings demonstrate that, when rigorously implemented using quality data and harmonized analytic strategies, both designs produce comparable effectiveness estimates.

The COVID-19 pandemic transformed telemedicine in Poland from a niche service into a core mode of health care delivery, supported by nationwide eHealth infrastructure such as obligatory e-prescriptions and the central P1 platform. Despite this rapid expansion, concerns persist that the benefits of digital health are not shared equally, and that a digital divide limits equitable access to telemedicine services across sociodemographic and geographic groups.

This study aimed to describe the patterns of telemedicine and eHealth tool use among Polish adults in the postpandemic era, to identify key sociodemographic, economic, and health-related predictors of their adoption, and to map digital inequalities in access to health care services.

This cross-sectional study used data from the "National Test for Poles' Health" (Narodowy Test Zdrowia Polaków), a nationwide online survey conducted annually in Poland between 2020 and 2024. The full surveyed sample comprised 1,196,102 adults, of whom 820,000 completed the telemedicine-use module and formed the analytic sample; detailed questions on 12 specific eHealth services were administered to a randomly assigned subsample of 120,000 respondents under a split-questionnaire design. Sociodemographic factors (age, gender, education level, and place of residence), health status, and barriers to accessing care were analyzed as predictors using ordered and binary logistic regression models, with results expressed as odds ratios (ORs) with 95% CIs, and statistical significance set at P≤.05.

Overall, 49.7% (407,502/820,000) of respondents reported using a telemedicine visit at least once in the preceding 12 months. Telephone consultations were the most common form of remote visit (43,598/120,000, 36.3%), whereas video consultations were rare (8736/120,000, 7.3%). System-driven tools showed high adoption (e-prescriptions: 87,121/120,000, 72.6%; e-referrals: 64,083/120,000, 53.4%), while patient-driven tools, such as mobile health apps (24,341/120,000, 20.3%), were used less frequently. Education and place of residence were the strongest sociodemographic predictors: participants with a master's degree were 2.2 times more likely than those with secondary education to use the Internet Patient Account (OR 2.2, 95% CI 2.1-2.2), and residents of cities with over 500,000 inhabitants had higher odds of telemedicine use (OR 1.5, 95% CI 1.5-1.6). Chronic disease was a strong health-related predictor (OR 1.8, 95% CI 1.7-1.9). Gender differences were also observed: women used telephone consultations more often, whereas men more frequently used the Internet Patient Account.

Telemedicine adoption in postpandemic Poland is driven more by pre-existing socioeconomic advantage, particularly higher education and urban residence, than by clinical need alone, indicating a persistent digital divide. Telemedicine functions largely as a tool of convenience for the already connected rather than a tool of necessity for underserved groups. Targeted interventions, including community-based digital literacy programs, investment in rural broadband infrastructure, and guaranteed hybrid in-person alternatives, are needed to ensure that Poland's eHealth transformation promotes inclusion rather than exacerbating health inequalities.

Most short-term air pollution studies rely on linear, single-pollutant models that cannot adequately describe the nonlinear and interdependent nature of pollutant-health associations.

We developed a nonlinear multi-pollutant Bayesian case-crossover model to jointly evaluate short-term health effects of PM 2.5, NO2, and O3. The model accommodates overdispersion, propagates exposure uncertainty from imputed monitoring data, and pools Census Division (CD)-specific exposure-response functions through a Bayesian hierarchical framework. We applied this approach to cause-specific daily mortality (2001-2015) and hospitalization (2001-2018) data across 20 Canadian CDs, covering more than half of the national population.

The estimated exposure-response relationships varied by pollutant and health outcome. The combined PM 2.5+NO2 metric showed the clearest positive associations with all non-accidental mortality and hospitalization. Respiratory hospitalization estimates were higher among seniors, but evidence of an age difference remained uncertain. An approximate 10-unit contrast in combined PM 2.5+NO2 corresponded to an estimated 1.5% (95% credible interval [CrI]: 0.3, 2.2) increase in all non-accidental mortality and a 0.6% (95% CrI: 0.0, 1.3) increase in all non-accidental hospitalization, while the corresponding estimate for senior respiratory hospitalization was 2.7% (95% CrI: 0.9, 4.5). Several PM 2.5 and NO2 curves were nonlinear, whereas O3 associations were closer to linear over much of the observed range.

Our study introduces a flexible epidemiologic modelling framework for quantifying the short-term health impacts of correlated pollutants. The results highlight the value of accounting for nonlinear and joint exposure patterns in multi-pollutant settings, while uncertainty remains substantial for several cause- and age-specific estimates.

Asthma and allergic rhinitis are the most common respiratory allergic disorders in the Mexican population. Montelukast is a leukotriene receptor antagonist that has been widely used in these conditions. An association has been documented with the onset and modification of multiple sleep disorders, as well as other neuropsychiatric alterations in pediatric population.

To analyze the association between montelukast and sleep disorders in children with respiratory allergies.

A prospective and analytical cohort study was conducted. Patients aged 5 to 17 years diagnosed with asthma and allergic rhinitis were recruited from a third-level hospital. They were divided into 2 groups: a montelukast user group and a control group. Patients who withdrew their consent or did not complete the questionnaires were excluded.

120 children were analyzed, 60 children using montelukast and 60 not using it. The median age was 9 and 10 years, respectively. Five (4.17%) of the children had asthma as their primary diagnosis, 60 (50%) had allergic rhinitis, and 55 (45.83%) had both asthma and allergic rhinitis. Among the children taking montelukast, 46 (73.02%) had sleep disorders, compared to 17 (14.17%) of those not taking montelukast. The association showed an odds ratio (OR) of 8.31, p < 0.0001.

Montelukast use was associated with the presence of sleep disorders in the studied population.

To identify care coproduction strategies based on patient experience throughout the hospitalization process triggered by COVID-19.

This was a qualitative, exploratory-descriptive study derived from a multicenter research project conducted in Brazilian university hospitals. Thirty-four patients who were discharged after hospitalization for COVID-19 participated in the study. Data were collected from May 2021 to January 2022. The data were analyzed using thematic content analysis.

Thirty-two codes were generated, giving rise to the thematic category "Care coproduction in the pandemic setting", composed of four subcategories: "Health education in care production"; "Care coproduction during hospitalization"; "Hospital discharge instructions and guidance following COVID-19"; and "Continuity of care during post-COVID-19 Recovery".

The findings revealed emerging strategies for care coproduction, including promoting health education, considering the patient's experience and care journey during healthcare delivery, developing and implementing a shared discharge plan, and ensuring social support and access to the healthcare system throughout the health-disease-rehabilitation process.

Overtesting with computed tomographic pulmonary angiography (CTPA) to diagnose pulmonary embolism (PE) is a quality improvement target in emergency departments (EDs).

To describe how ED clinicians vary in their diagnostic practices for PE, specific to key decision moments, and how these practices are associated with CTPA diagnostic yield, the primary modality for definitively diagnosing PE, as well as potential missed opportunities to diagnose.

This retrospective cohort study included ED visits and clinicians at 29 Michigan EDs from January 1, 2023, to November 30, 2025. ED visits were stratified by clinician's diagnostic practices.

Three decision moments were evaluated: (1) the decision to test for PE (proportion of visits with either a D-dimer assay or CTPA performed); (2) the decision on initial testing modality (proportion of tested visits with CTPA performed without D-dimer assay first); and (3) the decision on interpreting the negative D-dimer result (proportion of negative age-adjusted visits that proceeded from D-dimer assay to CTPA).

Diagnostic yield was defined as the percentage of CTPAs used to diagnose an acute PE. Potential missed opportunities to diagnose PE were defined using 10-day ED revisits and symptom-disease pair analysis.

The sample included 4 180 159 ED visits (median patient age, 52 [IQR, 34-69] years; 2 334 043 [55.8%] female) and 747 ED clinicians (463 [62.0%] male; median graduation year, 2013 [IQR, 2006-2017]). Diagnostic yield was associated with diagnostic practices at the decision to test for PE and the decision on initial testing modality. The decision to test for PE showed a pooled CTPA yield for the lowest-testing quintile of clinicians of 9.6% (95% CI, 9.0%-10.1%), while the corresponding yield for the highest-testing quintile was 6.4% (95% CI, 5.5%-7.3%; difference, -3.2 percentage points [95% CI, -4.2 to -2.1 percentage points]). A total of 189 potential missed opportunities to diagnose PE of 13 530 acute cases (1.4% of PEs) were identified, and these were associated with lower testing intensity.

In this cohort study of 4 180 159 ED visits and 747 clinicians, variation in the first decision moment, the decision to test for PE, was associated with diagnostic yield. Future research should target standardizing this most upstream decision to best improve diagnostic quality.

Acute severe mitral regurgitation (MR) can cause cardiogenic shock and fulminant pulmonary edema. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) may worsen pulmonary congestion by increasing left ventricular afterload. We report a 61-year-old man with acute severe MR and extreme respiratory failure (FiO₂ 1.0: pH 7.144, PaO₂ 48 mmHg, PaCO₂ 101 mmHg) who underwent emergency mitral valve replacement. Because severe pulmonary edema and post-cardiotomy shock compromised separation from cardiopulmonary bypass, an Impella 5.5 was inserted via a direct aortic graft, followed by veno-venous (VV) ECMO. This combined support enabled decoupled circulatory and respiratory stabilization. Although substantial vasoactive and inotropic support was initially required, systemic perfusion was maintained and subsequently stabilized with Impella-mediated antegrade flow without conversion to VA- or V-AV ECMO. Serum lactate transiently peaked at 10.9 mmol/L on postoperative day (POD) 1 and subsequently normalized as circulatory function recovered. Respiratory function and bilateral pulmonary opacities progressively improved under VV-ECMO-supported lung rest and intensive diuretic therapy. VV-ECMO was removed on POD 3, Impella on POD 6, and the patient was discharged on POD 46 without neurological sequelae. This case suggests that combined VV-ECMO and Impella support may provide an effective decoupled strategy for selected patients with concomitant severe respiratory and circulatory failure.

The apnea-hypopnea index (AHI), traditionally used to assess obstructive sleep apnea (OSA) severity and surgical outcomes, has limitations in reflecting cardiovascular risk and pathophysiological burden. Although lateral pharyngoplasty has demonstrated favorable outcomes regarding AHI reduction, its impact on hypoxic burden (HB) remains unknown. This study evaluated HB changes after lateral pharyngoplasty in patients with OSA, including those classified as surgical failures according to Sher's criteria.

This observational, longitudinal study with a mixed retrospective and prospective design included 27 adults with OSA who underwent lateral pharyngoplasty (version 6) between 2016 and 2025, with complete preoperative and postoperative polysomnographic data for HB assessment. HB was calculated using validated commercial software. Nonparametric tests were used for intra- and intergroup comparisons. Surgical success was defined according to Sher's criteria.

A significant reduction in HB was observed across all variants: total sleep time (median from 97.1%·min/h to 35.0%·min/h, p < 0.0001), REM sleep, NREM sleep, and supine and non-supine positions, with a significant reduction in median AHI (median from 33.8 to 12.3 events/h, p < 0.0001). Even among surgical failures according to Sher's criteria, HB decreased significantly (median from 102.5%·min/h to 67.3%·min/h, p = 0.0107), suggesting pathophysiological improvement not captured by AHI alone.

HB is a potentially more sensitive metric to assess therapeutic response in OSA, incorporating multiple dimensions of nocturnal hypoxemia beyond AHI. Lateral pharyngoplasty promoted consistent HB reduction, including in surgical failures, supporting HB as a complementary tool for therapeutic evaluation, with potential applications in cardiovascular risk stratification.

Respiratory syncytial virus (RSV) and human metapneumovirus (hMPV) are major causes of acute respiratory tract infections in young children and share many epidemiological and clinical characteristics. This study aimed to compare the clinical characteristics, outcomes, and healthcare costs associated with RSV and hMPV infections in children younger than five years of age. In this retrospective comparative cohort study, children aged 1-71 months with laboratory-confirmed RSV or hMPV infection identified by multiplex real-time polymerase chain reaction were included. RSV cases identified between September 2022 and April 2023 and hMPV cases identified between September 2022 and December 2025 were included. Both outpatient and hospitalized patients evaluated at a tertiary pediatric hospital were enrolled. A total of 693 children were included, comprising 547 with RSV infection and 146 with hMPV infection. Children with hMPV infection were significantly older and more frequently had underlying comorbidities than those with RSV infection. Bronchiolitis, cough, nasal congestion, tachypnea, chest retractions, rhonchi, oxygen supplementation, inhaled therapies, corticosteroid use, and hospitalization were more common among children with RSV infection (all p < 0.05). In contrast, pneumonia was more frequently observed in the hMPV group (p = 0.015). Lengths of hospital and pediatric intensive care unit stay were comparable between the groups (all p > 0.05).

Consistent with previous studies, RSV and hMPV differed in age distribution, clinical presentation, and healthcare utilization. These data provide additional evidence from a tertiary pediatric center in Türkiye and support the generalizability of these observations across different geographic settings.

• RSV and hMPV are major causes of acute respiratory tract infections in young children, but direct comparisons between these viruses remain limited.

• In this large pediatric cohort, RSV predominantly affected younger children and was associated with more bronchiolitis, hospitalization, and supportive treatment needs, whereas hMPV was more common in older children with comorbidities and was more frequently associated with pneumonia.