OBJECTIVE:Neonatal sepsis remains a leading cause of neonatal mortality, yet comprehensive evaluations of its current and future burden are limited. This study assessed global, regional, and national trends and projected mortality through 2050. STUDY DESIGN:Data from the UN child mortality database (2000-2021) across 194 countries were analyzed. Neonatal sepsis was defined using ICD-10 codes P35-P39, excluding P37.3-P37.4. Trends were assessed using annual percentage change, and mortality was projected under three scenarios: continuation of current trends, convergence to high-income country trends, and attainment of the greatest observed national reduction. RESULTS:In 2021, the global neonatal sepsis mortality rate was 129.34 per 100,000 live births, a 41.6% reduction since 2000. West and Central Africa had the highest mortality and slowest decline. By 2050, mortality is projected to decline to 61.49 per 100,000. CONCLUSIONS:Despite progress, substantial regional disparities persist, highlighting the need for targeted interventions in high-burden regions.

Socio-economic status plays a critical role in shaping unmet healthcare needs, and the COVID-19 pandemic has further intensified these disparities; however, research to date remains insufficient. Therefore, this study aims to analyze unmet healthcare needs by household income using large-scale longitudinal data (2010-2022) including pre- and post- pandemic differences. This large-scale study (n = 2,628,584) utilized nationwide data from the Korea Community Health Survey (KCHS) conducted between 2010 and 2022, administered by the Korea Disease Control and Prevention Agency. The analysis employed complex, weighted sampling to examine trends in unmet healthcare needs, with a specific focus on changes during the COVID-19 pandemic. Weighted logistic regression models were used to calculate odds ratios and β differences (βdiff) between the pre-pandemic (2010-2019) and pandemic (2020-2022) periods. In total, 2,628,584 individuals participated in the KCHS from 2010 to 2022, comprising 1,454,129 males (55.3%) and 1,174,455 females (44.7%). Before the pandemic, there was a consistent decline in the prevalence of unmet healthcare needs. However, following the onset of the pandemic, unmet healthcare needs increased (βdiff, low-level of household income: 1.66 [95% CI, 1.41-1.92]; mid-level of household income: 0.88 [95% CI, 0.77-0.99]; high-level of household income: 0.71 [95% CI, 0.57-0.85]). Overall, households with lower incomes exhibited higher levels of unmet healthcare needs compared to those with higher incomes (low household income: 14.8 [95% CI, 13.91-14.24]; high household income: 8.45 [95% CI, 8.34-8.55]). Additionally, the disparity in healthcare access due to income differences was more pronounced among older individuals, those with lower educational attainment, and those with lower subjective health status. Our analysis found that older adults in low-income households consistently faced higher rates of unmet healthcare needs. The reversal of a pre-pandemic trend toward reducing healthcare gaps highlights the urgent need for targeted interventions to address socio-economic disparities.

BACKGROUND:Given the rising demand for cosmetic botulinum toxin (BoNT) procedures in the UK, the potential for adverse outcomes and a notable gap in evidence regarding how injector type, treatment location and product choice influence risk, this study aims to investigate these associations. OBJECTIVES:To assess the relationships between BoNT type, administer and location with odds of adverse events in a large UK patient sample. METHODS:A cross-sectional observational survey was designed to gather data on individuals' (aged ≥ 18 years) experiences and adverse events (AEs) with cosmetic BoNT injections across the UK. Data were collected on participants' age, sex, injector role, treatment location, BoNT type, AEs and satisfaction. Binary logistic regression models were fitted for each AE to examine the association between the occurrence of the symptom (yes/no) and injector role, treatment location and BoNT type. RESULTS:There were 919 participants. Receiving BoNT injections from a beautician was associated significantly with increased odds of some AEs, including pain and eyelid ptosis. Interestingly, BoNT administered by pharmacists was significantly associated with bruising and swelling, whereas BoNT administered by a doctor was associated with increased odds of nerve damage. Medical clinics outperformed all other environments, with patients reporting lower odds of complications across multiple AEs. By contrast, home-based injections carried significantly elevated odds of bruising and swelling. Participants reported unknown or undisclosed BoNT type A products had markedly poorer outcomes across multiple AEs. CONCLUSIONS:Findings from this cross-sectional study suggest that injectors operating from informal settings, particularly without disclosing the product used, pose a potential measurable and preventable risk. As public demand grows, safeguarding patient outcomes requires further legislative action.

INTRODUCTION:This study systematically synthesized evidence on adverse health outcomes related to gestational diabetes mellitus (GDM) via an umbrella review with integrated meta-analyses. METHODS:The search covered publications from the database (PubMed/MEDLINE, Google Scholar, Embase, and CINAHL) inception to August 12, 2024. Meta-analyses of observational studies examining the impact of GDM on maternal and neonatal health outcomes were included. Two independent researchers screened and extracted data. Associations were reanalyzed and presented as equivalent odds ratios (eORs) with 95% confidence intervals (CI). The quality of meta-analyses was assessed using AMSTAR 2, and the credibility of associations was categorized into five levels: convincing (Class I), highly suggestive (Class II), suggestive (Class III), weak (Class IV), or nonsignificant (NS). RESULTS:A total of 27 meta-analyses encompassing 85 associations were included. Among 28 significant maternal outcomes, 11 (subclinical atherosclerosis, angina, hypertension, overall cardiovascular diseases, ischemic stroke, overall stroke, combined cardiovascular/cerebrovascular diseases, subclinical left ventricle systolic dysfunction, type 2 diabetes, postpartum metabolic syndrome, and infections) were supported by convincing or highly suggestive evidence. Of 13 significant neonatal outcomes, three (atrial septal defect, congenital heart disease, and ventricular septal defect) were highly suggestive, while four of eight significant delivery outcomes (hypertensive disorders, cesarean delivery, admission to neonatal intensive care unit admission, and preterm birth) reached this level. Notably, no outcomes previously deemed nonsignificant turned significant upon reanalysis. CONCLUSIONS:These findings underscore the need for targeted prevention and management, and further research is needed to clarify causality and refine guidelines. STUDY REGISTRATION:PROSPERO CRD42024590322.

Background:Dyslipidemia is a multifactorial and complex condition that warrants investigation through advanced analytical approaches such as machine learning (ML). Few previous ML studies predicting dyslipidemia have been validated across multiple international populations. Objective:This study aimed to develop an ML model to predict the 5-year incidence of dyslipidemia using routinely collected health examination data. To ensure generalizability, the model was externally validated in populations from South Korea, Japan, and the United Kingdom. Furthermore, the clinical relevance of the model-derived risk was evaluated by examining its association with atherosclerotic outcomes, including acute myocardial infarction and cerebral infarction. Methods:This study was conducted using 3 independent, large-scale, population-based cohorts. The discovery cohort from South Korea (n=471,650) was used for model training and internal validation, while 2 validation cohorts from Japan (validation A; n=7,255,685) and the United Kingdom (validation B; n=408,725) were used for external validation. We evaluated various ML-based models using 23 features extracted from regular health screening data to predict the new onset of dyslipidemia within 5 years. Shapley Additive Explanations values were calculated to assess feature importance. To ensure the robustness of the proposed ML model, we evaluated the risk of atherothrombotic events (acute myocardial infarction or cerebral infarction) based on the model probability (tertiles; T1, T2, and T3) using a Cox proportional hazards model. Results:In the discovery cohort, soft-voting ensemble learning with Light Gradient Boosting Machine and categorical boosting exhibited performance metrics of area under the receiver operating characteristic curve (AUROC) of 0.783, precision of 37.9%, and area under the precision-recall curve of 0.469. The model showed moderate discriminatory performance in the external validation cohorts (cohort A: AUROC 0.744; precision 27.2%; and cohort B: AUROC 0.687; precision 5.07%). Shapley Additive Explanations value analysis identified smoking, alcohol intake, and physical activity as the most important features for predicting dyslipidemia. Finally, a higher model probability (T3 vs reference) was pronounced with an increased risk of acute myocardial infarction (adjusted hazard ratio 2.34, 95% CI 1.84-2.97) and cerebral infarction (adjusted hazard ratio 2.43, 95% CI 2.19-2.71). Conclusions:This multinational study developed and validated an ML-based model using routine health checkup data to predict the 5-year risk of new-onset dyslipidemia, which was also associated with atherosclerotic events.

Although severe depression and suicidal ideation among adolescents could be driven by excessive academic competition, research on this problem is still insufficient. Therefore, this study aims to analyze the relationship between academic achievement, depression, and suicidal ideation based on large-scale data. This study utilized data from the nationwide Korea Youth Risk Behavior Web-based Survey conducted from 2006 to 2022, investigating a total of 1,138,802 adolescents. Weighted proportions with 95% confidence intervals (CIs) and crude numbers and percentages were utilized to analyze and present the results in various formats. To accurately assess the association of academic achievement with depression and suicidal ideation, weighted odds ratios and their 95% CIs were calculated using weighted logistic regression analysis. Compared to students with high academic achievement, those with moderate achievement showed a 1.12 (95% CI = 1.11-1.13) times higher risk of depression, while those with low achievement had a 1.54 (1.52-1.56) times higher risk. Similarly, students with low academic achievement had a 1.49 (95% CI = 1.47-1.51) times higher risk of suicidal ideation. The prevalence of both depression and suicidal ideation decreased before the coronavirus disease 2019 pandemic but steadily increased during the pandemic. Females experienced higher rates of depression in each academic achievement group (high: weighted odds ratio = 1.49 [95% CI = 1.46-1.52]; middle: 1.59 [1.56-1.63]; low: 1.72 [1.69-1.75]) and suicidal ideation (high: 1.60 [1.57-1.64]; middle: 1.63 [1.59-1.68]; low: 1.82 [1.78-1.86]) than males. This study suggests that academic achievement can be associated with depression and suicidal ideation. Therefore, implementing mental health and educational programs targeting students with lower academic achievement may be crucial.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted a complex, bidirectional relationship between SARSCoV-2 infection and autoimmune diseases. This review examines how SARS-CoV-2 infection influences the incidence, progression, and outcomes of five major autoimmune conditions: systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and Guillain–Barré syndrome. Patients with autoimmune diseases are at increased risk of severe COVID-19 due to intrinsic immune dysregulation and the use of immunosuppressive therapies, both of which impair antiviral host defenses. Conversely, COVID-19 has been implicated in the initiation and exacerbation of autoimmune responses through mechanisms such as molecular mimicry and bystander activation. Concerns have also arisen regarding the safety and efficacy of COVID-19 vaccines in immunocompromised populations. Although vaccines are generally tolerated in these individuals, certain immunosuppressive therapies may attenuate humoral and cellular immune responses. Strategies such as adjusting immunosuppressive regimens and optimizing the timing of vaccination have been proposed to improve vaccine efficacy. Disease-specific considerations are essential to balance infection risk with adequate control of autoimmune activity. Overall, this review underscores the importance of individualized treatment strategies, close clinical monitoring, and interdisciplinary care in managing patients with autoimmune diseases during the COVID-19 pandemic. A deeper understanding of these interactions will be critical for improving patient outcomes and preparing for future pandemics involving immune-mediated diseases.

Small randomized controlled trials (RCTs) in COVID-19 meta-analyses have been associated with more favourable treatment effects and reduced result stability. This study assessed how trial size impacts effect estimates, statistical stability, and risk of bias. Following PRISMA guidelines, we identified meta-analyses of COVID-19 treatments included in WHO, NIH, and the LIVING Project. Trials were classified by log-scale sample size, and separate pooled meta-analyses were conducted for large-only, small-only, and combined trials. Comparative metrics included the Ratio of Odds Ratios (ROR), Kappa statistics, Fragility Index (FI), Reverse Fragility Index (RFI), and Cochrane Risk of Bias assessments. Sensitivity analyses applied alternative size thresholds (≥ 1000 participants and median-based cutoffs) and stratified results by treatment and outcome type. Across 25 meta-analyses including 221 RCTs (46 large, 175 small), small trials produced more extreme estimates in 19 analyses and wider confidence intervals in 23. The pooled ROR was 0.85 (95% CI: 0.76-0.95; P = 0.004), decreasing to 0.81 (95% CI: 0.68-0.95; P = 0.011) when limited to small trials published before the first large trial. RORs remained below 1 across treatment and outcome types. Agreement between small and large trials was minimal, while large trials showed substantial agreement with overall estimates. Stability and bias profiles favoured large trials (FI: 14.0 vs. 4.0; RFI: 10.0 vs. 5.0). In conclusion, small RCTs tend to overestimate treatment effects and yield less precise, less stable results. Meta-analyses should prioritise large, high-quality trials and interpret small-study findings with caution, particularly in rapidly evolving research contexts.

Background Residential greenness has been associated with lower ischemic heart disease risk in general populations; however, its relevance after SARS‐CoV‐2 infection is unclear. We evaluated the associations between residential greenness and incident coronary artery disease following COVID‐19. Methods In this nationwide cohort study using the South Korean K‐COV‐N (Korea Disease Control and Prevention Agency–COVID‐19–National Health Insurance Service) database, we included individuals aged ≥19 years with confirmed SARS‐CoV‐2 infection. The data set linked National Health Insurance Service health screening and claims data with Korea Disease Control and Prevention Agency surveillance records. Residential greenness was measured using the normalized difference vegetation index (NDVI; low 0.2–<0.4, moderate 0.4–<0.6, high ≥0.6). The primary outcome was first diagnosis of coronary artery disease (acute coronary syndrome or chronic ischemic heart disease) ≥30 days after infection. Inverse probability of treatment weighting was used to balance covariates, and weighted Cox models were applied to estimate adjusted hazard ratios (aHRs) with 95% CIs. Analyses were stratified by COVID‐19 severity, vaccination status, variant period, sex, age, and income. Results Among 3 097 179 individuals (61.4% men), 25.3%, 59.7%, and 15.0% were classified as having low, moderate, and high NDVI exposure, respectively. Although NDVI was not associated with risk of acute coronary syndrome, higher NDVI was associated with lower risk of chronic ischemic heart disease (aHR, 0.86 [95% CI, 0.84–0.88] for moderate NDVI; aHR, 0.82 [95% CI, 0.80–0.84] for high NDVI). Associations were stronger in moderate to severe COVID‐19, vaccinated individuals, males, and younger individuals. Conclusions Residential greenness was not associated with post‐COVID acute coronary events but was consistently associated with lower chronic ischemic heart disease risk, suggesting a potential role in long‐term cardiovascular health after SARS‐CoV‐2 infection.

Over recent decades the incidence of dengue has increased on a global scale and in 2023 reached unprecedented levels. One potential promising approach to prevent dengue and reduce dengue symptoms is vaccination. We systematically searched PubMed/Medline, Scopus, Embase, Web of Science, Cochrane, and Lilacs databases from inception to the 27th of July 2025 (PROSPERO registration CRD42024579006). Outcomes were pooled and expressed as odds ratio (OR) with corresponding 95% confidence intervals (CI). Meta-analysis was conducted for each outcome using Review Manager and the grading of evidence was carried out using the GRADE. We included 42 studies with a total of 175,434 participants. Efficacy of vaccine was demonstrated by the lower rate of viremia OR= 0.35, 95%CI (0.25, 0.48), p<0.00001, hemorrhagic fever OR= 0.16, 95%CI (0.09, 0.28), p<0.00001and high percentage of antibody production. In terms of safety, all vaccines showed promising results with no significant difference in serious adverse events when compared to placebo group. A higher rate of reaction at the injection site was reported only for swelling, erythema, pruritus, and rash. Asthenia, myalgia, arthralgia, malaise, nausea, and neutropenia were identified systemic side effects reported with a higher rate in the vaccinated group. Our findings suggest that dengue vaccination is potentially both safe and efficacious.

Perceived social support is a key determinant of pediatric health and well-being, yet little is known about how its sources vary and evolve across populations. This study evaluated the prevalence, time trends, and correlates of perceived social support from family, friends, classmates, and teachers in a large, multinational sample. Data were drawn from 455,031 participants (mean age = 13.5 years; 51

The triglyceride-glucose body mass index (TyG-BMI), a composite marker reflecting both metabolic dysfunction and obesity, has been proposed as a practical indicator for hypertension risk. However, population-based evidence from East Asian countries remains limited. This study aimed to investigate the association between TyG-BMI and early-onset hypertension among Korean adults using nationally representative cross-sectional data. We analyzed data from 20,948 participants aged 19–39 years in the Korea National Health and Nutrition Examination Survey conducted between 2007 and 2023. TyG-BMI was derived by multiplying the TyG index by BMI to evaluate the association of early-onset hypertension. Early-onset hypertension was defined as a diagnosis occurring at 40 years of age or younger. Weighted logistic regression models were used to estimate adjusted odds ratios (aOR) with 95

OBJECTIVE:In South Korea, where suicide is the leading cause of adolescent death, this study examined national trends in suicidal ideation, suicide plan, and suicide attempt in relation to pandemic-related changes and population-level risk factors. METHOD:This study analyzed trends in suicidal behaviors from the Korea Youth Risk Behavior Web-based Survey (2012-2025). All three outcomes were defined by self-reported questionnaires. The period was categorized as pre-pandemic (2012-2019), intra-pandemic (2020-2022), and post-pandemic (2023-2025). Temporal trends were assessed using weighted linear regression (β, βdiff), and risk factors were evaluated using weighted multivariable logistic regression with weighted odds ratios (wORs) and 95% CIs. RESULTS:Overall, the prevalence of suicidal ideation, suicide planning, and suicide attempts declined pre-pandemic (2012-2019), increased during the pandemic (2020-2022), and declined again post-pandemic (2023-2025), with 2025 prevalence of 16.24% (95% CI, 15.46-17.01), 6.18% (5.69-6.67), and 4.03% (3.64-4.43), respectively. Higher prevalence was consistently observed among those aged ≤15 years and females, with the steepest intra-pandemic increase in suicidal ideation among the youngest group (β, 2.53 [95% CI, 1.75-3.30]).Temporal contrasts were most pronounced for suicide attempt, decreasing intra-pandemic versus pre-pandemic (wOR, 0.86 [95% CI, 0.81-0.91]) and increasing post-pandemic versus intra-pandemic (1.25 [1.16-1.35]).Alcohol consumption showed a graded association by severity, with the strongest effects observed post-pandemic. CONCLUSIONS:Suicidal ideation, suicide planning, and suicide attempts among South Korean adolescents showed marked disruptions during the COVID-19 pandemic, and although rates declined post-pandemic, the findings underscore adverse mental health impacts and the need for preparedness for future global crises.

BACKGROUND:There is growing demand for Botulinum toxin (BoNT) injections in the UK. However, there is a scarcity of research in relation to associations between medical conditions and BoNT adverse events. OBJECTIVES:To investigate cross-sectional associations between existing medical conditions and the likelihood of adverse events in a large sample of UK BoNT users. METHODS:A cross-sectional observational survey on individuals' (≥18 years) experiences and adverse events with cosmetic BoNT injections. Data were collected on participants age, gender, existing health conditions, acute and long-term adverse events following BoNT treatment. To investigate the association between pre-existing physical conditions and the occurrence of post-BoNT adverse effects, multivariable logistic regression models were performed. RESULTS:Nine hundred and nineteen participants who received BoNT were included in the analysis. Multivariable logistic regression revealed that several pre-existing physical and psychiatric conditions were significantly associated with increased odds of specific post-BoNT adverse effects. Notably, individuals with skin disease (odds ratio [OR] 22.95, 95% confidence interval [CI] 2.64-132.03, P = .001), type 1 diabetes mellitus (OR 110.34, 95% CI 3.85-3381.06, P = .002), chronic migraine (OR 7.69, 95% CI 1.84-27.61, P = .003), and thyroid disorders (OR 6.18, 95% CI 1.27-23.44, P = .012) demonstrated significantly higher odds of developing nausea following BoNT administration. Multiple other significant associations were found between numerous existing health conditions and numerous adverse events. CONCLUSIONS:This study found that autoimmune, endocrine, neurological, and mental health comorbidities significantly increase the likelihood of adverse outcomes, ranging from bruising and ptosis to mood disturbance, neuromuscular weakness, and apparent treatment failure. LEVEL OF EVIDENCE 4 (THERAPEUTIC):

BACKGROUND:To investigate the long-term trends in prevalence and pandemic-related factors of unmet healthcare needs among a nationwide large-scale cohort with or without depressive symptoms from the Korea Community Health Survey. METHODS:We analyzed 2,850,315 Korean adults aged 19 years or older, including individuals with or without depressive symptoms. Our study investigated the trends and risk factors for unmet healthcare needs among individuals, stratified by the presence of depressive symptoms during the pre-pandemic (2009-2019) and pandemic era (2020-2022). Weighted odds ratios and weighted regression slope coefficients (β) with 95% confidence intervals (CIs) were employed to analyze the prevalence of unmet healthcare needs. RESULTS:Of a total of 2,850,315 individuals (mean ± standard deviation age, 53.04 ± 17.43 years; male, 44.81%). Unmet healthcare needs decreased in both groups during the observation period. Individuals with depressive symptoms had a 2-3 times higher prevalence of unmet healthcare needs. The downward trend for those with depressive symptoms, from 34.55% (95% CI, 33.77-35.34) in 2009-2010 to 21.50% (20.91-22.09) in 2017-2019, reversed during the pandemic, increasing from 13.82% (12.95-14.69) in 2020 to 14.37% (13.62-15.12) in 2022. CONCLUSION:The study highlights increased unmet healthcare needs among individuals with depressive symptoms during the pandemic, emphasizing the necessity for tailored policies and effective healthcare distribution to reduce barriers for vulnerable populations during global crises.

OBJECTIVE:The World Health Organization (WHO) launched the Global Cervical Cancer Elimination Initiative, but comprehensive global assessments remain limited. Therefore, this study aimed to evaluate the current burden of cervical cancer, examine recent trends, and project progress toward elimination through 2050. METHODS:The global burden of cervical cancer across 185 countries or territories in 2022 was assessed using data from the Global Cancer Observatory 2022, stratified by age and human development index. Trends from 1943 to 2020 were analyzed using data from the Cancer Incidence in Five Continents Plus database, the WHO Mortality Database, and the Nordic Cancer Database. Age-standardized incidence rates and mortality rates were calculated using the Segi-Doll world standard population. Average annual percent changes over the most recent 10 years were estimated using Joinpoint regression. Future projections to 2050 were modeled using constant-rate and annual percent change-based scenarios. RESULTS:In 2022, an estimated 662,301 new cases and 348,874 deaths from cervical cancer occurred worldwide. Substantial regional disparities in the age-standardized rates were observed, with Eastern Africa and Southern Africa reporting the highest burden. Although countries with lower human development index had higher burdens in 2022, recent increasing trends were notable in countries with higher human development index. Future projections indicate that countries with very high and high human development indexes would require a 3% to 4% annual reduction in age-standardized incidence rate to achieve the WHO elimination target by 2050. However, countries with medium and low human development indexes are unlikely to reach the target even with a 5% annual decline. CONCLUSIONS:Significant disparities in the burden of cervical cancer persist, and without accelerated efforts, many countries with low human development index scores-as well as some countries with high or very high human development index scores-may fail to achieve the elimination target.

BACKGROUND:Despite the significant global impact of the COVID-19 pandemic, limited studies have investigated the long-term cardiovascular sequelae of SARS-CoV-2 infection, particularly among Asian populations. This large-scale, population-based binational cohort study with long-term follow-up aimed to investigate the association between SARS-CoV-2 infection and the risk of cardiovascular events. METHODS:We used binational, large-scale, and population-based cohorts, including a Korean nationwide cohort (K-CONV-N [Korea Disease Control and Prevention Agency-COVID-19-National Health Insurance Service cohort]; discovery cohort; n=18 989 129) and a Japanese nationwide cohort (Japan Medical Data Center; validation cohort; n=12 218 680). Individuals aged 20 years or older were included from January 1, 2020, to December 31, 2022. We assessed the long-term risk of incident cardiovascular outcomes after SARS-CoV-2 infection. The primary outcome was the risk of cardiovascular diseases based on International Classification of Diseases, Tenth Revision code diagnosis. After propensity score-based overlap weighting, Cox proportional hazard models were used to estimate adjusted hazard ratios for cardiovascular outcomes. We assessed the time attenuation effect of cardiovascular outcomes after SARS-CoV-2 infection. Multiple subgroup analyses were conducted by 16 cardiovascular outcomes, COVID-19 severity, vaccination, and SARS-CoV-2 strain. RESULTS:In the overlap-weighted discovery cohort, 7 960 357 individuals were included (mean age, 48.52 years [SD, 9.33]; men, 4 283 878 [53.82%]). SARS-CoV-2 infection was associated with a long-term increased risk of overall cardiovascular outcomes (adjusted hazard ratio, 1.62 [95% CI, 1.60-1.64]), particularly ischemic heart disease (1.81 [95% CI, 1.77-1.84]), heart failure (1.79 [95% CI, 1.73-1.85]), cerebrovascular disorders (1.65 [95% CI, 1.60-1.69]), major adverse cardiovascular events (1.65 [95% CI, 1.60-1.70]), inflammatory heart diseases (1.53 [95% CI, 1.31-1.80]), dysrhythmia (1.44 [95% CI, 1.42-1.46]), and thrombotic disorders (1.42 [95% CI, 1.35-1.48]). The increased risk persisted up to 18 months, with the highest association observed for 1 to 6 months after infection. The risk of cardiovascular diseases was pronounced with COVID-19 severity; however, it decreased with the administration of complete vaccination and subsequent booster doses. A similar risk of cardiovascular outcomes existed across every SARS-CoV-2 era (pre-delta, delta, and omicron). Similar patterns were observed in the validation cohort. The absolute risk of cardiovascular disease events after SARS-CoV-2 infection remained remarkably low (2.12% versus 1.31% in the noninfected population), particularly stroke (0.24% versus 0.13%) and ischemic heart disease (0.73% versus 0.39%). CONCLUSIONS:This binational study observed associations between SARS-CoV-2 infection and cardiovascular events during extended follow-up across viral eras. Complete vaccination was linked to lower cardiovascular events. However, the absolute risk of cardiovascular disease events after SARS-CoV-2 infection remained remarkably low, particularly for stroke and ischemic heart disease. Although these findings suggest ongoing vigilance and preventive measures remain crucial, they should be interpreted within the context of these low absolute risks when considering long-term cardiovascular complications.

BACKGROUND:Epilepsy is a common neurological disease that heavily impacts children and adolescents and carries serious physical, cognitive, psychological, social and economic consequences for patients and their caregivers. METHODS:Data was obtained via the Global Burden of Disease Study 2021. We reported numbers, rates and percentage changes of prevalence, mortality and disability-adjusted life years (DALYs). RESULTS:In 2021, there were 18.15 million [95% UI: 14.61-21.85] prevalent cases of epilepsy in children and adolescents worldwide, 8.24 million [5.77-11.13] of which were idiopathic epilepsy and 9.91 million [8.72-11.06] of which were secondary epilepsy. While mortality and DALY rates of idiopathic epilepsy declined between 1990 and 2021, the burden of secondary epilepsy remained substantial and, in some cases, increased-particularly in low-SDI regions. The prevalence rate of secondary epilepsy increased by 16.14% [4.28-29.24], driven by increases in epilepsy attributable to neonatal encephalopathy (82.02%), neonatal jaundice (18.45%) and malaria (77.03%). There were notable geographic variations in the burden of epilepsy, with the burden generally concentrated in Sub-Saharan Africa, Latin America and the Caribbean and Southeast Asia. CONCLUSIONS:While efforts to reduce premature mortality of epilepsy have been successful, the burden on children and adolescents living with epilepsy is still significant. A healthcare gap remains for vulnerable populations with increased risk of infectious diseases, perinatal insults, poor sanitation and limited access to healthcare. Global and national action is needed to improve access to specialist care and medication, manage comorbidities, address stigma and discrimination and strengthen primary prevention initiatives.

BACKGROUND:Recent previous study suggests that live zoster vaccination may reduce the risk of diseases like dementia and cardiovascular diseases, through prevention of herpes zoster. Thus, this study aims to evaluate whether live zoster vaccination can reduce the risk of chronic respiratory disease including chronic obstructive pulmonary disease (COPD), asthma, and interstitial lung disease (ILD). METHODS:This target trial emulation study utilized a nationwide, population-based cohort of 2,519,582 individuals aged ≥ 50 years in South Korea. The cohort was constructed by integrating health insurance data from the Korea Health Insurance Review and Assessment Service, national health examination data from the Korean National Health Insurance Service, and vaccination records from the Korea Disease Control and Prevention Agency. The exposure was receipt of at least one dose of live zoster vaccination between January 1, 2012, and December 31, 2021. Outcomes included the incidence of newly diagnosed COPD, asthma, and ILD, as well as hospitalizations associated with these conditions. Following stabilized inverse probability of treatment weighting, we employed the Cox proportional hazards model to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) and calculated restricted mean survival time (RMST) for the risk of outcomes associated with live zoster vaccination. The observation period extends from the index date to January 31, 2024. MEASUREMENTS AND MAIN RESULTS:After stabilized inverse probability of treatment weighting, 745,644 individuals were assigned to the vaccinated group and 1,069,230 to the unvaccinated group, with a mean age of 62.12 years (SD, 3.45) and 49.18% were male. Live zoster vaccination significantly reduced the risk of COPD (aHR, 0.70 [95% CI, 0.69-0.71]; RMST difference, 23.22 days [95% CI, 21.72-24.71]), asthma (0.68 [0.67-0.69]; 25.96 days [24.52-27.40]) and ILD (0.78 [0.73-0.82]; 2.39 days [2.05-2.74]). Additionally, the vaccination significantly reduced the risk of hospital admissions due to these conditions: COPD (0.59 [0.53-0.65]), asthma (0.54 [0.49-0.59]), and ILD (0.68 [0.58-0.79]). The observed protective benefit was more pronounced in non-smokers compared to current smokers. The time-attenuated effect was strongest during 1 to 2 years following live zoster vaccination and remained evident for up to 6 years. CONCLUSIONS:Live zoster vaccination significantly reduced the incidence of chronic respiratory disease and related hospitalizations. These findings suggest that live zoster vaccination may provide public health benefits beyond preventing herpes zoster in adults aged ≥ 50 years.