Diagnosing psychological issues in adolescents is generally more challenging than in adults. The need to enhance early identification and risk assessment for adolescent mental health problems has become particularly urgent, especially given the surge in such issues brought about by the COVID-19 pandemic and its isolation policies. Traditional approaches relying on scales or interviews can be difficult to administer at scale and may miss at-risk youths, while recent attempts at artificial intelligence-assisted clinical diagnosis have not yet achieved consistent performance for routine clinical use. Using youth census survey data from the National Survey of Children's Health (NSCH) from 2020 to 2022 (147,772 samples), we propose a novel data synthesis and training management method tailored for imbalanced health data, and develop a heuristic decision model based on daily-life indicators to predict survey-reported adolescent depression risk. Experimental results demonstrate that our data management approach improves the average accuracy of conventional models by 14%. Compared with general artificial intelligence methods, the proposed decision model achieves higher accuracy, precision, and sensitivity. Built on AutoML, the model can adapt to factor replacement and incremental data updates, supporting scalable screening workflows and model maintenance. Using Shapley values, we identify several key daily-life factors associated with adolescent depression risk, such as social interactions and sleep duration. The interpretability analysis further supports the utility of our approach for risk stratification and practical decision support, rather than replacing clinician-administered diagnosis.

Active tuberculosis (TB) infection can induce hyperglycaemia and insulin resistance, increasing the risk of type 2 diabetes mellitus and worsening TB disease severity. However, data on the dynamics of TB-associated hyperglycaemia and its effect on TB treatment outcomes among individuals not previously diabetic remain limited, particularly in high TB-burden settings. In this study, we aimed to investigate the prevalence and temporal patterns of TB-associated hyperglycaemia and its impact on disease presentation and TB treatment outcomes among a cohort of individuals not previously diabetic.

This was a five-month longitudinal prospective cohort study conducted at two urban specialized TB healthcare facilities in Kenya among adults aged >18 years with bacteriologically confirmed pulmonary TB (PTB). Known diabetes mellitus (DM) or prediabetic individuals were excluded during enrolment. Glycaemic status was assessed at baseline and months two and five using glycated haemoglobin (HbA1c) according to the American Diabetes Association guideline. Hyperglycaemia was defined as HbA1c ≥5.7% and categorized as normoglycaemia, persistent, transient, or incident hyperglycaemia based on longitudinal measurements. Socio-demographic and clinical data were collected using a structured questionnaire and analysed using SPSS version 26.0 and GraphPad Prism version 9.0. Longitudinal trends in HbA1c levels and the association of hyperglycaemia with DM-related symptoms, as well as TB treatment outcomes, were assessed using the Friedman test and the Generalized Estimating Equations (GEE), respectively.

We enrolled and followed 87 individuals newly diagnosed with PTB. Of these, 66 were tested for hyperglycaemia in month two after 7 died and 14 were lost to follow-up/transferred out (LTFU/TO), and 70 in month 5, after an additional death, 7 re-engagements, and 2 LTFU/TO were reported. At enrolment, the cohort was predominantly male (76%), not married (53%), and HIV-negative (84%), with a median age of 37 years (IQR 29-44). Prevalence of hyperglycaemia at baseline was 75% (95% Confidence Interval [CI] 65-83), with 45% of the individuals presenting as prediabetic and 30% as diabetic. At the month-two and month-five time points, the proportion of participants with prediabetes (pre-DM) increased from 24% (16/66) to 30% (21/70), while the prevalence of DM declined from 21% (14/66) to 9% (6/70). Across the time points, HbA1c levels varied significantly (p < 0.001). In GEE analysis, hyperglycaemic participants were more likely to experience classic symptoms of DM such as frequent micturition (adjusted Relative Risk [aRR] 1.76, 95% CI 1.12-2.77), increased thirst (aRR 2.37, 95% CI 1.38-4.05), unintentional weight loss (aRR 1.84, 95% CI 1.24-2.75), and blurred vision (aRR 1.95, 95% CI 1.20-3.18). After adjusting for age, BMI, HIV, alcohol use, and smoking, hyperglycaemia was independently associated with an increased risk of sputum positivity (aRR 4.22, 95% CI 2.09-8.52). Glycaemic variability was significantly associated with unfavourable TB treatment outcomes (p < 0.001).

New-onset hyperglycaemia was highly prevalent in adults newly diagnosed with TB and persisted through the fifth month of TB treatment. Hyperglycaemia was associated with classic diabetic symptoms and persisting sputum positivity, highlighting the need to integrate glycaemic monitoring and management into routine TB follow-up care.

Seasonal respiratory viruses, including respiratory syncytial virus (RSV) and human metapneumovirus (hMPV), are major contributors to global respiratory infection burden. Estimating viral incidence using real-world data (RWD) is challenging as misalignment of data collection with seasonal circulation can lead to underestimated incidence and hinder inter-study comparisons.

We developed a regression-based approach to retrospectively correct partial-season time series with contiguous missing weeks at the start or end of a season. Weekly RSV clinical incidence (per 100,000) was extracted from U.S. RWD sources (Optum® CDM and PharMetrics Plus, adults ≥65 years; Kaiser Permanente Northwest [KPNW], all ages) for seasons 2018-19 to 2023-24 and aligned to RSV‑Net hospitalization surveillance. Weekly early- and late-season missingness scenarios were created (approximately 10%, 15%, 20%, and 25% of weeks removed). Models were fit within each season using harmonic terms and the surveillance-aligned covariate. Uncertainty was quantified using moving block bootstrap 95% prediction intervals. Weekly accuracy was evaluated using RMSE and normalized RMSE, and seasonal burden reconstruction accuracy using cumulative percent error and signed difference. For hMPV, we evaluated an illustrative extension using Optum® CDM (adults ≥65 years; 2022-23 and 2023-24) and NREVSS test positivity; because positivity is bounded and depends on testing volume, we used a denominator-aware binomial/logit model (positives out of tests).

For RSV, weekly prediction error increased with missingness level, while reconstructed seasonal burden generally remained close to observed totals in applicable scenarios. Early-season gaps were associated with larger cumulative errors than late-season gaps in Optum® CDM and PharMetrics Plus, whereas late-season median percent errors were closer to zero across missingness levels. Applicability was reduced primarily for higher early-season missingness in KPNW due to peak overlap (e.g., early 25% scenarios not applicable). For hMPV test positivity (illustrative; two seasons), weekly prediction RMSE was on the order of ~1-2 percentage points across missingness scenarios.

Across multiple RSV seasons and data sources, reconstructed seasonal burden generally agreed with observed totals when missingness was confined to contiguous early- or late-season weeks and did not overlap peak activity. This approach provides a transparent method to improve the utility and comparability of partial-season respiratory virus time series. However, applicability is reduced when peak weeks are missing, and hMPV findings are illustrative given limited seasons and the use of test positivity.

The COVID-19 pandemic caused major disruptions in solid organ transplantation worldwide, particularly in kidney transplantation. Patients on deceased-donor kidney transplant waiting lists represent a vulnerable population due to ongoing dialysis requirements and concerns regarding immunosuppression and infection risk.

This study aimed to evaluate the attitudes, behaviors, and concerns of patients on the deceased-donor kidney transplant waiting list regarding kidney transplantation during the second wave of the COVID-19 pandemic.

A cross-sectional, telephone-based survey was conducted between October and December 2020 at one tertiary care centre in Turkiye. The survey assessed adherence to preventive measures, COVID-19 exposure history, perceptions of renal replacement therapy modalities, attitudes toward kidney transplantation, and transplantation-related concerns during the pandemic. Demographic and clinical data were collected, and responses were analyzed using appropriate statistical methods.

A total of 188 transplant candidates (mean age 47.3 ± 13.1 years; 56.4% male) were included. Adherence to preventive measures was reported by 99.5% of participants, and 80.9% followed quarantine rules. Although 76% of participants preferred kidney transplantation before the pandemic, this rate decreased to 55.3% during the pandemic. Despite this decline, 86.7% of participants stated that they would accept a deceased-donor kidney transplant if offered during the pandemic. Only 38.3% reported concerns about undergoing transplantation, with the most common concerns being infection risk related to immunosuppressive therapy, hospital-acquired COVID-19, and donor-related transmission. Shorter renal replacement therapy duration and preemptive transplant status were associated with more favorable attitudes toward transplantation during the pandemic.

Despite pandemic-related uncertainties and concerns, most patients on the deceased-donor kidney transplant waiting list demonstrated a willingness to proceed with kidney transplantation and showed high adherence to preventive measures. These findings highlight the importance of patient education, infection-control strategies, and transparent communication to ensure the sustainability of kidney transplant programs during current and future pandemics.

University students frequently self-manage common cold and influenza symptoms using herbal remedies, pharmaceutical treatments, or both. However, evidence regarding treatment preferences among Jordanian university students remains limited.

To assess treatment preferences and factors associated with four outcomes: first-line treatment choice, timing of treatment initiation, response to perceived herbal treatment failure, and medication-obtaining behavior.

An observational cross-sectional study was conducted in Jordan among 1,797 undergraduate students from 16 April to 16 September 2025 using a confidential, de-identified Arabic online questionnaire. Descriptive statistics and multinomial logistic regression were used to evaluate the four outcomes. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported.

Combined therapy was the most common first-line choice (44.5%), and 42.5% initiated treatment on the same day. Female participants had higher odds of preferring combined therapy than males (aOR = 2.55, 95% CI: 1.64-3.96; p < 0.001), whereas medical-field students had lower odds of same-day treatment initiation (aOR = 0.55, 95% CI: 0.42-0.72; p < 0.001). After perceived herbal treatment failure, 50.7% switched to pharmaceutical treatments; reliance on doctor-prescribed treatments was associated with lower odds of continuing herbal remedies (aOR = 0.38, 95% CI: 0.27-0.51; p < 0.001) or combining herbal and pharmaceutical treatments (aOR = 0.56, 95% CI: 0.45-0.70; p < 0.001). Regarding medication-obtaining behavior, 28.2% purchased pharmaceutical treatments without a prescription based on personal experience, and medical-field students had higher odds of this behavior (aOR = 1.76, 95% CI: 1.39-2.23; p < 0.001).

Treatment decisions reflected frequent combined self-care and were associated with sex, field of study, symptoms, prescription-related behavior, and treatment beliefs. Targeted health education may support more informed and rational self-care among university students.

To investigate sexual dysfunction as a clinically relevant but under-recognized manifestation of disease burden in women with COPD and to identify its clinical and psychological determinants.

In this cross-sectional study, 100 consecutive women with stable COPD (mean age 57 ± 7 years) attending an outpatient chest clinic were enrolled.

Participants underwent pulmonary function testing and completed the COPD Assessment Test (CAT), Modified Medical Research Council (mMRC) scale, Beck Depression Inventory, Short Form-36 (SF-36), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-FS), and Female Sexual Function Index (FSFI).

Sexual dysfunction (FSFI ≤26.55) was more prevalent in patients with greater disease burden, particularly those in GOLD stage E, and was associated with significantly higher fatigue and depressive symptoms. FSFI scores showed a positive correlation with FACIT-FS and quality-of-life domains, and a negative correlation with depression scores (all p < 0.05). In multivariable analysis, fatigue was positively associated with FSFI scores, whereas depression and body mass index were negatively associated. Patients with more severe disease (GOLD E), comorbidities, and dyspnea during intercourse had lower FSFI scores, while those receiving triple therapy demonstrated higher scores.

Sexual dysfunction was associated with greater symptom burden in women with COPD and was closely related to fatigue and depression. Assessment of sexual function may contribute to a more comprehensive evaluation of disease burden in clinical practice.

Acute bronchiolitis is a leading cause of pediatric hospital admissions, particularly during winter months, placing significant pressure on healthcare systems. Currently, the BROSJOD scale allows for severity stratification based on clinical variables. However, the incorporation of biomarkers could improve predictive capacity. The main purpose of this study is to analyze whether adrenomedullin (MR-proADM) can serve as a predictor of severity and prognosis in patients with bronchiolitis. A single-center, prospective, observational cohort study was conducted over two consecutive epidemic periods (2022-2024) at a tertiary care hospital. The study included hospitalized patients under 2 years of age presenting with an episode of acute bronchiolitis. Demographic variables, clinical severity score (BROSJOD), and laboratory parameters were systematically collected. MR-proADM levels were measured in urine for all patients and in plasma for patients requiring blood tests as part of standard care. Multivariate regression models and receiver operating characteristic (ROC) curves were utilized to evaluate the predictive value of MR-proADM levels and clinical score regarding different morbidity and mortality outcomes. A total of 107 patients were analyzed; given the small mild subgroup (n = 2), findings for these patients remain descriptive. Urinary MR-proADM levels were higher in patients with moderate and severe bronchiolitis. However, after normalization for urinary creatinine, the association disappeared, suggesting that the observed differences were largely influenced by urine concentration. Plasma MR-proADM levels at admission were identified as significant independent predictors for both the total duration of respiratory support and total hospital length of stay. Plasma MR-proADM was also a significant predictor of the need for fluid resuscitation (AUC 0.849) and the presence of bacterial coinfection (AUC 0.730). Notably, combining plasma MR-proADM with the admission BROSJOD score significantly enhanced predictive performance for the duration of respiratory support and fluid requirements compared to clinical scoring alone.Conclusion: Plasma MR-proADM emerges as a promising biomarker to complement clinical assessment in bronchiolitis at admission. Its integration with clinical scoring systems, including the BROSJOD scale, may enhance early risk stratification and help identify infants at increased risk of a severe clinical course or bacterial coinfection. However, in this cohort, urinary MR-proADM showed limited prognostic contribution after adjustment for urine concentration. These findings support the potential clinical utility of plasma MR-proADM to guide early decision-making and optimize resource use. Multicenter validation is needed to confirm generalizability and define clinically actionable thresholds. What is known? • MR-proADM is a biomarker with prognostic value in infectious and respiratory diseases, but its role in pediatric bronchiolitis, particularly when measured in urine, remains poorly defined. • Clinical scores such as BROSJOD are useful for assessing bronchiolitis severity, althougn additional biomarkers could improve risk stratification. What is new? • Plasma MR-proADM emerges as a robust prognostic biomarker independently predicting prolonged hospital stays, bacterial respiratory coinfection, and the need for respiratory, fluid, and inotropic support; its integration with standardized clinical scoring systems, such as the BROSJOD scale, could enhance early risk stratification. • Urinary MR-proADM increases with bronchiolitis severity; however, this association becomes less consistent after adjustment for urinary creatinine, highlighting the need for further evaluation of its interpretation and standardization.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2026 report revised the combined chronic obstructive pulmonary disease (COPD) assessment. Patients in groups B and E are recommended dual long-acting β₂-agonist (LABA)/long-acting muscarinic antagonist (LAMA) as the initial inhalation therapy. However, some patients still experience exacerbations during treatment. This study aimed to investigate the risk factors for future exacerbations in patients with COPD treated with dual LABA/LAMA.

This was a retrospective cohort study. Baseline data included demographic characteristics, pulmonary function, symptom scores, GOLD grades, GOLD groups, the number of exacerbations and hospitalizations in the past year, LABA/LAMA, and comorbidities were collected. The number of future exacerbations was collected during one year of follow-up.

A total of 1076 patients with COPD were included. There were 284 (26.4%) patients experienced exacerbations during follow-up. Patients who experienced exacerbations were older and had higher clinical COPD questionnaire scores, a great number of exacerbations and hospitalizations in the past year, and a higher proportion of GOLD grades 3-4. Logistic regression analysis showed that GOLD grades 3-4 (odds ratio [OR] = 1.343, 95% confidence intervals [CI] = 1.016-1.776), one exacerbation in the past year (OR = 1.763, 95% CI = 1.248-2.489), and ≥ 2 exacerbations in the past year (OR = 2.514, 95% CI = 1.792-3.525) were independent risk factors for experiencing exacerbations. Furthermore, in group B, logistic regression analysis showed that GOLD grades 3-4 (OR = 1.808, 95% CI = 1.096-2.981) and hypertension (OR = 3.400, 95% CI = 1.712-6.752) were independent risk factors for experiencing exacerbations. In group E, logistic regression analysis showed that ≥ 2 exacerbations in the past year (OR = 1.426, 95% CI = 1.021-1.993) was an independent risk factor for experiencing exacerbations.

Patients with COPD treated with LABA/LAMA remained at high risk of future exacerbations. GOLD grades 3-4 and exacerbations in the past year were associated with future exacerbations and may warrant particular attention from clinicians.

Macrolide-resistant Mycoplasma pneumoniae (MRMP) is a growing concern in pediatric pneumonia. This study investigated current diagnostic and treatment practices for M. pneumoniae infections among Korean pediatricians, focusing on variations and challenges related to MRMP management.

A cross-sectional online survey was conducted among Korean pediatricians, including general pediatricians and subspecialists in September 2024. The survey assessed diagnostic methods, antibiotic choices, corticosteroid use, and factors influencing treatment decisions.

A total of 452 pediatricians participated in the survey. Polymerase chain reaction was the preferred diagnostic method (92.0%), although serologic tests were also commonly used (37.4%). Macrolides were the dominant first-line treatment (89.0%), with clarithromycin and roxithromycin being equally favored. Doxycycline was the most frequent second-line choice (67.0%). Corticosteroid use varied among specialties, with up to 94% of respondents using them occasionally or almost always. Treatment guidelines were the primary factor influencing antibiotic choices (76.5% for first-line, 59.7% for second-line).

This study reveals diverse practices and a need for standardized guidelines in managing M. pneumoniae infections, particularly in the context of rising MRMP prevalence. Clearer recommendations on diagnostic testing, antibiotic selection, and corticosteroid use are crucial to optimize patient care and mitigate the spread of resistance.

A consensual criterion regarding lung function (LF) assessment that could be included in the definition of asthma remission on treatment (tAR) is currently lacking.

This work aimed to identify a criterion concerning LF evaluation corresponding to this concept.

A survey was conducted using the Delphi method. The scientific board established 16 candidate statements to be included in the questionnaire. A 5-point Likert scale was used to measure agreement for each statement. The predefined conditions for statement selection were a median score ≥ 4 and >60% of responses indicating agreement. The survey included four rounds: three including the board members and one - 177 participants through the Interasma Scientific Network platform.

Following the first two rounds, six statements reaching consensus were included in the large survey. They incorporated various definitions used for 'normal' and 'stable' LF together with elimination of airway hyperresponsiveness and variability during bronchodilator testing. Three statements gained consensus during the third round. The final selected criterion associates 'stable LF' over time with a 'negative reversibility test' or 'negative challenge test'.

This Delphi process identified a criterion based on LF assessment that may serve as support for future consensual definition of _tAR after prospective validation.