To examine the association of age, gender, and race/ethnicity with depression stigma, barriers to care, and treatment-seeking intentions among adolescents. 1127 US adolescents (aged 14-18) recruited via CloudResearch, a crowdsourcing platform, completed online measures of depression stigma, treatment-seeking intentions and barriers to care. Significant differences were found across gender groups in depression stigma (F(2,1124)=78.05, p < .001), barriers to care (F(2,1124)=5.96, p=.003) and treatment-seeking intentions (F(2,1124)=53.71, p<.001). Boys reported the highest depression stigma and lowest treatment-seeking intentions compared to girls and TGD youth (stigma: boys vs. TGD, t = 13.5, p < .001, d = 1.21; treatment-seeking: boys vs. TGD, t = 10.19, p < .001, d = 1.02). TGD youth endorsed the highest barriers to care (boys vs. TGD, t=-3.07, p = .007, d = 0.37). Significant differences were also found across racial/ethnic groups in depression stigma (F(3,1123)=11.49, p < .001) and treatment-seeking intentions (F(3,1123)=4.11, p = .007). Older adolescents reported higher treatment-seeking intentions (t=-2.99, p=.003) and higher barriers to care (t=-2.92, p=.004) than younger ones. Depression stigma, barriers to care, and treatment-seeking intentions vary significantly across different demographic groups. Tailored interventions addressing specific subgroup needs are therefore essential. Crowdsourcing offered results comparable to traditional recruitment strategies, alongside large-scale sample recruitment with hard-to-reach populations such as TGD youth. The trial was prospectively registered with clinicaltrials.gov (NCT06222528).
The COVID-19 pandemic and its associated lockdowns had a detrimental impact on adolescent mental health, exacerbating levels of emotional difficulties that were already increasing in this population. The course of these difficulties after lockdown protocols ended, however, is not fully understood. Further, the effects of early life stress (ELS) and biological sex on mental health during and following the pandemic are also not clear. This study leverages data from a longitudinal project examining adolescent mental health that predates the pandemic. Internalizing problems were assessed in 222 children (58.6% females) ages 9-13 years at recruitment (baseline; 2013-2016) and at four more timepoints, each approximately two years apart. Participants also completed an interview assessing ELS at baseline. We assessed internalizing problems across each phase of the pandemic (i.e., pre-COVID, during the COVID lockdown, after reopening) as a function of ELS and biological sex. We found that whereas unpredictability-related ELS was associated with internalizing problems in girls across all COVID phases, the association between threat-related ELS and internalizing problems from pre-lockdown to post-reopening decreased in girls and increased in boys. Further, threat-related ELS was associated with post-reopening internalizing problems in boys through lower adaptability. Sensitivity analysis showed that the attenuation of the threat-internalizing association in girls and strengthening of the association in boys was not due to aging. Collectively, these findings suggest that there are sex- and ELS-specific changes in psychological functioning in relation to the pandemic. Further research is needed to better understand mechanisms that foster risk or resilience following stress exposure.
To evaluate whether bullying, physical aggression, and peer rejection cluster among Brazilian adolescent students and whether aggressive-behavior cluster pairs are associated with leisure-time physical activity according to sex. This cross-sectional study analyzed data from PeNSE 2019, including 157,921 adolescents aged 13 to 17 years. Bullying, physical aggression, and rejection in the previous 30 days were dichotomized as present or absent. Clustering was assessed using observed/expected ratios (O/E) and 99% confidence intervals. Logistic regression models estimated associations between aggressive-behavior cluster pairs and sufficient leisure-time physical activity, defined as ≥300 min/week. Bullying, physical aggression, and rejection were reported by 39.41%, 14.60%, and 26.69% of adolescents, respectively. The simultaneous occurrence of all three behaviors exceeded expectation in the overall sample (O/E = 127.69), boys (O/E = 122.05), and girls (O/E = 170.23). In boys, physical aggression plus rejection was associated with lower odds of sufficient leisure-time physical activity (aOR = 0.99, 99%CI: 0.97-0.99). In girls, physical aggression plus rejection (aOR = 0.88, 99%CI: 0.86-0.89), bullying plus rejection (aOR = 0.97, 99%CI: 0.96-0.98), and bullying plus physical aggression (aOR = 0.98, 99%CI: 0.97-0.99) were associated with lower odds of sufficient leisure-time physical activity. Aggressive behaviors clustered among Brazilian adolescents and were associated with leisure-time physical activity, particularly among girls. Because this study was cross-sectional and several effect sizes were small, findings should be interpreted as associations rather than causal effects.
To investigate whether the increased birth size linked to frozen-thawed embryo transfer (FET) compared with fresh embryo transfer (FreET) and natural conception persists at 12 years of age. This multicenter prospective cohort study included singleton children born between 2008 and 2009 at 23 JISART-affiliated facilities in Japan. Children conceived via assisted reproductive technology (ART) (FreET and FET) were compared with those conceived naturally by couples who are infertile without ART. Overweight and obesity were defined according to the International Obesity Task Force criteria (overweight: body mass index [BMI] ≥ 23, obesity: BMI ≥ 27). Analyses were performed using analysis of covariance and multiple regression, adjusting for gestational age, maternal age, parity, small/large for gestational age (SGA/LGA), parental body size, education, and infertility duration. Logistic regression was used to assess the risk of overweight/obesity. Of 6,434 children initially contacted, 3,002 eligible singletons (1,115 FreET, 1,341 FET, and 546 non-ART) were included in the birth cohort, with 671 (331 boys, 340 girls) finally enrolled. The adjusted mean weight, height, and BMI did not differ among the FreET, FET, and non-ART groups. The odds ratios for overweight and obesity also showed no significant group differences. Parental body size was associated with child anthropometry, and LGA at birth independently predicted a larger body size and being overweight in boys. At 12  years, body size and overweight risk were comparable among the three conception groups (FreET, FET, and non-ART groups). We found no statistical evidence that the FET-associated increase in birth size persisted into early adolescence. Continued follow-up during adolescence is warranted.
Undescended testes (UDT) are a common congenital disorder in boys, yet delays in diagnosis and referral still occur, especially in low-and middle-income countries where access to specialist care may vary. Our study aimed to examine the accuracy and timing of referrals of UDT to paediatric surgical services across different healthcare settings and to evaluate knowledge regarding UDT among paediatric and family medicine trainees. A prospective cohort study was conducted from January to December 2022 involving patients referred for UDT at three paediatric surgical centres representing urban and rural health-system structures. Diagnostic accuracy was confirmed by paediatric surgeons. Referral beyond 12 months of age was considered delayed. An anonymised survey assessing knowledge of diagnosis and management of UDT was distributed to paediatric and family medicine trainees. Two hundred and one boys were referred for UDT. Median age at referral was 8 months (1-24), and median age at review was 14 months (6-26). Most referrals were from community clinics (42%), followed by paediatricians (31%), in-hospital (18%), and private general practitioners (GP, 9%). 50% were confirmed UDT. Diagnostic accuracy was significantly related to patient age < 1 year (p = 0.001), unilaterality (p < 0.001), impalpability (p = 0.037), and UDT identified at birth (p = 0.004). Our survey showed that 22% of trainees would refer after 12 months of age and another 12% would refer after obtaining imaging. Delayed UDT referrals remain and may reflect clinician knowledge gaps and differences in referral pathways across a geographically extensive and heterogeneous healthcare system. Targeted education among referring healthcare professionals and locally tailored referral pathways may improve referral timeliness and accuracy.
School active commuting is a key behavior to promote physical activity in children, yet limited evidence exists in Chile. This study examined its prevalence and associated factors among Chilean schoolchildren. A cross-sectional study was conducted using data from the Chilean National Physical Activity and Sports Habits Survey, including a subsample of 1137 children aged 5-10 years derived from a nationally representative survey. School active commuting was defined as the dependent variable. Independent variables included sex, area of residence, socioeconomic status (SES), caregiver's education, self-rated health, leisure activities, and home-based physical or sedentary behaviors. About one in three children (35%) reported commuting actively to school. Boys showed higher participation than girls, and active commuting was more common among children from lower SES households and among those whose caregivers had lower educational attainment. Children who preferred physical activities during leisure time were also more likely to commute actively. No differences were observed by geographic area, self-rated health, or home-based activity levels. Schools and local communities should work together to ensure safe, equitable, and accessible environments that support active commuting. Active commuting remains low in Chilean children, emphasizing the need for multisectoral policies to promote physical activity and reduce inequalities.
To investigate the genetic basis of early-onset systemic lupus erythematosus (EOSLE) in a large Indian pediatric SLE (pSLE) cohort. This prospective observational study investigated monogenic causes in 97 of 365 pSLE patients. Inclusion criteria for the study comprised patients with EOSLE (age ≤8 years) and/or those with a clinical suspicion of monogenic lupus. Monogenic cause was suspected in 97 patients. Genetic screening using targeted next-generation sequencing on the Ion S5 system in 55 of 97 patients [complement defect gene panel in 28 and type 1 interferonopathy gene Interferon (IFN)+ Adaptive Immunity panel in 27] was performed. The remaining 42 patients underwent whole-exome sequencing (WES). Among 97 patients, 22 (22.68%; 11 boys and 11 girls) were found to carry pathogenic variants. Median symptom onset in monogenic cases was 2 years (range: 2 months to 9 years). Monogenic lupus was identified in both EOSLE and older children with strong clinical suspicion. EOSLE patients showed a higher diagnostic yield (28.4%) compared with older children (4.4%). Consanguinity was reported in 7/22 (31.8%) patients. Variants were found in C1QA (n = 7), C1QC (n = 2), C1QB (n = 1), C1R (n = 1), C3 (n = 2), ACP5 (n = 2), STING1, DNASE2, ADAR, TREX1, DNASE1L3, PEPD and SLC7A7 (each n = 1). Monogenic causes were found in at least 6.1% of the overall cohort of pSLE and in 22.7% of genetically screened cases, with the highest yield in EOSLE (28.4%). C1QA was the most common single-gene defect (7.2%). These findings underscore the value of genetic testing in pSLE, especially those with EOSLE or suggestive clinical features.
Recent studies have indicated that heavy metals and chlorinated paraffins (CPs) are risk factors for neurodevelopmental disorders. However, evidence regarding their potential combined effects remains limited. To investigate the joint associations of heavy metals and CPs with attention-deficit/hyperactivity disorder (ADHD) symptoms, we recruited 122,965 participants under 18 from the Pearl River Delta in China. We measured concentrations of six heavy metals (Pb, As, Cd, Hg, Mn and Ni) and three types of CPs (SCCPs, MCCPs and LCCPs) in atmospheric particulate matter (PM2.5) samples. ADHD symptoms was defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Generalized linear mixed-effects models (GLMMs) were used to evaluate the associations between individual pollutants and ADHD symptoms. We investigated the combined effects using a weighted quantile sum (WQS) regression model and examined potential interactions through both multiplicative and additive models. In single-pollutant models, all metals and CPs demonstrated significant positive associations with ADHD symptoms. Additive interaction analyses revealed significant synergistic effects between heavy metals and CPs, particularly between SCCPs and Mn (RERI = 4.63, 95% CI: 4.38, 4.88) and between SCCPs and Pb (RERI = 4.15, 95% CI: 3.92, 4.39). WQS analysis demonstrated a positive association between mixed exposure and ADHD symptoms, with Mn, Pb, and SCCPs as the main contributors. Boys and children younger than 12 years were more susceptible to these combined effects. These findings suggest that heavy metals and CPs may exert synergistic effects on the odds of ADHD symptoms, highlighting the importance of coordinated regulatory strategies targeting both pollutants.
Mental health providers face serious challenges identifying risks and providing effective and accessible help for young people with eating disorders. The present study conducted a preliminary evaluation of Operation Self-esteem (OS), a manualized school-based intervention program for promoting eating disorder related mental health in adolescents, delivered by a patient advocacy group for eating disorders. A cluster-randomized design was used to study OS or controls with no OS in eight high schools (girls: OS N = 104, controls N = 120; boys: OS N = 60, controls N = 60; total N = 344). Three months post-intervention OS participants scored significantly lower than controls on Internalization of Media Ideals and had a greater propensity to turn to teachers and school health services when encountering mental health problems. However, there were no significant differences on other key measures (e.g. Self-esteem, Body Dissatisfaction, and General help-seeking behavior). The study suggests that collaboration between researchers and patient advocacy groups in the development and implementation of interventions is highly important for addressing today's mental health challenges. OS shows promise as a low-cost, implementation focused intervention to reduce internalization of media ideals and promote help-seeking behavior, but more research is needed to further optimize intervention.
Globally, vitamin D deficiency (VDD) represents a significant public health concern. Population-level data on vitamin D status in Tunisia are lacking. This study aimed to estimate the national prevalence of VDD among Tunisian school-aged children and identify associated factors. A national cross-sectional survey in 2023 randomly sampled 2670 children aged 6-12 years. Plasma 25-hydroxyvitamin D was measured. Dietary vitamin D (VD) intake and socio-demographics were assessed via questionnaires. Logistic regression identified factors associated to inadequate VD status. The prevalence of VDD (< 30 nmol/L) was 15.8%. Adjusted analysis showed that older children (10-12 years) had a 1.4-fold (P = 0.030) higher likelihood of VDD than younger children. Girls were twice as likely to be VD deficient as boys (adjusted relative prevalence ratio (aRPR) = 2.1; P = 0.001). Significant regional variations in VDD were observed (P < 0.0001). Low and moderate consumption of VD-rich foods was associated with significantly increased odds of severe deficiency (aRRR = 2.0, P = 0.026; aRRR = 1.6, P = 0.005, respectively) relative to high consumption. Finally, overweight status was associated with a 2.0-fold (P < 0.0001) increased odds of severe VDD compared to children with normal weight. VDD is prevalent and increases with age. Vitamin D supplementation strategies should be considered to optimize vitamin D status among children.
Skilled readers plan and execute saccades to target the center of upcoming words, ensuring optimal placement for recognition. Accurate saccadic targeting is crucial for efficient reading. This study examines whether children at the end of their first year at school target saccades toward the center of words, whether this behavior is influenced by reading proficiency, and whether children are able to rapidly adapt their eye movements to visual input. Seventy-three Russian-speaking first graders (36 girls and 37 boys; mean age = 7) read sentences composed of words of uniform (3, 4, or 5 letters) and nonuniform length (3-to-5 letters) while their eye movements were tracked. Children's saccades and fixation locations were compared to a matched adult dataset from Parshina et al. (2024). Results revealed that, unlike adults, children tended to land near the beginning of the word, with longer saccades and landing positions shifting slightly closer to the beginning of the word as word length increased. Children's reading proficiency was associated with longer saccades and landing positions closer to the word center, suggesting that more fluent readers process words more efficiently, resembling adults. At the same time, children were able to quickly adapt their eye movements in uniform sentences. These findings indicate that efficient saccadic targeting is shaped by reading proficiency rather than by maturation of the eye-movement system, and that at the end of their first year at school, children have not yet accumulated sufficient proficiency to fully resemble adult-like saccade targeting.
Sport climbing imposes high endurance demands on finger flexor muscles, which sustain near-isometric loads for prolonged periods. Although women often demonstrate greater muscle endurance than men, the neuromuscular mechanisms underlying potential sex differences in climbing remain unclear. Determine whether sex differences in climbing endurance are explained by physiological muscle adaptations, neural strategies of motor unit (MU) control, or both. High-density surface electromyograms (HD-sEMG) were recorded from the dominant forearm of 9 female and 13 male intermediate climbers during sustained body suspension on a campus board until failure, using two grip depths (20 and 30 mm) to manipulate task demand. EMGs were decomposed into MU discharge trains. Physiological adaptation was assessed via temporal changes in MU action potential amplitude and median frequency (MDF), while neural strategies were evaluated using traditional MU discharge metrics and a mode-based analysis of MU firing patterns. Despite anthropometric differences, time to failure did not differ between sexes. MDF declined more slowly in women, indicating greater resistance to muscle fatigue. Traditional MU metrics showed greater discharge variability and intermittency in women. Mode analysis revealed three common temporal MU firing modes across sexes; however, men exhibited greater reliance on sustained early-phase MU activation, particularly under higher task demands. Sex differences in climbing endurance are not reflected in outcomes alone but arise from distinct neuromuscular mechanisms. Greater physiological fatigue resistance in women is complemented by sex-specific neural strategies of MU rate coding, underscoring the importance of integrating physiological and neural analyses when examining endurance performance in climbing.
To analyze whether elevated uric acid levels are associated with an increased risk of developing cardiovascular events and diseases. Retrospective observational cohort study. The clinical laboratory and inpatient area of the Vic Hospital Consortium (Vic, Barcelona). Uric acid measurements and discharges due to cardiovascular disease recorded in the information systems between 2019 and 2024 were included. From the automated healthcare information systems, uric acid levels and discharges with a primary diagnosis of cardiovascular disease were extracted. Patients were grouped according to normouricemia or hyperuricemia, having one or more hospital discharges during the period, and whether these were strictly cardiovascular or cerebrovascular. Regression models were defined to predict the impact of uricemia on discharges due to cardiovascular disease. The analysis included 159,235 uric acid measurements from 60,481 different patients and 3,517 hospital discharges relating to 2,919 patients. For all patients, higher uric acid values were associated with older age. No differences were detected with regard to sex. Hyperuricemia was associated with a higher prevalence of hypertension (82.7 vs. 61.7%) and diabetes mellitus (36.9 vs. 28.0%), but not with dyslipidemia and smoking. In the group without admissions for cardiovascular disease, both age and sex were compared with the two categories of uricemia, and an increase in age and a higher proportion of men were observed in the hyperuricemia group. A logistic regression analysis to predict cardiovascular events showed an odds ratio of 1.080 (95% CI: 1.053-1.108) for uric acid levels, 1.053 (95% CI: 1.050-1.056) for age, and 0.488 (95% CI: 0.443-0.538) for female sex. Hyperuricemia is associated with older age and, in patients admitted for cardiovascular disease, also with a higher prevalence of hypertension and diabetes mellitus.
Sexual dysfunction associated with psychological reasons is one of the factors impacting unfulfilled marriages. There are limited data on treatment outcomes in this context. The aim of this study was determining the treatment of unconsummated marriage in psychogenic erectile dysfunction in Iranian Couples. A total of 66 cases were selected from individuals referred to the Family Health Clinic (from 2006 to 2019), who had unconsummated marriages and experienced psychogenic erectile dysfunction, meeting the inclusion criteria for the study. Research tools included couples' demographic information, face-to-face interviews, and the International Index of Erectile Function (IIEF). The treatment was based on couple's therapy. In the initial session, a comprehensive assessment of the couples' condition was conducted, and research instruments were completed. Additionally, during this session, the formation of psychogenic erectile dysfunction and the lack of successful foreplay were discussed. In subsequent sessions, desensitization, instruction on foreplay, and intercourse were addressed. Treatment success was defined as the ability to achieve complete vaginal penetration. Data was analyzed using SPSS 16 software. All 66 couples continued the treatment until they achieved successful vaginal penetration. All International Index of Erectile Function (IIEF) domains improved significantly after couple-based behavioral therapy in men with psychogenic erectile dysfunction in unconsummated marriages (all p < .001; large effect sizes for most domains). No significant associations were found between educational level, place of residence, engagement duration, or marriage duration and post-treatment scores (all p > 0.05). Male age correlated negatively with overall ED (r = -.314, P = .001), erectile function (r = -.361, P = .003), intercourse satisfaction (r = -.365, P = .003), and overall satisfaction (r = -.266, P = .031). Similar negative associations were observed for female age with overall ED (r = -.371, P = .002), erectile function (r = -.354, P = .004), intercourse satisfaction (r = -.344, P = .005), and overall satisfaction (r = -.246, P = .047). Psychogenic erectile dysfunction in unconsummated marriage can be addressed through couple-based therapy.
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The COVID-19 pandemic disrupted healthcare systems and may have influenced mortality trends in hematologic-immune disorders (D50-D89) and Diseases of the circulatory system (I00-I99). This study evaluates US mortality trends from 2010 to 2023 to assess potential pandemic-related changes. We utilized spline regression modeling on CDC WONDER mortality data (2010-2023) to quantify post-pandemic trend shifts in both age-adjusted and sex/age-stratified mortality rates. Post-2019 mortality trends for D50-D89 and I00-I99 diseases showed significant increases, particularly among older adults and younger males. D50-D89 mortality in females ≥ 65 increased ~ 2.6% (95% CI 1.70% to 3.68%) annually, while males ≥ 65 increased ~ 1.6% (95% CI 0.28% to 3.07%) annually; younger males (15-34 years) showed a 4.5% (95% CI 0.49% to 8.87%) annual increase. I00-I99 mortality increases were most pronounced in older females (~ 1.4% annual increase, 95% CI 0.49 to 2.31). Analysis of standardized rates in all groups except for men in I00-I99 showed a positive slope-shift after 2019. (p < 0.05)". These findings highlight the persistent impact of the COVID-19 pandemic on hematologic and circulatory system disease mortality, emphasizing the need for continued monitoring of vulnerable populations.
Gender disparities in later life cognition call for a deeper understanding of how social determinants interact to shape cognitive outcomes. This study investigates the gendered moderating role of the social network in the association between employment status (employed, retired, homemaker, unemployed) and cognitive functioning (episodic memory, verbal fluency) among adults aged 50+ in Europe. Using data from the Survey of Health, Ageing and Retirement in Europe (SHARE; waves 4 (2011-2012), 6 (2015-2016), 8 (2019-2020)), we apply linear multilevel models stratified by gender, with episodic memory and verbal fluency as outcomes (N = 145,107). Results indicate that a stronger social network may buffer negative effects of non-employment on episodic memory for women, whereas for men, benefits are primarily indicated at lower social network strength levels. Our findings highlight gender-specific cognitive advantages of social networks, suggesting that gender should be considered a structural factor, not merely a demographic characteristic, in studies of cognitive aging.
Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV, but out-of-pocket costs represent a critical barrier to uptake. We conducted an online survey from May 2020 to October 2021. Gay and bisexual men who have sex with men (GBMSM) in New England recruited through social networking apps were randomly assigned to view different monthly PrEP costs ($0-$105) and asked about their willingness to pay. Among 612 participants, each $10 increase in monthly costs was associated with a 6.0% point decrease in willingness to pay (p < 0.001). In logistic regression, each $1 increase reduced the odds of willingness to pay by 4% (odds ratio, 0.960; 95% CI, 0.952-0.968; p < 0.001). At $40 per month, 68% were willing to pay. Lower-income participants (<$75,000 annually) showed greater cost sensitivity (8.0% point decrease per $10 increase; p < 0.001). Participants at higher HIV acquisition risk (HIRI-MSM ≥ 10) were more willing to pay (β = 0.119; p = 0.001), as were those perceiving they definitely needed PrEP (β=-0.134 for those who may not or definitely did not need it; p = 0.005). These findings support policies that minimize or eliminate cost-sharing for PrEP to achieve HIV prevention goals. La profilaxis previa a la exposición (PrEP) es muy eficaz para prevenir el VIH, pero los costos de bolsillo representan una barrera crítica para su adopción. Realizamos una encuesta en línea desde mayo de 2020 hasta octubre de 2021. Hombres gay y bisexuales que tienen sexo con hombres (GBMSM) de Nueva Inglaterra reclutados a través de aplicaciones de redes sociales fueron asignados al azar para ver diferentes costos mensuales de PrEP (de $0 a $105) y se les preguntó sobre su disposición a pagar. Entre 612 participantes, cada incremento de $10 en los costos mensuales se asoció con una disminución de 6.0 puntos porcentuales en la disposición a pagar (p < 0.001). En la regresión logística, cada aumento de $1 redujo las probabilidades de disposición a pagar en un 4% (proporción de probabilidades: 0.960; IC del 95%: 0.952–0.968; p < 0.001). Con un costo de $40 al mes, el 68% estaba dispuesto a pagar. Los participantes de menores ingresos (menos de $75,000 anuales) mostraron una mayor sensibilidad al costo (disminución de 8.0 puntos porcentuales por cada aumento de $10; p < 0.001). Los participantes con mayor riesgo de adquirir VIH (HIRI-MSM ≥ 10) mostraron mayor disposición a pagar (β = 0.119; p = 0.001), al igual que quienes percibían que definitivamente necesitaban la PrEP (β=−0.134 para quienes creían que tal vez no o definitivamente no la necesitaban; p = 0.005). Estos hallazgos respaldan las políticas que minimizan o eliminan el reparto de costos para la PrEP a fin de lograr los objetivos de prevención del VIH.
Injuries remain major causes of preventable mortality and premature loss of life. This study aimed to examine 12-year trends in mortality and years of life lost (YLL) due to injuries in West Azerbaijan Province, Iran, and to forecast future mortality patterns. This registry-based retrospective observational study investigated the mortality patterns and YLL due to injuries. Data were extracted from the death registration and classification system of the Iranian Ministry of Health and Medical Education. Indicators including crude mortality rates, Age-Standardized Rates (ASR), and YLL were calculated. Future trends were predicted using ARIMA modeling (313). A total of 20,003 deaths due to injuries were recorded over the 12-year period. The majority of cases were men (76%) and occurred in urban areas (59.7%). The annual number of deaths increased by 37.94%, rising from 1,389 in 2013 to 1,916 in 2024. Traffic accidents remained the primary cause of death (increasing by 21.35%), while suicide rates showed a significant surge of 141.50%. The total YLL during the study period reached 473,700 years (17 per 1,000 in males and 6 per 1,000 in females). The highest burden of YLL was observed in the 15-29-year age group. Prediction models suggest that mortality will continue to fluctuate between 120 and 182 deaths per month over the next three years. Injuries, particularly traffic accidents and the rising trend of suicide, impose a heavy and increasing burden of premature mortality in West Azerbaijan. The high YLL among adolescents and young adults underscores the critical need for urgent preventive strategies, improved road safety measures, and targeted mental health interventions to mitigate this public health crisis.
The US adopted an individual donor assessment (IDA) policy in 2023 to evaluate blood donor risk, potentially resulting in more eligible donors and first-time donors (FTDs). FTDs are associated with higher transfusion-transmissible infectious disease (TTID) risk. Thus, we compared FTD demographics, characteristics, and return behavior during the first 2 years of the IDA compared to the previous 2 years during the 3-month deferral (3MD) policy. FTD donation data from the transfusion-transmissible infections monitoring system (TTIMS) during the initial 2 years of IDA were compared to the preceding 2 years (3MD). Descriptive statistics were used to assess changes in FTD demographics, donation characteristics, state of residence, and return behavior during the IDA policy compared to the 3MD policy. There were slightly over 4 million donations from FTDs during the entire study period, with a 6% increase overall during the IDA period, led mostly by male FTDs (14% increase). Increases were observed in most other demographic/characteristic groups except for a few (female, aged 16-24, or other procedure types). There was a higher absolute number of returning donors and subsequent donations from the FTDs during the IDA period compared to the previous period. The Northeastern US states were found to have the highest increase in FTDs. There were variable increases in FTDs among most demographic and characteristic groups post-implementation of the IDA policy, notably among men. Although attributability to the new policy is unclear, blood availability may increase with such policies. Continued monitoring will ensure blood safety during donor policy changes.