The impact of breathing frequency on respiratory oscillometry measurements is unknown. We aimed to investigate the impact of different breathing frequencies in patients with asthma.

We recruited patients from the severe asthma clinic at Cambridge University Hospitals. Using a randomised-crossover design, participants performed the forced oscillation technique at three different breathing frequencies (15, 30, 40 bpm) in a randomised order for each participant. A metronome was used to ensure the correct breathing frequency. Analysis of variance (ANOVA) and Friedman tests were utilised to assess the significance of any differences across the breathing frequencies. We then leveraged cross-sectional data from asthma patients who performed respiratory oscillometry and investigated the determinants of self-selected breathing frequency using multivariable linear regression.

We recruited 59 patients. Mean age 54.1 years, 58% female, median forced expiratory volume in 1 s (FEV₁)/FVC z-score -2.56 (-3.26 to -1.96). As breathing frequency increased from 15 bpm to 40 bpm, there was a significant reduction (-8.6%, p<0.001) in total airway resistance (Rrs at 5 Hz), which was not mediated by changes in tidal volume or flow rate. There was also a significant reduction (-14.9%, p<0.001) in Delta R5-R19, and an increase (+10.9%, p=0.081) in reactance (Xrs at 5 Hz). At higher breathing frequencies, 5% of study participants were reclassified as having respiratory oscillometry measurements within normal limits. Data from 796 asthma patients were extracted for the cross-sectional analysis. The median (range) self-selected breathing frequency was 16.55 bpm (8.0, 42.0). Demographic data and lung function explained 23.5% of the variation in breathing frequency.

Higher breathing frequencies significantly reduce total Rrs . When performing respiratory oscillometry, breathing frequency should be controlled at approximately 15 bpm to reduce risk of misclassification.

Post-COVID-19 syndrome (PCS) is characterised by persistent symptoms, such as fatigue, dyspnoea, depression and sleep problems, following SARS-CoV-2 infection. The long-term course and impact on quality of life remain unclear. This review aims to synthesise evidence on longitudinal changes in symptom prevalence, severity and health-related quality of life (HRQoL) in adults with PCS.

This systematic review will include longitudinal studies (randomised controlled trials, non-randomised trials, prospective and retrospective cohort studies) of adults (≥18 years) with PCS, defined by symptoms persisting beyond 4 weeks after acute infection. Eligible studies must report changes in prevalence or severity of fatigue, dyspnoea, depression, sleep problems or HRQoL from baseline to at least one follow-up visit.We will systematically search MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL and Epistemonikos, with no restrictions on language, date or publication status. Two reviewers will independently screen studies, extract data and assess risk of bias using validated tools appropriate to study design. Disagreements will be resolved by consensus or a third reviewer.A narrative synthesis will summarise study characteristics and symptom trajectories. Where sufficient data are available, random-effects meta-analyses will be conducted to estimate pooled changes in symptom prevalence (ORs), severity ((standardised) mean differences) and HRQoL ((standardised) mean differences). Meta-regression and subgroup analyses will explore potential effect modifiers. Certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

No ethical approval is required. Findings will be disseminated via peer-reviewed publication, conference presentations and plain language summaries.

CRD420251011612.

Acute respiratory distress syndrome (ARDS) is a major public health problem, accounting for 23% of intubated patients and associated with high mortality rates. Although lifesaving, invasive mechanical ventilation can worsen lung injury when ventilator settings are poorly adjusted to lung physiology. We hypothesise that individualising ventilator settings via (1) the bedside assessment of lung recruitability using a one-breath derecruitment manoeuvre and measurement of airway opening pressure to set positive end-expiratory pressure (PEEP), (2) controlling the distending pressure and (3) controlling respiratory drive improves ARDS outcomes.

The CAreful Ventilation In ARDS trial is an investigator-led multicentre (33 centres in eight countries), open-label, randomised controlled basket trial comparing two ventilation strategies in two subpopulations of moderate-to-severe ARDS: induced or not by COVID-19. A total of 740 patients will be randomised (370 in each substudy) in a 1:1 ratio to individualised ventilator settings or to using traditional PEEP to inspired fraction of oxygen tables for PEEP setting. Indications for proning and weaning strategies are similar in both arms. The primary outcome is all-cause mortality at day 60. Secondary outcomes include duration of mechanical ventilation, duration of intensive care unit (ICU) and hospital stay, organ dysfunction, barotrauma and mortality in ICU, at day 28 and in hospital.

Ethics approval has been obtained for all participating centres: Unity Health Toronto Research Ethics Board (for three centres: St Michael's Hospital, Toronto General Hospital and Toronto Western Hospital); Comité de Ética de Investigación con Medicamentos del Hospital Universitari Vall d'Hebron; Comité de protection des personnes Ile de France III; Comité d'Ética de la Investigatción con Medicamentos de la Fundació de Gestió Sanitària del Hospital de la Santa Creu i Sant Pau; Comitato Etico-Fondazione Policlinico Gemelli; Comitato Etico di Area Vasta Emilia Centro; NYU Langone Health Institutional Review Board; Comité Ético Científico de Ciencias de la Salud; Il Comitato Etico Area 1 dell'Azienda Ospedaliero-Universitaria 'Ospedali Riuniti' di Foggia; HIGA 'Eva Perón' Comité de Bioética; Comité de Revisión Institucional del Hospital Británico Comité de Ética en Investigación; Complejo Médico Churruca-Visca Comité de Ética Biomédica; Comité de Ética SATI Comité de Ética en Investigación; Comité de Ética en Investigación del CEMIC; Comité de Ética SATI Comité de Ética en Investigación; Medical Research Ethics Committees United. Findings will be disseminated in peer review journals and conference presentations.

NCT03963622.

Suicidal thoughts among physicians are common and increased during the COVID-19 pandemic, yet many hesitate to seek mental health support. We sought to examine factors influencing seeking help for suicidality among physicians and trainees, their narrative descriptions of suicidality, and the impacts of losing a physician in their lives to suicide.

We conducted a qualitative analysis of published narratives from physicians and trainees describing experiences in seeking help for suicidality. We systematically searched MEDLINE and PsycInfo (March 2000 to March 2023) and manually reviewed reference lists of included articles. We analyzed narratives and generated themes using reflexive thematic analysis.

Across 52 narratives, authors commonly described preceding pressures, ways of coping, and intense emotional distress and altered self-perceptions. Barriers to seeking help were rooted in pressures that contributed to suicidality, including a medical culture that values achievement and stoicism, the growing severity of illness, stigma regarding mental health, fears about losing one's license, reluctance to burden others, and limited access to timely, confidential care. In contrast, facilitators to seeking help included access to confidential services, mental health literacy and, most notably, the care and role modelling of seeking help by others. Narratives advocated for cultural and systemic changes within the profession.

Intense pressures to achieve in medicine discourage physicians from acknowledging distress and seeking help, but role modelling of seeking help can attenuate the stigma. Understanding these intersecting factors can inform changes needed to develop targeted suicide prevention strategies for physicians and promote physician well-being.

To examine spatial, temporal and seasonal patterns in childhood and adolescent asthma hospitalisations across Queensland, and assess variation in hospitalisation risk by age and sex across climate regions.

A retrospective, population-based ecological study using area-level administrative data from hospital admissions.

All public and private hospitals in Queensland, Australia, 1 January 2000-31 December 2019.

Children and adolescents aged 0-19 years who were admitted to hospital with a principal diagnosis of asthma.

Age-standardised admission rates and relative risks (RRs) from spatial models; temporal patterns from time-series analysis; spatial variation from mapping; age-, sex- and climate zone-specific risks.

Hospitalisations among children aged 0-4 years declined from 48.1% (1640 admissions) in 2000 to 23.2% (721 admissions) in 2019, whereas proportions in older age groups increased. Seasonal peaks occurred in May, June and February, with male patients showing a stronger February peak and female patients maintaining higher risks into July. Hot desert regions had the highest RRs, rising from 3.73 (95% credible interval [CrI], 3.71-3.74) in 2000-2001 to 9.37 (95% CrI, 9.28-9.47) in 2009-2010, then declining to 2.37 (95% CrI, 2.37-2.38) in 2018-2019. Hot semi-arid and tropical savanna regions showed persistently elevated risks (hot semi-arid: RR, 1.86-3.75; tropical savanna: RR, 1.81-4.58). Three temporal phases were evident statewide: an early lower-risk period (2000-2002), a higher-risk period (2002-2012) and a later reduction (2012-2019), with most RRs between 0.5 and 1.5. Seasonality was strongest in hot desert zones (seasonal strength, 0.519) and weakest in tropical savanna zones (0.063).

Childhood and adolescent asthma hospitalisations in Queensland exhibit significant spatiotemporal variation, with burden shifting from younger to older children, and climate-specific risks, although observed reductions in the youngest age group may partly reflect diagnostic and hospital admission practice changes. Higher asthma risks in arid and tropical savanna regions underscore the need for geographically tailored services and planning. These findings suggest that targeted public health strategies might help reduce asthma burden in vulnerable communities.

We analysed Australian Immunisation Register (AIR) data, predominantly for National Immunisation Program (NIP) funded vaccines, as at 4 February 2024 for children, adolescents and adults, focusing on the calendar year 2023 and trends from previous years. This report aims to provide comprehensive analysis and interpretation of vaccination coverage data to inform immunisation policy and programs.

Fully vaccinated coverage in Australian children in 2023 was lower than in 2022 at the 12-month (92.8%, down from 93.3%), 24-month (90.8%, down from 91.0%) and 60-month (93.3%, down from 93.4%) age assessment milestones. This follows the 1.1-1.5 percentage point decrease at these three milestones between the 2020 and 2022 reports, which came after eight years of generally increasing coverage. Fully vaccinated coverage in Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) children was also slightly lower in 2023 than in 2022 at the 12-month (89.7%, down from 90.0%), 24-month (87.8%, down from 87.9%) and 60-month (95.0%, down from 95.1%) milestones, following a 1.9-3.3 percentage point decrease between the 2020 and 2022 reports. Due to the lag time involved in assessment, fully vaccinated coverage figures for 2023 predominantly reflect vaccinations due in 2022, when COVID-19 pandemic-related restrictions had largely been removed. Factors contributing to this ongoing decline in coverage in children include a combination of acceptance and access issues.

Among adolescents turning 15 years in 2023, 84.2% of girls and 81.8% of boys (80.9% and 75.0% of Indigenous girls and boys) had received at least one dose of human papillomavirus (HPV) vaccine by their fifteenth birthday, 1.1 and 1.3 percentage points lower than in 2022, respectively (2.1-3.1 percentage points lower for Indigenous adolescents). Coverage of an adolescent dose of meningococcal ACWY vaccine in adolescents turning 17 years in 2023 was 72.8% overall and 62.3% in Indigenous adolescents, 3.1 and 3.3 percentage points lower than in 2022, respectively. These decreases reflect impacts of the pandemic on school-based programs in 2020-2021. To provide an early insight into any immediate impacts on coverage of moving to the NIP single-dose HPV vaccine schedule in 2023 (offered in Year 7 in all jurisdictions), we calculated coverage of at least one dose of HPV vaccine by 31 December in adolescents turning 13 years, with South Australia excluded due to change of delivery from Year 8 in 2022, and found it to be around 3 percentage points lower in 2023 than 2022, and 6 percentage points lower in Indigenous girls, with patterns of diphtheria-tetanus-pertussis vaccination (also single-dose at this age) and HPV vaccination coverage broadly similar. This decrease in vaccinations due in school programs after pandemic restrictions had been removed could be due to impacts of the single-dose HPV transition (i.e. if fewer opportunities for vaccination are provided due to fewer school visits) or may be due to other factors that have changed or disrupted previous school immunisation program operations or reduced parental confidence in vaccination. It is important to promote catch-up vaccination and to monitor renewed efforts to ensure equitable coverage is achieved, particularly given HPV vaccine coverage by 15 years of age in 2023 was 4-8 percentage points lower in adolescents residing in socio-economically disadvantaged and remote areas.

Zoster vaccination coverage in adults turning 71 years was 41.0% overall in 2023, down from 41.3% in 2022, and 36.1% in Indigenous adults, down from 36.5%. However, the availability of the new (non-live) protein-based herpes zoster vaccine (Shingrix) from 1 November 2023 has resulted in increased uptake for the larger eligible cohort. Coverage of 13-valent pneumococcal conjugate vaccine (13vPCV) in adults turning 71 years was 37.6% in 2023, up from 33.8% in 2022, and 43.0% in Indigenous adults, up from 37.7%. Coverage of 13vPCV was lower among Indigenous adults turning 50-59 years (17.5%) and 60-69 years (23.4%) in 2023, despite this vaccine being funded under the NIP. Influenza vaccination coverage decreased across all adult age groups in 2023, both overall and in Indigenous adults, with decreases ranging from 5-11 percentage points.

There have continued to be modest but concerning declines in vaccination coverage in children and adolescents relative to pre-pandemic peaks, with decreases greater in Indigenous children and adolescents. Evidence suggests that the factors contributing to these ongoing declines are complex and variable but include both vaccine acceptance and access issues. The picture for adult coverage is more mixed, with coverage increasing for 13vPCV, stable for zoster and decreasing for influenza vaccination, though consistently suboptimal across all vaccines. Ongoing monitoring of vaccination coverage, and further exploration of the reasons underpinning these decreases and suboptimal coverage, are needed to inform approaches to address barriers effectively and to increase vaccine uptake and equity of coverage.

Adverse pregnancy outcomes are significant public health issues in developing countries. This study aims to evaluate the trimester-specific impact of COVID-19 infection on maternal and neonatal outcomes in a cohort of unvaccinated Iranian women. A multi-center cross-sectional study was conducted between March 21, 2020, and March 21, 2021, involving 217 unvaccinated pregnant women with RT-PCR-confirmed SARS-CoV-2 infection who delivered in hospitals across three counties in Northwest Iran. Participants were stratified by the trimester of COVID-19 diagnosis: first (n = 20), second (n = 87), and third (n = 110). Data on demographics, as well as maternal, obstetric, and neonatal outcomes, were extracted from the National Health System. Statistical analyses included ANOVA, Chi-square, Fisher's exact and Kruskal-Wallis tests, with post-hoc Bonferroni corrections. A significant association was found between the trimester of infection and the rate of PTB (p = 0.028). Women infected in the third trimester had a substantially higher PTB rate (26.4%) compared to those infected in the second (11.5%) and first (15.0%) trimesters. Neonatal outcomes also varied significantly; APGAR scores at 1 and 5 minutes were lowest in the third-trimester infection group (8.16 ± 0.78 and 8.39 ± 0.80, respectively) compared to the first (9.08 ± 0.88 and 9.03 ± 0.90) and second (8.45 ± 0.71 and 8.79 ± 0.83) trimesters (p < 0.001 for both). Fever was significantly more prevalent in the third trimester (33.6%) than in the first (10.0%, p = 0.013). No vertical transmission or neonatal deaths were recorded. This study demonstrates a clear trimester-specific risk gradient for SARS-CoV-2 infection in unvaccinated pregnant women. Infection during the third trimester was associated with a significantly increased odds of PTB and lower neonatal APGAR scores(1,5). These findings underscore the critical vulnerability of late pregnancy to COVID-19 complications and highlight the importance of trimester-specific vigilance, enhanced antenatal surveillance, and robust vaccination advocacy for pregnant women.

Approximately 700 million women and girls worldwide live with disabilities, facing compounded discrimination due to both gender and disability. Despite their large numbers, they are often excluded from decision-making and rendered invisible. Research shows that crisis such as nature disasters and public health crises affects people with disabilities more severely than the general population, and women more than men. Yet, studies focusing specifically on women with disabilities in such contexts remain scarce. The present qualitative study aimed to address this gap by analyzing 56 semi-structured interviews with women with motor and/or sensory impairments about their life experiences during COVID-19 and afterwards, using reflexive thematic analysis. Participants aged 26-69, mostly with motor impairments (66.1%), reported satisfaction with their health (71.4%). Findings are organized into four main themes and six sub-themes corresponding to the components of the International Classification of Functioning, Disability, and Health (ICF) as follows: Physical and mental health through daily care and environmental contexts; Navigating accessibility and attitudinal barriers in daily life; Maintaining decision-making autonomy and financial independence; Family and social relationships as sources of support. The findings demonstrate multifaceted impacts on women with disabilities across personal, social, and contextual domains, during both stable periods and crises. To effectively address their needs, policymakers should incorporate the perspectives of women with disabilities in the planning of support programs for both routine periods and crises responses.

Long COVID, a multi-system-disease characterized by persistent somatic and mental symptoms following a SARS-CoV-2 infection, can severely impair health and quality of life of those affected. In the absence of adequate therapeutic approaches and a fragmented care landscape, our focus is on identifying individual stressors, the resulting needs and strategies people use to cope with the ongoing burden of the disease and its long-term stressors. This qualitative interview study is part of a pilot multicenter study addressing psychosocial needs in patients with Long COVID. The surveyed sample (n = 40) consists of affected people, who suffer from persistent symptoms and psychosocial stress after a SARS-CoV-2 infection. Based on the Transactional Stress Model according to Lazarus and Folkman and the Brief COPE by Carver, the qualitative analysis of semi-structured interviews focused on the various and individual coping attempts of the interviewees. Participants reported a wide range of persistent physical and mental complaints. Fatigue-associated complaints, cognitive impairments, fears and worries were mentioned frequently and perceived as particularly stressful. Job insecurity and financial worries, lack of recognition, stigmatization, lack of treatment and therapy approaches, withdrawal and social isolation were reported as stressors. In most cases, we identified an interplay between emotion-oriented (such as emotional support, self-care and positive thinking) and problem-oriented coping strategies (such as planning/pacing, self-help, withdrawal and avoidance). Emotional support as the most frequently mentioned strategy and as a fundamental resource in coping with this disease should be strengthened. These findings offer a valuable insight into the diverse stressors and coping patterns in dealing with post-viral symptoms of COVID-19. The analysis reveals that complaints and attempts to cope vary significantly among the participants. This underlines the importance of providing tailored support to those affected to help them manage their symptoms, improve their quality of life and enable them to participate in social life again.

The disproportional risk of microbial infections affecting immunocompromised individuals underlines the critical need to develop effective infection preventive strategies. Using the COVID-19 pandemic as an example, we developed a mathematical model to evaluate interventions to protect severely immunocompromised (SIC) subjects against COVID-19. Predictions were well-aligned with UK available data for 2021 and 2022, and the model was used to retrospectively quantify the impact of preventive interventions in alternative scenarios during that period. Model simulations indicated that while the UK vaccination program reduced hospitalizations and deaths in the general population, SIC subjects remained at high risk of severe COVID-19. Simulated protective strategies, such as passive immunization, during seasonal SARS-CoV-2 peaks, showed potential to significantly reduce infection rates in this vulnerable group. We demonstrated the application of mathematical models to describe complex interactions among multiple dynamic processes and assess interventions to prevent disease transmission in both immunocompetent and immunosuppressed individuals.