There is a need to reflect on the COVID-19 vaccine distribution plans across Canada and the extent to which they considered equity-deserving populations, as lessons from the rollout can inform future emergency responses and foster trust in public health. This paper examined and compared strategies implemented by six Canadian provinces to increase access and promote the uptake of COVID-19 vaccines among selected priority populations. We also explored the factors that impacted the implementation of these strategies.

In six provinces (Alberta, British Columbia, Manitoba, Nova Scotia, Ontario, and Quebec), we conducted an environmental scan of provincial rollout documents and media sources reporting vaccine distribution among selected priority populations: First Nations, Inuit, and Métis; Black communities; essential workers; people experiencing homelessness; and people with disabilities. We subsequently interviewed 39 key informants to validate the environmental scan results, identify additional strategies to increase COVID-19 vaccine uptake, and uncover perceptions of the facilitators and challenges that influenced the strategies implementation.

We identified that provincial health authorities employed several strategies to overcome structural, geographical, and attitudinal barriers to COVID-19 vaccines experienced by the priority populations. Most provinces implemented walk-in, mobile, and pop-up vaccination clinics, mobilized their public and private health workforce, and designed multilingual communication materials. Facilitators in implementing COVID-19 vaccination strategies included harmonizing communication efforts, leveraging existing relationships and networks, and ensuring representation and leadership of community partners. Challenges to implementing COVID-19 vaccination strategies included uncoordinated communication efforts, inadequate distribution of vaccines to areas with the greatest need, mistrust in the government and healthcare system, vaccine hesitancy, and lack of cultural competence by vaccine providers.

This study highlights the divide between well-intentioned strategies and interventions and the reality of on-the-ground implementation. The findings offer valuable insights and can inform the implementation of strategies to distribute vaccines equitably in future large-scale vaccination efforts in Canada and globally.

After COVID-19 was declared a pandemic by the World Health Organization (WHO) in March 2020, global responses relied on nonpharmaceutical interventions such as physical distancing and mask mandates. These measures were guided by mathematical models built on empirical data. Although traditional methods such as surveys and observational studies provide high-quality data, they are often slow and resource-intensive. Social media polls (SMPs) offer a faster, more cost-effective alternative.

This study aims to evaluate the reliability and biases of SMPs as a rapid supplementary tool for epidemiological data collection and to compare their representativeness and data quality with conventional approaches.

In this cross-sectional observational study in Germany, we used SMPs to collect data on infections and demographic attributes via Twitter and Mastodon. We collected data directly on the social media platforms as well as through forwarding to an external survey via post. The time frame covered was from 2019 to 2024. Data were analyzed for infection rates, sociodemographic representativeness, and overall data quality.

SMPs demonstrated viability as a rapid data collection tool. Based on a sample of 6127 answers on social media and 867 responses from the external survey, the self-reported frequency of infection aligned well with conventional sources. Across all 4 studies, approximately one-third of respondents reported having never been infected, half reported having had 1 infection, and one-sixth reported having had 2 or more infections. Statistical analyses of differences between data from Twitter, Mastodon, the external survey, and conventional data showed only small effect sizes (Cohen w=0.105-0.188). Spearman rank correlation demonstrated strong positive associations between infection dates in the external survey and conventional data (ρ=0.883, P<.001), as well as between the external survey and the Robert Koch Institute (ρ=0.640, P<.001). However, demographic analyses revealed biases in the external survey. By design, SMPs do not provide detailed demographic data, limiting options for subgroup analyses.

We found SMPs to be a practical and cost-effective method for quickly gathering epidemiological insights. In particular, self-reported infection frequency can aid during periods of high availability of self-testing during epidemics. We demonstrate that, even with a nonrepresentative and biased sample, we were able to closely match infection numbers with Multilocal and Serial Prevalence Study of Antibodies Against Respiratory Infectious Diseases in Germany data and produce incidence trends comparable to those in official Robert Koch Institute data. One can argue that SMPs alone are insufficient for public health modeling, as they do not allow real-time monitoring of, for example, population infection rates based on serological data. They are also limited with regard to inherent demographic bias related to recruitment and the inability to collect individual-level covariates. However, they can complement traditional approaches by offering rapid, low-cost insights.

Chronic obstructive pulmonary disease (COPD) is associated with high mortality and morbidity, with a complex inflammatory mechanism. Previous studies have demonstrated that Bactericidal/Perme Ability-Increasing Fold-Containing Family B member 4 (BPIFB4) plays a significant role in maintaining inflammatory balance. This study aimed to explore the roles of BPIFB4, microRNA (miR)-181a, and long non-coding (lnc) RNA TUG1 in COPD inflammatory processes.

Induced sputum was collected from 20 COPD patients and 20 healthy controls. THP-1 cells were treated with cigarette smoke extract (CSE) to simulate an in vitro inflammatory response. Expression levels of BPIFB4, LncTUG1, and miR-181a were detected by qPCR and western blot. Bioinformatic prediction and dual luciferase assays were used to predict the targeting relationship. Flow cytometry and ELISA assays evaluated the content of macrophages and inflammatory cytokines, respectively.

The expression levels of BPIFB4 and LncTUG1 were elevated in COPD patients, while miR-181a expression was downregulated. BPIFB4 and LncTUG1 were direct targets of miR-181a. Overexpression of BPIFB4 led to increased M2 macrophages and related anti-inflammatory cytokines. In contrast, silencing BPIFB4 resulted in elevated M1 macrophages and associated cytokines. Silencing LncTUG1 elevated miR-181a expression, reduced BPIFB4 expression, and increased M1-type macrophages and pro-inflammatory factors, while overexpression of LncTUG1 showed the opposite effects.

This study concludes that downregulation of LncTUG1 promotes inflammation by reducing BPIFB4 expression through miR-181a. Overexpression of BPIFB4 promotes macrophage polarization toward the M2 type, thereby alleviating the inflammatory response in COPD. These findings provide theoretical support and potential new targets for COPD treatment.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease with increasing incidence and poor prognosis, with a median survival of approximately 3 years. Although antifibrotic therapies such as nintedanib and pirfenidone offer modest benefits in slowing disease progression. In addition, nerandomilast, a selective phosphodiesterase-4B inhibitor recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of IPF and progressive pulmonary fibrosis (PPF), has demonstrated efficacy in slowing disease progression. Acute exacerbations significantly contribute to mortality, with a median survival of approximately 4 months. Current demographic, clinical, physiological, and radiological parameters provide limited prognostic insights, often detecting disease only after substantial pulmonary damage has occurred. This underscores an urgent need for circulating biomarkers capable of detecting early disease progression, including subtle declines in lung function and radiologic progression of fibrosis, before clinically apparent deterioration occurs. Such biomarkers may allow earlier identification of patients at risk of rapid disease progression by detecting biological changes that precede measurable declines in forced vital capacity or radiologic progression on high-resolution computed tomography. Among emerging approaches for disease monitoring and prognostic assessment, blood-based biomarkers have emerged as promising tools for assessing disease progression and prognosis due to their minimally invasive nature. However, the reproducibility and validation of these biomarkers across diverse populations remain suboptimal. Integrating multiple biomarkers with established clinical and radiological parameters holds the potential to enhance prognostic precision. While high-resolution computed tomography (HRCT) is pivotal for diagnosis, its prognostic utility remains constrained. This review delves into the latest advancements in biomarker research for IPF, shedding light on their prospective applications in disease monitoring, therapeutic stratification, and the paradigm of precision medicine.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive interstitial lung disease with increasing incidence and poor prognosis, with a median survival of approximately 3 years. Although antifibrotic therapies such as nintedanib and pirfenidone offer modest benefits in slowing disease progression, nerandomilast, a selective phosphodiesterase-4B inhibitor recently approved by the U.S. Food and Drug Administration (FDA) for the treatment of IPF and progressive pulmonary fibrosis (PPF), has demonstrated efficacy in slowing disease progression. Acute exacerbations significantly contribute to mortality, with a median survival of approximately 4 months. This review aims to summarize current evidence on circulating biomarkers for predicting disease progression in IPF.

A comprehensive review of the literature was conducted to identify studies evaluating circulating biomarkers associated with disease progression and prognosis in IPF, with a focus on clinically relevant biomarkers and their relationship with physiological and radiological parameters.

Current demographic, clinical, physiological, and radiological parameters provide limited prognostic insights, often detecting disease only after substantial pulmonary damage has occurred. Circulating biomarkers have emerged as promising tools for detecting early disease progression, including subtle declines in lung function and radiologic progression of fibrosis before clinically apparent deterioration occurs. These biomarkers may enable earlier identification of patients at risk of rapid disease progression by capturing biological changes that precede measurable declines in forced vital capacity or progression on high-resolution computed tomography (HRCT). However, their reproducibility and validation across diverse populations remain suboptimal. Integrating multiple biomarkers with established clinical and radiological parameters may enhance prognostic precision.

While HRCT remains pivotal for diagnosis, its prognostic utility is limited. Circulating biomarkers hold significant potential for improving disease monitoring, therapeutic stratification, and advancing precision medicine in IPF, although further validation is required before routine clinical implementation.

To develop a masked image modeling framework that integrates clinical visual priors to enhance semantic understanding and diagnostic performance on chest X-ray images.

A novel framework VP-MIM was constructed by incorporating clinical visual priors into the MIM process. Eye-tracking data from radiologists were used to distinguish diagnostically relevant from irrelevant regions during the masking phase, enabling a controlled masking strategy. In the reconstruction phase, a pyramid attentive reconstruction module was developed to introduce multi-scale supervision, which was further refined by semantic-aware recalibrated gaze heatmaps to optimize feature learning.

Experiments conducted on the RSNA Pneumonia and ChestXray-14 public datasets showed that under linear evaluation with only 2616 pre-training samples, VP-MIM achieved an AUC of 86.83 on the RSNA Pneumonia single-label classification task and a mean AUC (mAUC) of 72.82 on the ChestXray-14 multi-label classification task. In full fine-tuning experiments, VP-MIM showed strong scalability when the amount of pre-training data increased, reaching an mAUC of 85.49 on ChestXray-14, which verified good scalability and excellent performance of this model in practical diagnostic tasks.

VP-MIM alleviates the limitations of semantic loss and insufficient multi-scale modeling in medical imaging MIM to result in improved diagnostic performance of chest X-ray.

The Kahramanmaraş-centered earthquakes of February 6, 2023 severely disrupted healthcare services, with children-one of the most vulnerable groups-being at particular risk for trauma, infections, and interruptions in chronic disease management. This study evaluated the demographic and clinical characteristics of pediatric inpatients in 2 hospitals in Hatay (Defne State Hospital and Mustafa Kemal University Hospital) by comparing pre- and post-earthquake periods.

This retrospective cross-sectional study included pediatric patients admitted between December 2020-March 2022 (pre-earthquake) and December 2023-March 2024 (post-earthquake). Medical records were reviewed for demographic data, diagnoses, length of hospital stay, and discharge outcomes.

A total of 920 patients were included (313 pre-earthquake, 607 post-earthquake). After the earthquake, children admitted were younger (mean age 3.6 ± 4.3 years), had shorter hospital stays (2.6 ± 2.1 days), and were less often foreign nationals compared to the pre-earthquake cohort. Respiratory system infections were the leading diagnosis overall (61.7%), with a notable increase in the post-earthquake period (75.9%). Pediatric neurology and nephrology wards were entirely closed, while endocrinology admissions nearly disappeared. Most patients (90.1%) were discharged in good condition, and referral rates to higher-level centers remained low.

Respiratory infections emerged as the leading cause of pediatric hospitalizations after the earthquake. The rapid re-establishment of pediatric inpatient services allowed most cases to be treated locally, yet the closure of pediatric subspecialty wards underscores long-term challenges. Disaster preparedness must therefore encompass not only acute trauma care but also sustained management of pediatric infections and chronic diseases.

Influenza is a contagious viral respiratory tract infection that causes severe illness, particularly in high-risk populations such as young children and individuals with pre-existing health conditions. The study aims to identify clinical characteristics and key risk factors associated with respiratory support and mortality in children with influenza infection.

This retrospective, multicenter study was conducted across 33 hospitals from 19 cities in Türkiye. Data from pediatric inpatients aged <18 years diagnosed with influenza between October 2023 and May 2024 were analyzed.

Among 1032 hospitalized children infected with influenza, 394 (38.2%) required respiratory support. The respiratory support group was significantly younger, with a mean age of 3.40 ± 4.37 years, compared to 4.96 ± 4.36 years in the non-respiratory support group (P < .001). The frequency of any underlying disease was significantly higher in the respiratory support group (P < .001). Notably, conditions such as neurometabolic disorders (20.3% vs. 9.6%) and pulmonary diseases (7.1% vs. 2.8%) were more common in this group. Influenza A infection and viral coinfections, particularly with respiratory syncytial virus, increased the likelihood of mechanical ventilation and mortality. The mortality proportion of all patients with influenza infection was 1.3% and the influenza vaccine coverage was only 1.1%.

These findings highlight the urgent need to incorporate influenza vaccination into the national immunization program, especially for high-risk pediatric populations.

Obstructive sleep apnea (OSA) affects approximately 5% of children and requires polysomnography (PSG) for diagnosis. As such, population-based longitudinal studies of OSA in children are scarce. We aimed to validate pediatric case definitions of OSA using provincial health administrative datasets and establish a methodology for future longitudinal studies in this population. We performed a multicenter validation study, linking Ontario health administrative data with clinical data for children aged 0-18 years who underwent PSG between 2009-2016 at two tertiary care children's hospitals. We used various administrative case definitions to identify those with the highest sensitivity, specificity, positive and negative likelihood ratios for capturing children with moderate-severe OSA (apnea-hypopnea index ≥5), stratified by age groups (<10 and age ≥ 10 years). The reference cohort included 1,254 children who underwent PSG, with 317 moderate-severe OSA. The overall mean age was 7.7 ± 4.8 years, with 64.8% < 10 years of age and 44% female. The best-performing case definitions included combinations of PSG and adenotonsillectomy or initiation of positive airway pressure therapy within 0-18 months post PSG, or PSG and a diagnostic code for OSA within 6 months pre and 0-18 months post PSG. In children <10 years, these definitions exhibited high specificity (0.80-0.88), with moderate sensitivity (0.62-0.79), positive (3.82-5.25) and negative likelihood ratios (0.27-0.43). However, the performance in children ≥10 was less robust with high specificity (0.85-0.92), moderate positive likelihood ratios (3.48-4.19) and low sensitivity (0.28-0.59), and negative likelihood ratios (0.48-0.78). We have identified case definitions within Ontario health administrative data that have good specificity, and moderate sensitivity, positive and negative likelihood ratios for identifying moderate-severe OSA in children <10 years of age. These can be used in future studies to understand the natural history, predictors and outcomes of young children with OSA, while refined case definitions may still be needed for children ≥10.

Patients diagnosed with chronic obstructive pulmonary disease (COPD) often face acute symptom exacerbations. Current management approaches lack precision in diagnosis. To address this, the Biofire Film Array Respiratory Panel RP 2.1 (RP 2.1+) test was developed, aiming to swiftly confirm or rule out common respiratory viral and bacterial infections. This study aims to evaluate the RP 2.1 + test's cost-effectiveness and explore the potential impact of accounting for the costs of antimicrobial resistance.

We conducted a model-based cost-utility analysis from a healthcare perspective over 40 years. The design of our model, along with its parameters, was informed by insights from a targeted literature review and expert opinions. To account for antimicrobial resistance (AMR) two approaches were adopted. Including applying penalty points to the cost of antibiotic prescriptions and estimating the potential cost savings from reductions in AMR.

The results indicate that the RP 2.1 + test is cost-saving and more effective. The difference in costs and QALYs between arms were £2762.40 and 0.03 respectively and there is a 70% chance that the RP 2.1 + test is cost-effective. The analysis suggest that potential annual savings from adopting the RP 2.1 + test could range between £118 million and £18.6 billion annually.

The RP 2.1 + test represents a cost-effective use of healthcare resources and would lead to significant savings with respect to AMR. The study has attempted to account for AMR within the economic evaluation and has highlighted areas where further research is needed to account for AMR more precisely in future evaluations.

Chlamydia pneumoniae is a significant cause of community-acquired pneumonia, yet its diagnosis remains challenging due to non-specific symptoms and the limitations of traditional methods like serology, which can cause delays. We present the case of a 14-year-old female admitted with cough and right-sided chest pain. Initial laboratory tests were unremarkable, except for a positive C. pneumoniae IgM result. A chest CT scan revealed right upper lobe infiltrates. Despite empirical azithromycin, her improvement was limited. Bronchoscopy was performed, and bronchoalveolar lavage fluid was analyzed by targeted next-generation sequencing (tNGS), which identified C. pneumoniae as the dominant pathogen with a high sequence count (9886), providing strong evidence for the etiology. Targeted macrolide therapy was continued (transitioned to oral doxycycline), leading to marked clinical improvement within 72 h. Longitudinal lab monitoring revealed a self-resolving transaminitis and a rise in Serum Amyloid A post-treatment. This case suggests that tNGS can serve as a valuable adjunctive tool in providing a rapid, culture-independent etiological diagnosis for atypical pneumonias, helping to guide effective therapy in selected patients with complex respiratory infections.