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Urban agriculture is increasingly promoted as a strategy for enhancing household food security in African cities, yet empirical evidence from rapidly growing secondary cities remains limited, particularly regarding how different urban agricultural enterprises contribute to food access. This study examines the role of urban agriculture in shaping household food security in Mbarara City, Uganda, by comparing outcomes across arable, poultry, livestock and mixed farming enterprises. Using a cross-sectional survey of 310 urban farming households, food security was assessed using the Household Food Insecurity Access Scale (HFIAS), and differences across enterprise types were analysed using descriptive statistics and chi-square tests. The results indicate variation in food security outcomes across enterprise types. Households engaged in arable farming were more likely to be food-secure than those relying primarily on poultry or livestock enterprises, whereas mixed-enterprise households were associated with more stable food security outcomes, suggesting that diversification may buffer households against production- and market-related risks. These differences reflect variations in land requirements, input costs and compatibility with dense urban environments. Overall, the study demonstrates that urban agriculture is associated with differing food security outcomes across enterprise types. By focusing on a secondary city context, the findings provide empirical evidence for debates on urban food systems and highlight the importance of enterprise selection and diversification in urban food planning amid rapid urbanisation and land constraints.

Publicly financed health insurance expansions in India have often increased inpatient utilisation without commensurate reductions in out-of-pocket (OOP) spending. Whether integrating benefits to cover chronic-disease medicines improves financial protection has received little empirical attention. This study examines whether the Karunya Arogya Suraksha Padhathi (KASP), Kerala's implementation of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), which consolidated multiple state and national schemes under a unified purchaser and expanded package-based cashless coverage for secondary, tertiary, and eligible day-care services from April 2019, reduced household OOP health expenditure. We use household panel data from the Consumer Pyramids Household Survey (CPHS) covering April 2017 to February 2020, comprising 58,171 household interview observations across Kerala, Tamil Nadu, and Karnataka, and apply a difference-in-differences (DiD) design. Outcomes include net OOP health spending and its components. KASP reduced net OOP health spending by approximately 31.7% in specifications allowing Kerala-specific trends. The decline was concentrated in medicine spending, while hospitalisation rates were statistically unchanged. Total health spending declined in baseline two-way fixed-effects (TWFE) models but was statistically indistinguishable from zero in trend-adjusted specifications; the net OOP reduction remained robust. Effects were larger among poorer households and those with chronic conditions, and smaller in rural areas, consistent with limited access to empanelled hospitals. Results are robust to event-study diagnostics, alternative comparator pools, and a timing placebo based on Tamil Nadu's December 2018 inpatient-cap expansion. Benefit expansion covering medicine costs can improve financial protection by reducing point-of-care payments, even without reducing total costs in the short run. The findings suggest that aligning public insurance benefit packages with households' pharmaceutical spending patterns, particularly among those managing chronic conditions, may offer a more direct route to financial protection than hospitalisation-focused expansion alone.

Hereditary angioedema (HAE) is a rare disease characterized by unpredictable, painful swelling attacks. Social determinants of health may affect healthcare resource utilization (HCRU) for HAE attacks. Estimate HCRU among patients with HAE analyzed by race and ethnicity, household income, and rural/urban residency. This retrospective, observational study used healthcare insurance claims data (1/1/2016-9/30/2023) from Inovalon's closed claims database. Eligible patients had a new HAE diagnosis or treatment claim (first claim defined index date), no prior claim in previous 12 months' continuous health plan enrollment, maintained 24-month continuous enrollment post-index, and were not using angiotensin-converting enzyme inhibitors. Multivariable models and HAE-related HCRU data revealed patients from lower-income households (<$50,000 annually) had a higher risk of emergency department (ED) visits (risk ratio [95% confidence interval {CI}], 1.44 [1.23-1.68]), but no difference in hospitalization risk (1.07 [0.69-1.65]) versus those from higher-income households. Black patients had a higher risk of HAE-related ED visit (risk ratio [95% CI], 1.50 [1.27-1.76]), more ED visits (rate ratio [95% CI], 2.33 [1.74-3.13]), and higher hospitalization rates (2.25 [1.10-4.57]) versus White patients. ED visit rate ratios were higher for Hispanic/Latino versus White patients (1.71 [1.16-2.50]). Rural versus urban residency did not significantly affect HAE-related HCRU. Allergist/immunologist care access was lower among Black patients (16.7%) and those from lower-income households (25.5%) versus the overall study population (27.5%). Among patients with HAE, disparities exist in HCRU. Targeted strategies are essential for ensuring equitable access and improving outcomes for underserved patients.

The Supplemental Nutrition Assistance Program (SNAP) is the largest food assistance program in the United States providing income-eligible households with cash-like assistance to spend on food. In October 2021, a historic policy change permanently increased benefit amounts by 21 percent. This study assessed differences in diet quality and food security, supplemented by participant descriptions of using SNAP, among adults with low incomes residing in the state of Massachusetts from before (October 2020-January 2021) to after (December 2021-February 2022) the benefit increases. Derived from The Greater Boston Food Bank's Annual Statewide Survey, our sample included adults with household incomes &#x2264;300% of the federal poverty level who completed diet and food security measures. We calculated Prime Diet Quality Scores (PDQSs), with higher scores reflecting more nutritious diets on a scale of 0-70. Adjusted difference-in-difference regression models evaluated differences in PDQS and food security between SNAP participants and non-participants from before to after the benefit increases. Reflexive thematic analysis of write-in responses summarized experiences with SNAP. Complete data were available for 1051 respondents before and 801 respondents after SNAP benefit increases. We found no significant differences in diet quality or household food security for SNAP participants, compared to non-participants, from before to after the benefit increases. In write-in comments, respondents expressed gratitude for increased benefits but also fear of them being rescinded. Increased benefits helped some better meet food needs, yet many noted rising costs of living prevented benefits from stretching as far. Increased SNAP benefits did not impact food security or diet quality among this sample. SNAP benefits may need to be further increased to meet the nutritional needs of families.

Respiratory syncytial virus (RSV) is a leading cause of severe respiratory infections in children and is predominantly acquired and spread in community settings such as households and early childhood education centres. This review aims to synthesise the available evidence on RSV transmission in closed community settings that include children, with a focus on secondary attack rates (SAR). We conducted a systematic review informed by Cochrane guidelines. We searched Ovid Medline, Ovid Embase Classic and Embase, Ovid Global Health, Cochrane Library, Web of Science, and Scopus from inception to March 2025. Grey literature was searched through Google Scholar and relevant websites. We included articles reporting primary data on RSV SAR or other attack rates in closed community settings that included children aged under 18&#x2009;years. Two reviewers independently screened articles, extracted data, and assessed study quality using a modified Newcastle-Ottawa Scale. Random-effects meta-analysis was performed for SAR and attack rates. Subgroup analyses explored outcomes by study design, study setting and participant age. A total of 38 articles were eligible and reported data from 30 unique study populations from 1956 to 2023 spanning 12 countries. Study settings included households (n&#x2009;=&#x2009;19), early childhood education and care (n&#x2009;=&#x2009;6) and residential care (n&#x2009;=&#x2009;5). Pooled household SAR was 23.8% (95% CI: 16.5-30.0%) across all ages and 26.8% (95% CI: 15.5-38.2%) for children aged less than 5&#x2009;years. Pooled outbreak attack rate among children in early childhood education and residential care was 59.2% (95% CI: 31.7-86.8%). There was substantial heterogeneity of methods, reporting and outcomes across studies. Risk of RSV transmission in closed community settings that include children is substantial, yet current evidence is limited. Well-designed transmission studies, particularly in early childhood education and care settings, are needed to support disease prevention and control, and to optimise population-level modelling.

Chronic obstructive pulmonary disease (COPD) a major cause of morbidity, hospitalization, and healthcare burden worldwide and is increasingly recognized as a heterogeneous syndrome with diverse environmental and socioeconomic determinants. We aimed to identify phenotype-specific determinants of hospitalized exacerbations and annual total length of hospital stay (LHS) in smoking and non-smoking COPD. We analyzed 3,913 COPD patients from a nationwide multicenter prospective cohort in China, stratified by smoking status. Hospitalized exacerbations at baseline and during one-year follow-up, as well as LHS, were assessed. Multivariable logistic regression and ordinal logistic regression models were used to estimate adjusted odds ratios (ORs) for hospitalized exacerbations and annual total LHS within each subgroup. Among 3,913 participants, 1,709 (43.7%) had non-smoking COPD and 2,204 (56.3%) had smoking-related COPD. During follow-up, 28.0% of non-smokers and 29.9% of smokers experienced hospitalized exacerbations. Rural residence, larger household size, and prior hospitalizations in the preceding year were consistently associated with hospitalized exacerbations and longer annual total LHS in both groups. Biomass exposure was independently associated with hospitalized exacerbations among non-smoking patients but not among smokers after full adjustment. Low body mass index (BMI) was associated with increased risk in non-smoking COPD. Findings were consistent across baseline and prospective analyses, as well as binary and ordinal outcome models. In China, rural residence, larger household size, and prior exacerbation history were common determinants of hospitalized exacerbations and longer annual total LHS in patients with COPD, while biomass exposure and low BMI exerted stronger effects in non-smoking COPD.

This paper examines the effects of birth order on child nutrition in Kyrgyzstan, a lower-middle-income country in Central Asia characterized by a Soviet legacy of universal healthcare, relatively high fertility, widespread multigenerational co-residence, and growing economic vulnerability. Using nationally representative data from three waves of the Kyrgyzstan Multiple Indicator Cluster Survey and a mother fixed-effects design, we find that later-born children have worse nutritional outcomes than firstborns, with differences most pronounced and robust for height-for-age (HAZ). Differences in weight-for-age (WAZ) are smaller and less precisely estimated, while weight-for-height (WHZ) shows no systematic variation. Subgroup analyses suggest that birth order disparities vary descriptively across household environments, while formal tests generally do not indicate statistically significant differences across most dimensions. Although grandmother co-residence and higher household head's education are associated with smaller birth order penalties, they do not fully eliminate birth order disparities.

Lifestyle factors such as diet and physical activity significantly impact on the risk of obesity in individuals with Down syndrome (DS). However, in the absence of national nutritional guidelines in individuals with DS, further work is needed to understand their dietary and physical activity patterns. In this work we retrieved caregivers' responses on those aspects. We analyzed data from a cross-sectional online survey of caregivers of individuals with DS conducted as part of the GO-DS21 project and reported in the accompanying paper (nutrients-4216283) (n = 764). We explored physical activity patterns, dietary habits, beliefs around weight-loss interventions and caregiver confidence that family members with DS would engage in a healthier lifestyle. Associations were examined using correlation analysis, and cumulative and binary logistic regression models. Caregivers reported that most individuals with DS exercised 1-3 times per week, with frequency declining with age. Males were more likely to exercise daily than females. Caregiver exercise frequency was positively correlated with that of their DS family member (&#x3c1; = 0.521, p < 0.001), suggesting clustering of shared health behaviors within households. In adjusted models, caregivers who exercised regularly had up to thirteen-fold higher odds of having a physically active family member with DS (aOR = 13.02, 95% CI: 7.40-24.06, p < 0.001). Fried food consumption and higher snack frequency were independently associated with perceived obesity status, while sugar-sweetened beverage consumption was not. Caregivers favored exercise as a weight-loss strategy, while anti-obesity drugs were endorsed by only 11% of caregivers primarily and were more likely to be endorsed when obesity was perceived (aOR = 4.21, 95% CI: 2.44-7.39, p < 0.001). Finally, caregiver confidence that their family member with DS would engage in healthier behaviors was associated with perceived obesity status and strongly associated with higher physical activity levels (aOR 14.68, 95% CI: 6.59-33.40, p < 0.001). In this large European caregiver survey, reported consumption of selected energy-dense foods was generally low, although fried food intake and higher snack frequency were associated with perceived obesity. Physical activity patterns were closely aligned between caregivers and individuals with DS, suggesting shared household health behaviors. These findings highlight the importance of involving caregivers and family environments in lifestyle interventions aimed at supporting physical activity and weight management in individuals with DS.

The rapid expansion of medicinal Cannabis sativa L. cultivation contrasts with limited knowledge of its aphid pests and the contribution of parasitoids to their biological control. Quantitative studies evaluating aphid-parasitoid networks in Cannabis under cultivation conditions are scarce. This study characterized aphid-parasitoid interactions in Cannabis grown in households in Argentina over two consecutive cropping seasons. Weekly sampling of 101 chemotype III Cannabidiol (CBD-dominant) plants across 20 households (2020-2021 and 2021-2022) recorded five aphid and five parasitoid species. A total of nine and twelve aphid-parasitoid interactions were recorded in the first and second seasons, respectively, and 90.5% of collected mummies yielded primary parasitoids. In the second season, the network exhibited higher connectedness (0.65) and modularity (0.104), and lower nestedness (4.45), indicating increased compartmentalization. Interactions involving Aphis fabae and Aphis gossypii with Lysiphlebus testaceipes, Aphidius matricaria, and Aphidius avenae showed high temporal constancy (&#x2265;77%) and spatial ubiquity (&#x2265;90%). Parasitism varied significantly between phenophases (&#x3c7;2&#x2009;=&#x2009;23.7; P&#x2009;<&#x2009;0.001), with A.&#x2009;gossypii reaching 52.8% during the vegetative stage and 42.9% during flowering. L.&#x2009;testaceipes accounted for 72% of parasitism (N&#x2009;=&#x2009;5564 mummies). Most parasitoid emergence occurred during flowering, when 69.5% of all parasitoids were redorded. Aphid-parasitoid networks in medicinal Cannabis were functionally structured and temporally consistent across seasons. L.&#x2009;testaceipes emerged as the dominant and most stable parasitoid, supporting its key role in natural aphid regulation. These findings provide a basis for conservation biological control strategies in emerging Cannabis production systems. &#xa9; 2026 Society of Chemical Industry.

Endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) is associated with risks such as endoleaks and late aneurysm rupture, highlighting the importance of long-term survival prediction. Despite recent advancements in machine learning (ML), predictive models utilizing time-to-event analysis remain limited for AAA patients undergoing EVAR. We aimed to develop a stacking ensemble ML model to predict long-term outcomes in EVAR-treated AAA patients. From 2002 to 2019, a total of 12,312 patients underwent EVAR. The primary outcome was AAA-related mortality, with follow-up until December 31, 2019. Using 5 ML algorithms, we developed a model comprising 34 variables. Model performance was assessed using the time-dependent C-index and Brier score. Variable importance was evaluated through permutation-based and partial dependent plots. The stacking ensemble model showed the best predictive performance among the tested models (time-dependent C-index: 0.759 at 30 days, 0.716 at 365 days). The time-dependent Brier scores generally increased slightly over time but remained stable across all ML algorithms. Important predictors included age, smoking status, duration between diagnosis and surgery, household income, renal function, and blood pressure. Variable importance differed over time, and each predictor presented a nonlinear relationship with AAA-related mortality risk. The stacking ensemble ML model for time-to-event prediction identified dynamic, time-varying changes in predictor importance, providing improved risk stratification and phase-specific management after EVAR.

measles-rubella remains a major public health concern, with vaccination as the most effective preventive strategy. Despite the introduction of the measles-rubella second dose (MR-2) vaccine to improve immunity, uptake in informal settlements like Mathare, Nairobi, remains suboptimal. This study assessed determinants of MR-2 uptake among children aged 18-59 months in Mathare. this cross-sectional analytical study used a convergent mixed- methods design. Quantitative data were collected through structured household surveys, while qualitative insights were obtained from Key Informant Interviews and Focus Group Discussions. a total of 370 caregivers responded (103% of the targeted 359). MR-2 coverage was 84%, 14% lower than the measles-rubella first dose (MR-1). Uptake was significantly associated with religion, education level, ward of residence, place of delivery, immunization site, and previous unsuccessful vaccination attempts (p < 0.05). Caregivers unaware of the MR-2 schedule were over four times more likely to miss the dose (OR = 4.146, p < 0.001), as well as those who had previously failed to access services (OR = 4.215, p = 0.007). Lack of a vaccination card (OR = 0.314, p = 0.015) and poor schedule knowledge (OR = 0.322, p = 0.014) were also key predictors. Children in Kiamaiko ward (OR = 5.421) and Ngei ward (OR = 4.281) had higher odds of MR-2 uptake compared to Mlango Kubwa ward. Qualitative findings highlighted barriers such as low awareness, misinformation, economic hardship, and health system gaps. improving MR-2 uptake requires enhanced health education, mobile reminders, consistent vaccine supply, extended clinic hours, and targeted outreach.

Given concerns that screen time may impact dietary habits, this study investigated the association between screen time and dietary intake among adolescents in the United States. We analyzed a prospective cohort (N&#x2009;=&#x2009;6485, 47.3% female, age: 12&#x2009;&#xb1;&#x2009;0.7 years) from the Adolescent Brain Cognitive Development (ABCD) Study, using data from Year 2 (2018-2020) and Year 3 (2019-2021). Multinomial logistic regression models estimated the associations between participant-reported screen time (watching television shows and videos, playing video games, socializing, browsing the internet, and total screen time (hours/day)) and parent/participant-reported intake of various food/nutrient categories 1 year later (Year 3). We adjusted for age, sex, race and ethnicity, household income, parent education, average daily kilocalorie intake, respective food or nutrient, and study site (Year 2). Each additional hour of most screen time modalities was prospectively associated with higher odds of consuming fewer fruits, vegetables, whole grains, legumes, fiber, and dairy, and higher glycemic index, and higher odds of consuming more added sugars and a higher polyunsaturated fats ratio 1 year later. These findings highlight the need for parental guidance and clinical interventions to support screen time habits and promote healthy dietary choices among adolescents. This study examines the association between contemporary screen time modalities and dietary intake 1 year later in a demographically diverse U.S. sample of early adolescents. Most screen time modalities, such as total screen time and watching television shows and videos, were prospectively associated with higher odds of consuming fewer fruits, vegetables, whole grains, legumes, and fiber 1 year later. Greater total screen time and time spent socializing were prospectively associated with higher odds of a higher polyunsaturated fats ratio 1 year later.

Malaria remains a major public health burden in Southeast Asia, where elimination depends on consistent community-level use of insecticide-treated nets (ITNs) and residual spraying, despite limited regional evidence on ITN utilization. To address this gap, a systematic review and meta-analysis were conducted to assess ITN utilization in Southeast Asia. A comprehensive search was performed across PubMed, Web of Science, and ScienceDirect, followed by PRISMA guidelines. Of 450 records screened, 28 studies published between 2003 and 2023 met the inclusion criteria for qualitative synthesis, with 20 included in quantitative analyses, comprising 14,556 households and 122,258 individuals. Meta-analysis results indicated a consistent disparity between insecticide-treated net ownership or access and their actual use across different population groups. Substantial heterogeneity was observed across studies, reflecting pronounced variability between settings. The risk factor meta-analysis indicated that geographic region was the strongest determinant of ITN non-use, with higher odds in coastal areas than in delta regions (pooled OR&#x202f;=&#x202f;4.73, 95% CI: 1.59-14.06), followed by socioeconomic status, with higher non-use in the poorest than in the richest (pooled OR&#x202f;=&#x202f;1.70, 95% CI: 1.01-2.86). These findings highlight the predominance of contextual and structural determinants, particularly geographic settings and socioeconomic status, over demographic factors alone. Effective malaria prevention requires area-specific risk assessment that accounts for spatial and population-level heterogeneity to optimize the coverage and impact of preventive interventions. Toward elimination of malaria in Southeast Asia, targeted efforts to improve consistent ITN utilization remain essential, and these findings can guide population-specific control strategies and evidence-based policy decisions.

Early during the COVID-19 pandemic, many U.S. adults changed their alcohol use, and mortality due to causes fully attributable to alcohol increased. We assessed county-level changes in and correlates of six types of fully and partially alcohol-attributable mortality causes before and during the early phases of the pandemic. We used Bayesian spatial regression models to study six categories of alcohol-attributable mortality in 2019 and 2020 in 3,107 counties in the contiguous U.S. by season. Outcomes included chronic fully alcohol-attributable deaths, poisonings, motor vehicle traffic accidents, suicides, homicides, and falls. Covariates included year, season, rurality, region, and socioeconomic and demographic county-level characteristics. Crude county-level rates and counts increased for chronic fully alcohol-attributable deaths, poisonings, falls, and homicides and decreased for motor vehicle accidents and suicides from the spring of 2019 to the spring of 2020. In adjusted multivariable models, compared to the spring of 2019, the spring of 2020 was associated with elevated relative rates of chronic fully alcohol-attributable deaths, poisonings, and homicides, and decreased relative rates of deaths caused by suicide, motor vehicle accidents, and falls. While some covariate relationships were comparable across outcomes (e.g., higher median household income was negatively associated with most outcomes), others varied by outcome (e.g., greater proportions of older populations were positively associated with falls but negatively associated with most other outcomes). Alcohol-attributable mortality trends from before to during the early phases of the COVID-19 pandemic varied by specific cause. Interventions taking county-specific conditions into account may be more effective in decreasing alcohol-attributable mortality than one-size-fits-all approaches.

Hepatitis C virus (HCV) infection is one of the leading causes of liver-related diseases such as cirrhosis and hepatocellular carcinoma. Despite ongoing efforts, no effective vaccine has been developed to date due to the virus's high mutation rate and extensive genetic variability. This study aimed to determine the prevalence of HCV infection among family members of HCV-positive index cases, within related risk factors in them. Additionally, the study evaluated the therapeutic efficacy of the combination drug Sovodak (sofosbuvir-daclatasvir) based on HCV genotype. This study is a descriptive cross-sectional study conducted on the families of individuals with Hepatitis C (12 people) within the Guilan cohort population. Twenty family members of HCV-positive individuals were enrolled. Data were collected using structured questionnaires that included socio-demographic and clinical information. Blood samples were drawn from each participant, and sera were separated for serological analysis. HCV antibody-positive samples were assessed by HCV-RNA detection. Subsequently, positive samples underwent HCV genotyping. Then, HCV-positive individuals were referred in Phase 3 clinical trial with ID: NCT03200184. for treatment and follow-up. Treatment consisted of Sovodak (a combination of sofosbuvir 400&#x2009;mg and daclatasvir 60&#x2009;mg). The clinical and diagnostic effectiveness of the treatment was evaluated 12 weeks after therapy initiation. Out of the total cases, two were HCV antibody positive, and one of them was a 13-year-old girl who tested positive for HCV RNA by PCR. Her genotype was 1a, which matched her mother's genotype. This patient was successfully treated with Sovodak. The post-treatment HCV RNA results were negative, indicating a sustained virologic response (SVR&#x2009;=&#x2009;12). Evidence of intrafamilial transmission was observed in this study, its frequency was extremely low and statistically negligible. Shared household items, although seemingly unlikely, such as toothpaste, may serve as a potential route of transmission within families, independent of direct interpersonal contact.