Objective: To compare demographic characteristics and healthcare-seeking behaviors of patients with chronic obstructive pulmonary disease (COPD) identified through community-based pulmonary function test (PFT) screening and symptom-prompted diagnosis via a regional health information platform in Songjiang district, Shanghai. Methods: A total of 2 038 COPD patients aged ≥40 years were included from a suburban population-based cohort and a regional healthcare information platform, including 216 screening diagnosed patients and 1 822 symptom-prompted diagnosed patients (the patients diagnosed in outpatients). Demographic characteristics and outpatient visits, hospitalizations, and respiratory-related visits during follow-up were compared. Associations between case-finding pathways and healthcare-seeking behaviors were analyzed by using a hurdle negative binomial regression model. Results: Compared with the screening-diagnosed group, the symptom-prompted diagnosed patients had higher proportion of women, lower prevalence of smoking and alcohol consumption, higher prevalence of respiratory comorbidities, and higher severity grade by Global Initiative for Chronic Obstructive Lung Disease. Compared with the screening diagnosed group, the symptom-prompted diagnosed group had higher risk for outpatient visits, respiratory illness-related outpatient visits, hospitalizations, and respiratory illness-related hospitalizations, with ORs of 17.28 (95%CI: 1.46-204.32), 13.30 (95%CI: 8.28-21.36), 2.26 (95%CI: 1.66-3.08), and 4.07 (95%CI: 2.10-8.31), respectively. In addition, the outpatient visit density, respiratory illness-related outpatient visit density, and hospitalization density were higher in the symptom-prompted diagnosed group than in screening diagnosed group, with RRs of 2.00 (95%CI: 1.80-2.22), 2.84 (95%CI: 2.35-3.43), and 1.52 (95%CI: 1.14-2.02) , respectively. Conclusions: Healthcare-seeking behaviors differed significantly by COPD case- finding pathway. The symptom-prompted diagnosed patients showed higher healthcare-seeking intensity, whereas community-based PFT screening was more likely to identify early-stage patients with lower healthcare dependence, supporting pathway-specific stratified management of COPD.

Objective: To analyzes the current status of delayed medical consultation and influencing factors in pulmonary tuberculosis (TB) patients aged ≥65 years in Henan Province from 2020 to 2024, and provide scientific evidence for the improvement of the prevention and control of pulmonary TB in the elderly. Methods: The information were collected from the Tuberculosis Information Management Subsystem of Chinese Information System for Disease Control and Prevention. Study participants were pulmonary TB patients aged ≥65 years who were registered and managed in Henan from January 1, 2020, to December 31, 2024. A retrospective epidemiological survey was conducted to collect information of elderly pulmonary TB patients with delayed medical consultation to understand the distribution and temporal variation trends of those with delayed medical consultation, and χ² test and multivariate logistic regression model were used to identify the influencing factors of delayed medical consultation. Results: A total of 50 031 elderly pulmonary TB patients were included, in whom 26 783 had delayed medical consultation, with an overall delayed consultation rate of 53.53%. The median time (Q₁, Q₃) of delayed consultation was 16.0 (4.0, 37.0) days. The delayed consultation rate remained stable at 50.49%-50.94% from 2020 to 2022, then increased rapidly to 55.97% in 2023 and 58.41% in 2024, showing an accelerating upward trend (trend χ²=193.65, P<0.001). In terms of regional distribution, the delayed consultation rate was lowest in Zhumadian (32.00%) and highest in Luohe (77.27%), the difference was significant (χ²=2 428.79, P<0.001). Multivariate logistic regression analysis revealed that the risk factors for delayed medical consultation included jobless/unemployment (aOR=1.24, 95%CI: 1.14-1.36), direct hospital visit (aOR=3.86, 95%CI: 3.07-4.85), referral (aOR=3.45, 95%CI:2.75-4.34), follow-up (aOR=4.31, 95%CI: 3.42-5.42), no complication (aOR=2.15, 95%CI:1.97-2.35), recurrence (aOR=1.30, 95%CI: 1.22-1.39), return visit (aOR=1.84, 95%CI:1.01-3.33), and lack of etiological results (aOR=1.99, 95%CI: 1.29-3.06). Conversely, protective factors were being man (aOR=0.93, 95%CI: 0.89-0.97), population at low risk (aOR=0.59, 95%CI: 0.53-0.65), and non-floating population (aOR=0.89, 95%CI: 0.82-0.96). Conclusions: The rate of delayed medical consultation in elderly pulmonary TB patients in Henan remained stable from 2020 to 2022, then increased rapidly in 2023 and 2024, with an unbalanced regional distribution. More attention should be paid to the early detection of elderly pulmonary TB, especially in women, farmers, floating population, cases identified by passive screening (direct hospital visit, referral and follow-up), those have recurrent illness or lack etiological test results. It is suggested to effectively conduct digital chest radiography screening for the elderly population in combination with basic public health services and strengthen the full-course management and regular follow-up of recurrent patients.

Reports worldwide on suspected child maltreatment (CM) during and after the COVID-19 pandemic have been inconsistent. As no study has yet systematically examined whether structural disruptions to child protection systems have left measurable and lasting traces in referral patterns beyond the acute crisis phase, this study investigated the pandemic's impact on suspected CM referrals to the Forensic Examination Center for Children and Adolescents (FOKUS) in Vienna, Austria, and whether enduring shifts in CM presentation and referral dynamics have occurred.

Retrospective study using patient administrative data of suspected CM cases referred to FOKUS between 16 March 2019 and 15 March 2023, covering the periods before, during and after the pandemic.

A total of 401 patients were referred to FOKUS during the study period. During the COVID-19 period, suspected physical abuse cases declined by 55.3% (p=0.029), while sexual abuse cases remained stable. Post-pandemic reports of suspected physical abuse returned to pre-pandemic levels, whereas suspected sexual abuse cases increased (p=0.013). Suspected sexual abuse cases showed a progressive increase in median age over time (p=0.025). Psychological support was more frequently required during the pandemic (63.5% vs 43.8% pre-pandemic, p=0.019), with elevated need continuing into the post-pandemic period (59.8%, p=0.018).

The ongoing rise in suspected sexual abuse cases accompanied by different age victim profiles and increased need of psychological support following the pandemic indicates that a return to pre-pandemic norms is unlikely and the notion of 'back to normal' seems an oversimplification.

Asthma is one of the most common chronic diseases affecting children in the United States, with millions impacted annually. There is ongoing concern and disparity in the pediatric workforce. However, there is limited research evaluating how the geographic distribution of these providers aligns with pediatric asthma burden across states.

To assess the degree of geographic alignment between pediatric asthma prevalence and the distribution of general pediatricians and pediatric hospitalists in the United States using inequality metrics and spatial analysis.

This was a cross-sectional, state-level ecological study using publicly available data. Pediatric asthma prevalence was obtained from the CDC Behavioral Risk Factor Surveillance System. Pediatric provider data were sourced from the American Board of Pediatrics, and child population estimates were retrieved from the U.S. Census Bureau. Workforce density was calculated as the number of general pediatricians and pediatric hospitalists per 100,000 children in each state. Lorenz curves and Gini coefficients were used to quantify geographic inequality in asthma burden and workforce distribution. Bivariate choropleth maps and Pearson correlation coefficients were employed to assess spatial mismatch and association between asthma prevalence and provider availability.

General pediatricians had a mean state-level density of 70.6 per 100,000 children, while pediatric hospitalists had a mean density of 5.3 per 100,000 children (p < 0.0001). Gini coefficients revealed moderate inequality in the distribution of general pediatricians (0.20) and higher inequality among pediatric hospitalists (0.33). In contrast, the Gini index for pediatric asthma prevalence was 0.11. Correlation analysis showed a weak, marginally significant association between asthma prevalence and general pediatrician density (r = 0.30, p = 0.032), and a non-significant association with pediatric hospitalist density (r = 0.24, p = 0.094). Bivariate mapping identified several states with high asthma burden and low provider density, revealing substantial spatial mismatches.

There is a misalignment between the burden of pediatric asthma and the distribution of pediatric healthcare providers in the U.S., particularly in pediatric hospital medicine. States with higher asthma prevalence are not consistently supported by proportionally larger pediatric workforces. Policies that support provider redistribution, rural practice incentives, and data-driven workforce modeling are essential to improving health equity and optimizing care for children with asthma.

Severe Mycoplasma pneumoniae pneumonia (MPP) in children is associated with immune dysregulation and unfavorable outcomes; however, the clinical significance of routinely measured immune and inflammatory markers remains uncertain. This retrospective exploratory study evaluated factors associated with poor prognosis and the individual discriminatory performance of immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM), and C-reactive protein (CRP). A total of 172 children with MPP treated between April 2018 and April 2021, and 40 healthy controls were included. Biomarker levels were compared across disease severity and prognostic groups. Individual receiver operating characteristic (ROC) curve analyses and exploratory logistic regression were performed. Serum IgA, IgG, and IgM levels were significantly lower, whereas CRP levels were significantly higher, in children with severe disease and in those with poor prognosis than in the corresponding comparison groups (P < 0.05). The areas under the ROC curve (AUCs) for IgA, IgG, IgM, and CRP were 0.788, 0.707, 0.696, and 0.796, respectively. Fever duration, lesion type, immune dysfunction, elevated CRP, and extrapulmonary complications differed significantly between the prognostic groups. Exploratory multivariable analysis identified immune dysfunction and extrapulmonary complications as independent factors associated with poor prognosis. These findings support further investigation of immune and inflammatory biomarkers for risk stratification in children with severe MPP; however, prospective studies are needed to validate their clinical utility, and the present results should not be interpreted as a validated clinical prediction model.

Timely access to COVID-19 antivirals is essential for high-risk populations; however, access remains inequitable for many multicultural communities. This study aims to capture the perspectives and experiences of frontline and multicultural support workers on barriers and enablers to antiviral access for members of multicultural communities in New South Wales (NSW) during COVID-19. We conducted three focus groups with 13 frontline and multicultural support workers employed by NSW Health in three local health districts between February and April 2025 to capture participants' reflections on the 2022 COVID antiviral rollout. During the pandemic, all participants highlighted the extensive and rapid provision of information related to vaccination. In comparison, they received little information and had limited awareness about the rollout of COVID antivirals. Emerging barriers were identified, such as no training on antivirals for multicultural support workers, health system strain from COVID fatigue, and a lack of community trust in novel medications. Trusted relationships within the community were recognised as a key enabling factor in facilitating access to health information during the public health emergency. Persistent health inequities are evident in how multicultural communities were supported to access antivirals, even as these groups have experienced disproportionate impacts across multiple dimensions of the pandemic.

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and healthcare expenditure worldwide. Disease burden and economic value are typically evaluated separately, limiting integrated assessment for value-based healthcare and resource allocation. This review integrated COPD burden-reduction potential with the incremental cost-effectiveness ratio (ICER) to prioritise interventions by health impact and economic value.

This narrative review was conducted with reference to the Scale for the Assessment of Narrative Review Articles (SANRA). PubMed, Embase, and the Cochrane Library were searched from inception to August 2026 for evidence on COPD burden, healthcare costs, and intervention economic outcomes. Reporting completeness and methodological quality were assessed using CHEERS 2022, the CHEC-list, and AMSTAR 2, as appropriate. Interventions were synthesised within an integrated disability-adjusted life years (DALYs)-ICER framework.

Eighty publications contributed to the synthesis. Acute exacerbations, pulmonary complications, and major comorbidities were the principal drivers of COPD burden and healthcare costs. Smoking cessation and pulmonary rehabilitation showed the most favourable combination of burden-reduction and economic value. Influenza and pneumococcal vaccination showed favourable profiles, although their classification remains provisional because COPD-specific economic evidence is limited. Triple inhaled therapy showed context-dependent economic value across healthcare settings, while long-term azithromycin and long-term oxygen therapy combined with home mechanical ventilation were economically favourable primarily in selected high-risk populations. Ensifentrine and mepolizumab in type 2 COPD demonstrated clinically meaningful benefits but less favourable economic value at the prices evaluated in their source settings. ICS-containing therapy in low-eosinophil, non-exacerbating patients, household air pollution control, and comorbidity-directed interventions could not be formally classified because applicable COPD-specific economic evidence was insufficient.

Integrating burden-reduction potential with ICER-based cost-effectiveness provides a conceptual framework for prioritising COPD interventions by health impact and economic value, while highlighting priorities for COPD-specific economic evaluation and future validation.

Sarcopenia is a common but underdiagnosed extrapulmonary complication in patients with chronic obstructive pulmonary disease (COPD) and contributes to poor clinical outcomes. This study aimed to investigate the screening utility of rectus femoris cross-sectional area (RFCSA), femoral muscle thickness (FMT), and quadriceps femoris muscle thickness (QFMT) for sarcopenia in COPD patients.

This single-center cross-sectional study enrolled 61 COPD patients. According to the sarcopenia criteria, patients were classified into sarcopenia group (n=24) and non-sarcopenia group (n=37). All participants underwent pulmonary function tests, grip strength measurement, 6-meter walk test, 5-repetition sit-to-stand test, and bioelectrical impedance analysis. QFMT, FMT, and RFCSA were measured by a single experienced sonographer using a standardized protocol. Multivariable logistic regression and receiver operating characteristic (ROC) curve analysis were performed.

The proportion of participants with sarcopenia in this COPD cohort was 39.34% (24/61). All ultrasound parameters were significantly reduced in the sarcopenia group: QFMT (2.28 cm vs 2.57 cm, p<0.001), FMT (1.30±0.21 cm vs 1.43±0.23 cm, p=0.033), and RFCSA (4.25±0.75 cm² vs 4.72±0.75 cm², p=0.019). Multivariable logistic regression adjusting for age, sex, BMI, and FEV₁% pred confirmed QFMT as an independent factor of sarcopenia (OR=0.121, 95% CI: 0.021-0.697, p=0.018). ROC analysis revealed that QFMT had the highest AUC among single parameters (AUC=0.767, 95% CI: 0.642-0.866). At the optimal cut-off of 2.833 cm, QFMT showed a sensitivity of 100% and specificity of 43.24%. When QFMT, FMT, and RFCSA were combined, the AUC was 0.777 (95% CI: 0.652-0.874), with a sensitivity of 50% and specificity of 94.59%, representing only a marginal improvement over QFMT alone (p=0.711 by DeLong test).

Lower limb muscle ultrasound parameters, particularly QFMT, are significantly reduced in COPD patients with sarcopenia. Ultrasound appears promising as a screening tool but requires validation in larger, prospective, multicenter studies.

To develop a consensus document on how to follow-up patients with COPD in clinical practice in Spain.

A qualitative, three-round Delphi survey was conducted in the framework of Spanish pneumologists attending COPD patients in routine daily practice. Participants completed a 35-item questionnaire on how to follow-up COPD patients, according to four sections: 1) assessment of the patient's clinical conditions, 2) therapeutical interventions, 3) frequency of follow-up visits, and 4) healthcare pathways. Consensus was defined if more than 70% of participants agree.

A total of 155 specialists in respiratory medicine (53% men; mean age 47 years) participated in the study (69% with more than 10 years of professional practice). More than 80% of participants agreed on the use of clinical practice guidelines but 81.9% considered that recommendations on follow-up should be more explicit. Assessment of lung function (FEV1), dyspnea, and exacerbations were the clinical variables that reached a higher level of consensus. Dyspnea values were reported as the main indicator to assess increased bronchodilation, and exacerbations were the most important to assess the use of inhaled corticosteroids. Follow-up of low-risk patients should be performed in the primary care setting, and patients should be visited every 12 months, whereas high‑risk patients should be monitored by pneumologists and including nursing visits.

The participants agree that the guidelines should include more specific indications to define the follow-up of the COPD patient, and there is lack of evidence in many aspects. There is consensus on the importance of care to coordinate with nursing and primary care, but the protocols to follow and the working tasks for each healthcare setting remain unclear.

To establish a prediction model for the 9-year risk of depression in individuals with chronic obstructive pulmonary disease (COPD) using survey data from a random, nationally representative population of Chinese adults with COPD.

Data from 851 middle-aged and older adults with COPD participating in the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Depression risk was described as the development of depression during follow-up among participants who were free of depression risk at baseline (CHARLS 2011) and met the depression risk criteria at the 9-year follow-up (CHARLS 2020). Relationships between candidate predictive factors and depression risk were examined using logistic regression, with bootstrapping applied to validate the final model. Model discrimination was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, while calibration was examined via the Hosmer-Lemeshow test.

Of the 851 participants included in the analysis, 434 developed depression risk during the subsequent 9 years. The final multivariable model incorporated age, educational level, marital status, exercise levels, peak expiratory flow (PEF), and smoking. The discriminative ability of the model was good, with an AUC of 0.717 (95% CI: 0.683-0.751). The Hosmer-Lemeshow test indicated satisfactory calibration (χ ² = 9.400, p = 0.310). A simple clinical scoring system was also developed to facilitate quantitative estimation of depression risk.

This predictive model may facilitate earlier identification of COPD patients likely to develop depression within 9 years and may help inform targeted preventive interventions.