Epidemiologia

Background/Objectives: Bone fractures represent a growing public health concern worldwide, yet national epidemiological assessments remain limited in Brazil. Understanding temporal trends, demographic disparities, and geographic heterogeneity is essential to guide prevention, resource allocation, and trauma-care planning. To characterize the epidemiological profile of bone-fracture-related hospitalizations and mortality in Brazil between 2015 and 2024, analyzing trends by sex, age, fracture type, and geographic and ethnic distribution. Methods: An epidemiological, observational, descriptive, and population-based ecological study was conducted using Hospital Information System of the Unified Health System SIH/SUS and IBGE data. Hospitalization rates, case fatality rates (CFR), relative risks, odds ratios, and Years of Life Lost (YLL) were calculated. Temporal trends were evaluated using Annual Percent Change (APC). Results: Other limb fractures were the most frequent injuries, while femur fractures showed the highest lethality. Men had nearly twice the hospitalization rate of women, driven by high-energy trauma in adults aged 20–59 years, whereas women experienced a sharp increase in femur-fracture admissions at older ages. Skull, facial, and thorax/pelvis fractures contributed disproportionately to premature mortality. Marked geographic and ethnic disparities were observed, with higher burdens in the North/Northeast and predominance among Brown and Indigenous populations. Conclusions: Fracture-related hospitalizations in Brazil have increased consistently, with distinct epidemiological patterns across demographic and regional groups. These findings highlight the need for targeted prevention and improved trauma-care strategies. Full article

Background/Objectives: A recent report by the Italian Ministry of Health showed that a high proportion of Emergency Department (ED) visits exceed the maximum recommended thresholds for both waiting time and overall length of stay. As no overall quantitative data are available on the magnitude, temporal evolution, and underlying drivers of ED performance from Southern Italian regions, we analyzed ED data from the Abruzzo region during the years 2017–2024, and evaluated potential predictors of prolonged waiting and process time. Methods: Official, administrative data from all the regional EDs were collected, and information on personnel, location and organizational change was obtained through a dedicated survey. All analyses were stratified and/or adjusted by triage code, hospital, age and sex. Results: From 2017 to 2024, a total of 3,563,565 accesses were recorded in the 16 regional EDs. From 2021, waiting time for the first visit steadily and progressively increased, reaching an average of 78 min in 2024 (+56.0%), largely exceeding recommended thresholds. The most critical growth was observed for the most severe patients, as mean waiting time for yellow and red admissions peaked at 81 (+100%) and 39 (+290%) minutes (m) in 2024, respectively. The mean process time also substantially increased in post-pandemic years, especially for yellow (from 300 m to 476 m) and red codes (from 330 m to 607 m). The trend was similar for both genders, in all age-classes, and higher in larger hospitals. Multivariable analyses confirmed a significant increase in ED time over the years. Conclusions: These findings indicate critical organizational and clinical issues in the regional emergency care system, requiring immediate action. The Regional Healthcare System recently tried to reduce ED overcrowding with specific plans, the impact of which requires urgent evaluation. Full article

Background/Objectives: Toxoplasmosis is a globally distributed parasitic zoonosis caused by Toxoplasma gondii (Apicomplexa, Sarcocystidae), an obligate intracellular protozoan with an indirect life cycle in which domestic cats and wild felids serve as definitive hosts, whereas humans and a broad range of domestic and wild animals act as intermediate hosts. The objective of the study was to document the seroprevalence of anti-Toxoplasma gondii antibodies in professionals and students of Veterinary Medicine in Aguascalientes, Mexico. Methods: The study included 153 clinically healthy individuals from two population segments: Veterinarians (70) and Veterinary Medicine Students (83). Serum samples were analyzed using a commercial ELISA test to determine the presence of T. gondii-specific IgG. A questionnaire was applied to collect sociodemographic information and information about contact with cats. Results: The overall prevalence of anti-T. gondii antibodies in the study population was 7.8% (12/153; CI 95% 4.3–13.6). In the group of Veterinarians, the seroprevalence was 11.4% (8/70; CI 95% 5.4–21.8), while in the group of students it was 4.8% (4/83; CI 95% 1.5–12.5), with no differences observed between them (p = 0.22). Association was found with those who consume raw/undercooked meat (p = 0.002). Conclusions: In this cross-sectional sample of veterinary professionals and students in Aguascalientes, anti-T. gondii IgG seroprevalence was 7.8%, with no statistically significant difference between occupational groups. Consumption of raw or undercooked meat was the only exposure significantly associated with seropositivity. Full article

Background/Objectives: Since June 2025, Japan has mandated countermeasures to prevent outdoor laborers from developing heat-related illness at work. However, the extent to which preventive behaviors can reduce the actual heatstroke risk has not been quantified. The present study aimed to (i) project future trends in the daily number of heat-related ambulance transports in the working population under climate change, and (ii) evaluate the population-level preventive impact of workplace-adopted preventive behaviors using effect estimates from observational data. Methods: Using daily maximum wet-bulb globe temperature, a long-term future projection of heat-related ambulance transports was performed in the working population. A cross-sectional survey was carried out to infer the effect size of behavioral interventions. The effectiveness of taking preventive behaviors was evaluated by increasing the coverage rate of workers adhering to all four behaviors (current: 23%): (i) regular hydration, (ii) use of an air-cooling vest, (iii) checking their own health condition before work, and (iv) recognizing warning signs. Theoretical scenarios in which workplace instructions to workers or teams increased adherence by 50%, 100%, and 300% relative to baseline were considered, corresponding to coverage rates at 34%, 45%, and 91%, respectively, and we evaluated the associated reduction in heatstroke risk. Results: Many future years were projected to have higher annual levels of heat-related ambulance transports than the median value from 2018–2024, indicating a long-term increasing trend. Even when all four possible countermeasures were implemented at an additional 50%, 100% or 300% from the current rate, the expected relative risk reduction in transports was 3.2%, 6.3%, and 19.0%, respectively, indicating only a small effect on future projected heat-related illnesses. Conclusions: The number of heat-related ambulance transports is expected to increase; however, the relative risk reduction with behavioral intervention is likely limited. A fundamental overhaul of working regulations and environment (e.g., drastic shift in working hours to earlier morning) is required via adaptation policies, and mitigation of climate change is vital. Full article

Background/Objectives: Adults with intellectual disability are known to experience complex health needs, including an elevated presence of chronic conditions. Cardiovascular risk factors are a concern, yet the evidence base is fragmented, and the scope and focus of current research are not well understood. Methods: We conducted a scoping review to map the existing evidence on cardiovascular risk factors among adults with intellectual disability. The review included studies reporting on risk factor prevalence as well as participant characteristics (ethnicity, living arrangements, age, sex, and type of disability). Cardiovascular-related outcomes were extracted to clarify the health disparities documented in this population. Results: Searches of seven databases for studies published from 2013 onward yielded 15,598records, of which 85 met the inclusion criteria. Evidence was dominated by cross-sectional studies, with a few randomized controlled trials. Hypertension, Type 2 diabetes and obesity were commonly reported. Patterns appeared to reflect lifestyle, medication effects, genetic syndromes—particularly Down syndrome and Prader–Willi syndrome—and the severity of the disability. A notable share of the studies originated from the United Kingdom and the United States. Findings reveal a complex cardiovascular risk profile, emphasizing the need for tailored prevention and management. Conclusions: Adults with intellectual disability face a substantial burden of cardiovascular risk factors. Evidence on effective interventions remains limited, highlighting a need for targeted, evidence-informed approaches to improve cardiovascular health and long-term outcomes. Full article

Background: The complex interplay between treatment interventions and asymptomatic carriers and its effect on the epidemic duration of an infectious disease is not fully understood. Methods: Here, we used Galton-Watson branching process and generating function technique to estimate the density functions of minor outbreak duration. Simulations were used to calculate the central tendency of outbreak duration and address how changing levels of treatment failure affect this estimated duration. Results:Streptococcus pyogenes infection was used as a case study. Given the existence of the threshold, the change in mean duration as the probability of treatment failure increases is shown to be similar to the pattern driven by the basic reproduction number. In a supercritical regime, the mean duration tends to decrease as the probability of treatment failure increases. The distribution changes in tail behavior, from heavy- to light-tailed, if a large fraction of long extinction times develops to a major outbreak. Conclusions: Treatment failure elevates the probability of secondary transmissions by prolonging the overall infectious period, resulting in an extended the outbreak duration. The threshold of treatment failure identifies the maximum tolerable error for medical intervention. An unusually long period implies a critical early warning signal of a potential major outbreak that was successfully contained. Full article

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic profoundly disrupted global respiratory virus circulation, with sharp declines during 2020–2021, followed by a resurgence after the relaxation of public health measures. In South America, post-pandemic respiratory virus dynamics remain insufficiently characterized, particularly in ecologically diverse regions. Arequipa, a high-altitude city in southern Peru, has unique environmental conditions, including marked seasonal temperature variability, that may influence viral transmission. Methods: We performed a cross-sectional analysis of 21,784 nasopharyngeal swabs collected from symptomatic patients at four major hospitals between June 2021 and September 2023. All samples were tested for SARS-CoV-2 by RT-qPCR. Because routine screening for other respiratory viruses was implemented only in SARS-CoV-2-negative cases during the study period, a subset of SARS-CoV-2-negative samples was subsequently analyzed for influenza A virus (IAV), influenza B virus (IBV), and respiratory syncytial virus (RSV) using VIASURE assays. Viral circulation patterns were evaluated by year, month, and epidemiological week. Meteorological data were obtained from the SENAMHI–La Pampilla station. Logistic regression models were used to assess epidemiological and climatic predictors of viral detection. Results: SARS-CoV-2 positivity declined from 20.0% in 2021 to 8.8% in 2023. Conversely, detection of other respiratory viruses among SARS-CoV-2-negative samples increased from 0.8% in 2021 to 29.0% in 2023 (p < 0.01). Temporal increases in detection were observed during 2022–2023, particularly for IAV and RSV. In exploratory analyses, calendar year and relative humidity were associated with IAV and RSV detection, while age and temperature variables were associated with IBV. Conclusions: Climatic and demographic variables were associated with changes in viral detection for IAV, IBV, and RSV during the post-pandemic transition period in Arequipa. These findings describe patterns of viral detection within SARS-CoV-2-negative symptomatic patients and should be interpreted as surveillance-based observations rather than population-level estimates. Strengthened integrated epidemiological and genomic surveillance will be essential for vaccine planning and outbreak preparedness in the post-pandemic era. Full article

Background: The prevalence of mental disorders, particularly anxiety and depression, has been increasing and is becoming a major public health concern in Portugal. Digital mental health solutions offer scalable and accessible tools for monitoring and managing mental health. ‘P5 Mental Health’ has been created as a platform to assess and monitor symptoms of anxiety and depression in the Portuguese population, and to offer strategies to promote well-being to support users. Objective: This study aims to (1) describe the P5 Mental Health platform, (2) evaluate its feasibility as a digital mental health monitoring tool, and (3) analyze trends in the prevalence and severity of anxiety and depression symptoms over a four-year period, particularly in response to major societal stressors. Methods: Between September 2020 and September 2024, 46,032 responses were collected from platform users. Anxiety and depression symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scales. Longitudinal trends were analyzed across four time periods. Welch’s ANOVA and Games–Howell post hoc tests were conducted to compare symptom severity across time, and ordinal logistic regression was used to examine the impact of time on symptom progression. Results: Anxiety and depression symptoms increased between 2020 and 2022, stabilized thereafter, and showed a slight decline in 2024. The proportion of users reporting moderate to severe anxiety (GAD-7 ≥ 10) rose from 30.87% in September 2020 to 66.30% in June 2022. Similarly, the prevalence of moderate to severe depressive symptoms (PHQ-9 ≥ 10) rose from 3.62% in March 2021 to 51.54% in August 2021. Despite a small decrease in 2024, symptom levels remained significantly higher than baseline levels recorded at the beginning (p < 0.001). A strong positive correlation was found between anxiety and depression symptoms (r = 0.739, p < 0.001), underscoring their high comorbidity. Conclusions: This study demonstrates the feasibility of the P5 Mental Health platform as a real-time mental health monitoring tool, particularly during periods of heightened social and economic stress. The findings highlight the need for sustained digital mental health interventions beyond crisis periods to ensure long-term engagement; however, future improvements should focus on increasing user engagement and adding personalized features to ensure long-term mental health management. Full article

Background: In 2018, malaria remained a leading cause of morbidity and mortality in the Democratic Republic of the Congo, accounting for 44% of all outpatient visits and 22% of deaths. This led to the development of the strategic plan for 2020–2023. To meet the objectives of this renewed plan, a monitoring and evaluation program focusing on performance indicators was established. This study aimed to assess the malaria control performance indicators in Kinshasa. Methods: A descriptive cross-sectional study used the National Malaria Control Program dataset of the period 2020–2023 to analyze malaria data from 23 HZ (Health Zone) in Kinshasa. Diagnostic, therapeutic, and preventive use of LLINs (long-lasting insecticidal nets) and sulfadoxine–pyrimethamin-based IPT (intermittent preventive treatment among pregnant women) indicators were evaluated following the targeted thresholds established in the strategic plan for 2020–2023. Results: Malaria was present in all studied HZ from 2020 to 2023, with a heterogeneous distribution. The malaria incidence during the study period was 30%, with an upward trend in both suspected and confirmed cases, peaking in 2022 and showing no further fluctuations thereafter. The proportion of LLINs distributed to pregnant women during antenatal care visits was 62%, 61%, 45%, and 88% in 2020, 2021, 2022, and 2023, respectively. A total of 83.1% of suspected malaria cases were diagnosed using RDT (Rapid Diagnosis Test), and confirmed malaria cases received antimalarial treatment. Conclusions: The objectives of the 2020–2023 strategic plan were only partially achieved, and no HZ reached 100% diagnosis by RDT, with only four HZs reaching at least 95% of the target. Thirty-four HZs were able to benefit from 95% treatment with antimalarial drugs. Full article

Background and Objective: The aim of this study is to describe the frequency of newly detected dysglycemia, including hyperglycemia and newly diagnosed diabetes mellitus, among hospitalized COVID-19 patients without previously known diabetes and to identify associated clinical and therapeutic factors, in an exploratory, descriptive manner. Materials and Methods: We conducted a retrospective study on 562 COVID-19 patients. Demographic and clinical data were collected at admission and during hospitalization. Newly diagnosed diabetes mellitus was defined based on plasma glucose values meeting international diagnostic criteria during hospitalization in patients without prior diabetes, while newly altered blood sugar referred to transient hyperglycemia or impaired fasting glucose not fulfilling diabetes criteria. Comparisons between groups were performed using appropriate statistical tests, with a p-value < 0.05 considered statistically significant. Results: Out of the total number of 562 COVID-19 patients, 14 (2.49%) were classified as having newly diagnosed diabetes, and 27 (4.8%) as having newly altered blood sugar levels. The median age of the participants was 67.5 years (interquartile range: 59.75; 71.75). Newly diagnosed diabetes was more frequently observed among patients presenting with gastrointestinal symptoms, elevated inflammatory markers, and those receiving specific in-hospital treatments. Newly altered blood sugar levels were more commonly associated with dyslipidemia, respiratory symptoms at admission, oxygen therapy, and selected COVID-19 treatments. COVID-19 vaccination status was descriptively stratified by admission period. Conclusions: New interdisciplinary approaches may support the identification and monitoring of glycemic alterations in hospitalized COVID-19 patients, with potential implications for clinical management and public health strategies. Full article

Background/Objectives: Diabetes is associated with an increased risk of influenza-related complications; therefore, annual vaccination constitutes an essential preventive measure. The objective of this study is to analyze the evolution of influenza vaccination coverage among the population with diabetes in Spain between 2020 and 2023 and to identify factors associated with adherence, comparing it with a matched population without diabetes. Methods: A cross-sectional study was conducted using data from the European Health Survey in Spain 2020 and the Spanish National Health Survey 2023, applying 1:1 matching by age, gender, and place of residence. Multivariable logistic regression was applied to assess time trend and to identify adherence predictors. Results: Vaccination coverage among individuals with diabetes increased from 52.0% in 2020 to 65.9% in 2023 and was higher than that observed among the matched participants without diabetes in both periods. Older age and the presence of comorbidities, such as myocardial infarction or respiratory diseases, were associated with a higher likelihood of vaccination, whereas alcohol consumption and smoking were associated with lower adherence among subjects with diabetes. The year 2023 was independently associated with a higher probability of vaccination compared with 2020 (OR: 1.82; 95% CI: 1.56–2.12). Conclusions: Although influenza vaccination coverage among the Spanish people with diabetes has improved following the COVID-19 pandemic, it remains below recommended targets, highlighting the need to strengthen targeted strategies aimed at less adherent subgroups. Full article

Background: The Karamoja sub-region of Uganda addresses significant challenges in water, sanitation, and hygiene (WaSH), deeply linked to public and environmental health and regional development. Objectives: This study applied a Knowledge, Attitudes, and Practices (KAP) survey within a One Health framework to assess WaSH conditions, hygiene behaviour, livestock management, and disease prevention in the Moroto and Napak districts. Methods: A total of 195 respondents were surveyed, providing insights into socio-demographic factors, hygiene practices, livestock management, and disease prevention. Results: Findings highlighted gender disparities, with women less likely to achieve good knowledge compared to men (OR = 0.04; p = 0.002), probably reflecting limited access to information in traditionally male-focused community settings, and their greater involvement in water collection tasks. Age significantly influenced WaSH knowledge, with older individuals (aged ≥ 30 years) showing higher odds of good knowledge (OR = 20.39; 95% CI: 2.74–151.83; p = 0.003), probably due to their roles in knowledge transmission within the community. Proximity to water sources shaped behaviours, with greater distances associated with improved attitudes (OR = 3.56; p = 0.002) but reduced hygienic practices (OR = 0.20; p = 0.01). Livestock ownership, particularly of small ruminants, strongly correlates with good hygiene knowledge (OR = 16.89; p = 0.02), probably due to interactions with veterinarians and authorities during vaccination campaigns. Integrated communication strategies, including community meetings, home visits, and radio outreach, were strongly associated with improved practices (e.g., home visits: OR = 30.78; p < 0.001). Conclusions: Despite progress, challenges such as water scarcity, waste management, and gender disparities persist. Improving water infrastructure, promoting equitable access, and integrating tailored communication strategies are essential for fostering sustainable development, health equity, and the empowerment of women in Karamoja. Full article

Background/Objectives: Body mass index (BMI) trajectories and transitions across adulthood are dynamic processes influenced by aging and social- and health-related factors, yet long-term patterns in older adults from middle-income countries remain insufficiently characterized. The objective of this study was to characterize long-term BMI trajectories and transitions, and to identify sociodemographic and clinical factors associated with adverse BMI patterns among Mexican adults aged ≥50 years followed over 20 years. Methods: This study used data from the Mexican Health and Aging Study (ENASEM), a nationally representative longitudinal cohort. Participants aged ≥50 years with repeated BMI measurements across survey waves were included. BMI trajectories and transitions between BMI categories were described, and multinomial regression models were used to examine factors associated with upward transitions and unstable high-BMI patterns. Results: Distinct BMI trajectory patterns were identified over the 20-year follow-up. Participants in stable normal-weight trajectories were younger, more frequently female, and had higher educational attainment and income. In contrast, those with stable overweight/obesity or fluctuating–adverse BMI patterns had higher baseline BMI and a greater prevalence of diabetes, hypertension, and multimorbidity. In multivariable analyses, age contributed to trajectory differences; however, sex, socioeconomic factors, baseline BMI, and chronic conditions remained independently associated with adverse BMI patterns. Conclusions: BMI trajectories in later life are heterogeneous and reflect the combined influence of aging, socioeconomic conditions, and chronic disease burden. Identifying groups at risk of adverse BMI patterns may support the development of targeted interventions to reduce obesity-related health consequences in older adults. Full article

The COVID-19 pandemic caused stark global mortality disparities, influenced by a complex interplay of demographic, economic, and health factors. This ecological study investigates associations between country macroscopic variables and COVID-19 accumulated mortality ratio (AMR) across 174 countries and may serve as a preparation for new pandemics. Methods: The study applies bidirectional stepwise multiple linear regression. To ensure statistical validity, we conducted diagnostic tests for multicollinearity and heteroscedasticity, applying robust M-estimation where necessary to minimize root mean squared error. The analysis covered six distinct stratifications based on development status (developed, developing, least developed, and combinations), and incorporated temporal analyses across three specific annual periods: 21 January 2020–20 January 2021; 21 January 2021–20 January 2022; and 21 January 2022–10 January 2023. Data: AMR per country values, accumulated between 21 January 2020 and 10 January 2023, and data on the prevalence of health conditions, and socioeconomic descriptive variables were extracted from Our World in Data (OWID) and other public data sites, like the World Bank. Results: The percentage of population aged over 65 years has the most consistent association with increased AMR globally. Obesity prevalence and income inequality (Gini index) were positively associated with AMR regardless of country development status. Conversely, the study finds a consistent negative correlation with diabetes prevalence, while the prevalence of respiratory diseases is a significant association only for developed nations. Socioeconomic factors were significantly associated with AMR, but this influence is stronger in developed countries than in the developing and least developed countries. Conclusions: While population aging is the primary association with increased AMR, the mortality impact of comorbidities and socioeconomic factors is heavily conditioned by a country’s development stage, pointing to the necessity of development-status-aware public health strategies for incoming pandemics. Full article

Background: In modern society, increased awareness of stress stems mainly from the pressures of competitive environments, where the pursuit of academic and professional success places substantial demands on individuals, who must adapt. Drawing on the Transactional Model and the Interactive Model of Human Adaptation to Stress, this paper presents a battery of instruments designed to comprehensively assess university students’ adaptation to stress. Methods: Data were collected from two academic years, using two independent samples of students: a calibration sample (n = 561) and a validation sample (n = 370) to test the psychometric properties of the instruments. The evaluation protocol included the Stress Questionnaire for Students (SQS), the Primary and Secondary Cognitive Appraisal Scale (PSCAS), the Reduced Coping Inventory (Coping-R), and the Academic Achievement Expectations (AAE). Results: Psychometric validation analyses indicated the best versions of the instruments’ battery. Namely, an 18-item version and a six-factor structure for the SQS, a 10-item version and a five-factor structure for the PSCAS, a 12-item version and a four-factor structure for the Coping-R, and a five-item, one-factor structure for the AAE. Conclusions: The proposed instruments can serve as a compound resource for screening for academic stress experiences in university students, and as an original tool to understand the entire process of stress adaptation. Full article

Background/Objectives: Nonpharmaceutical interventions such as social distancing and face mask use were central to controlling infectious disease transmission during the early phases of the COVID-19 pandemic, particularly when vaccines and treatments were limited or unevenly available. Although public health strategies emphasized individual compliance, adherence varied widely. Empirical evidence remains limited regarding how individuals integrate influences across individual, interpersonal, and community levels when assessing their ability and readiness to socially distance. This study examined how residents evaluated, prioritized, and experienced multi-level factors shaping perceived ability and readiness to practice social distancing during the early phase of the COVID-19 epidemic. Methods: We conducted a cross-sectional online survey of adults (≥18 years) residing in St. Louis City and St. Louis County, Missouri, between April and July 2020. Participants selected and ranked individual/interpersonal and community-level factors influencing social distancing and provided open-ended explanations of their choices. Quantitative data were analyzed descriptively to assess selection frequency and ranking priority. Qualitative responses were analyzed using iterative thematic coding to examine how participants interpreted and combined these factors. Results: The analytic sample included 1692 respondents. At the individual/interpersonal level, family and friends’ distancing behavior (58.9%), desire for in-person interaction (52.4%), and personal risk of COVID-19 (48.9%) were frequently selected, while personal risk, caring for others, and ability to work from home were most often ranked as the highest priority. At the community level, others’ distancing in public spaces (66.2%), availability of COVID-19 testing (58.9%), and businesses’ ability to ensure distancing and sanitation (57.2%) were most frequently selected, with epidemic severity, testing availability, and treatment availability ranked as most influential. Qualitative findings indicated that respondents experienced these influences as interconnected, integrating personal and relational risk, local epidemic conditions, healthcare access, visible community norms, and employer policies. Conclusions: Perceived ability and readiness to practice social distancing emerge from interdependent social and structural conditions rather than isolated individual motivations. Public health responses to emerging infectious diseases may be more effective when individual-level guidance is complemented by accessible testing and treatment, supportive workplace policies, and community environments that visibly reinforce protective behaviors. Full article

Background: Symptomatic cholelithiasis is the leading indication for pediatric cholecystectomy. While historically linked to hemolytic disorders, non-hemolytic gallbladder disease in children has become increasingly common in recent decades. Objective: The objective of this study was to describe the distribution and temporal trends of indications for cholecystectomy among children (ages ≤ 19 years) undergoing surgery at a tertiary pediatric center in Israel and to compare clinical presentation between hemolysis-related and non-hemolysis-related cases. Methods: We conducted a retrospective observational cohort study of all pediatric patients who underwent cholecystectomy at Schneider Children’s Medical Center between 2011 and 2024. Patients with congenital biliary tract anomalies or biliary tract neoplasms were excluded. Results: A total of 199 cholecystectomies were performed (median age 13.4 years). Hemolysis-related cholelithiasis accounted for 34.2% of cases; five patients (2.5%) had gallbladder polyps or other benign lesions, while the remaining patients had non-hemolysis-related cholelithiasis. No cases of biliary dyskinesia were identified. The proportion of non-hemolysis-related cholecystectomies remained stable over time. Among symptomatic patients, the rate of choledocholithiasis was significantly higher in the hemolysis-related group compared to the non-hemolysis group (27% vs. 7.9%, p = 0.004). No statistically significant association was observed between obesity and increased disease severity or adverse outcomes. Conclusion: Unlike trends reported in some Western countries, the number of cholecystectomies performed for non-hemolysis-related cholelithiasis in our single-center cohort did not increase over time. Hemolysis-related disease remains a leading indication for pediatric cholecystectomy. Prophylactic surgery may help prevent biliary complications in this group while symptomatic patients have substantial complication rates. Full article

Introduction: Lower urinary tract symptoms (LUTSs), including urinary incontinence (UI), are common problems present in the general population. However, these symptoms have also been seen in young, elite-level athletes, especially females, including those who are nulliparous. This preliminary study aimed to report on the prevalence of LUTSs within an elite athletic population, including both males and females, within the UK high-performance system (the Sports Institute of Northern Ireland) and a women’s elite cycling team, while also investigating the link between LUTSs and specific training and sporting activities. Methods: A cross-sectional study of elite athletes in the Sports Institute of Northern Ireland (SINI) and a women’s professional cycling team, using an online questionnaire, was conducted to investigate the prevalence of LUTSs and UI and their impact on quality of life (QOL) among both male and female elite athletes. The authors used the STROBE-SIIS guidelines to produce separate electronic questionnaires for male and female athletes. This is a preliminary pilot study due to the small sample size. Results: Ten male athletes completed the IPPS questionnaire, reporting a median score of 5.5/35. Meanwhile, 18 female athletes completed the Athlete Female LUTS (A-FLUTS) questionnaire and reported a median score of 6/44. Female athletes had a higher prevalence of UI in the last four weeks (66.7%) compared to male athletes (20%). Of the 28 athletes, 7 were explosive/sprint athletes, and 21 were endurance athletes. Explosive/sprint athletes (71.4%) appeared to have a higher prevalence of UI in the last four weeks compared to endurance athletes (42.9%). Athletes self-managed these UI symptoms through a variety of methods, including reducing fluid intake, which could impact their athletic performance. This is a preliminary pilot study and—despite its small size—it defines a methodology and shows some important results that encourage research to be carried out on a larger sample size. Conclusions: The reported QOL impact and potential impact on health and athletic performance highlight the need for better management and treatment protocols, including the need to screen for urinary symptoms in the pre-season medical. Full article

Background/Objectives: The implementation of COVID-19 vaccination in the United States has revealed substantial disparities driven by geography, socioeconomic conditions, and political ideology. This study examines the association between these factors and COVID-19 vaccination uptake across 360 counties in four U.S.–Mexico border states, characterized by distinct socio-political traits. Methods: Using county-level data, this study employed multivariable regression analysis and GIS mapping to assess the effects of income, education, employment, age, race, ethnicity, occupation, metropolitan status, border status, and political affiliation on Dose 1, Dose 2, and booster vaccination rates. Results: The analysis showed that Dose 1 vaccination rates were significantly higher in border counties and metropolitan areas. Democratic population share and per capita income were positively associated with vaccination uptake. Dose 2 vaccination rates exhibited patterns similar to those observed for Dose 1. Booster vaccination rates were positively associated with Democratic affiliation, the proportion of the population with at least a high school education, and the share of individuals aged 65 years and older. In contrast, unemployment rates were negatively associated with booster uptake. Racial and ethnic composition was also associated with vaccination outcomes: higher Black population shares were associated with lower Dose 1 vaccination rates, whereas higher Native American population shares were associated with higher vaccination rates. Booster uptake was higher with larger shares of the Asian population but slightly lower with larger shares of the White population. Conclusions: COVID-19 vaccination uptake in U.S.–Mexico border counties was associated with a complex interaction of geographic, socioeconomic, demographic, and political factors. These findings underscore the importance of targeted, context-specific public health strategies to reduce vaccination disparities and improve booster coverage in border regions. Full article