Search Results (17,097)

Background/Objectives: Transgender (trans) individuals experience a disproportionate burden of HIV and other sexually transmitted infections (STIs), although evidence based on point-of-care testing remains limited in Brazil. This study aimed to estimate the prevalence of reactive STI rapid test results and associated factors among transgender individuals receiving care in specialized health services in São Paulo, Brazil. Methods: A cross-sectional study was conducted between July and December 2025 with 400 participants attending two specialized healthcare services. Sociodemographic, behavioral, substance use, clinical, and HIV prevention-related data were collected. The primary outcome was reactivity to at least one rapid test for HIV, syphilis, hepatitis B, or hepatitis C; reactive results could include previously known infections and therefore were not interpreted as newly diagnosed or active infections. Associations were estimated using Poisson regression with robust variance. Results: Overall, 19.2% of participants had at least one reactive rapid test result, with HIV accounting for the largest proportion of reactive results (14.8%). In the adjusted model, increasing age was associated with a higher prevalence of the outcome (PR = 1.04; 95% CI: 1.02–1.05), whereas transgender men had a lower prevalence than transgender women (PR = 0.38; 95% CI: 0.19–0.73). Reported HIV prevention through PrEP and/or PEP was inversely associated with the outcome (PR = 0.37; 95% CI: 0.17–0.82); however, this association should not be interpreted as a direct protective effect because most reactive HIV results occurred among participants with previously known HIV, who would not be eligible for PrEP. Conclusions: These findings indicate a substantial frequency of reactive STI rapid test results among transgender individuals attending specialized health services and support continued access to testing, prevention, and culturally competent sexual healthcare. Full article

Aim: Gestational diabetes mellitus (GDM) is defined as glucose intolerance diagnosed during pregnancy and can lead to significant health problems for both the mother and the baby. We aimed to compare e-health literacy levels according to oral glucose tolerance test (OGTT) status at study enrollment and to examine the association between e-health literacy and OGTT status. Materials and Methods: The study included 45 pregnant women classified as OGTT-tested and 122 classified as OGTT-untested based on their OGTT status at study enrollment. All participants completed a sociodemographic data form and the e-health Literacy Scale (eHEALS). Results: A total of 167 pregnant women were included in the study; 45 (26.9%) had undergone an OGTT during their current pregnancy, while 122 (73.1%) had not. The mean total score on the eHEALS was 24.71 ± 8.58. No significant difference in eHEALS scores was observed between the OGTT-tested and OGTT-untested groups (25.04 ± 8.20 vs. 24.58 ± 8.75; Hodges–Lehmann median difference = 0.00, 95% CI: −3.00 to 4.00; p = 0.788; r = 0.027). In contrast, the proportion of women who had undergone an OGTT in a previous pregnancy was higher among those who underwent an OGTT in their current pregnancy (p < 0.001). eHEALS scores showed significant differences by age group (p = 0.019), education level (p < 0.001), and trimester (p = 0.014); the highest scores were observed in the ≥35 age group and among university graduates. eHEALS scores showed a positive correlation with age (rho = 0.240; p = 0.002) and a negative correlation with gestational week (rho = −0.225; p = 0.004). In the multiple linear regression model, having a college degree (B = 4.079; 95% CI: 0.244–7.915; p = 0.037) and trusting health information on the internet (B = 3.466; 95% CI: 0.421–6.511; p = 0.026) were independently associated with higher e-health literacy scores. Among the 45 pregnant women who underwent OGTT, 14 (31.1%) were diagnosed with GDM according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. In an exploratory subgroup analysis restricted to participants who underwent OGTT, eHEALS scores were higher among women diagnosed with GDM than among those without GDM (p = 0.042). Conclusions: In conclusion, in this sample, the level of e-health literacy did not differ significantly according to OGTT status at study enrollment. Full article

Background: The US has state variation in edentulism, commonly known as total tooth loss, in older adults. This paper identifies key social determinants of health (SDOH) associated with state differences in older adult edentulism that can be addressed with partnerships between dental providers and policymakers. Methods: Data was collected from three publicly available data sets, including County Health Rankings, provided by the University of Wisconsin Population Health Institute, the U.S. Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services (CMS). Results come from multiple regression analysis of panel data for all states and the District of Columbia for even years of 2012–2020. Results: A variety of SDOH, population health behaviors, and demographics are associated with older adult edentulism, with the largest effects for education and smoking. We have other variables of interest, and overall, our model explains over 80 percent of the variation. Conclusion: Policymaking in states should emphasize both education and smoking cessation programs for individuals. Future research may also consider the relationship between state-regulated dental insurance and dental practice location. States may also consider policies to encourage better dental professional training and incentives to address smoking cessation for patients. Full article

The National Survey of Children’s Health (NSCH) is widely used to estimate adverse childhood experiences (ACEs) in pediatric populations, but it only captures household adversity and economic hardship, omitting direct measures of emotional, physical, and sexual abuse present in the original ACE Study. We quantified this measurement gap by projecting unmeasured abuse domains onto the pooled 2023–2024 NSCH (n = 104,838) using parameter-bridging models estimated from the Behavioral Risk Factor Surveillance System (BRFSS; adults aged 18–49 years, n = 27,499) and the Youth Risk Behavior Surveillance System (YRBSS; adolescents, n = 11,016), both of which directly measure these abuse domains. Raw NSCH data classify 93.9% of infants under 12 months and 61.4% of adolescents aged 14–17 years as free of any ACEs; incorporating projected abuse domains reduces these figures to approximately 53–57% and 36–46%, respectively, depending on donor source. Conversely, the proportion with four or more ACEs—0.2% and 3.8% in the raw NSCH data for these two age groups—rises to approximately 2% and 7–14% once projected abuse is incorporated. These projected values represent model-based structural risk conditional on a child’s observed household environment, not direct measures of accumulated exposure or observed prevalence. Out-of-sample calibration testing indicates that projections from each donor source carry substantial asymmetric uncertainty: BRFSS-derived estimates over-predict and YRBSS-derived estimates under-predict emotional and sexual abuse relative to each source’s own directly observed rates. Despite this uncertainty, the direction and scale of the gap are consistent across donor sources and sensitivity analyses. NSCH-based ACE indices that omit direct abuse likely substantially understate true childhood adversity, with implications for screening, resource allocation, and cross-population comparisons relying on this widely used pediatric surveillance tool. Full article

Research on sustainable consumption has largely emphasized secular motivations, leaving the psychological role of spirituality/religiosity underexplored within Muslim societies. Addressing this gap, this study investigates the relationship between spirituality and sustainable consumption behaviors (SCBs) among Muslim consumers in Türkiye, with environmental and health consciousness examined as parallel mediating mechanisms. Data were collected from 414 adult Muslim consumers through an online survey and analyzed using confirmatory factor analysis and structural path analysis via Hayes’ PROCESS macro (Model 4). The empirical findings indicate that spirituality is significantly and positively associated with sustainable consumption behaviors both directly and indirectly. Environmental consciousness emerged as a numerically stronger mediating pathway than health consciousness in the relationship between spirituality and sustainable consumption. Notably, when both mediators are included in the model, the direct path from spirituality to sustainable consumption behaviors becomes non-significant, consistent with a full-mediation pattern in the estimated model, in line with the value–attitude–behavior hierarchy. These results suggest that spirituality’s association with consumption decisions is, within the estimated model, transmitted through intervening attitudinal states. The study suggests that sustainable consumption initiatives in Muslim contexts can be meaningfully strengthened by integrating eco-friendly practices with consumers’ underlying spiritual and religious values. Full article

Due to the intersection of factors such as cultural practices, socioeconomic context and living conditions, not only the educational experiences and outcomes, but also the environmental attitudes of Roma students are potentially different from those of non-Roma students; this suggests that the commonly implemented environmental education programs and recycling awareness campaigns may not be as effective as previously assumed. Yet, empirical research focusing on Roma students’ environmental behavior remains scarce; the aim of this study is to examine the environmental attitudes and recycling behavior of Roma students to inform the existing environmental education approaches and to detect the areas that require attention. Results based on quantitative data showed that most students (57.9%) did not recycle, while the availability of recycling infrastructure emerged as a decisive factor for the respondents who reported recycling. Irrespective of their recycling engagement, most students perceived that environmental protection contributes to quality of life and acknowledged the negative impact of waste on human health. Moreover, categorical regression analysis showed that recycling engagement was associated with parents’ occupation and the place of residence. Finally, despite the socioeconomic challenges, the findings indicate an overall positive attitude towards environmental protection, challenging widespread stereotypical assumptions about this ethnic group. Full article

Background/Objectives: Repetitive head impacts (RHI) from contact and collision sports have been associated with later-life cognitive and neurobehavioral impairments, as well as neurodegenerative conditions such as chronic traumatic encephalopathy (CTE). RHI-associated clinical sequelae among female former soccer players, specifically, are not well understood. This cross-sectional study aimed to examine the relationship of RHI exposure proxies (e.g., total years of soccer play, concussion history, highest level of play, and estimated cumulative heading frequency) with clinical measures (e.g., subjective cognitive complaints, objective cognitive performance, behavioral dysregulation, and depressive symptoms) among 2732 women, aged 40 years or above, enrolled in the Head Impact and Trauma Surveillance Study (HITSS), all of whom formerly played organized soccer. Methods: HITSS participants completed an online battery that elicited self-reported cognitive and behavioral complaints and depressive symptoms and that assessed cognitive performance via computerized tests. Multivariable linear regression models estimated associations between soccer-related RHI proxies and outcome measures, adjusting for age and education. Results: Among the former soccer players, longer duration of soccer play, higher level of play, greater estimated cumulative heading frequency, and concussion history were significantly associated with worse self-reported cognitive functioning, greater behavioral dysregulation, and elevated depressive symptom severity. Apart from a single association between concussion history and visual learning and episodic memory performance, we found no other associations between RHI proxies and objective cognitive test performance. Conclusions: Among middle-aged women who played organized soccer, cumulative RHI exposure corresponded to a higher degree of subjective cognitive complaints, worse behavioral functioning, and more severe depressive symptoms. Continued monitoring of this large cohort of female former soccer players offers a more comprehensive understanding of long-term health consequences of soccer play. Full article

Pediatric obesity is a chronic, multifactorial neuroendocrine disease in which disrupted gut–brain signaling, hypothalamic appetite regulation, adipose tissue dysfunction, and altered inter-organ communication sustain positive energy balance. Incretin-based therapies translate this biology into mechanism-based treatment, yet their developmental implications remain incompletely defined. This narrative review integrates evidence on GLP-1 and GIP receptor signaling with pediatric trial data and clinical implementation, with particular attention to developmental modifiers of gut–brain signaling and treatment during growth and puberty. We describe how GLP-1 receptor agonists act across central and peripheral tissues to reduce appetite, delay gastric emptying, and enhance glucose-dependent insulin secretion and examine the rationale for dual GIP/GLP-1 receptor agonism. Randomized pediatric trials demonstrate clinically meaningful BMI reduction with liraglutide and semaglutide, with the largest mean effect reported for semaglutide in adolescents; however, long-term effects on growth, puberty, bone health, body composition, and weight maintenance remain uncertain. Tirzepatide has shown greater weight-loss efficacy than selective GLP-1 receptor agonism in adults, but no randomized trial has evaluated it in pediatric obesity without diabetes. Incretin-based therapies should be integrated with nutritional, behavioral, psychological, and family-based care. Their future value will depend on durable efficacy, developmental safety, equitable access, and identification of patients most likely to benefit. Full article

Mental health problems represent a growing public health burden, particularly in middle-income countries where population-based evidence remains limited. This study aimed to analyze the risk profiles and heterogeneity of symptoms compatible with depression, suicidal ideation, and panic in the adult population of Paraguay. A cross-sectional study was conducted using nationally representative data from the 2022 STEPS survey. The presence of symptoms compatible with depression, panic, and suicidal ideation was assessed using self-reported dichotomous screening questions. Associations with sociodemographic, behavioral, and clinical variables were analyzed using multivariate models, estimating adjusted odds ratios (aOR) with 95% confidence intervals, and the analyses accounted for the complex sampling design. The prevalence of symptoms compatible with depression was 35.8%, panic 22.4%, and suicidal ideation 8.0%. Higher odds were observed in women, younger age groups, urban residents, and individuals reporting daily smoking as well as those with diabetes mellitus. Associations varied across outcomes, reflecting heterogeneous risk patterns. Symptoms compatible with depression, panic, and suicidal ideation are highly prevalent and unequally distributed in the adult population of Paraguay. These findings highlight the need for targeted prevention strategies, early detection, and the integration of mental health into public health and noncommunicable disease policies and management. Full article

Bipolar disorder is characterized by marked circadian and metabolic vulnerability, but direct evidence linking the timing of food intake to its course remains sparse. This structured narrative review examines chrono-nutritional disruption, including irregular meal timing, nocturnal eating, prolonged or inconsistent fasting, eating-window variability, and eating jet lag, as a potential behavioral correlate and mechanistic contributor to bipolar instability. PubMed/MEDLINE, Scopus, and Web of Science were searched for literature published from January 2000 to 30 June 2026, supplemented by predefined foundational studies. Evidence was organized as direct bipolar-specific, indirect human, or translational/preclinical. The strongest direct findings are cross-sectional associations involving night eating, eveningness, sleep disturbance, and functioning; bipolar-specific longitudinal and completed interventional evidence remains insufficient. Indirect human and experimental studies suggest that biologically mistimed eating can alter peripheral-clock entrainment, glucose–insulin regulation, cortisol rhythmicity, mitochondrial function, inflammatory signaling, and gut microbial rhythms. On this basis, we propose a hypothesis-generating chrono-metabolic model in which food timing may interact bidirectionally with sleep, mood state, medication effects, and metabolic health. Routine attention to nutritionally adequate and feasible meal regularity may be considered within broader monitoring of social rhythms, but it has not been shown independently to prevent relapse or improve mood outcomes. Time-restricted eating is investigational in bipolar disorder and should be evaluated only in carefully monitored research or specialist contexts. Prospective within-person studies and adequately powered trials are required before chrono-nutritional strategies can be regarded as evidence-based bipolar interventions. Full article

Chronic low back pain (CLBP) is a leading cause of disability and is characterized by marked clinical heterogeneity. Structural imaging remains fundamental for diagnosis and treatment planning, yet anatomical abnormalities alone do not fully explain differences in pain, disability, physical performance, or treatment response. Increasing evidence implicates paraspinal muscle morphology, composition, neuromuscular behavior, endurance, and physical conditioning as complementary determinants of spinal function. This narrative review synthesizes current evidence within the concept of spinal muscle health, defined here as a multidimensional, region-specific construct reflecting the structural, compositional, neuromuscular, and functional capacity of the muscles contributing to spinal control and load management. The construct is not proposed as a new diagnosis or as a substitute for established concepts such as sarcopenia, myosteatosis, or deconditioning; rather, it provides an integrative framework for considering complementary muscle-related domains that cannot be represented adequately by a single imaging or performance measure. We review muscle-specific and level-specific findings, measurement approaches, sources of heterogeneity, longitudinal and interventional evidence, and the interaction of muscle-related features with systemic and psychosocial factors. Current evidence supports associations between selected paraspinal muscle abnormalities and CLBP, particularly for multifidus composition, but findings vary substantially across muscles, spinal levels, populations, and measurement methods. Most evidence remains cross-sectional, and causal direction is uncertain. Clinical improvement after exercise may occur without consistent normalization of imaging-derived muscle composition. Accordingly, spinal muscle health is best regarded at present as a research and clinical reasoning framework rather than a validated diagnostic phenotype. Standardized measurement, longitudinal studies, and intervention trials linking changes in muscle-related parameters to patient-centered outcomes are required before routine clinical implementation. Full article

Acrylonitrile–butadiene rubber (NBR) is one of the most widely used elastomers in healthcare products owing to its excellent mechanical performance, chemical resistance, and durability. However, conventional sulfur vulcanization systems rely on accelerators such as tetramethylthiuram disulfide (TMTD), 2-mercaptobenzothiazole (MBT), and 1,3-diphenylguanidine (DPG), which are associated with allergenic reactions and potential toxicological concerns. The replacement of these substances with naturally derived compounds represents an attractive strategy for developing safer and more sustainable elastomeric materials. In this work, three naturally occurring amino acids, L-cystine, L-cysteine, and creatine, were investigated as alternative health-friendly sulfur vulcanization accelerators in NBR compounds filled with carbon black. Their influence on curing characteristics, crosslink density, morphology, mechanical performance, viscoelastic behavior, thermal stability, and thermo-oxidative aging resistance of NBR composites was systematically evaluated and compared with that of conventional accelerator systems. The amino acids effectively promoted sulfur crosslinking, although their activity depended strongly on molecular structure. Cystine and creatine exhibited the most promising performance, providing cure characteristics and mechanical properties comparable to those achieved with commercial accelerators while maintaining satisfactory thermal stability and aging resistance of carbon black-filled rubber composites. These findings demonstrate that naturally occurring amino acids constitute promising bio-derived and non-allergenic alternatives to conventional sulfur vulcanization accelerators and may contribute to the development of safer elastomeric materials with reduced reliance on potentially hazardous or allergenic substances. Full article

Continued use of fitness technology is often treated as a prerequisite for health behavior change, yet platform engagement and behavioral regulation may operate through different mechanisms. This four-wave panel study tested whether an engagement pathway in online fitness communities extends across the digital–physical boundary. After a priori quality screening, 506 Chinese adults who had used the community functions of a smart fitness platform, application, or wearable device within the previous three months and had access to a community activity venue were retained at T1, with 417 at T2, 377 at T3, and 394 at the outcome-only T4 wave. A unified full-information maximum-likelihood path system adjusted for prior outcomes and demographics and used 2000 participant-level bootstrap resamples. Perceived interaction at T1 predicted social presence ($\beta$ = 0.297), flow ($\beta$ = 0.355), and belonging ($\beta$ = 0.245) at T2, and all three independently predicted continuance intention at T3 ($\beta$s = 0.203–0.302). Continuance intention is the intention to keep using the community, not observed use. It showed no detectable association with physical activity at T4 once prior activity was controlled ($\beta$ = 0.016, 95% CI [−0.061, 0.082]), and the serial indirect effects were likewise undetectable. This did not follow from conditioning on the strong autoregressive path: the zero-order correlation between continuance intention and later activity was 0.068, while associations along the hypothesized within-platform chain ranged from 0.218 to 0.563. Missing-data, complete-case, log-transformed, and inverse-probability-weighted specifications converged. Exploratory equivalence testing rendered standardized effects of ±0.10 or larger implausible (p = 0.012) but not ±0.05, and a BIC approximation favored the model without the path (BF₀₁ = 17.81). Experiences that sustain digital continuity should not be assumed to produce physical activity spillover. Full article

Background: Nonfatal strangulation (NFS) is one of the most lethal forms of intimate partner violence (IPV) that is associated with increased risk of future homicide, yet it frequently goes unrecognized within healthcare settings. Black women experience disproportionately high rates of IPV while simultaneously facing structural barriers to healthcare access. Little research has examined how Black women survivors experience strangulation and navigate decisions about seeking care following NFS and other potentially lethal forms of IPV. Methods: This secondary qualitative analysis draws on interview data from 28 Black women survivors of IPV who participated in a larger community-engaged mixed-methods study conducted during the COVID-19 pandemic in an Upper Midwestern state. Of these, 17 (60.7%) both reported experiencing strangulation on the parent-study survey and described experiences consistent with nonfatal strangulation during their qualitative interviews and comprised the analytic sample for the present analysis. Guided by Black Feminist Thought, semi-structured interviews examined survivors’ experiences with violence, safety, help-seeking, and interactions with healthcare and social service systems. Data were analyzed using thematic analysis following Schensul and Schensul. Results: Three interconnected themes were identified. First, survivors described racism and anticipated discrimination as significant barriers to seeking healthcare following strangulation. Second, shame, stigma, and fear of judgment contributed to self-silencing and avoidance of formal services. Third, survivors described strangulation as a terrifying and potentially lethal form of violence occurring within broader histories of polyvictimization and cumulative trauma. Despite experiencing serious symptoms, many participants avoided healthcare because they feared retaliation from abusive partners, anticipated dismissive treatment, or believed healthcare systems would be unable to protect them. Together, these experiences illustrate how structural racism, institutional mistrust, and gendered violence intersect to shape healthcare decision-making. Conclusions: Findings suggest that barriers to care following strangulation extend beyond individual help-seeking behaviors and are deeply rooted in structural inequities. Improving outcomes for Black women survivors requires enhanced provider training on strangulation assessment, trauma- and violence-informed approaches, culturally responsive care, and healthcare system reforms that address racism, mistrust, and survivor safety. These findings have important implications for reducing disparities in IPV-related health outcomes and improving responses to high-lethality violence. Full article

Mental health concerns remain a major public health challenge, while artificial intelligence (AI)-based tools are increasingly used to obtain mental health-related information. However, little is known about the relationship between AI use and professional psychological help-seeking intentions, particularly among Saudi women. This cross-sectional study examined this association among 134 Saudi women aged 18 years and older recruited through social media platforms. An online questionnaire assessed AI use for mental health information, confidence in AI-provided information, perceived barriers to professional help-seeking, and professional psychological help-seeking intentions. Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression. AI use was negatively correlated with professional psychological help-seeking intentions (r = −0.45, p < 0.001). Multiple regression analysis showed that greater AI use and higher perceived barriers were associated with lower professional psychological help-seeking intentions, whereas confidence in AI-provided information was not significantly associated with help-seeking intentions. These findings provide preliminary evidence of an association between AI use and professional psychological help-seeking intentions but do not establish causality. Given the cross-sectional design and smaller-than-planned sample, the findings should be interpreted cautiously. Larger longitudinal studies are needed to clarify this relationship and examine actual help-seeking behavior. Full article