Calcium disturbances are common in patients with traumatic injuries, exacerbated by shock and blood product resuscitation. Recently, empiric calcium supplementation has been recommended with the first unit of blood transfusion, despite a lack of data supporting this practice. We hypothesize that there are risks associated with calcium administration in patients receiving small volume transfusion.

This is a retrospective review of patients admitted to our Level 1 trauma center from 2018 to 2024 who received 1-3 units of red blood cells (RBCs). Patients were stratified by calcium levels and whether they received early calcium supplementation. A logistic regression was used to estimate odds ratios for the association between calcium levels, calcium supplementation, and outcomes. The primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury, myocardial infarction, acute respiratory distress syndrome, and venous thromboembolism. The model was adjusted for age, sex, ISS and shock index.

A total of 2,680 patients were included. When stratified by calcium levels and supplementation status, patients were similar in terms of age, sex, mechanism and injury severity score, but shock index was higher among patients receiving calcium supplementation. After adjustment, hypocalcemic patients who received calcium supplementation had higher odds of developing acute kidney injury, acute respiratory distress syndrome, deep vein thrombosis, and pulmonary embolism (all p < 0.05).

In trauma patients who received 1-3 units of RBCs, early calcium supplementation was associated with adverse outcomes. The use of early, empiric calcium supplementation in conjunction with minimal transfusion should be carefully considered.

Kidney transplant recipients are highly susceptible to respiratory tract infections (RTIs), and short-term exposure to ambient air pollution may aggravate their clinical outcomes. However, evidence regarding the effects of specific pollutants on hospitalization burden in this population remains limited. This study aims to investigate the effects of pollutants such as PM_2.5 on hospitalization burden after RTIs in kidney transplant recipients.

This retrospective time-series study included 874 kidney transplant recipients who were hospitalized for RTIs at the Third Xiangya Hospital of Central South University between 2017 and 2023. High-resolution environmental data were used to assess daily exposure to 6 ambient air pollutants, namely PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃, within the 7 days before the onset of RTI symptoms. Distributed lag non-linear models (DLNMs) were applied to evaluate pollutant-specific lagged and cumulative associations between the 6 ambient air pollutants and hospitalization costs and length of hospital stay, with adjustment for meteorological conditions and individual-level variables.

PM_2.5 showed the most significant association with hospitalization burden. At a cumulative exposure level of 160 µg/m³, hospitalization costs increased by 9 544.5 yuan (95% CI 2 548.8 to 21 637.7). When PM_2.5 exposure reached 200 µg/m³ on lag day 0, it was associated with prolonged hospital stay and increased hospitalization costs. PM₁₀ showed a trend toward dose-dependent cumulative effect on length of hospital stay, with a relative risk of 1.63 at 300 µg/m³ (95% CI 0.18 to 15.94). SO₂ levels above 75 µg/m³ were also associated with increased hospitalization burden. In contrast, no consistent or significant associations were observed for CO, NO₂, or O₃.

Short-term exposure to higher levels of PM_2.5, PM₁₀, and SO₂ significantly increases the clinical and economic burden of RTIs in kidney transplant recipients. These findings highlight the importance of developing targeted air pollution prevention and control strategies to protect susceptible patient populations.

The burden of respiratory conditions, especially asthma, is likely to increase with urbanisation and pollution unless effectively managed. Petaling Jaya, a metropolitan area, faced heightened risk due to worsening outdoor air pollution, which can trigger asthma exacerbations. We aimed to examine the relationships between environmental factors and emergency visits for asthma exacerbations.

We used retrospective data over four years (1 January 2014 to 13 April 2017) comprising clinical records from a main hospital in Klang Valley and environmental data (air pollutants and meteorological data) obtained from nearby stations. We used generalised additive models to assess the associations between environmental factors and asthma emergency visits. We used distributed lag nonlinear models to address the delayed effects and nonlinearity of particulate matter at 10 μm (PM₁₀) exposure on these visits.

Asthma exacerbations accounted for 2.3% of total emergency visits. Daily mean (x̄) PM₁₀ level exceeding Malaysian Ambient Air Quality Standard (MAAQS) threshold was associated with a 21.3% (95% confidence interval (CI) = 2.2, 44.0) increase when levels reached 200 μg/m³ and 34.0% (95% CI = 4.7, 71.7) increase when levels reached 300 μg/m³ in asthma emergency visits. The lag effect was associated with PM₁₀ exposure levels, peaking on days two and three at 100 μg/m³ and on the same day at 200 μg/m³ and 250 μg/m³. The cumulative exposure-response curve from lag 0-7 days shows that the increased relative risk of asthma emergency visits began at PM₁₀ levels of 150 μg/m³.

We provide preliminary insights into the respiratory health burden in the Klang Valley. The associations observed between PM₁₀ and asthma emergency visits are exploratory. Our findings suggest that the risk of visits may increase when PM₁₀ levels near or above current MAAQS thresholds, highlighting the potential benefit of aligning local air quality standards with stricter international guidelines. These results may support the value of targeted preventive measures and healthcare resource planning for asthma, though larger multi-year data sets are required to enhance statistical robustness.

Influenza vaccination is an evidence-based intervention for older adults. However, vaccination coverage remains low and uneven in China, indicating persistent evidence-practice gap. Although older adults often express willingness to be vaccinated, uptake often varies across different implementation contexts. Therefore, we explored how implementation determinants govern vaccination uptake.

We conducted a comparative qualitative study using semi-structured interviews with older adults in Beijing and Guizhou. The interview guide was developed using the Consolidated Framework for Implementation Research (CFIR), and data were analyzed thematically and mapped to CFIR domains to compare determinants across sites.

Seventy-six participants were enrolled, including 40 from Beijing and 36 from Guizhou. Across both locations, many participants expressed willingness to be vaccinated but did not always follow through, reflecting an intention-uptake gap. Determinants in the Outer Setting and Process/Inner Setting domains were most significant in shaping vaccination uptake. Trusted communication and institutional triggers, including clinician recommendations and community reminders, facilitated vaccination uptake in Beijing. These cues were less available in Guizhou, where fragmented information contributed to delays and non-uptake.

Implementation strategies should make influenza vaccination a more routine and system-supported component of healthy aging services. This requires stronger service delivery systems and standardized communication.

The increasing frequency and severity of climate-related disasters pose major threats to public health, particularly when they intersect with other crises like pandemics. Puerto Rico has faced multiple large-scale disasters in recent years, yet research on their cumulative health effects remains limited. This study examines associations between disaster exposure-Hurricane María and the COVID-19 pandemic-and self-reported physical, mental, and behavioral health among Puerto Rican adults using Behavioral Risk Factor Surveillance System data (2015-2021).

We used multivariable linear and log-binomial models, adjusting for key sociodemographic factors.

Among 35,517 respondents, post-disaster periods were mostly linked to worse health outcomes, including more days of poor mental health, increased substance use, and more negative health perceptions. The early post-hurricane period showed the greatest harm, with participants reporting 2.47 more poor mental health days (P < 0.002), lower likelihood of exercise (PR = 0.65), and higher likelihood of smoking (PR = 1.20). Conversely, early and late pandemic periods showed apparent health improvements, though these findings require cautious interpretation.

Our results underscore the need for disaster-responsive mental health care, resilient infrastructure, and policies addressing financial inequities that heighten vulnerability. Strengthening community networks and ensuring equitable preparedness and relief efforts are essential to reducing the health impacts of future disasters.

This systematic review and meta-analysis aimed to identify and synthesize evidence on risk factors for COVID-19 in incarcerated populations.

A systematic search of PubMed, Scopus, and Google Scholar was conducted for English articles until October 2025. Study quality was assessed using the PRISMA checklist and NOS tool. Meta-analysis was performed in Stata 17 using a random-effects model, with odds ratios as the primary effect measure and statistical significance set at P < 0.05. Heterogeneity was evaluated via I² statistics.

Twelve articles were ultimately included in the study. For the meta-analysis, only 5 articles were considered, which evaluated sex, age, and vaccination status as the risk factors of COVID-19. The total sample size was 176169, consisting of 169117 males and 7,726 females. In most studies, the average age was reported to be around 40 years. Fully vaccinated prisoners were less likely to contract COVID-19 than unvaccinated ones (OR: 0.38; 95% CI: 0.22, 0.67; P = 0.001), while no significant relationships were found regarding sex and age.

Our findings confirm that full vaccination significantly protects against COVID-19 in prisons. Prioritizing vaccination campaigns, along with measures like mask use and hand hygiene, is essential to protect incarcerated individuals and the wider community.

BACKGROUNDThe ongoing panzootic of highly pathogenic avian influenza A(H5N1) presents a risk to human health both from infections resulting from exposure to infected birds or mammals, and from potential mutations enabling human-to-human transmission of a virus to which there is little or no population immunity.AIMThis cohort study was designed with the aim of informing assessments of the risk of avian influenza to human health and the public health management of influenza A(H5N1) exposures.METHODSWe recruited 428 individuals at 34 highly pathogenic avian influenza A(H5N1) outbreak sites between April 2023 to March 2025, throughout England. Through nasopharyngeal samples and questionnaires, we investigated risk factors including exposure periods and usage of personal protective equipment (PPE), and characteristics of influenza A(H5N1) infection.RESULTSThe median participant age was 37 years (interquartile range: 28-51 years), 296 (69%) were male. Most participants (85%) reported full PPE use when exposed, and 82 (19%) were vaccinated against seasonal influenza. Six persons tested PCR-positive for influenza A(H5N1), of whom three (< 1%) met the case definition for infection (two confirmed, one unclear) attributable to exposure periods. No severe illness was reported; no secondary cases were identified. None of the six cases with positive detections were vaccinated against seasonal influenza; two of them reported not wearing full PPE when exposed.CONCLUSIONWe recommend continued conscientious PPE use and the resumption of enhanced surveillance following detection of an increased risk of animal-human transmission, with a One Health focus, to mitigate pandemic risk of influenza A(H5N1).

The evidence linking long-term exposure to air pollution and the development of chronic obstructive pulmonary disease (COPD) is still controversial. Furthermore, most studies have investigated associations with particulate matter (PM) and nitrogen dioxide (NO₂), disregarding their emission source and other relevant air pollutants, such as ultrafine particles (UFP) and elemental carbon (EC).

This study aimed to assess associations between long-term residential exposure to PM_2.5, NO₂, UFP, and EC and the risk of COPD, distinguishing the effects of air pollution from local traffic and other sources.

We pooled data from two large Danish cohorts, the Diet, Cancer, and Health cohort and the Danish National Health Survey. For all participants (N = 159,769), we estimated long-term air pollution exposure to total, local traffic, and other contributions, based on complete address histories. We used Cox proportional hazards models to estimate associations between 10-year time-weighted averaged air pollution and incident COPD, adjusting for demographic, socioeconomic, and lifestyle factors, including smoking. We evaluated the possible modification of these associations by sex, smoking status, and previous asthma diagnosis.

Long-term exposures to PM_2.5, NO₂, UFP, and EC were associated with higher risk of COPD. The highest hazard ratio (HR) per interquartile range of total contributions was observed for PM_2.5 (HR: 1.11 [95% confidence interval: 1.05, 1.17]), followed by NO₂ (1.08 [1.04, 1.13]), UFP (1.05 [0.99, 1.11]), and EC (1.02 [1.00, 1.05]), after full adjustment. PM_2.5 from other sources than local traffic was more strongly associated with COPD than PM_2.5 from local traffic, while for UFP and EC, the contributions from local traffic seemed to be the most harmful. Effect modification analyses showed stronger associations among women, never smokers, and those with an asthma diagnosis.

Our findings suggest that air pollution from local traffic and other sources contributes to COPD risk, with variations depending on the pollutant type. Further research is needed to validate these findings across different populations and geographical settings.

Primary spontaneous pneumothorax (PSP) predominantly affects young individuals and presents with variable treatment outcomes and considerable recurrence rates. Understanding the relationship between treatment approach and recurrence is essential for guiding clinical decision-making. The aim of this study was to evaluate demographic characteristics, treatment modalities, and recurrence rates in patients with PSP.

This single-center, retrospective study included patients diagnosed with PSP between January 2014 and December 2023. Recurrence rates following treatment were analyzed.

A total of 314 patients (median age 28 years; 93.0% male) were included. Tube thoracostomy was the initial treatment in 250 patients (79.6%). Recurrence occurred in 78 patients (24.8%), with higher rates following tube thoracostomy (28.0%) compared to oxygen therapy (17.8%). No recurrence was observed after initial video-assisted thoracoscopic surgery (VATS). In recurrent cases, 44.9% underwent VATS, 25.6% tube thoracostomy, and 29.5% oxygen therapy. Treatment choice and smoking status showed significant associations (p<0.001 for the first episode and p=0.007 for the second episode). Notably, all patients who underwent VATS were smokers.

VATS performed during the first pneumothorax episode in selected patients prevents recurrence. The feasibility of VATS as the first treatment option in selected patients should be further investigated in larger series.

Hypocholesterolaemia in pulmonary tuberculosis(TB) patients is disregarded but is a predictor of poor survival.

To determine serum lipid profile differences at diagnosis and various times of medication based on sex, HIV(human immune virus) and wasting status and factors associated with hypocholesterolaemia.

A repeated cross-sectional study was conducted to assess triglyceride(TG), total cholesterol (TC), high-density lipoprotein(HDL) and low-density lipoprotein(LDL) among 414 participants.

Majority of the participants were males(239/414)(58%), with a median age of 28years. TB patients showed significantly lower lipid profile at diagnosis regardless of HIV-status and sex. Presence of anaemia among HIV-seropositive participants with TB, prevalence ratio(PR):2.6, 95%confidence interval(CI):1.0-7.1, p<0.05) and HIV-seronegative participants with TB(PR:2.5, 95%CI:1.1-5.5, p<0.05), moderate/severe TB(PR:2.5,95%CI:1.1-5.5, p<0.05) and CD4 cells>200(PR:0.3 95%CI:0.1-0.8, p<0.05) among HIV-seropositive participants with TB were associated with HDL-hypocholesterolaemia. Male sex, moderate/severe TB, body wasting, dyspnoea and chest pain were independently associated with TC-hypocholesterolaemia. Regardless of sex and wasting status, the pattern of cholesterol recovery was similar at varying times.

We envisage that hypocholesterolemia is a marker of clinical TB-disease severity and its recovery indicates treatment response.