Background: Dysphagia is a common functional impairment in elderly populations, often leading to severe complications such as malnutrition and aspiration pneumonia, significantly increasing healthcare burdens. Currently, effective prognostic assessment tools are lacking. The absolute lymphocyte count (ALC), a biomarker reflecting immune-nutritional status, has potential predictive value in this context, though its role in dysphagia prognosis remains unclear. Methods: This retrospective cohort study included 253 dysphagic patients who received percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN) between 2014 and 2017. Five patients with missing ALC were excluded. Cox regression models assessed the association between ALC and mortality. ALC was analyzed as both continuous variable (using restriocted cubic splines) and categorical tertiles, with additional threshold analyses to assess non-linearity. Kaplan–Meier survival curves and subgroup analyses were also performed. Results: Lower ALC was associated with poorer nutritional status, higher inflammatory markers, and greater comorbidity burden. Higher ALC was independently associated with reduced mortality (adjusted HR: 0.60; 95% CI: 0.44–0.83; p = 0.002). Patients in the highest tertile had significantly better survival than those in the lowest (HR: 0.37; 95% CI: 0.23–0.59; P < 0.001). A non-linear threshold effect was identified at ALC = 1.899×10⁹/L (p for non-linearity = 0.009). Kaplan–Meier analysis confirmed improved survival with higher ALC (p < 0.0001). Subgroup analyses showed the protective effect of higher ALC was consistent across age, sex, BMI, PEG use, and comorbidity strata, with no significant interactions. Conclusions: ALC is an independent, non-linear predictor of mortality in older dysphagic patients and may aid clinical risk stratification across diverse patient subgroups.

This article presents a mathematical model designed to simulate the impact of targeted interventions aimed at preventing HIV transmission among female sex workers (FSWs) and their clients, while also analyzing their effects on the health of the general population. The compartmental model distinguishes between high-risk populations (FSWs and their clients) and low-risk populations (sexually active men and women in the general population), and links prevention efforts in high-risk groups to the evolution of the epidemic in the low-risk population. The fundamental properties of the model, such as the positivity of solutions and the boundedness of the system, have been verified, and the basic reproduction number R₀ has been calculated. Finally, the stability of the model was studied using Varga’s theorem and the Lyapunov method. Simulation results show that targeted prevention among FSWs and their clients reduces HIV incidence in the general population. This framework provides a valuable tool for guiding policymakers in the design of effective strategies to combat the epidemic, especially relevant in the context of suspension of USAID funding.

This study investigated adolescent students‟ knowledge of sexually transmitted infections (STIs) in eastern region schools for the deaf in Ghana. A descriptive survey design was used for the study. The researchers used HIV- The knowledge Questionnaire to assess the knowledge of respondents on STIs. Stratified sampling and simple random sampling techniques were employed. Proportional representation was used to select a sample of ninety-five (95) adolescent students with deafness from JHS2 and JHS3 between the ages of 13 and 24 years. Data were analyzed descriptively into frequencies and percentages. The results of the study indicated that the students knew of some of the types of STIs such as Gonorrhea, Syphilis, and HIV/AIDS. They, however, had inadequate knowledge of STIs such as Hepatitis B and Chlamydia.

Addressing adolescent and sexual reproductive healthcare is essential to providing young patients with the resources they need to navigate and empower themselves with. However, there is limited data about how often this occurs. Several studies have previously indicated that there is a large gap in accessing this gap in low-income neighborhoods. Our study aims to identify the establishment of gynecologic care among adolescent cisgender women and elucidate potential reasons for seeking or not seeking out care. We approached women in the pediatric emergency room that matched the inclusion criteria set out. Qualitative surveys were conducted until thematic saturation was reached and a cross-section study design was employed. Interviews were analyzed through modified ground theory. The study was conducted at the pediatric emergency department at University Hospital located in Newark, NJ. In 2018 estimates, the Newark population consists of 47.0% Black and 39.2% Hispanic or Latinos. Semi-structured interviews were conducted with 27 cisgendered, English-speaking females between ages 18 to 25 presenting to the pediatric emergency room who may or may not have previously established primary care with a gynecologist. Transcriptions were analyzed using modified grounded theory and themes were identified using inductive coding of patient interviews.

The principle of Undetectable = Untransmittable (U=U) posits that people living with the human immunodeficiency virus (HIV) who are able to achieve and maintain a viral load of <200 copies/mL by regularly taking antiretroviral drugs (ARVs) are considered virally suppressed and cannot transmit the HIV virus to other individuals through sex. This groundbreaking message has emerged as a key HIV prevention strategy for eliminating transmission risks and enhancing the quality of life of people living with HIV. This narrative review explores the clinical foundation of U=U, the level of awareness and acceptance of the message globally, and the psychosocial impact on people living with HIV. It has been discovered that this message minimizes stigma, improves mental health, promote treatment adherence and good disclosure behaviors among people living with HIV. Evidence has shown that despite the U=U revolution for HIV prevention, there are significant differences in awareness and acceptance of the message among different population groups. The challenges noted were poor communication by healthcare providers, limitations in the health system, and stigma issues. Nevertheless, the inclusion of U=U in mainstream HIV services has proven to increase awareness and enhance its adoption. The urgent need in the present review is to advocate for strategies to increase the equitable distribution of U=U to harness its full potential in public health.

Introduction: Stroke remains one of the leading causes of death and disability worldwide, with ischemic stroke accounting for most cases. Structural vascular factors such as carotid artery tortuosity have gained attention as potential markers of vascular aging and cerebrovascular risk. The carotid tortuosity index (CTI), defined as the ratio of actual vessel length to the straight-line distance between two fixed points, provides a quantitative measure of arterial curvature. A CTI value of ≥1.2 indicates pathological tortuosity. Although noninvasive modalities such as CTA and MRA are frequently used, digital subtraction angiography (DSA) remains the gold standard for evaluating vessel geometry due to its higher spatial precision. This study aimed to determine the association of age, sex, and hypertension with CTI measured by DSA. Methods: A cross-sectional study was conducted from November to December 2025 at the Neurointervention Clinic, RS Pelni Jakarta, Indonesia, involving 61 adult patients who underwent carotid DSA. CTI was measured bilaterally using digital imaging software and classified as <1.2 (non-tortuous) or ≥1.2 (tortuous). Clinical data, including age, sex, and hypertension status, were collected from medical records and analyzed using bivariate tests. Results: Older age (≥65 years), female sex, and hypertension were significantly associated with higher CTI values on both carotid sides. Tortuosity was more common among hypertensive patients and elderly females, indicating the influence of vascular remodeling and chronic hemodynamic stress. Conclusion: Carotid tortuosity increases with age, hypertension, and female sex. DSA-based CTI measurement provides a reliable and precise approach for evaluating vascular changes associated with cerebrovascular risk.

Background: Resting-state functional MRI (rsfMRI) provides insights into large-scale brain network organization associated with cognitive control, emotion regulation, and attentional processes. The ventral attention network (VAN) is a key salience-driven network that supports attentional re-orienting to behaviorally relevant stimuli. However, little is known about how VAN resting state functional connectivity varies by demographic, socioeconomic, psychosocial, and behavioral factors during early adolescence. Objective: To examine associations between VAN rsfMRI connectivity and multiple demographic, socioeconomic, psychosocial, and behavioral characteristics. Methods: Data came from the baseline and early follow-up waves of the Adolescent Brain Cognitive Development (ABCD) Study. The analytic sample included youth with high-quality baseline rsfMRI data and complete socioeconomic and psychosocial measures. The primary outcome was mean resting-state functional connectivity within the VAN across subcortical and cortical regions of interest (ROIs). Bivariate correlations were computed between VAN connectivity and demographic (age, sex, puberty, race/ethnicity), socioeconomic (income, parental education, marital status, neighborhood income), psychosocial (trauma, discrimination, financial difficulty), trait (impulsivity), and behavioral variables (body mass index, depression, suicide, prodromal symptoms, and substance use). Unadjusted bivariate correlations and adjusted logistic regressions were used for data analysis. Results: VAN connectivity showed small but significant correlations with multiple contextual factors. Higher household income, parental education, and neighborhood affluence were associated with greater connectivity, whereas Black race and Hispanic ethnicity were related to lower connectivity. Youth reporting higher discrimination and financial difficulty exhibited weaker VAN connectivity. Greater VAN connectivity was negatively associated with impulsive reward-driven trait (drive), prodromal symptoms, BMI, and marijuana and alcohol use. Associations between VAN connectivity and suicide, depression, marijuana use, and alcohol use remained significant in age and sex adjusted models. Conclusions: VAN connectivity reflects subtle neural correlates of socioeconomic and psychosocial context in early adolescence. Our results underscore the importance of integrating structural and contextual factors in interpreting brain-behavior associations across diverse populations. These findings are suggestive of stable socioeconomic and psychosocial correlates of network efficiency.

Background: Adolescence is a critical developmental stage for the emergence of major depressive disorder (MDD). Structural and diffusion neuroimaging studies have highlighted the anterior cingulate cortex (ACC) as a key region implicated in emotion regulation, stress reactivity, and mood processing. However, few studies have examined whether microstructural characteristics of the ACC, reflected by mean diffusivity (MD) within gray matter–white matter (GM–WM) contrast regions, are associated with depression in early adolescence. Objective: To examine whether mean diffusivity (MD) within the GM–WM contrast of the left caudal anterior cingulate cortex (ACC) is associated with a past diagnosis of MDD among adolescents in the Adolescent Brain Cognitive Development (ABCD) Study, after accounting for demographic, socioeconomic, and adversity-related factors. Methods: Data were drawn from adolescents with diffusion MRI–derived mean diffusivity measures and diagnostics. The independent variable was mean diffusivity (MD) of the GM–WM contrast in the left caudal ACC. The primary outcome was past MDD diagnosis based on structured psychiatric assessments. Covariates included age, sex, socioeconomic status (SES), and exposure to adverse childhood experiences (ACEs). Logistic regression models tested the association between ACC MD and past MDD. A secondary model evaluated the relationship between ACC MD and past suicide attempt. Results: Mean diffusivity of the left caudal ACC was associated with the odds of past MDD, independent of age, sex, SES, and adversity exposure. In contrast, ACC mean diffusivity was not associated with a history of suicide attempt. Conclusions: Increased mean diffusivity in the caudal ACC may indicate microstructural alterations associated with depressive vulnerability in adolescence. ACC tissue integrity may serve as a sensitive neural correlate of early-onset depression.

Background: Sexual and gender minority (SGM) youth are at elevated risk for adverse mental health and substance use outcomes. Stressors such as family conflict, discrimination, and trauma have been suggested as possible mediators of these disparities. Aims: This study examined whether family conflict, discrimination, and trauma mediate the associations between SGM identity and adverse outcomes, including suicide attempt, major depressive disorder (MDD), nicotine use, and marijuana use. Methods: Participants were children from the Adolescent Brain Cognitive Development (ABCD) study. SGM identity was reported at baseline, while outcomes included past MDD and suicide attempts as well as future nicotine and marijuana use. Structural equation modeling (SEM) was used to test both direct and indirect pathways linking SGM identity to mental health and behavioral outcomes. Results: No significant mediation was found through family conflict, discrimination, or trauma. Instead, effects of SGM identity were primarily direct: SGM youth had higher odds of past suicide attempts and MDD, as well as future marijuana use, but not future nicotine use. Stressor variables, however, were independently associated with outcomes. Discrimination predicted all outcomes; trauma was positively associated with suicide, nicotine, and marijuana use but not MDD; and family conflict predicted all outcomes except MDD. Conclusion: Family conflict, discrimination, and trauma did not mediate SGM disparities in mental health and substance use, but each emerged as an independent predictor of risk. These findings highlight the complexity of mechanisms underlying SGM-related disparities and suggest the need for future research to explore additional pathways and contextual influences.