Search Results (726)

Background: Despite well-established racial/ethnic disparities in cancer outcomes, little is known about the extent to which race/ethnicity influences adverse pregnancy outcomes (APOs) among women with early onset cancer. We evaluated racial/ethnic disparity in the occurrence of cancer during pregnancy and APOs among women with cancer in the United States. Methods: Data consisted of 17.6 million singleton deliveries among females aged 18–49 years from the National Inpatient Sample. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). Results: From 2000 to 2022, the prevalence of births among women with cancer increased more than 225%, from 120.4 to 391.8 per 100,000. After accounting for sociodemographic and behavioral/lifestyle factors and comorbidity index among women with cancer (n = 49,824, mean age = 33.4 years), non-Hispanic Black women had the highest odds for hypertensive disorders of pregnancy (OR = 1.67, CI: 1.54–1.82), preterm birth (OR = 1.44, CI: 1.26–1.64) and fetal death (OR = 3.04, CI: 1.99–4.63). Asian or Pacific Islander and Native American women had the highest odds for gestational diabetes (OR = 2.48, CI: 2.17–2.85) and fetal growth restriction (OR = 1.92, CI: 1.00–3.69), respectively. Among racial/ethnic minority women, the odds for maternal mortality and several APOs were significantly higher among those with cancer than those without cancer, with the odds for APOs being highest for breast cancer (OR = 1.39, CI: 1.23–1.56). Conclusions: This large population-based study showed significant racial and ethnic disparities in APOs among women with a concurrent cancer diagnosis at delivery. Targeted management of APO risk factors during pregnancy among racial/ethnic minority populations with cancer may help reduce adverse maternal and neonatal outcomes. Full article

Background/Objectives: Fentanyl test strips (FTS) are a harm reduction tool used to detect fentanyl in illicit substances. However, little is known regarding Americans’ beliefs regarding FTS. Therefore, the purpose of this study was to assess the U.S. general public’s FTS knowledge and perceptions. Methods: This study utilized a cross-sectional design. Adults ≥18 residing in the U.S. were recruited to participate in an anonymous online survey via Amazon Mechanical Turk (MTurk). Participants received $5 upon survey completion. The survey instrument was informed by the Health Belief Model, and primary outcome measures included: (1) FTS knowledge (13-items); (2) perceived susceptibility to fentanyl exposure (8-items); (3) perceived severity of fentanyl exposure (10-items); (4) perceived FTS benefits (9-items); (5) perceived barriers to FTS access (13-items); (6) comfort using and accessing FTS (15-items); (7) confidence using and accessing FTS (11-items); and (8) FTS utilization intentions (6-items). Outcomes were measured via 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Data were analyzed using descriptive statistics and Mann–Whitney U tests to compare differences in scale scores across participant sociodemographics. Predictors of FTS utilization intentions were assessed via multiple linear regression, controlling for participant age, race, sex, geographic setting (rural/urban), and recreational drug use history (yes/no) (α = 0.05). Results: Of n = 206 respondents, the majority were male (55.8%) and White (83.0%) with a mean age of 46.4. Approximately 81% resided in urban areas and 58.5% reported a history of recreational drug use. Participants who identified as Black, Asian, Indigenous, Pacific Islander, or Multiracial reported significantly higher mean (SD) perceived susceptibility compared to White participants (2.06 [0.54] vs. 1.91 [0.58]; p = 0.034). Participants residing in urban areas reported significantly higher comfort using and accessing FTS (3.61 [0.86]) than those in rural areas (3.29 [0.92]; p = 0.048), and younger individuals (≤44.5 years) were more confident in their ability to access FTS (3.75 [0.73]) compared to their older counterparts (3.60 [0.64]; p = 0.048). Perceived susceptibility (β = 0.442; p < 0.001), benefits (β = 0.250; p = 0.020), and comfort (β = 0.453; p < 0.001) were positive predictors of FTS utilization intention (R² = 0.417). Conclusions: Perceptions regarding FTS varied across race, geographic setting, and age. Perceived susceptibility, perceived benefits, and comfort positively predicted the U.S. general public’s FTS utilization intentions. Future interventions may leverage these influential factors to enhance FTS uptake. Full article

Background: Keloid scarring is a fibroproliferative disorder driven by a complex interplay of genetic, epigenetic, and environmental factors, resulting in significant cosmetic and functional impairment. Despite its high prevalence in African, Asian, and Hispanic populations, the molecular mechanisms underlying ancestry-dependent susceptibility remain incompletely understood. Methods: This narrative review synthesizes current genomic, epigenetic, and multi-omic evidence related to keloid scarring. Relevant literature was identified through a targeted, structured, non-systematic search of PubMed, Scopus, Web of Science, SciELO, and Google Scholar up to August 2025, focusing on genetic susceptibility loci, epigenetic regulation, and ancestry-related differences. PRISMA-ScR guidelines were used as a reporting framework to enhance transparency, without implying a formal systematic review methodology. Results: This synthesis identifies recurrent susceptibility loci at 1q41, 3q22.3, and 15q21.3 across multiple populations. Variants in NEDD4 and regulatory regions near BMP2 emerge as key modulators of profibrotic signaling pathways, including TGF-β/SMAD and NF-κB. Additionally, epigenetic reprogramming and long non-coding RNA networks, such as CACNA1G-AS1, appear to sustain fibroblast hyperactivation. A persistent limitation is the marked underrepresentation of Latin American populations in current genomic studies. Conclusions: Integrating ancestry-specific genomic variation with epigenetic markers is essential for advancing precision diagnostic and therapeutic strategies in keloid scarring. Future research should prioritize diverse, multicenter cohorts and integrative multi-omics approaches to improve risk stratification and enable targeted interventions for this disfiguring condition. Full article

Background: Hepatorenal syndrome (HRS) is a severe complication of liver cirrhosis, marked by rapid renal function decline and poor prognosis. Although clinical predictors of HRS outcomes have been extensively studied, less is known about how demographic factors influence mortality patterns. Methods: This analysis utilized CDC WONDER data to assess U.S. mortality trends for hepatorenal syndrome (HRS) in adults aged ≥25 years from 1999 to 2024. We calculated crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 100,000 and analyzed temporal trends using Joinpoint regression to determine the annual percentage change (APC) and average annual percentage change (AAPC). Results: From 1999 to 2024, 118,894 HRS-associated deaths were recorded. The overall AAMR decreased significantly from 2.43 in 1999 to 2.12 in 2024, with an AAPC of (AAPC −0.69% [95% CI: −0.90% to −0.51%]). Males consistently exhibited higher AAMRs than females (Males: 2.62 vs. Females: 1.63 in 2024). When stratified by race, the highest AAMR in 2024 was observed among non-Hispanic (NH) American Indian or Alaska Native populations (11.02), followed by Hispanic or Latino (2.58), NH White (2.23), NH Black or African American (1.30), and NH Asian or Pacific Islander populations (0.72). Regionally, the highest mortality was observed in the West, followed by the Midwest, South, and Northeast (2.88, 2.00, 1.92, and 1.53, respectively, in 2024). Rural areas (2.44) consistently exhibited higher AAMRs than urban areas (1.91) throughout the study period. Conclusions: HRS-related mortality has decreased modestly in the U.S over the last 26 years, yet significant inequities remain across population subgroups and regions. Mortality is disproportionately higher among males, NH American Indian or Alaska Native individuals, and residents of rural and western areas, highlighting the continued necessity for focused public health strategies. Full article

In this article, I argue that a significant stream of Asian and Asian American Protestant theology is best understood not only as recurring themes (e.g., suffering, marginality, race, diaspora) but also as the methods through which lived experience is translated into theological reasoning. It proposes a methodological typology that differentiates operative logics across five experiential sites: woundedness and healing; coerced in-betweenness and liminal creativity; political struggle and praxis; racialized peoplehood and communion; and postcolonial/feminist diasporic imagination. Across these types, “Protestant” functions as an analytic theological grammar—Scripture-centered hermeneutics, the grace-justice dialectic, reform and public witness, and eschatological hope expressed as praxis—rather than a mere denominational label. By specifying experiential sites, theological problems, operative methods, and normative aims, the typology clarifies internal differences among influential figures whose vocabularies often overlap and provides a framework for extending analysis to additional Asian and diasporic Protestant trajectories. Full article

In countries where Dengue virus is endemic, the occurrence of outbreaks and epidemic events is strongly associated with viral genomic evolution. In addition, the introduction of a new agent, such as Zika virus, in a naive population and its concomitant circulation may increase mutations and virulence. This study aimed to characterize the molecular patterns and circulation of Zika and Dengue viruses inland of midwestern Brazil. Samples from reported cases of zika and dengue fever were subjected to molecular and phylogenetic analyses. Partial genomes of these viruses were recovered and characterized from six samples. Phylogenetic analysis revealed that the Zika virus clustered within the American strain of Asian/American lineage and Dengue virus grouped within the Brazilian lineage (BR04) of serotype 2 from the Asian/American genotype. Amino acid substitutions, and consequently nonsynonymous mutations, were identified in the RdRp domain of the NS5 protein coding region in the recovered genomes from both viruses. These findings highlight the importance of molecular epidemiological surveillance, especially in endemic regions with cocirculation and substantial epidemic risk. Ongoing monitoring efforts are crucial to better understand viral evolution and its potential impact on future outbreaks and epidemic dynamics. Full article

Within the U.S., there are racial–ethnic and regional disparities in climate event experiences. For example, the West region has experienced increased frequencies of wildfires, whereas minoritized racial–ethnic groups have experienced more climate events. There is limited research investigating the intersection between race–ethnicity and region in relation to multiple climate events, particularly with a national U.S. sample. We aimed to examine regional (Northeast, Midwest, South, and West) differences in five climate event exposures (wildfire, drought, sea level rise, severe weather, and heat wave), and assess whether race–ethnicity (White, Black, Hispanic, and Asian) moderates this relationship. Our study utilized the 2022 American Trends Panel data, a nationally representative sample of 9799 U.S. adults. Regional and climate associations were analyzed using chi-square tests, while moderation was tested using interactions between race–ethnicity and region in separate logistic regression models that adjusted for sociodemographic factors. We found elevated frequencies of wildfires, drought, and heat waves in the West, sea level rise in all coastal regions except the inland Midwest, and severe weather in the South. Within the Northeast, Black adults were less exposed to sea level rise, while Asian adults were less exposed to wildfires and sea level rise. Within the Midwest, Black adults were less exposed to drought. Within the South, Hispanic adults were more exposed to drought. These findings provide insights into tailoring emergency preparedness efforts by region and prompt further investigation into reasons why some racial–ethnic groups are less likely to experience certain climate events. Full article

Importance: Multiple myeloma (MM) is the second most common hematologic malignancy in the U.S., with a higher incidence among Black patients than White patients. Chimeric antigen receptor T-cell (CAR-T) therapies show clinical promise, but their limited availability raises concerns about access. Objective: To examine associations between disease characteristics, treatment location, and patient demographics with receipt of CAR-T therapy among patients with MM. Design: Retrospective cohort study using electronic health record data from the University of California Health Data Warehouse (UCHDW) between January 2021 and January 2025. Setting: Six academic health centers and twelve affiliated hospitals within the UCHDW. Participants: A population-based cohort of 12,360 adult patients diagnosed with MM and treated at a University of California facility offering CAR-T administration. Analyses were conducted from February 2025 to March 2025. Exposures: Receipt of multiple cancer therapies following MM diagnosis. Main Outcomes and Measures: Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between disease characteristics, treatment locations, and patient demographics with receipt of CAR-T therapy. A zero-shot GPT-4 inference model was applied to UCSF clinical notes to assess whether CAR-T therapy was discussed, determine documented eligibility, and classify rationale for eligibility determinations. Results: Among 12,360 patients with MM (mean age, 68.5 years; 51.6% male), 320 (2.6%) received CAR-T therapy. Disease characteristics at diagnosis, measured by the International Staging System (ISS), was distributed as follows: Stage I (65.3%), Stage II (24.4%), Stage III (2.8%), and Unknown (7.5%). Patients treated at UC-1 (49.3%), and UC-2 (50.0%) were more frequently diagnosed with ISS Stage II, whereas patients treated at UC-3 (55.5%) were more frequently diagnosed with ISS Stage I. Our model showed that patients identifying as Black or African American had lower odds of receiving CAR-T therapy compared with White patients (OR, 0.33; [95% CI, 0.17–0.62]). Patients treated at UC-3 also had lower odds of receiving CAR-T therapy compared with UC-1 (OR, 0.42; [95% CI, 0.30–0.59]). Among 270 UCSF patients assessed for CAR-T eligibility using clinical notes, the proportion of patients deemed eligible without documented CAR-T discussions was highest among those identifying as Other Pacific Islander (50%), followed by Black or African American (4.2%), Asian (3.2%), and White patients (0.6%). Conclusions and Relevance: Within a large academic health system, receipt of CAR-T therapy varied by treatment location and patient-reported race. A subset of patients with documented eligibility lacked recorded discussions of CAR-T therapy, suggesting potential differences in referral, documentation, or care pathways influencing observed treatment patterns. Full article

South Asian Americans experience multifaceted sociocultural and acculturative stressors that influence mental well-being, yet few studies have applied contemporary behavioral theories to understand relaxation behaviors in this population. This cross-sectional study examined predictors of initiating and sustaining relaxation behaviors using the Multi-Theory Model (MTM) of health behavior change. A web-based survey of 271 South Asian adults incorporated the Perceived Stress Scale (PSS-10), MTM constructs, and sociodemographic characteristics. Reliability was high across MTM subscales (Cronbach’s α = 0.81–0.93). Structural equation modeling demonstrated acceptable fit (CFI > 0.90, TLI > 0.90, RMSEA < 0.08, SRMR < 0.08). Hierarchical regressions revealed that among participants practicing relaxation (n = 202), behavioral confidence significantly predicted initiation (β = 0.481, p < 0.001), followed by participatory dialogue (β = 0.194, p < 0.05) and changes in the physical environment (β = 0.242, p < 0.01). Emotional transformation strongly predicted sustenance (β = 0.395, p < 0.001), along with practice for change (β = 0.307, p < 0.05) and changes in the social environment (β = 0.210, p < 0.05). MTM constructs explained 69.8% of initiation variance and 70.4% of sustenance variance. Among non-practitioners, participatory dialogue predicted initiation (β ≈ 0.18–0.34, p < 0.05), and emotional transformation predicted sustenance (β = 0.570, p < 0.001). These findings underscore MTM’s strong predictive utility and support culturally tailored interventions enhancing confidence, emotional regulation, and social/environmental supports to promote relaxation behaviors in South Asian communities in the United States. Full article

Background: Adjuvant radiation therapy for breast cancer improves survival but may expose thoracic organs to low-dose radiation, increasing the risk of second primary lung cancer (SPLC). Racial and ethnic disparities and social factors influencing SPLC risk remain underexplored. Objectives: We quantified racial and ethnic differences in SPLC incidence and survival among radiotherapy-treated breast cancer survivors and assessed the potential protective role of marital status. Methods: Using SEER-17 (2000–2022), we identified patients with first primary breast cancer receiving radiotherapy, excluding those who died within two months. Standardized incidence ratios (SIRs) assessed observed versus expected SPLC cases by race and ethnicity and marital status, and five-year overall survival (OS) after SPLC and mean age at death were calculated. Racial categories included White, Black, Asian or Pacific Islander (API), and American Indian or Alaska Native (AI/AN); ethnicity was categorized as Hispanic or non-Hispanic. Results: Among 558,493 patients, 6674 developed SPLC (1.19%). Risk varied significantly by race (p < 0.05). AI/AN patients had the highest overall risk (SIR 1.82), particularly 12–59 months and ≥120 months post-treatment. Black (SIR 1.21) and API (SIR 1.23) survivors had sustained elevated risk, while White survivors showed no overall increase (SIR 0.96) and Hispanic survivors had lower risk (SIR 0.72). Married individuals had 12% lower SPLC incidence (SIR 0.88). Five-year overall survival after SPLC was 28.0%, with significant variation by race and ethnicity (p = 0.002). API (32.2%) and AI/AN (32.5%) patients had the highest survival, followed by White (28.0%) and Black patients (25.6%). Married patients had higher five-year survival (31.8% vs. 25.0%) and older mean age at death (64.3 vs. 48.6 years) compared to unmarried patients. Conclusions: SPLC risk and prognosis after breast radiotherapy differ by race, ethnicity, and marital status. These findings highlight the importance of context-aware survivorship counseling and support the consideration of personalized lung cancer screening for breast cancer survivors. Full article

Background/Objectives: Socio-cultural adversities and health disparities across Asian American origin groups remain understudied, particularly in early childhood. This limits the development of culturally responsive prevention and intervention strategies. A family-based Asian American epidemiologic study is essential to address these gaps and to inform tailored solutions. As an initial pilot effort, this pilot study was designed primarily to assess feasibility and generate preliminary data to inform future hypothesis-driven, large-scale epidemiologic research. The study objectives were to evaluate the feasibility of a remote study protocol and to collect preliminary data on child development and parental factors among Asian Indian, Filipino, and Korean American families with young children. Methods: A remote pilot study was conducted in 2024–25 among 48 mother–father–child (age 1–4 years) triads residing in Illinois, including 18 Asian Indian, 12 Filipino, and 18 Korean American mothers. Parents completed an online survey, and children wore an ActiGraph accelerometer on their hips. Analyses were conducted to describe child development, parental experiences, and parenting practices among the three ethnic groups. Results: Of the 48 mothers, 29 (60%) were US-born, and all but 1 had at least a bachelor’s degree. All parent pairs completed the survey, whereas only 34 children (71%) provided valid accelerometer data. Disaggregated data showed that, compared to children of Asian Indian mothers, children of Filipino mothers had higher daily screen time (p < 0.10) and higher sleep problem scores (p < 0.05), and children of Korean mothers had higher child–caregiver interaction scores (p < 0.05). Across all three groups, more favorable parenting practices were associated with lower sleep problem scores, higher wellbeing scores, and higher child–caregiver interaction scores (p < 0.01). Conclusions: The remote study protocol was generally feasible; however, child compliance with hip accelerometer wear was suboptimal. Preliminary data revealed differences in children’s physical behaviors and social-emotional development across Asian ethnic groups. A full-scale study should enhance the engagement of socioeconomically diverse families and refine wearable data collection methods to improve data representativeness and completeness. Full article

Air transport networks function as strategic infrastructure whose structural evolution reflects broader geopolitical and economic forces. This study introduces a network-based interpretive framework for Geoeconomics in Air Transport by integrating complex network analysis with geoeconomic perspectives. It conceptualizes air transport networks as strategic economic infrastructure in which network topology encodes market access, power asymmetries, and resilience under geopolitical uncertainty. Using global civil aviation data, this paper constructs air transport networks at both the global level and across major regions—including the United States, Europe, the Middle East, ASEAN, China, and Japan—and compares passenger and cargo connectivity before (2019) and after (2023) the COVID-19 pandemic. Standard network metrics, such as centrality, topology, and connectivity, are used to quantify structural changes, which are subsequently interpreted through a geoeconomic lens. Global connectivity increased by approximately 8% in the post-pandemic period. In contrast, the United States—maintaining the most structurally resilient national air transport network—expanded by about 12%, while connectivity across Asian countries contracted, either domestically, internationally, or both. These patterns reflect a combination of intentional strategic responses and unintended structural adjustments. North American and European networks remain large-scale, meshed, and structurally resilient, whereas regions outside these core areas exhibit stronger hub-and-spoke dependence, both internally and in their connections with core regions. Such dependence signals persistent geoeconomic asymmetries and increased exposure to external shocks, despite higher traffic volumes per route. Betweenness centrality shifted markedly from European and North American hubs toward the Middle East, indicating the emergence of a geoeconomic intermediary region capable of sustaining connectivity across increasingly fragmented markets. The findings further demonstrate that, despite the United Kingdom’s withdrawal from the European Union, institutional and strategic realignments can enhance air transport network resilience in ways not anticipated by conventional geoeconomic interpretations of regional integration. By linking quantitative network outcomes with geoeconomic interpretation, this study provides reproducible insights into the strategic reconfiguration of global air transport systems under rising geopolitical uncertainty. Full article

Background: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is increasing despite declining colorectal cancer (CRC) rates among older adults. Emerging evidence suggests widening racial and ethnic disparities. We aimed to characterize long-term EOCRC incidence and mortality trends across racial and ethnic groups in the United States with comparisons by tumor subtype. Methods: We conducted a population-based analysis using United States Cancer Statistics data (2001–2021) for EOCRC incidence and National Center for Health Statistics data (2000–2022) for mortality. Analyses were stratified by race/ethnicity and histology. Trends were quantified using average annual percent change (AAPC) with 95% confidence intervals (Cis). Results: Among 474,601 early-onset adenocarcinoma (EO-ADC) cases, incidence increased in all racial and ethnic groups except Non-Hispanic Black individuals, in whom incidence declined (AAPC = −0.35%, 95% CI −0.63 to −0.08; p = 0.01). The steepest incidence increases occurred among American Indian/Alaska Native (AIAN; AAPC = 3.39%, 95% CI 2.70–4.15), Hispanic (AAPC = 0.94%, 95% CI 0.61–1.30), and Asian/Pacific Islander populations (AAPC = 0.64%, 95% CI 0.37–0.95; all p < 0.001). EOCRC mortality increased among AIAN (AAPC = 2.67%, 95% CI 1.26–4.26; p = 0.001) and Hispanic populations (AAPC = 0.81%, 95% CI 0.39–1.27; p < 0.001), but declined among Black individuals (AAPC = −1.08%, 95% CI −1.29 to −0.77; p < 0.001). Neuroendocrine tumors increased more rapidly than adenocarcinomas across all groups. Conclusions: EOCRC incidence and mortality are rising most rapidly among AIAN and Hispanic populations. Distinct incidence trajectories of colorectal neuroendocrine tumors compared with adenocarcinomas highlight the importance of histology-specific analyses for accurate epidemiologic interpretation. Full article

Background/Objectives: There is an invisibility of the diabetes epidemic among Vietnamese Americans. Not only is there limited availability of culturally and linguistically tailored national Diabetes Prevention Program (DPP) and Diabetes Self-Management Education and Support (DSMES) programs, but there are enrollment and retention challenges that hinder these programs’ sustainability and expansion. The purpose of this study was to explore the cultural beliefs, perceived barriers, and motivating factors that influence Vietnamese Americans’ willingness to engage in existing diabetes prevention and self-management programs. Methods: A qualitative descriptive study design was used. A total of 26 participants were recruited through snowball sampling. Bilingual Vietnamese American researchers conducted semi-structured interviews. Content analysis was used to analyze data. Results: Most participants were in the earlier stages of readiness for engagement in a national diabetes program. Major barriers to engagement were related to financial and time constraints, notable among middle-aged participants. Key motivators for engagement included increasing health awareness and family and other social support. Despite their hesitation regarding diabetes program engagement, most participants were further along in the stages of readiness for self-directed lifestyle management. Conclusions: These results will guide the development of a linguistically and culturally adapted diabetes prevention and management program that will support individuals at various stages of their behavior change journey. The program should align with cultural values, address structural barriers, and emphasize the integration of social and familial motivators. Full article

Enteroviruses (EVs) are small, non-enveloped RNA viruses that can cause diverse clinical outcomes, particularly severe in patients with primary immunodeficiency (PID) due to their impaired ability to clear infections. This study aimed to characterize EV excretion among 138 Tunisian PID patients over a five-year period, to identify circulating EV serotypes and assess their genetic diversity. A total of 558 stool samples were collected and analyzed by virus isolation and intratypic differentiation using RT-qPCR. Molecular typing was performed through Sanger sequencing of the VP1 region and whole genome sequencing using Next-Generation Sequencing (NGS) technologies. Phylogenetic analysis was conducted using the Maximum Likelihood (ML) method. EVs were detected in 55 stool samples from 23 patients. The excretion kinetics of EVs ranged between 30 and 946 days. Thirteen serotypes were identified, including one Poliovirus (PV) and twelve Non-Polio Enteroviruses (NPEVs), predominantly belonging to species B. Two previously unreported serotypes in Tunisia were detected: Coxsackievirus A5 (CVA5) and Echovirus type 19 (E19). In addition, five patients presented enhanced susceptibility to the excretion of successive EV serotypes, and one patient exhibited a co-infection. A possible recombination event was identified in one patient involving Coxsackievirus B5 (CVB5), Coxsackievirus A9 (CVA9) and Coxsackievirus B1 (CVB1) sequences. Phylogenetic analysis showed close genetic relationships with European, American and Asian strains. These findings underscore the dynamic nature of EV circulation and the importance of ongoing molecular surveillance to detect emerging serotypes and guide public health strategies. Full article