Inhalant allergies from airborne allergens, such as pollen, dust mites, and animal dander, substantially contribute to allergic respiratory diseases globally. Sensitization to aeroallergens is influenced by environmental, urban, and climatic factors and demographic characteristics, including age and sex. However, long-term data from large non-disease-specific patient cohorts in Jordan are unavailable, particularly those covering the COVID-19 pandemic years.

To characterize prevalence and patterns of aeroallergen-specific IgE (s-IgE) sensitization in Jordan over a 10-year period (2012-2022), evaluating associations with age, sex, and temporal trends.

We retrospectively analyzed 4675 serum samples from patients tested at Biolab Diagnostic Laboratories. Aeroallergen s-IgE was measured using the CE-certified EUROLINE immunoblot panel covering 29 inhalant allergens. Samples positive for cross-reactive carbohydrate determinants (2.4%) or repeat tests (3.8%) were excluded. Multivariable logistic regression assessed associations of sensitization with sex, age group (<20, 20-40, >40 years), and sample collection period (2012-2015, 2016-2019, 2020-2022).

Overall, 45.5% were sensitized to ≥1 aeroallergen. Males had higher odds of sensitization than females (OR = 1.35, p < 0.0001). Sensitization was most prevalent in the 20-40-year age group. Temporal analysis showed an increase in overall sensitization from 40% in 2012-2015 to 50.6% in 2020-2022. The most common sensitizers were predominantly pollens (olive pollen being the single most prevalent at 21.9%), along with cat dander (17.5%) and dust mites (~12% combined). A mixed pattern of increased sensitization to both outdoor and indoor aeroallergens was observed during the pandemic years.

Aeroallergen sensitization in Jordan shows significant sex-, age-, and time-related patterns, with an overall increasing trend over the past decade, including during the COVID-19 pandemic. These findings provide a robust epidemiologic baseline to inform public health strategies, allergen mitigation, and clinical management in urban and regional contexts.

School nurses are vital to childhood asthma management. Although school-based asthma therapy (SBAT) improves clinical outcomes, its academic impact remains unclear. SBAT reduces barriers to guideline-based care through directly observed preventive medication therapy for children with persistent, poorly controlled asthma.

Retrospective academic record review (2013-2019) for 552 SBAT-enrolled children in a large urban district. Outcomes included missed instructional time, behavioral incidents, and grades compared across 4 quarters pre- and post-enrollment, stratified by school level, sex, race/ethnicity, and SES.

Unexcused hours decreased significantly post-SBAT: 17% elementary; 53% middle/high school, with no sex or race/ethnicity differences. Excused hours decreased 27% among middle/high school students. Level 2 incidents decreased 32% in elementary and 34% in middle/high school students. Females had more excused hours and Level 1/2 behavioral incidents than males, while Black elementary students had fewer Level 1/2 incidents than Whites. Grades did not change significantly.

SBAT has potential as an equity-promoting school healthcare practice to mitigate disparities in asthma morbidity, absenteeism, and school engagement among students in disadvantaged communities.

SBAT highlights potential educational benefits, supporting integration of guideline-based asthma management into routine school health services.

This study is aimed at evaluating postpartum women's vaccination status in two major maternity hospitals in Athens, Greece, and identifying demographic, socioeconomic, and behavioral factors influencing vaccine acceptance.

A cross-sectional study was conducted at Leto General Hospital and Alexandra Hospital. Postpartum women completed a questionnaire covering demographics, obstetric history, vaccination status (COVID-19, tetanus-diphtheria-acellular pertussis [Tdap], influenza, and respiratory syncytial virus [RSV]), and reasons for vaccine acceptance or refusal. Data were analyzed to assess the potential factors associated with vaccination uptake.

A total of 725 postpartum women participated (Site 1: 531, Site 2: 194; median age: 34 years). Overall, 51.2% received at least one vaccine during pregnancy, with the highest uptake observed for Tdap (42.5%), followed by influenza (19.6%) and COVID-19 vaccination (3.6%). RSV vaccination was negligible (< 1%). Influenza vaccination was significantly higher in Site 1 (22.2%) compared with Site 2 (12.4%, p < 0.001), whereas uptake rates for the other vaccines did not differ significantly between sites. Key barriers to vaccination included lack of physician advice (Site 1: 29.0%, Site 2: 18.6%), personal choice (Site 1: 12.4%, Site 2: 14.9%), and safety concerns, which were more prevalent in Site 2. Higher educational attainment and urban residence remained independently associated with vaccine uptake, after adjustment for potential confounding factors.

Maternal immunization in Greece still remains a great challenge, since only 14.62% of the studied sample received multiple vaccines. Enhancing immunization strategies necessitates targeted interventions that address provider-patient communication, systemic barriers, and perceptions of vaccine safety in order to improve adherence to recommended vaccination schedules.

Chronic obstructive pulmonary disease (COPD) is a major contributor to disability worldwide. Rehabilitation plays an important role in improving functional outcomes, yet global patterns of potential population-level rehabilitation needs among people with COPD remain insufficiently described.

We used the WHO Rehabilitation Need Estimates to estimate potential rehabilitation needs and years lived with disability (YLDs) among people with COPD across 195 countries from 1990 to 2021, with projections to 2050. Temporal trends, decomposition of drivers, associations with the socio-demographic index (SDI), and inequality indices were assessed.

In 2021, potential rehabilitation needs related to COPD reached 123.5 million (95% UI 105.5-142.2), and YLDs reached 14.9 million (11.9-17.9). From 1990 to 2021, both measures increased substantially, whereas the age-standardized prevalence rate (ASPR) remained stable and the age-standardized YLD rate (ASYR) increased slightly. The largest burdens were observed in the South-East Asia and Western Pacific Regions, with the fastest growth in the African and Eastern Mediterranean Regions. China, India, and the United States had the largest absolute numbers. By 2050, potential rehabilitation needs and YLDs are projected to reach 150.2 million and 18.6 million, respectively. Increases were mainly driven by population growth and population aging. Women had higher absolute numbers of potential rehabilitation needs and YLDs, whereas men had higher ASPRs at older ages. YLDs were disproportionately concentrated in lower-SDI countries, with persistent inequalities.

Potential rehabilitation needs among people with COPD have increased substantially and are projected to continue rising through 2050, primarily driven by demographic changes and persistent socioeconomic inequalities. These findings highlight the importance of strengthening COPD prevention and improving rehabilitation planning, particularly for aging populations and lower-SDI settings.

Obesity is heterogeneous; conventional anthropometric measures combine fat distribution, ectopic fat deposition, and muscle volume, limiting refined causal inference for chronic airway diseases. We used four magnetic resonance imaging (MRI)-defined obesity axes to assess their causal effects on chronic obstructive pulmonary disease (COPD), asthma, and allergic rhinitis (AR), and to evaluate mediation by circulating inflammatory proteins.

Genetic instruments were selected for four MRI-defined obesity axes. Two-sample Mendelian randomization (MR) used inverse-variance weighting as the primary method, with complementary sensitivity analyses and false discovery rate correction. Non-overlapping FinnGen outcome data were used for discovery, with replication in the Global Biobank Meta-analysis Initiative for COPD and asthma and the Million Veteran Program for AR, followed by meta-analysis. Two-step MR assessed inflammatory protein mediation.

Genetically predicted general obesity axis was associated with increased risks of COPD (OR = 1.125, 95% CI: 1.012-1.250), asthma (OR = 1.533, 95% CI: 1.426-1.647), and AR (OR = 1.624, 95% CI: 1.328-1.987). The lower-body fat axis was associated with higher risks of COPD (OR = 1.192, 95% CI: 1.088-1.306) and asthma (OR = 1.135, 95% CI: 1.052-1.224). No causal evidence was observed for the other obesity axes. Replication and meta-analysis largely supported these findings, except for general obesity and AR, which showed borderline pooled evidence (P = 0.055). Mediation analysis identified 17 candidate inflammatory pathways, of which 10 were significant. FLT3L mediated 18.17% of the effect of general obesity on COPD, and CXCL5 mediated 3.78% of its effect on asthma. CD40L receptor and LIFR mediated 5.59% and 12.65% of the lower-body fat-asthma effect, respectively, whereas CD40L receptor, CXCL10, IL-12B, OPG, and TNFRSF9 showed suppressive mediation in selected pathways.

MRI-defined obesity axes provided genetic evidence supporting potential causal associations with airway diseases through inflammatory mediation pathways.

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death worldwide, with current pharmacotherapy constrained by low pulmonary drug deposition, pathological barriers, treatment resistance, and poor patient adherence. Nano-drug delivery systems (NDDS) offer a transformative strategy to overcome these obstacles. This review adopts a distinctive "clinically-driven" perspective, systematically exploring the structural design strategies of targeted inhaled NDDS tailored to each specific therapeutic bottleneck. We analyze a hierarchical progression of strategies-from the "nano-in-micro" approach to enhance pulmonary deposition post-inhalation, through diverse surface modification techniques to improve mucus penetration and cellular targeting, to intelligent stimuli-responsive systems enabling site-specific drug release. These design strategies are not applied in isolation but function synergistically, endowing NDDS with customized functionalities-including sustained lung retention, anti-inflammatory, antioxidant, anti-infective, or resistance-reversing effects-according to distinct therapeutic needs, enhancing local efficacy while reducing systemic side effects. Furthermore, we critically assess the current landscape of clinical trials for NDDS in COPD, dissecting key translational barriers such as preclinical model limitations, patient heterogeneity, and regulatory hurdles. Finally, we integrate and discuss emerging frontiers including artificial intelligence-guided design and multi-omics patient stratification, offering a forward-looking roadmap for the development of precision nanotherapeutics poised for clinical adoption.

To address the limitations of current imaging modalities, the present study aimed to develop and validate a novel intracavitary contrast-enhanced ultrasound (CEUS) approach for the quantitative assessment of pleural effusion (PE) volume and differentiation of exudative PE from transudative PE.

This cross-sectional diagnostic accuracy study prospectively enrolled 100 patients with PE undergoing US-guided thoracentesis. Intracavitary CEUS was performed using SonoVue microbubbles, and time-intensity curve parameters (A, B, and A+B) were analyzed. PE volume was measured based on the drainage volume, and effusions were classified as exudates or transudates according to Light's criteria. Diagnostic performance was assessed by receiver operating characteristic (ROC) analysis, and a linear regression model was developed to predict PE volume.

Exudative PE showed significantly higher baseline intensity parameter B (-35.18 ± 5.17 vs. -41.41 ± 8.64, p < 0.01) and lower peak intensity increment parameter A (1.20 ±  3.27 vs. 6.61 ± 6.10, p < 0.01) compared to transudative PE. The combined parameter A+B (steady-state microbubble concentration index) showed a strong correlation with PE volume (r = 0.912, R ² = 0.831), yielding the predictive model: V(mL) = -33.345 × (A+B) - 453.071 (intraclass correlation coefficient = 0.950). The ROC analysis revealed moderate diagnostic accuracy for the A value (area under the curve (AUC) = 0.779) and B value (AUC = 0.719) in differentiating exudative PE from transudative PE.

Intracavitary CEUS could serve as a reliable, minimally invasive, feasible radiation-free adjunctive technique for quantifying PE volume and differentiating exudative versus transudative PE in patients undergoing thoracentesis. The A+B-based regression model provides high predictive accuracy, while A and B values facilitate effusion classification. This quantitative CEUS workflow may facilitate clinical decision-making, and its utility for serial monitoring requires further verification in large-scale real-world cohorts.

This comprehensive meta-analysis on the efficacy and safety of traditional Chinese medicine (TCM) as an adjunctive therapy to conventional treatment of chronic obstructive pulmonary disease (COPD) with osteoporosis (OP) aimed to provide evidence and guidance for clinical practice. We systematically searched four international databases and four Chinese databases to identify relevant randomized controlled trials (RCTs) published up to November 2025. Meta-analysis and sensitivity analysis were performed in R using the meta and gemtc packages. The revised Cochrane risk of bias tool (ROB2) was employed to assess the quality of included studies to ensure their rigor and clinical applicability. A total of 11 eligible studies involving 944 patients were identified. The results indicated that compared with conventional Western medical therapy (CWMT) alone, CWMT plus TCM demonstrated a certain degree of improvement in the primary outcomes, namely bone mineral density (BMD) (standardized mean difference [SMD] = 0.71, 95% confidence interval [CI]: 0.34-1.07, I² = 83.8%, P_HEW < 0.001) and forced expiratory volume in 1 second (FEV1) (SMD = 0.54, 95% CI: 0.17-0.90, I² = 76.5%, P_HEW = 0.007). Statistically significant improvements were observed in some secondary outcomes. The original studies did not adequately report adverse events. The available data only suggested short-term tolerability. According to network meta-analysis results, among the three treatment approaches, the TLKRBS (tonifying the lung and kidney and resolving blood stasis) approach had the highest probability of being ranked first for increasing BMD (surface under the cumulative ranking curve [SUCRA] = 98.82%) and FEV1 (SUCRA = 99.99%), indicating a substantial effect on improvement. The combination of CWMT and TCM may yield more favorable outcomes compared to CWMT alone for treating COPD with OP. The meta-analysis results indicate that the therapeutic efficacy of TCM combined with CWMT may be improved to a certain extent compared with CWMT alone. However, the certainty of the evidence is limited due to small sample sizes, high heterogeneity, and risks of bias. Future high-quality RCTs with rigorous designs, larger sample sizes, and standardized outcome measures are warranted to strengthen the evidence base for the application of TCM in patients with COPD and comorbid OP and to further confirm its efficacy.

To systematically evaluate the influenza vaccination rate among health care workers in China and identify influencing factors.

Systematic review and meta-analysis of cross-sectional studies.

CNKI, Wanfang, VIP, Web of Science, PubMed, Cochrane Library, Scopus, and Embase, searched from database inception to October 4, 2025.

Two reviewers independently screened studies, extracted data, and assessed study quality using the Agency for Healthcare Research and Quality (AHRQ) tool. Random-effects models were used to pool vaccination rates and odds ratios. Heterogeneity was assessed using I² statistics, with supplementary subgroup analysis, meta-regression, and sensitivity analysis. Publication bias was assessed via funnel plot and Egger's test.

Forty-nine studies involving 111,544 participants were included. The pooled influenza vaccination rate was 27% (95% CI: 21-34%). Factors positively associated with vaccination included: age 40-49 years, female gender, monthly income > 3,000 RMB, professional title, prior vaccination history, institutional encouragement or requirement, free vaccination policies, awareness of optimal vaccination timing, and vaccination willingness.

Influenza vaccination coverage among Chinese health care workers remains inadequate. Structural interventions-such as free vaccination, institutional encouragement, and on-site services-combined with tailored strategies targeting younger, male, low-income, and vaccine-naïve individuals are recommended. Given the observational nature of the included studies, the potential role of mandatory policies should be interpreted cautiously, pilot implementation in high-risk settings is suggested before broader adoption.

This study provides an evidence base for formulating targeted influenza vaccination strategies for health care workers in China, which is crucial for reducing nosocomial infection risk and aligning with global public health goals.

No patient or public contribution.

PROSPERO registration CRD: 42024553631.

This study aimed to explore the lived experiences of Iranian immigrants in Canada with Long COVID (LC) and to examine how these experiences can inform culturally responsive healthcare approaches.

This qualitative study employed an interpretive description (ID) methodology and was conducted in Canada in 2024. Twenty adult Iranian immigrants (11 women) with physician-approved LC diagnoses were recruited from across eight Canadian provinces using purposive and snowball sampling via the Telegram application. Data collection comprised one-on-one, semi-structured, in-depth interviews conducted in Persian language through the Zoom video conferencing platform. Interviews lasted an average of 70.8 min (ranging from 51 to 96 min) and were transcribed, translated, and thematically analyzed following Thorn's ID approach, using manual thematic analysis, constant comparative analysis, and inductive reasoning. The social determinants of health (SDH) framework guided the interpretation, situating findings within broader structural and sociocultural contexts.

Five major themes emerged: embodied disruptions and symptom unpredictability, systemic barriers and healthcare navigation, emotional and existential distress, economic and workplace insecurity, and cultural integration and healing pathways. Regarding healthcare needs, participants identified systemic barriers to navigating healthcare.

The findings underscored the need for culturally responsive, linguistically accessible, and holistic care strategies that address both health and socio-economic dimensions. Healthcare providers and policymakers could integrate cultural competence, language accessibility, mental health support, and recognition of diaspora-based coping resources into LC care to improve health outcomes for Iranian immigrant populations.