Hospital at Home (HaH) has emerged internationally as an effective model of healthcare delivery for older adults, providing care within patients' homes as an alternative to inpatient admission when appropriate. Since the COVID-19 pandemic, there has been rapid expansion of HaH services, of which older people are the majority users. This collection in Age and Ageing journal brings together contemporary evidence examining the evolution, effectiveness, implementation and experience of HaH care for older people. The papers highlight the heterogeneity of HaH models, ranging from admission avoidance and early supported discharge services to comprehensive geriatric assessment-based multidisciplinary care. Collectively, the evidence suggests that well-supported HaH models can achieve outcomes comparable to inpatient care, with evidence supporting cost-effectiveness and reduced care home admission, whilst improving patient experience and increasing time spent living at home. Importantly, the collection also explores the complexities underlying HaH implementation. Several papers demonstrate that successful HaH depends not only on technology, but on multidisciplinary clinical expertise, coordination across services and substantial contributions from informal caregivers. Challenges relating to workforce capacity, digital exclusion, caregiver burden and service integration remain significant.

The objective of the study is to evaluate a classification and regression tree (CART) model combined with odds ratio (OR) to identify key predictors of COVID-19 mortality. Data from 1,432 patients hospitalized at Hospital General de México during the pandemic's 1^st year were analyzed.

A CART model was constructed using demographic, clinical, and laboratory data collected at admission. The model's performance was evaluated using multiple criteria, and ORs were calculated for each node to measure mortality.

Mechanical ventilation emerged as the strongest predictor of mortality. Patients intubated at admission with hospital stays under 17.5 days had the highest mortality rate (99%, OR = 80). Conversely, non-intubated patients hospitalized over 5.5 days with glomerular filtration rates above 66.5 had the lowest mortality (5%, OR = 0.26). The model showed excellent performance, with an F1 score of 0.918, accuracy of 0.903, and area under the curve of 0.955.

The CART model, combined with OR calculations, offers a reliable and comprehensible tool for predicting COVID-19 mortality risk. This model provides practical utility in various healthcare settings, including resource-limited contexts, by focusing on readily available clinical parameters. The results emphasize the significant influence of mechanical ventilation on patient outcomes and the need for timely interventions in high-risk patients.

Obesity is a key risk factor underlying both obstructive sleep apnea (OSA) and cardiovascular disease (CVD). The objective of this study was to determine differential strength of associations of adiposity indices with recurrent CVD events in patients with established CVD and OSA.

Post hoc analyses of the international Sleep Apnea Cardiovascular Endpoints (SAVE) trial where participants with moderate-to-severe OSA and established CVD were randomized to usual care plus continuous positive airway pressure (CPAP) treatment or usual care alone. Cox proportional hazards models were used to evaluate associations of body-mass index (BMI) and waist-to-height ratio (WHtR), with the risk of composite CVD events.

Of 2,662 participants with OSA with established CVD, 846 (31.8%) were obese by BMI (≥30 kg/m²), while 2,544 (95.6%) had central adiposity (WHtR ≥0.50). Over a 3.7-year follow-up, conventional BMI categories were not clearly associated with composite CVD events, although spline analyses suggested potential nonlinear associations. In contrast, WHtR showed a clear overall association with composite CVD events (p for overall = 0.0187). In quartile analyses, participants in the highest WHtR quartile had a 1.52-fold higher risk of composite CVD events than those in the lowest quartile (hazard ratio 1.52, 95% CI 1.12-2.05). There was no heterogeneity in the effect of CPAP treatment on composite CVD events or CPAP adherence by any baseline adiposity measures.

In this large trial of adults with co-occurring OSA and CVD, nearly all had central adiposity (as assessed by WHtR), which showed a more consistent association with the risk of future CVD events. In contrast, the relationship between BMI and CVD outcomes appeared more complex, suggesting that conventional BMI categories may not adequately capture cardiovascular risk in this population.

The SAVE trial is registered at ClinicalTrials.gov (Unique identifier: NCT00738179).

Respiratory virus circulation may vary across healthcare settings and age groups, potentially limiting the interpretability of surveillance based on a single source. In Milan, Italy, established community- and emergency department-based systems coexist with hospital laboratory testing, but hospital ward-level data are not routinely integrated. The aims of this study were to describe respiratory viruses' epidemiology and assess whether ward-based surveillance complements community and ED surveillance. We analyzed molecular test results from respiratory samples collected from January 1, 2024 (W1/2024) to October 12, 2025 (W41/2025) in community, ED, and hospital ward settings. Viruses included influenza A (IAV), influenza B (IBV), RSV, and SARS-CoV-2 (with extended panels in a subset). Among 8029 samples, overall positivity for ≥ 1 virus was 46.8%, highest in ED (51.1%) and community (50.5%) and lower in wards (36.7%) (p < 0.001). During 2024-2025, IAV was first detected in wards (W33/2024) and peaked earlier in wards (W2/2025) than community (W3/2025) and ED (W4/2025). IBV was first detected in ED (W36/2024) and peaked in ED (W5/2025), community (W7/2025), and wards (W8/2025). RSV reappeared first in community (W37/2024) and peaked in community/ED (W50/2024) and later in wards (W2/2025). Respiratory virus positivity and descriptive peak timing differed across healthcare settings and age groups. Ward-based surveillance provided complementary information for hospitalized and older populations, but it was not consistently earlier or superior to community or ED surveillance. Integrated, multi-setting surveillance can improve situational awareness when interpreted alongside differences in tested populations, testing indications, and clinical outcome availability.

Chronic respiratory diseases (CRDs) and heart failure (HF) impose substantial global burdens. However, the long-term population-level burden of HF impairment under CRD cause categories remains insufficiently characterized within the GBD framework.

Using GBD 2021 data, we estimated the prevalence and years lived with disability (YLDs) of HF impairment under CRD cause categories among adults aged ≥55 years from 1990 to 2021. CRD cause categories included chronic obstructive pulmonary disease (COPD), interstitial lung disease and pulmonary sarcoidosis (ILD&PS), and pneumoconiosis (PC). Cases, rates, relative changes, and EAPCs were used as primary descriptive measures. Joinpoint regression, age-period-cohort analysis, inequality indices, and BAPC-based projections were used as secondary analyses to describe trend timing, age-cohort patterns, socioeconomic distribution, and historical-trend extensions through 2032.

From 1990 to 2021, the global prevalent cases and YLDs of HF impairment under CRD cause categories increased markedly, while prevalence and YLD rates changed only modestly overall. The burden rose sharply with age, especially after age 75, and was generally higher in males. Temporal trends differed across periods. Patterns varied across SDI strata and differed by CRD subtype. Model-based extensions of historical patterns suggested that this burden pattern may remain substantial through 2032.

The burden of HF impairment under CRD cause categories showed marked population-level variation across age, sex, SDI strata, and CRD subtypes. These findings may help inform burden monitoring, public health planning, resource allocation, and long-term service planning for older adults.

COVID-19 produced a detrimental effect on mental health that could not be appropriately addressed due to a reduced accessibility of healthcare services, as patients with socioeconomic vulnerabilities faced the largest barriers in accessing healthcare during the pandemic. This study aimed to investigate emergency department (ED) accesses with a psychiatric diagnosis before and after COVID-19, with a specific focus on the role of socioeconomic factors.

This is a multicentre longitudinal retrospective study that involves a population-based open cohort of residents and National Health Service (NHS)beneficiaries aged ≥ 10, enrolled in three large Italian areas from 1 January 2018 to 31 December 2021 (n = 5,159,363). The primary outcome of interest was the First Mental Health Emergency Access (FMHEA); sex, age, deprivation level, citizenship and groups of diagnosis were considered as covariates. Crude incidence rates were calculated comparing the two time periods (pre- and post-COVID-19) by each covariate. In the context of interrupted time series (ITS), incidence rate ratios (IRR) of FMHEAs with 95%CI were estimated via an ITS analysis using a step-change negative binomial model. Temporal trend of FMHEAs was investigated through an ITS analysis on their monthly numbers.

During follow-up, 56,762 FMHEAs were observed. The multivariate analysis showed that before COVID-19, the rate of FMHEA was higher among the highly deprived (IRR: 1.28; 95%CI:1.22.-1.35 for highest vs lowest deprivation level), females, people aged ≤24 and ≥85 and immigrants. A significant interaction between the COVID-19 period and deprivation level was found: the probability of reduced FMHEA increased with the deprivation level. The greater impact of COVID-19 was found in the central age classes resulting in a reduction in the differences in FMHEA rates by age in the post-Covid-19 period.

COVID-19 reduced incidence rates of ED accesses, but increased socioeconomic inequalities in the use of ED for mental health disorders.

Carbapenems are commonly used empirically in referral hospitals; however, the appropriateness and outcomes of meropenem use in regional settings with rising multidrug resistance remain unclear.

A retrospective cohort study of 528 patients who received at least 1 dose of meropenem in the internal medicine ward at Lampang hospital, Thailand during the study period (1 August 2022 and 31 December 2022).

A total of 528 patients were enrolled. Of these, 281 (53.22%) were survivors, while 247 (46.78%) were non-survivors. Gram-negative bacteria were the most common infections, with 28.2% susceptible to carbapenems. The most frequent pathogens were Acinetobacter baumannii (16.7%), followed by Escherichia coli (13.6%) and Klebsiella spp. (8.0%). Pneumonia (36.93%) and urinary tract infection (21.97%) were the most common sites of infection. Appropriate empirical meropenem use was significantly more frequent among survivors than among non-survivors (93.7% vs. 87.4%; p = 0.020). Additionally, appropriate targeted meropenem therapy was administered in 13.96% of cases and was significantly more frequent among survivors than non-survivors (18.40% vs. 9.91%; p < 0.001). Multivariate analysis identified higher SOFA score and multiorgan dysfunction-particularly respiratory failure-as independent risk factors for 30-day all-cause mortality; respiratory tract infection and shorter length of hospital stay were also associated with mortality. Survivors had a significantly longer hospital stay than non-survivors (5.92 vs. 3.61 days; p = 0.007) and a higher microbiological cure rate (40.21% vs. 23.89%; p < 0.001).

Although appropriate antibiotic coverage was more frequently observed among patients with favorable outcomes, severity of illness and organ dysfunction remained the primary determinants of survival. Appropriate empirical and targeted therapy, alongside optimal critical care management, should be emphasized in the treatment of these severe infections in regional settings.

Non-cystic fibrosis bronchiectasis is associated with many causes including post-infectious damage, immunodeficiency, connective tissue disease and ciliary dysfunction and can also overlap with chronic obstructive pulmonary disease and asthma. Renal transplantation (RT) is the most common solid-organ transplantation worldwide. Since 2004, bronchiectasis associated with RT has been described in case reports and series involving children and adult patients. The pathogenesis remains unclear and may combine underlying renal diseases, immunodeficiency, direct toxicity of immunosuppressive drugs and lower tract infections. This narrative review, supported by the extensive literature in PubMed, Cochrane Library and Web of Science, provides a state-of-the-art of current knowledge regarding the epidemiology, pathophysiology and clinical impact of bronchiectasis in renal transplant patients. Finally, we provide management proposals for RT-associated bronchiectasis in clinical practice.

Influenza vaccination coverage is suboptimal nationwide.

To evaluate the effectiveness of centralized text message recall for influenza vaccination among children conducted by the New York City Department of Health and Mental Hygiene.

A randomized assignment of 149 860 children, split between the intervention and control groups.

Pediatric patients drawn from the Citywide Immunization Registry in New York City.

Children aged 15 months to 18 years who did not receive an influenza vaccine in the 2016-2017 season and as of the study date in the 2017-2018 season.

The Citywide Immunization Registry sent a generic Short Message Service (SMS) text message to the parents or guardians of the children: "The Health Department recommends that your child/children receive an annual flu shot. Call your doctor today!"

Risk ratios of the proportions of children who received an influenza vaccine in the intervention and control groups within 28 days after the text message was sent.

On October 25-26, 2017, 74 553 parents or guardians were sent a text message and 74 526 served as the control group. Of text messages sent, 73% were delivered successfully. Within 28 days of the intervention, 4.7% of children aged 15 months to 4 years in the text message group received an influenza vaccine compared with 4.3% in the control group, a statistically significant 9.5% relative increase in vaccination uptake (RR: 1.095, 95% CI: 1.001-1.199).

Centralized text messages had a small positive effect on influenza vaccination among younger children. This approach may contribute to improving influenza vaccination in the pediatric population.

Obstructive sleep apnea syndrome (OSAS) is increasingly recognized as a multisystem disorder with important effects on the lower urinary tract, including overactive bladder (OAB). Although the association between OSAS and OAB has been widely investigated, most available evidence originates from male populations, whereas women remain underrepresented despite distinct hormonal, anatomical, and pelvic floor characteristics. Unlike previous reviews that primarily focused on OSAS and nocturia or predominantly male populations, this review specifically highlights female-related pathophysiological mechanisms, emerging clinical evidence, and their potential implications for the evaluation of women with OAB.

Recent evidence supports a significant association between OSAS and OAB through multiple interacting mechanisms, including intermittent hypoxia, autonomic nervous system dysregulation, increased atrial natriuretic peptide secretion, circadian rhythm disruption, systemic inflammation, and oxidative stress. Emerging studies suggest that female-specific factors such as menopause, estrogen deficiency, and pelvic floor dysfunction may further amplify bladder symptoms. In addition, treatment of OSAS, particularly with continuous positive airway pressure, has been associated with improvement in OAB symptoms, supporting a potentially modifiable relationship. Current evidence demonstrates a consistent association between OSAS and OAB, although a causal relationship has not yet been established. Recognition of OSAS as a potential contributing factor, particularly in women with refractory OAB or prominent nocturia, may improve clinical evaluation and support a more comprehensive multidisciplinary approach. Further prospective studies focusing on female populations are needed to clarify causal mechanisms and determine which patients are most likely to benefit from targeted screening.