Search Results (1,589)

Screening for spinal muscular atrophy (SMA) was adopted by all US state newborn screening programs between 2018 and 2024; by the end of 2022, 48 states were screening for SMA. We assessed trends in health insurance records of SMA diagnoses to quantify improvements in the timeliness of SMA identification following the adoption of screening. We used nationally representative Medicaid claims data for approximately half of US births covered by public insurance and a convenience sample of employer-sponsored health plans. We analyzed records for birth cohorts with at least 1 full year of follow-up (i.e., through the end of the following calendar year). For 2017 births, 1.3 per 100,000 infants had SMA codes first recorded by 1 month of age; this increased to 6.6 per 100,000 among publicly insured newborns born in 2022. The rollout of SMA newborn screening across US states was also followed by improvements in the timely detection of SMA. The proportion of infants with SMA detected by 1 month increased from 18% in 2017 to 61% in 2021 and is projected to reach 75% in 2022. Growth in timely detection was even greater in the employer-insured sample. Timely diagnosis of SMA can enable the initiation of treatment prior to the irreversible loss of motor function. 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

National forest inventory (NFI) data are often collected over a 5-year or 10-year period, meaning some are already outdated by the time the complete results are available. This study assesses changes in growing stock volume (GSV, m³/ha) using hybrid estimation supported by Sentinel-2 metrics. It focuses on constructing a model for estimating the change in GSV using NFI plot data and bitemporal remotely sensed auxiliary data, where such data are available for both points in time ($t_1\mathrm{a}\mathrm{n}\mathrm{d}{t}_2$), and unitemporal data for which remotely sensed auxiliary data are available only for $t_2$. A machine-learning approach based on the random forests (RFs) algorithm was used to predict plot-level GSV change. The original data for $t_2$ and $t_3$ were first used to evaluate the accuracy of the change prediction at the plot level, after which the predicted changes were applied to update the plot-level GSV to predict plot-level GSV at $t_3$, which was then assessed against the observed plot-level GSV at $t_3$. Predicted change was assessed with the Mean Average Annual Volume Change (MAAVC) method, representing the average annual change in GSV over a given period. The results indicate that at the plot level, the bitemporal model produced GSV change estimates with low accuracy (R² = 0.26, RMSE = 4.06 m³/ha, and MAE = 3.26 m³/ha), while the unitemporal model achieved R² = 0.40, RMSE = 3.64 m³/ha, and MAE = 2.65 m³/ha when predicting the $t_1-t_2$ GSV change. Using the predicted change to predict plot-level GSV at $t_3$, the MAAVC based on field data yielded R² = 0.91 and RMSE = 45.11 m³/ha, while the RS unitemporal yielded R² = 0.73 and RMSE = 83.79 m³/ha, and the bitemporal yielded R² = 0.72 and RMSE = 83.61 m³/ha. Mean population GSV at $t_3$, estimated from the RF models, was 254.61 and 255.19 m³/ha for the unitemporal and bitemporal models, respectively. Monte Carlo simulations with a novel stopping criterion were then used to estimate total standard errors, which were 10.48 and 10.40 m³/ha for the unitemporal and bitemporal models, respectively, incorporating both model prediction uncertainty and sampling variability. A test of significance revealed a significant effect of the proposed method on the estimated mean population GSV at $t_3$ (p < 0.001). Conclusively, MAAVC and spatiotemporal RS methods provide a robust framework for predicting GSV at $t_3$ using Estonian NFI and Sentinel-2 data. Full article

Background/Objectives: This study focused on the sub-national regional heterogeneity in childhood obesity prevalence across five countries in south-east Europe and the correlation between this heterogeneity and socioeconomic differences. Previous studies have mainly observed national or cross-national data but this study used a sub-national regional approach that may be beneficial in the further investigation of childhood obesity. Methods: Nationally representative samples of children from Croatia, Montenegro, North Macedonia, Serbia and Slovenia were selected using the COSI methodology and used to estimate regional childhood obesity prevalence values. The Sub-national Human Development Database provided data on the Sub-national Human Development Index (SHDI). The spatial autocorrelation analysis of childhood obesity prevalence in sub-national regions was performed and its association with sub-national human development was tested with an ordinary least squares regression model. Results: This study found statistically significant differences in childhood obesity prevalence across sub-national regions in Croatia, Slovenia and Serbia, while no such differences were observed in North Macedonia and Montenegro. There was moderate clustering in childhood obesity rates (Moran’s I = 0.337). The results indicated a significant negative association between SHDI and childhood obesity prevalence across the 48 regions (β = −66.63, p < 0.001). Conclusions: Future public health efforts should take into consideration regional differences in childhood obesity prevalence, and more targeted research is essential for understanding the mechanisms of resilience and vulnerability on a sub-national level. Full article

Digital victimization has been increasingly linked to adverse mental health outcomes during adolescence; however, less is known about its association with depressive symptoms when accounting for other forms of peer victimization and underlying psychological mechanisms. This study examined the relationship between lifetime digital victimization and depressive symptoms in a nationally representative sample of Chilean adolescents (N = 11,439) and tested the mediating role of self-esteem. Lifetime exposure to digital victimization, emotional bullying, and harassment were assessed using dichotomous indicators. Depressive symptoms were measured with the Birleson Depression Self-Rating Scale, and self-esteem with the Rosenberg Self-Esteem Scale. Overall, 27.2% of Chilean adolescents reported lifetime digital victimization. The proposed model showed an adequate fit to the data (CFI = 0.992; TLI = 0.942; RMSEA = 0.065; SRMR = 0.012). Lifetime exposure to digital victimization was directly associated with higher depressive symptoms and lower self-esteem, and self-esteem significantly mediated this association after controlling for age and in-person peer victimization. These findings highlight the importance of self-esteem as a key mechanism linking digital victimization and depressive symptoms in adolescents. Full article

Background: The literature shows a strong association between level of education and the risk of developing Coronary Heart Disease (CHD). However, the extent to which this association attenuates after accounting for sociodemographic characteristics and cardiovascular risk factors in a survey-weighted national sample warrants further evaluation. Objective: We aimed to assess the association between educational attainment and angina and myocardial infarction (MI) across age groups in a nationally representative U.S. sample. Methods: The study analyzed 2021 Behavioral Risk Factor Surveillance System (BRFSS) data from 438,693 adults, a nationally representative telephone survey of U.S. adults. The dataset was accessed from the Centers for Disease Control and Prevention BRFSS website in February 2023. Angina and MI were identified based on self-reported physician diagnoses. Analyses included adults aged 18 years and older with no missing data for education and outcomes. Results: In survey-weighted analyses with college graduates as the reference group, lower educational attainment was associated with higher odds of angina and MI, compared with college graduates. In the fully adjusted model (Model 2), attending high school was associated with higher odds of angina (OR 1.439) and MI (OR 2.390). Conclusions: Lower educational attainment is associated with higher odds of angina and MI, particularly among younger adults. Although the magnitude of these associations was attenuated after adjustment for sociodemographic and cardiovascular risk factors, the persistence of the association underscores the importance of considering educational disparities in cardiovascular risk assessment. Full article

Feminist identification has become an increasingly salient yet contested collective identity in contemporary societies marked by political polarization. This study examines how affective, perceptual, and ideological dimensions are associated with feminist identification in Spain, using data from a nationally representative sample of adults (N = 4005). Structural equation modeling was used to estimate the relationships between sympathy for progressive social movements, perceived gender discrimination, political ideology (understood as left–right political alignment), and feminist identification, with gender-stratified models estimated separately for women and men. Results indicate that affective alignment with progressive social movements and recognition of gender discrimination are consistently associated with feminist identification in both gender-stratified models. Political ideology shows a more limited pattern, emerging as significantly associated with feminist identification in the model estimated for women but not in the model estimated for men. Overall, the findings suggest that feminist identification in polarized contexts is anchored primarily in affective resonance and perceived injustice, while ideological positioning operates more conditionally, highlighting distinct relational configurations across the gender-stratified models in relation to feminist identification. Full article

The rapid development of rural and peri-urban areas increases the demand for decentralized wastewater treatment systems. Small wastewater treatment plants (SWTPs) with a capacity below 2000 PE are becoming an important element of local water protection and circular-economy strategies, yet clear guidelines for selecting appropriate technologies are still lacking. This study analyzes the criteria used in decision-making for SWTPs from a multi-stakeholder perspective and evaluates the relative importance of technical, economic, environmental and social factors. The research was conducted in Poland and included a survey of 130 respondents representing six stakeholder groups (officials, operators, designers, contractors, scientists and residents). Respondents allocated weights to four main groups of criteria and assessed eleven detailed parameters on a 1–10 scale. The data were analyzed using descriptive statistics, the Kolmogorov–Smirnov test with the Lilliefors correction to verify distribution assumptions, and the Kruskal–Wallis test to examine differences between stakeholder groups. The results show a consistent hierarchy of criteria, with technical reliability, treatment efficiency and operating costs ranked as the most important factors. Social and environmental aspects were assessed as relevant but secondary. Only minor differences between stakeholder groups were observed. The study highlights the need for integrated, multicriteria approaches in SWTP planning, particularly in dispersed rural areas. The findings may support local authorities, designers and investors in technology selection. The research is limited by the non-probability sampling strategy, the national scope of the dataset and the cross-sectional character of the survey. Full article

Background/Objectives: As part of the European Union’s harmonized monitoring framework, Belgium conducts antimicrobial resistance (AMR) monitoring in commensal bacteria from livestock. The aim of this study was to conduct a cost analysis of the national AMR monitoring in livestock, and to explore sampling size scenarios in relation to their associated costs and statistical performance (power and confidence) of monitoring. Methods: To our knowledge, this is the first published cost evaluation using unit cost aggregation of a national AMR monitoring program in animals. Results: The testing of the different sample size scenarios showed that if the sample size increases, the costs increase linearly. A sample size increase of 10 samples/isolates (e.g., from 170 to 180) can increase the yearly total costs per animal species by 5.2%. Moreover, the testing of the different scenarios showed that if the sample size increases, the power and the confidence level also increase, providing a higher level of trust in the results of the monitoring program. The highest total monitoring costs per animal category were estimated for fattening pigs, broilers and veal calves (over 18% of total costs each, using 2024 data). Among the various monitoring activities, antimicrobial susceptibility testing emerged as the costliest component, representing 50.2% of the total monitoring costs. Conclusions: The approach presented allows it to be used by other countries aiming to estimate the cost of their national AMR monitoring in animals or other similar activities. This economic and scenario testing analysis can be used to suggest informed suggestions to improve AMR monitoring in animals. Full article

Background/Objectives: The present study explored the extent to which children’s executive function (EF) mediates the relationship between maternal warm parenting and children’s problem behaviors during the early school-age years. Methods: Using data from a nationally representative sample of 1516 mother–child dyads participating in the Panel Study on Korean Children, the analysis drew on parent-reported measures collected through standardized questionnaires. Results: Structural equation modeling indicated that warm, responsive maternal parenting contributed to lower levels of children’s problem behaviors both directly and indirectly by fostering stronger EF skills. Conclusions: The findings highlight the developmental importance of warm parenting practices and identify children’s EF as a central mechanism through which early caregiving environments promote behavioral adjustment. Full article

Background: Administrative data help managers monitor and manage health care enrollees’ health. Of the few available administrative measures of psychiatric illness severity, however, most either commingle sociodemographics and medical comorbidities or lack ordinal properties. Objective: To assess construct, concurrent, and predictive validity of a novel, 6-item, administrative measure of psychiatric severity, the Manifestations of Psychiatric Severity Index (MoPSI). Methods: A panel study of 960 gender-stratified, nationally representative, post-9/11 US Veterans with pending disability claims for posttraumatic stress disorder (PTSD). MoPSI scoring was based on the joint probability density (JPD) method and a JPD linear approximation. Results: The JPD MoPSI score and its linear approximated score had a correlation of 0.999. Relative to their counterparts, unmarried Veterans, Veterans with low income, and Veterans with serious mental illness or PTSD had higher MoPSI scores (Ps: <0.0001–0.03). Higher MoPSI scores predicted cigarette and street drug use and PTSD and depression/anxiety symptoms six months later, and disability award approximately 1 year later (Ps: 0.01–0.02). Conclusions: In this sample, the MoPSI had evidence of construct, concurrent, and predictive validity. Full article

Background: Canada’s cervical cancer elimination plan is challenged by suboptimal screening participation and rising incidence of cervical cancer over the past decade. Cytology, the primary cervical screening method in Canada, is being replaced with HPV testing, which offers superior sensitivity for detecting pre-cancerous lesions and supports initiating screening at age 25 or older and extending screening intervals to five years. Research has shown that women’s insufficient knowledge and negative attitudes toward HPV screening represent a significant barrier to screening uptake. Methods: We conducted a web-based national survey using Best–Worst Scaling (trade off utilities) to quantify women’s preferences for screening test modality, age of initiation, and screening intervals. We also assessed preferences for information sources, provider type, and communication methods. Underscreened individuals were oversampled. Results: Among adequately screened (N = 1778) and underscreened (N = 1570) individuals, preferences favoured co-testing (cytology plus HPV testing), initiating screening at age 21, and three-year screening intervals. Underscreened participants showed relatively higher preference for HPV self-sampling, and as opposed to adequately screened participants, preferred screening by a gynecologist rather than a family physician. Across groups, participants preferred receiving screening-related information and communication by email over postal mail. Conclusions: The misalignment between women’s preferences and current HPV test-based screening implementation plans requires immediate education interventions and modernized, user-preferred communication channels for cervical screening-eligible individuals in Canada. Full article

Past research has consistently demonstrated the negative effects of interpersonal mistreatment on student experiences by employing retrospective studies; however, little is known about the daily effects that could lead to career derailment. The present study advances evidence of the consequences of experiencing multiple forms of interpersonal mistreatment, including sexual harassment, racial harassment and microaggressions, and incivility (collectively labeled HARM) by employing an experience sampling methodology (ESM) to estimate the immediate impact of HARM on career-relevant attitudes among a sample of 202 biomedical health trainees (mentees) funded by a National Institutes of Health fellowship. Grounded in Affective Events Theory, we found that mentees’ daily experiences of HARM were associated with an immediate degradation of their attitudes toward their training program mediated by negative affect. Being racially isolated in a lab or having a racially different mentor increased the prevalence of HARM; moreover, accounting for negative affect, experiences of HARM were positively associated with program attitudes for mentees who were racially well-represented, suggesting that majority status may buffer the negative impact of HARM on attitudes. Understanding these dynamics provides insight into the importance of assessing and addressing daily experiences of mistreatment among graduate and postdoctoral trainees. Full article

Background/Objectives: The global population is ageing rapidly, with projections indicating that there will be over two billion individuals aged ≥60 years by 2050. Sarcopenia and frailty are major age-related syndromes associated with loss of muscle mass, reduced strength, and increased vulnerability, for which adequate protein and amino acid intake are key preventive factors. However, nationally representative data on dietary amino acid intakes and sources among older adults are lacking, particularly in Europe. Methods: This study aimed to address this gap by updating the Irish Food Composition Database (IFCD) (2011) with amino acid composition data and estimating amino acid intakes and dietary sources in older adults in Ireland (≥65 years) using data from the National Adult Nutrition Survey (2008–2010; n = 226). Results: Mean total amino acid intake was 76.2 g/day (1.0 g/kg body weight/day). Intakes of all essential amino acids were above the US Institute of Medicine (IOM) recommendations, with no significant differences observed between sexes or age groups (65–74 y, 75+ y). ‘Meat and meat dishes’ were the principal contributors to amino acid intake (28–47%), followed by ‘breads and rolls’, ‘milk and yoghurt’, and ‘fish and fish dishes’. Conclusions: This study provides the first nationally representative estimates of amino acid intakes in older adults in Europe, establishing a baseline for future dietary surveillance and informing protein quality assessment amid dietary transitions toward plant-based foods. Full article

Withcontinuous advancements in remote sensing technology, object detection in remote sensing images has emerged as a critical research direction in maritime surveillance, port management, and national defense. Among these applications, ship detection is a key task. Due to the fact that ships in images typically exhibit arbitrary rotations, multi-scale distributions, and complex backgrounds, conventional detection methods based on horizontal or rotated bounding boxes often fail to adequately capture the fine-grained information of the targets, thereby compromising detection accuracy. This paper proposes the Dense Representative Points-Guided Rotated-Ship Detection (DenseRRSD) method. The proposed approach represents ship objects using dense representative points (RepPoints) to effectively capture local semantic information, thereby avoiding the background noise issues associated with traditional rectangular bounding box representations. To further enhance detection accuracy, an edge region sampling strategy is devised to uniformly sample RepPoints from critical ship parts, and a Weighted Residual Feature Pyramid Network (WRFPN) is introduced to efficiently fuse the multi-scale features through residual connections and learnable weights. In addition, a Weighted Chamfer Loss (WCL) combined with a staged localization loss strategy is employed to progressively refine localization from coarse to fine stages. Experimental results on both the HRSC2016 dataset and the newly constructed DOTA-SHIP dataset demonstrate that DenseRRSD achieves state-of-the-art detection accuracy, with mean Average Precision (mAP) scores of 91.2% and 83.2%, respectively, significantly outperforming existing methods. These results verify the effectiveness and robustness of the proposed approach in rotated-ship detection under diverse conditions. Full article