Search Results (1,039)

Purpose: This study aimed to evaluate retrospectively self-reported changes in tinnitus severity and distress associated with the COVID-19 pandemic and vaccination using validated self-report instruments. It further explored patient-reported onset of tinnitus following vaccination, gender differences in symptom severity, and associations with psychological distress. Method: A cross-sectional online survey was completed by 189 adults between December 2023 and April 2024. Participants retrospectively self-reported tinnitus onset and severity before, during, and after the COVID-19 pandemic using the Tinnitus Handicap Inventory (THI) and the Tinnitus Reaction Questionnaire (TRQ). Additional items assessed COVID-19 vaccination history, infection status, and adverse vaccine reactions. Repeated measures ANOVAs and chi-square tests were used to examine retrospectively reported longitudinal changes and group differences. Results: Mean THI scores increased significantly over time—before (M = 9.57, SD = 16.00), during (M = 29.97, SD = 32.30), and currently (M = 36.92, SD = 28.04)—with large effect sizes across functional, emotional, and catastrophic subscales (p < 0.001). TRQ scores also were reported to rise from before (M = 7.86, SD = 15.29) to during (M = 26.38, SD = 29.58) and remained elevated at the current time (M = 29.79, SD = 24.00), p < 0.001. Approximately 25.9% and 27.0% of respondents reported new or worsened tinnitus after the first and second vaccine doses, respectively. No significant gender differences in symptom severity were observed. TRQ severity classification revealed a marked shift, with moderate or greater distress increasing from 5.8% (before) to 35.6% (current). Conclusions: Retrospective self-reports indicated that tinnitus burden significantly increased during the COVID-19 pandemic and remained elevated at the time of survey completion. A notable proportion of individuals reported new-onset tinnitus following vaccination, though causality cannot be inferred. These findings highlight the need for continued monitoring and comprehensive care addressing both audiological and psychological components of tinnitus. Full article

Background: One of the primary strategies for preventing and reducing infectious diseases is vaccination. There are numerous licensed vaccinations of various kinds that can prevent viral infection by triggering the immune system’s reaction to specific antigens beforehand. To elicit a stronger immune response, however, two elements of the immune system—humoral and cellular immunity—should be addressed. Since they target proteins that are difficult to alter, recent innovative techniques for vaccine delivery systems—such as liposomes, nanogels, microemulsions, etc.—have shown excellent immunogenicity qualities. Methods: PubMed, ScienceDirect, and Google Scholar were used as the databases for literature search, and keywords such as “Virosomes”, “Hemagglutinin”, and “IRIV” were selected to ensure relevant articles were included. Results: This article examines a cutting-edge method called virosomes, which are an effective way to deliver pharmaceutically active ingredients that target a variety of illnesses and ailments, as well as vaccines. This resulted from the fact that virosomes possess numerous structural characteristics that might trigger sophisticated immune reactions by utilizing the inactivated virus’s envelope or by imitating it through recombinant methods. Conclusions: Here, we will walk you through the history of virosome development, explore various manufacturing techniques, provide an overview of the latest patents, and conclude with the potential for more virosomal revolutions. Full article

Background/Objectives: In Japan, the human papillomavirus (HPV) vaccine introduction process is unique, and no HPV knowledge scale with established reliability and validity currently exists. This study aimed to develop a new HPV knowledge scale and evaluate its reliability and validity for practical use. Methods: With permission from the original authors of the HPV Knowledge Scale (Jo Waller et al.), we created a Japanese version incorporating the original two subscales and adding new items. The translation process involved multiple researchers, back-translation by a professional agency, and expert review to ensure linguistic and contextual accuracy. The study was approved by the Clinical Research Ethics Review Board of the researchers’ affiliated universities and conducted between April and August 2024. Results: Reliability and validity were assessed using data from 793 parents of junior high school students, including both boys and girls. Confirmatory factor analysis showed a good model fit (Goodness-of-Fit Index [GFI] = 0.934, Adjusted GFI [AGFI] = 0.907, Comparative Fit Index [CFI] = 0.928, Root Mean Square Error of Approximation [RMSEA] = 0.063). Cronbach’s alpha ranged from 0.688 to 0.845 and item-total correlations ranged from 0.393 to 0.584. Test–retest reliability, assessed with Spearman’s rank correlation, was r = 0.791 (p < 0.001). The final scale, named the Japan HPV Knowledge Scale (J-HPV-KS), includes 17 items across five factors. Conclusions: The J-HPV-KS covers HPV-related diseases, transmission routes, natural history, and vaccines. It demonstrated sufficient reliability and validity for use in Japan and is a useful tool for assessing HPV-related knowledge among Japanese parents and guardians. Full article

Background: Pediatric asthma is a multifactorial condition influenced by environmental, biological, and social determinants. The COVID-19 pandemic introduced new variables that may have affected the severity and management of asthma in children and adolescents, particularly through changes in healthcare access, treatment adherence, and exposure to environmental risk factors. Objective: To evaluate the association between asthma severity and various factors including nutritional status, corticosteroid use, COVID-19 vaccination, and pollutant exposure before and during the COVID-19 pandemic in a pediatric population. Methods: A retrospective analysis was conducted using 307 medical records of patients aged 3 to 17 years. Data collected included sociodemographic characteristics, nutritional indicators, history of corticosteroid use, vaccination status against COVID-19, and exposure to environmental pollutants. Asthma severity was assessed using the pulmonary score, and multiple statistical analyses, including logistic regression using the Bayesian Logistic Regression Model (BLRM), were employed to identify significant associations. Results: The analysis revealed a statistically significant impact of the pandemic on hospitalization rates (p = 0.0187) and the use of corticosteroids (p = 0.009), indicating changes in asthma management during this period. Notable differences were observed in the geographic distribution of mild versus severe asthma cases prior to the pandemic, associated with nutritional status and gender (p = 0.018). During the pandemic, breastfeeding history, body weight, and hospitalization emerged as significant predictors of asthma severity (p < 0.05). In addition, breastfeeding in young children (aged 3 to 6 years) and hospitalization were strongly associated with pulmonary scores, with significance values of 0.022 and 0.012, respectively, as identified by the BLRM. Conclusions: These findings suggest that the pandemic context influenced both the clinical course and management of pediatric asthma. Preventive strategies should consider individual and environmental factors such as nutrition, early-life health practices (e.g., breastfeeding), and equitable access to appropriate asthma care and vaccination. Tailoring pediatric asthma management to these variables may improve outcomes and reduce disparities in disease severity. Full article

Background: Cervical intraepithelial neoplasia grade 2 (CIN2) represents a controversial lesion in cervical cancer prevention. Traditionally included in the aggregate CIN2+ endpoint for reasons of diagnostic stability and statistical power, isolated CIN2 has unique biological characteristics: greater interobserver variability, a high probability of spontaneous regression and a lower risk of progression compared to CIN3. Objectives: To critically describe the epidemiology, natural history and management strategies of CIN2, integrating data from clinical and population-based studies and comparing the recommendations of the main international guidelines. Methods: A narrative review was conducted using a search of PubMed and Scopus (1990–January 2025). Prospective and retrospective studies on isolated CIN2, screening and vaccination trials with CIN2+ endpoints, biomarker research, and consensus documents (ASCCP, ESGO, GISCi, Ministry of Health, WHO) were included. Results: Clinical studies have shown a high probability of CIN2 regression (50–70% within two years, >70% in those <25 years), compared to a 10–15% risk of progression, especially in the presence of persistent HPV16. Screening trials and vaccine evaluations with CIN2+ endpoints have documented the efficacy of the HPV test and a dramatic reduction in lesions in vaccinated cohorts, which was also confirmed for isolated CIN2. The most recent guidelines have progressively adopted a risk-based approach, which allows for active surveillance in young women or those seeking to conceive, while the WHO maintains a screen-and-treat model in resource-limited countries. Conclusions: CIN2 is not a lesion to be treated automatically, but rather a paradigmatic model for personalized management. Integrating epidemiological and clinical data, supported by biomarkers, allows for reducing overtreatment without compromising oncological safety. Full article

Vaccination has resulted in substantial public health benefits for human populations worldwide since it was first introduced more than a century ago. This article presents an overview of the history of vaccine development, its implementation, and price setting, the latter mainly from a developed world perspective. It considers potential issues and challenges. Over time, vaccine development and production has evolved to a market-driven approach, conducted largely by private commercial entities. The complex processes of identifying potential vaccine targets and developing and producing vaccines at scale have now become more efficient. However, vaccine pricing is an emerging concern. The elements that maximize the overall health benefit of vaccination include high volume, high coverage, and rapid initial implementation to achieve the high coverage with the vaccine as quickly as possible. It therefore requires substantial initial investment. Consequently, the price set for the vaccine should be reasonable to avoid limiting the coverage given the available budget. Suboptimal coverage leads to suboptimal benefit if herd protection is not fully achieved. This may disappoint health authorities and may result in program discontinuation. Conventional cost-effectiveness analysis is therefore not ideally suited to vaccine price setting, as it is based on the concept of ‘more for more’, i.e., higher health gain achieved at a higher reimbursement cost that does not account for limited budgets. Constrained optimization (CO) combines value assessment with constrained budget allocation into one analysis method and may therefore be the better option for vaccine pricing. Full article

Introduction: Vaccines are the most widely used public health measure to control the global COVID-19 pandemic. Most vaccines used in Europe and North America are mRNA-based. A mass vaccination campaign was carried out between 2021 and 2024. Some adverse events have been reported based on analogies with previous virus-attenuated vaccines. Objectives: Given the new mechanism inducing specific antibodies, we questioned the role of mRNA Spike vaccines and the significance of hyperproduction of anti-Spike antibodies in the emergence of early and late onset rheumatological manifestations observed after one or more injections. Material and Methods: A prospective observational study involving two cohorts was initiated. The first cohort was observed from 13 September 2021 to 30 September 2022, and the second cohort from 1 October 2022 to 30 September 2023. The study also focused on the interval between the last vaccine injection and the onset of rheumatic symptoms. None of the patients had a history of rheumatic or inflammatory diseases. We compared both cohorts and ankle arthritis case series to analyze the differences between early and late-onset adverse events. Results: In both cohorts and case series, the majority of patients were women. The most common symptoms included diffuse muscle pain, which mimics polymyalgia rheumatica, and ankle arthritis. Very high levels of anti-Spike antibodies (>2080 BAU/mL) were generally detected. The Pearson correlation coefficient between both cohorts and case series was very high, confirming the reproducibility of post-vaccine clinical and biological features. Conclusions: These rheumatological manifestations might be triggered by inappropriate individual immune responses to the vaccine’s Spike protein and/or the overproduction of Spike protein, which can mediate a pro-inflammatory reaction, explaining early and late-onset effects. Full article

Background/Objectives: The “TROVAILMIOVACCINO” platform was developed to help adults in Italy identify vaccines recommended for them based on individual characteristics, in line with the Italian National Immunization Plan (NIP). The website directs users to an anonymous online questionnaire addressing key factors such as age, sex, pregnancy status, travel history, medical conditions, and risky behaviors. It is intended for adults aged 18 and over and can be filled out either by individuals or by others on their behalf, such as healthcare professionals. The purpose of the study was to assess the platform’s reach, the health status of users, and its ability to inform users. Methods: Data were organized into tables and analyzed using frequencies, percentages, and statistical tests to assess user demographics and health conditions. Significant differences among sociodemographic groups were evaluated using the Chi-square and Fisher’s exact tests. Results: Over 30 months, the website was accessed 1897 times, with 1622 users (85.5%) completing the questionnaire for personal interest. The majority of users were aged 18–49 years (61.5%), with a nearly equal male–female distribution. Healthcare workers represented the most common professional group (29.2%) among users. Older individuals were more likely to have the questionnaire completed by someone else. Among respondents, 25.8% reported having a single medical condition, with cardiovascular diseases (11.9%), diabetes (6.7%), and respiratory diseases (4.8%) being the most frequent. The most common risk condition reported was potential contact with newborns. Conclusions: The findings highlight the value of the platform in reaching diverse user groups and offering tailored vaccine recommendations. Full article

Background: The widespread use of the human papillomavirus (HPV) vaccine and the rise in digital technologies like artificial intelligence (AI) are causing significant changes in the paradigms surrounding cervical cancer screening. Objective: This review addresses potential future paths toward risk-based, customized screening and prevention while summarizing the available data on how vaccination and digital innovation are changing cervical cancer screening methods. Results: A shift from cytology-based screening to HPV-based primary testing with longer intervals has been supported by the notable decrease in high-grade cervical lesions brought about by HPV vaccination. However, AI and digital health tools, such as digital colposcopy, automated cytology, telemedicine, and self-sampling, have the potential to increase diagnostic access, accuracy, and efficiency, especially in low-resource environments. Implementation hurdles, data security, and algorithmic bias are major obstacles. Conclusions: Digital platforms, molecular diagnostics, and vaccination histories must all be incorporated into screening methods in order to keep up with the decline in HPV-related illness. The elimination of cervical cancer could be accelerated and equality and efficiency increased with customized, risk-based algorithms. Full article

Non-viral myocarditis is rare but relatively more frequent in patients with systemic autoimmune diseases (such as systemic lupus erythematosus, SLE, and allied conditions) than in the general population. In rare cases, mRNA-based vaccines can also trigger non-viral myocarditis. Limited data are available about the cardiac safety of mRNA vaccines in this subset of patients. Here, we report data from a third-level hospital on long-term safety, leveraging on a previously described cohort of 13 consecutive patients with SLE, Undifferentiated (UCTD) and Mixed Connective Tissue disease (MCTD), and a history of myocarditis, who had received anti-COVID-19 vaccination between April 2021 and January 2022. Demographics and clinical data (including validated clinometric for SLE) were collected at baseline, at the first available visit following the primary vaccination cycle, after an additional 12 months, and at the last available follow-up after at least 36 months. Twelve patients, seven females, ten with SLE, one MCTD, and one UCTD, had a median follow-up of 41 (35–45) months. One patient was lost at follow-up. No disease flare or sign of myocarditis recurrence were observed. At last visit, all patients were in a low disease activity state (LLDAS), and all but one were in remission, according to the Definition of Remission in SLE (DORIS) criteria. No significant variations in disease activity or damage accrual nor in markers of inflammation and myocardial injury were observed. Our data suggest that mRNA-based anti-COVID-19 vaccines in patients with previous autoimmune myocarditis in the context of SLE and allied conditions have a good long-term safety profile. Full article

Dengue, caused by the dengue virus (DENV), is rapidly expanding its geographical footprint, with increasing incidence not only in over 100 endemic countries in the southern hemisphere but also with more autochthonous transmissions now reported in the northern hemisphere, including regions of Europe and the United States. The clinical presentation of DENV infection ranges from mild febrile illness to severe and potentially fatal conditions, such as dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS), and diverse neurological complications. While vaccine development efforts are underway, significant challenges remain, underscoring the urgent need for a deeper understanding of the virus. This urgency is particularly palpable in Brazil, which has faced an unprecedented surge in dengue cases during the 2024–2025 period. The country has recorded an alarmingly high number of infections and related deaths, stretching its public health infrastructure and highlighting the complex interplay of climate change, urbanization, and viral dynamics in disease propagation. This review provides a global perspective on dengue, systematically exploring its history, morphology, viral cycle, pathogenesis, and epidemiology. By integrating these critical aspects, this article aims to identify pivotal knowledge gaps and guide future research directions essential for developing improved public health interventions against this complex and evolving disease. Full article

Freedom of expression, in the context of recent events in our history—such as the COVID-19 pandemic and the situation in Ukraine—has once again sparked a significant and widely followed public debate about its limits. The escalation of these situations has revealed many of the negative aspects of freedom of expression and its direct and devastating impact on people’s everyday lives. In particular, hate speech and the spread of disinformation have gained strength, with effects not only in terms of legal liability or financial consequences relating to damages and harm, but also in ways that directly impact public health. Calls to avoid wearing facemasks and questioning of vaccines and protective measures have not only fuelled vulgar online debates and even physical attacks, but have also led to direct consequences for individual and public health. Therefore, it is essential that freedom of expression has limits—limits that do not amount to censorship. Only public authority—the state—has the legitimate power to set such boundaries. As EU member states are undergoing processes of legal unification and harmonization of their legal systems, it is important to also consider the stance of EU institutions on the future legislative framework of freedom of expression. This is particularly important given that individual member states do not share the same values or approaches to this issue. The aim of this paper is to assess the contribution of the European Union to the development of freedom of expression through selected legislative and non-legislative activities. The paper will also include a proposal for a forward-looking solution. Full article

Background/Objectives: Preventive care in Greece remains underdeveloped, especially in workplace settings. To address this, a mixed service model was piloted to integrate preventive and occupational health for public sector employees in Region of Crete. Methods: Between January and July 2025, 180 employees enrolled for a 30 min consultation including medical history review, lifestyle assessment, and evaluation of vaccination and screening status according to age, risk factors, and national guidelines. Standardized tools (PSS-14, PHQ-9) assessed perceived stress and mental well-being. Participants rated satisfaction and perceived care quality on a 10-point Likert scale. Results: Of 180 enrolled, 154 completed the evaluation. The majority of participants were female (68.8%), with a mean age of 54 years, and 42.9% held a higher education degree. Common lifestyle characteristics included current smoking (24.7%), regular alcohol consumption (9.8%), and insufficient sleep (mean 6.5 h/night). Overweight (40.3%) and obesity (29.2%) were prevalent. Chronic conditions were reported in 87.0% of participants, with dyslipidemia (54.5%), allergies (35.8%), and hypertension (26.9%) being the most frequent. Criteria for metabolic syndrome were found in 33.1% of participants with a higher prevalence in men (50.0% vs. 25.0%; p = 0.029). Mental health assessments revealed moderate stress levels (mean PSS-14: 23.7) and mostly minimal depressive symptoms (mean PHQ-9: 4.3). Preventive screening was variable, with higher adherence for mammography (79.2%) and lower for colonoscopy (40.2%). Service satisfaction was high, with significant increases in perceived usefulness (8.96 to 9.80, p < 0.001) and satisfaction (9.08 to 9.87, p < 0.001) after the intervention. Conclusions: This pilot revealed critical gaps in vaccination, cardiometabolic risk, and stress management among public employees. It was also shown that integrated workplace-based health models are both feasible and acceptable. These models can effectively deliver preventive actions on a scale and represent a promising strategy for strengthening occupational health in employed adult population. Full article

Background: The persistence of non-neonatal tetanus (non-NT) highlights the necessity of adult booster vaccines and post-traumatic prophylaxis. This Phase I/III clinical trial aimed to evaluate the safety and immunogenicity of a new adsorbed tetanus vaccine. Methods: A randomized, double-blind, positive-controlled clinical trial was conducted in Henan Province, China. A total of 1258 healthy participants aged 18–44 years (60 in Phase I and 1198 in Phase III) were enrolled, with no history of tetanus infection, or tetanus toxoid-containing vaccines (TTCVs) vaccination within the past 10 years. The participants were randomly assigned at a 1:1 ratio to receive a single dose of either the investigational vaccine or the licensed control vaccine. The Phase III clinical trial was initiated subsequent to the 7-day safety observation period following vaccination in the Phase I trial. The objective of the Phase III clinical trial was to assess the non-inferiority of the seroconversion rate of tetanus antibodies at 30 days post-vaccination with the investigational vaccine compared to the control vaccine. Serum samples were collected prior to and at 30 days post-vaccination. Adverse events were monitored for 30 days, with serious adverse events (SAEs) followed up for 6 months post-vaccination. Results: The investigational group achieved a seroconversion rate of 99.48%, which was non-inferior to that of the control group (99.66%), with a negligible rate difference of −0.17% (95% confidence interval [CI]: −1.20%, 0.78%). The investigational group exhibited a significantly higher geometric mean concentration (GMC) of antibodies (4.721 IU/mL vs. 3.627 IU/mL, p < 0.0001). Among the susceptible participants, the seroconversion rates were 99.78% in the investigational group and 99.79% in the control group, respectively, with a non-inferior rate difference of −0.01% (95%CI: −1.06%, 0.97%). Furthermore, the investigational group showed a low incidence of adverse reactions (ARs) within 30 days post-vaccination (12.26%), which was comparable to that of the control group (13.65%). All the reported ARs were mild or moderate, and no SAEs were associated with the vaccination. Conclusions: The new adsorbed tetanus vaccine demonstrated favorable safety and comparable immunogenicity to the marketed control vaccine, with a significantly higher antibody GMC, supporting its clinical application in tetanus prevention. Full article

Background: Vaccination against SARS-CoV-2 has been pivotal in controlling the COVID-19 pandemic. However, understanding vaccine-induced immunity in immunocompromised individuals remains critical, particularly how prior exposure to other coronaviruses modulates immune responses. The influence of previous infections with endemic human coronaviruses (HCoVs), such as OC43, on SARS-CoV-2 immunity is not fully understood. This study evaluates antibody responses to COVID-19 vaccination in hemodialysis patients (HD), transplant recipients (TR), and healthy controls (CO), accounting for prior SARS-CoV-2 infection and baseline human coronavirus (HCoV) reactivity. Methods: We obtained longitudinal antibody measurements from 70 subjects (CO: n = 33; HD: n = 13; TR: n = 24) and assessed antibody kinetics across multiple post-vaccination time points using multivariate linear mixed modeling (MLMM). Results: Limited but measurable cross-reactivity was observed between SARS-CoV-2 and endemic HCoVs, particularly the $\beta$-coronavirus OC43. Pre-existing immunity in healthy individuals modestly enhanced vaccine-induced anti-spike (S) IgG responses, supported by post-vaccination increases in SARS-CoV-2 IgG. Prior SARS-CoV-2 infection significantly influenced anti-S and nucleocapsid (N) IgG responses but had limited impact on endemic HCoVs responses. Vaccine type and immune status significantly affected antibody kinetics. mRNA vaccination (BNT162b2) elicited stronger and more durable SARS-CoV-2 anti-S IgG responses than the inactivated CoronaVac vaccine, especially in immunocompetent individuals. Immunocompromised groups showed delayed or attenuated responses, with modest anti-S IgG cross-reactive boosting. Elevated anti-N IgG in CoronaVac recipients raised questions about its origin—infection or vaccine effects. MLMM identified key immunological and clinical predictors of antibody responses, emphasizing the critical role of host immune history. Conclusions: These findings highlight a constrained but meaningful role for HCoV cross-reactivity in SARS-CoV-2 immunity and vaccine responsiveness, underscore the need for infection markers unaffected by vaccination, and support development of broadly protective pan-coronavirus vaccines and tailored strategies for at-risk populations. Full article