Background: Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave. Methods: This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training. Results: We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0–14.0) and the median awareness score was 29.6 (IQR = 26.6–32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a ’great-extent-of-confidence’ in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors. Interpretation: There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type.

Obstructive sleep apnea (OSA) is a common disease that is often under-diagnosed and under-treated in all ages. This is due to differences in morphology, diversity in clinical phenotypes, and differences in diagnosis and treatment of OSA in children and adults, even among individuals of the same age. Therefore, a personalized medicine approach to diagnosis and treatment of OSA is necessary for physicians in clinical practice. In children and adults without serious underlying medical conditions, polysomnography at sleep labs may be an inappropriate and inconvenient testing modality compared to home sleep apnea testing. In addition, the apnea–hypopnea index should not be considered as a single parameter for making treatment decisions. Thus, the treatment of OSA should be personalized and based on individual tolerance to sleep-quality-related parameters measured by the microarousal index, harmful effects of OSA on the cardiovascular system related to severe hypoxia, and patients’ comorbidities. The current treatment options for OSA include lifestyle modification, continuous positive airway pressure (CPAP) therapy, oral appliance, surgery, and other alternative treatments. CPAP therapy has been recommended as a cornerstone treatment for moderate-to-severe OSA in adults. However, not all patients can afford or tolerate CPAP therapy. This narrative review seeks to describe the current concepts and relevant approaches towards personalized management of patients with OSA, according to pathophysiology, cluster analysis of clinical characteristics, adequate combined therapy, and the consideration of patients’ expectations.

(1) Background: Exhaled nitric oxide (NO) has been considered as a biomarker of airway inflammation. The measurement of fractional exhaled NO (FENO) is a valuable test for assessing local inflammation in subjects with allergic rhinitis (AR). (2) Objective: To evaluate (a) the correlation between nasal FENO with anthropometric characteristics, symptoms of AR and nasal peak flows in children without and with AR; and (b) the cut-off of nasal FENO for diagnosis of AR in symptomatic children. (3) Methods: The study was a descriptive and cross-sectional study in subjects with and without AR < 18 years old. All clinical and functional characteristics of the study subjects were recorded for analysis. They were divided into healthy subjects for the control group and subjects with AR who met all inclusion criteria. (4) Results: 100 subjects (14 ± 3 years) were included, including 32 control subjects and 68 patients with AR. Nasal FENO in AR patients was significantly higher than in control subjects: 985 ± 232 ppb vs. 229 ± 65 ppb (p < 0.001). In control subjects, nasal FENO was not correlated with anthropometric characteristics and nasal inspiratory or expiratory peak flows (IPF or EPF) (p > 0.05). There was a correlation between nasal FENO and AR symptoms in AR patients and nasal IPF and EPF (p = 0.001 and 0.0001, respectively). The cut-off of nasal FENO for positive AR diagnosis with the highest specificity and sensitivity was ≥794 ppb (96.7% and 92.6%, respectively). (5) Conclusion: The use of nasal FENO as a biomarker of AR provides a useful tool and additional armamentarium in the management of allergic rhinitis.

Purpose: This study investigated changes in salivary melatonin and cortisol concentrations before and after Continuous Positive Airway Pressure (CPAP) therapy in patients with OSA. Underlying these hormonal changes is a key mechanism involving dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis and circadian rhythm. Patients and Methods: A prospective before-and-after study was conducted on 59 adults with OSA, of whom 27 completed an 8-week follow-up after CPAP therapy. Salivary melatonin and cortisol were measured via ELISA in morning and afternoon samples. Other habits that affect sleep were also assessed. Hormonal changes were analyzed using Wilcoxon signed-rank tests, and correlations with clinical variables were evaluated using Spearman correlation. Results: At baseline, mean melatonin concentration was 80.80 ± 52.48 pg/mL, higher in the afternoon, and mean cortisol concentrations was 7.58 ± 5.45 ng/mL, higher in the morning. After CPAP treatment, melatonin concentration decreased to 63.78 ± 39.85 pg/mL, with a reduced difference between morning and afternoon concentrations. Cortisol concentration increased slightly to 8.06 ± 8.08 ng/mL. These hormonal changes were not statistically significant (p> 0.05). Notably, melatonin concentrations correlated negatively with tea consumption (rho = – 0.43, p< 0.05) after adjustment. Conclusion: This research investigated salivary melatonin and cortisol as biomarkers for CPAP efficacy in OSA patients. Although no significant changes were detected, trends indicated reduced sleep pressure, including lower afternoon melatonin and higher cortisol levels. The substantial dropout rate limits how these results can be interpreted. More studies with larger sample sizes, longer treatment durations, and more comprehensive hormonal evaluations at various times of the day are needed to elucidate the potential significance of salivary biomarkers in understanding circadian control in OSA.

Insomnia is a prevalent sleep disorder worldwide, yet data among healthcare professionals in Southeast Asia remain limited. Occupational stressors, rotating shifts, and high emotional demands may increase vulnerability to sleep disturbance in this population. To estimate the prevalence of insomnia among Vietnamese healthcare professionals and to identify associated nocturnal symptoms, daytime impairments, and clinical associated factors. We conducted a nationwide multi-region cross-sectional survey of 1655 healthcare professionals across Vietnam. Participants completed a structured questionnaire assessing insomnia symptoms, daytime consequences, comorbidities, and occupational factors. Insomnia was ascertained per ICSD-3 criteria for chronic insomnia, requiring (i) ≥ 1 nocturnal symptom (DIMS: difficulty initiating sleep, difficulty maintaining sleep, or early-morning awakening); (ii) ≥ 1 associated daytime impairment; (iii) symptom frequency ≥ 3 nights/week; and (iv) chronicity ≥ 3 months, despite adequate sleep opportunity. Severity was evaluated using the Insomnia Severity Index (ISI). Logistic regression models estimated odds ratios (ORs) and adjusted odds ratios (aORs) with 95% confidence intervals (CIs), adjusting for age, sex, occupation, marital status, and stimulant use. The prevalence of insomnia was 24.2% (95% CI, 22.2–26.3), higher in women than men and increasing with age. The most common nocturnal symptoms were nocturnal awakenings (84.2%) and sleep-onset difficulty (57.2%), while daytime impairments included memory complaints (74.6%), mood disturbances (55.4%), and excessive daytime sleepiness (59.5%). In multivariable analysis, independent associated factors of insomnia included nocturnal awakenings (aOR 6.11), sleep-onset difficulty (aOR 2.89), mood disturbance (aOR 2.20), morning headache (aOR 2.18), and memory impairment (aOR 1.63). Stimulant consumption, particularly tea or coffee (aOR 2.10) and alcohol (aOR 1.98), was also independently associated. Approximately one in four Vietnamese healthcare professionals experience insomnia, characterized by substantial nocturnal fragmentation and daytime dysfunction. Given its potential implications for clinician well-being and patient safety, systematic screening and integrated occupational sleep-health interventions are warranted.

Introduction: Insomnia is a common disease in all societies and age groups. Among them, medical students are one of the population most susceptible to sleep problems. Studies from many countries have shown high prevalence of insomnia among medical students. Sleep diary is the gold standard for evaluating subjective insomnia and other sleep disorders. This research aims to study the prevalence of insomnia in Vietnamese medical students, associated factors, and their sleep patterns. Method: In a cross-sectional survey using stratified random sampling, a total of 176 medical students was recruited, each completed a self-administered questionnaire and a 7-consecutive-day sleep diary. Demographic data and lifestyle factors were obtained from the questionnaire, while sleep patterns and quality were collected from the sleep diary. We performed data analysis using SPSS ver 22, p<0.05 was statistically significant. Results: Overall, out of 176 participants, 93 (52.8%) were affected by insomnia. On average, students acquired 6.2 hours of sleep each night. 70.94% of the recorded nights had total sleep time (TST) less than 7 hours. Associated factors of insomnia include sleep environment, sleep efficiency (SE), bedtime, falling asleep time, get up time, self-reported sleep quality. Conclusion: The findings of our study revealed the high prevalence of insomnia among medical students. From recorded sleep data, we observed that sleep deprivation is also a common issue faced by the study participants. The valuable insights provided by sleep diary proved to be crucial in evaluating sleep patterns and quality.