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Low language proficiency (LLP) affects up to 10% of children, depending on how it is defined, and is a known risk factor for academic and social difficulties. Despite growing awareness, there is limited consensus on the long-term consequences of LLP across quality of life domains. This review synthesises evidence from longitudinal cohort studies to evaluate long-term risks associated with LLP identified between ages four and eight, with follow-up from age 12 onwards. To examine the long-term outcomes of children aged four to eight years with low language proficiency (LLP), in terms of language, literacy, and quality of life across five WHO domains (physical, psychological, independence, social relationships, and environment). CENTRAL, MEDLINE, Embase, PsycINFO, ERIC, and 17 other databases were searched without language or date restrictions. In addition, reference lists were checked, citation searching was conducted, and study authors were contacted to identify additional studies. The most recent search was completed in March 2025. We included prospective or retrospective longitudinal cohort studies that identified children with LLP between ages four and eight years and assessed outcomes at age 12 or older. Studies could include comparison groups or single-cohort designs. LLP was defined either using standardised diagnostic criteria (≤ -1 SD on normed language measures, encompassing ~10-15% of the population) or clinical judgement by qualified professionals. We extracted data on language, literacy, and World Health Organization (WHO) quality of life domains and used robust variance estimation (RVE) meta-analysis models, including hierarchical and correlated effects models. Effect sizes were reported as Hedges' g or risk ratios (RR), with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) applied to each outcome domain. We conducted sensitivity and moderator analyses and assessed small-study effects. We included 80 studies; 72 contributed to meta-analyses across 15 independent cohorts (≈ 28,828 participants). Studies were published between 1982 and 2024 and conducted in Europe and North America. Risk of bias, assessed across study participation, attrition, and outcome measurement, varied; only three studies were at low risk across all assessed domains, with study attrition most frequently rated as moderate or high. Language outcomes showed large adverse associations in long-term follow-up (145 effect sizes; 11 cohorts; Hedges' g = -1.36, 95% Confidence Interval (CI) -1.80 to -0.92; moderate certainty). Literacy outcomes were similarly affected (86 effect sizes; 7 cohorts; g = -1.12, 95% CI -1.28 to -0.96; high certainty). Physical outcomes were reported in only one study and could not be meta-analysed; evidence was insufficient to draw conclusions. Psychological outcomes showed moderate adverse associations (91 effect sizes; 7 cohorts; g = -0.50, 95% CI -0.80 to -0.19; moderate certainty), with risk ratio analyses indicating lower probability of favourable psychological outcomes (RR = 0.53, 95% CI 0.42 to 0.67). Independence outcomes showed smaller and more uncertain associations (17 effect sizes; 2 cohorts; g = -0.59, 95% CI -1.35 to 0.18; low certainty). Social relationship outcomes showed moderate adverse associations (35 effect sizes; 6 cohorts; g = -0.64, 95% CI -1.35 to 0.07; moderate certainty). Environmental outcomes showed large but imprecise adverse associations (23 effect sizes; 5 cohorts; g = -1.10, 95% CI -1.47 to -0.73; moderate certainty). Across domains, sensitivity analyses supported the robustness of findings, although degrees of freedom were often low due to the limited number of independent cohorts. Where binary outcome data were available, risk ratio estimates were directionally consistent with continuous outcomes but frequently imprecise. Early low language proficiency (LLP) is consistently associated with substantial long-term language and literacy difficulties. LLP is also associated with poorer psychological well-being and social relationship outcomes later in life, with moderate certainty of evidence. Associations with independence outcomes are smaller and more uncertain, reflecting limited data and low certainty. Environmental outcomes, including education, employment, and societal participation, show large adverse associations, although estimates are imprecise due to the small number of contributing cohorts. Physical health outcomes remain under-researched. Taken together, these findings indicate that childhood LLP is not a transient delay but a marker of enduring developmental vulnerability, underscoring the need for sustained identification and support across developmental stages. Further high-quality longitudinal studies are needed, particularly in under-represented outcome domains. Internal sources Department of Special Needs Education, University of Oslo, Norway, supported the preparation of the protocol and review to be carried out during office hours for ÅMH, KR, and MM-L. Department of Education, University of Oslo, Norway, supported the preparation of the protocol and review to be carried out during office hours for AL. External sources The Research Council of Norway, Norway This review is part of the project, Better Equipped, which is funded by the Research Council of Norway, Grant 324207. Lervåg and Melby-Lervågs participation was founded by The Research Council of Norway, Centres of Excellence, Grant 331640. The funder had no role in the study design, conduct, methods, data analysis, reporting, or publication of this protocol for the review. https://discovery.ucl.ac.uk/id/eprint/10165057/1/Hagen_et_al-2023-Cochrane_Database_of_Systematic_Reviews.pdf.

to determine prevalence and associated factors of severe pain in postoperative orthopedic surgery patients. a cross-sectional, quantitative, and analytical study was conducted at a university hospital in São Paulo with 63 postoperative orthopedic surgery patients. Clinical, demographic, and lifestyle variables were collected. The presence of severe pain was assessed using the Numerical Verbal Scale, considering scores ≥7 for severe pain. Statistical analysis employed the Mann-Whitney, Kruskal-Wallis, Fisher's chi-square, and Logistic Regression tests. the prevalence of severe pain was 63.5% (95% Confidence Interval: 51.6% to 75.4%). An association was found between mobilization and severe pain. Physical activity was a protective factor against severe pain (Odds Ratio=0.3; 95% Confidence Interval=0.1 to 0.8). the prevalence of severe pain was high and associated with mobilization, with prior physical activity being identified as a protective factor.

Among the various physical traits that serve as secondary sexual characteristics, breasts and buttocks are visually conspicuous cues used in male mate evaluation because they signal youth, fertility, developmental stability, and nutritional status. Although these features have been extensively studied, less is known about the extent to which men differ in the relative importance they place on each trait. Latent Profile Analysis (LPA) identified distinct subgroups of Norwegian men (N = 395) based on how much importance they placed on breasts and buttocks in their evaluations of romantic partners. A four-class solution emerged, comprising Highly Body-Oriented (53%), Moderately Body-Oriented (20%), Buttocks-Oriented (18%), and Body-Unoriented (9%) subgroups. Predictors such as egalitarianism, materialism, and preferences for sexiness were, as expected, significantly associated with class membership, providing support for the validity of the typology. Notably, a consistent buttocks-oriented class emerged across all LPA solutions, whereas no distinct breasts-oriented group was found, as ratings of breasts persistently co-occurred with high ratings of buttocks, suggesting that breasts do not function as a primary preference in isolation. These findings reveal that buttocks may occupy a more central and stable role than breasts in male mate preferences, offering novel insights into the structure of physical attraction and heterogeneity in the male mating mind.

The aim of this study was to evaluate the association between ganglion cysts and generalized joint hypermobility and to identify potential independent risk factors. In this retrospective case-control study, a total of 972 participants were included, comprising 243 patients diagnosed with ganglion cysts and 729 controls. Demographic characteristics, body mass index, occupational category, regular physical activity, and Beighton scores were recorded. Generalized joint hypermobility was defined as a Beighton score ≥4. Risk factors were analyzed using univariate and multivariate logistic regression models. There were no significant differences between the groups in terms of age (P = .185), sex (P = .629), body mass index (P = .412), or regular physical activity (P = .423). The proportion of individuals engaged in manual occupations was significantly higher in the ganglion cyst group compared to controls (P = .005). The mean Beighton score was significantly greater in patients with ganglion cysts and the prevalence of hypermobility was 64% in the ganglion group compared with 19% in controls. In multivariate analysis, hypermobility (adjusted OR, 7.1; 95% CI: 5.1-9.9) and manual occupation (adjusted OR, 1.4; 95% CI: 1.0-1.9) were identified as independent risk factors. A significant positive trend was observed across Beighton score categories. Generalized joint hypermobility seems to be a strong and independent risk factor for the development of ganglion cysts. The risk increases substantially with greater severity of hypermobility. These findings suggest that intrinsic connective tissue characteristics may play a key role in the pathogenesis of ganglion cysts. Aetiology (risk factors), case-control study. Level III.

The efficient approximation of time-variant outputs from high-fidelity numerical models is essential for sustainable groundwater management in coastal aquifers. While surrogate models are increasingly deployed to bypass the computational costs of simulation-optimization (S-O) under heterogeneity, their performance often degrades in high-dimensional input spaces. This study proposes a novel ensemble clustering framework integrated with a random forest (RF) surrogate model to optimize pumping strategies across extensive well networks. The framework utilizes MODFLOW and SEAWAT to generate a foundational dataset of hydraulic drawdown and saltwater intrusion (SI) distributions. A primary innovation lies in our clustering-based dimensionality reduction, which effectively reduces 52 physical pumping wells to 10 representative proxy wells. This strategy significantly reduces input dimensionality while identifying near-optimal pumping patterns. To train the RF model, targeted SEAWAT simulations were subsequently implemented to generate 5200 training samples, for each of which 100 realizations of hydraulic conductivity fields are generated. Results indicate that this integrated clustering-RF approach achieves 95% computational savings over traditional surrogate-numerical hybrids. This efficiency is realized through a drastic reduction in input variables via well-field classification and focused sampling near optimal extraction patterns. The resulting scalable framework provides a robust tool for decision-makers managing complex, saltwater-intruded aquifer systems.

Global energy challenges establish building-integrated photovoltaics as a pivotal decarbonization frontier, where semitransparent organic photovoltaics (ST-OPVs) represent a promising technology for simultaneous power generation and daylight transmission. However, their widespread application is constrained by a fundamental efficiency and transparency trade-off governed by complex photon management. Herein, we introduce a physics-enhanced deep learning (PDL) framework that embeds optical physical priors into neural network, significantly reducing the reliance on extensive experimental datasets while enhancing predictive accuracy beyond conventional simulation and purely data driven methods. Building on a novel halogen-additive engineering strategy, that enables opaque devices with a power conversion efficiency exceeding 20%, our PDL-guided optimal optical design delivers corresponding ST-OPVs with a record light utilization efficiency of 6.09%. When scaled to large-area manufactured modules, multi-scale building energy modeling demonstrates that the nationwide deployment of such ST-OPVs could meet up to one-fifth of China's total energy demand, highlighting their transformative potential in advancing sustainable energy systems and supporting global carbon neutrality goals.

Policy Points For half a century, firearm-related deaths and injuries have been endemic in the United States, with COVID-19 contributing to a record high of 48,830 deaths in 2021, an epidemic rate increase. By 2023, national trends masked a significant 10-fold difference in firearm-related death rates among states. Over decades, some states have experienced large, sustained reductions in firearm-related death rates, while others have experienced increases. Firearms are a consumer product that fit the definition of a market-driven epidemic (MDE), with the firearms industry having successfully marketed gun ownership through strategies that include fear, predatory tactics, and emphasis on lethality; stalling public health research for decades; and employing strategies used in other industries to promote potentially harmful products. Evidence from classic MDEs, such as tobacco and prescription opioids, demonstrates that large-scale, long-term reductions in harmful use can be achieved through a combination of focused, effective interventions and engaged governments, nongovernmental organizations, academia, media outlets, and, at times, companies themselves. The United States has developed a robust array of evidence-based mitigation strategies to reduce firearm-related harm, including gun safety laws, focused hospital and mental health programs, community and environmental programs, and social and economic policies. Applying insights from classic MDEs, building on what has worked, and increased active engagement among stakeholders are needed to reduce preventable firearm harm. The United States has among the highest firearm-related deaths in the world. In 2023, suicides accounted for 58% of firearm-related deaths and 38% of homicides. Firearms have become the leading cause of death among those under age 19. Nonfatal injuries, outnumbering deaths over two-to-one, often lead to lifelong physical and mental health sequelae. The firearms market, valued at around $40 billion per year, is one-tenth the estimated $500 billion cost of the epidemic due to medical costs, work loss, and quality-adjusted life years lost. Peer-reviewed literature, government documents, and media reports were used to analyze the firearms epidemic according to the market-driven epidemics (MDE) definition and framework of five often overlapping phases: (1) market development; (2) evidence of harm; (3) corporate resistance; (4) mitigation; and (5) market adaptation. The MDE framework emerged from the analysis of efforts that reduced cigarette, sugar, and prescription opioid use. The central question for mitigating the firearm MDE is: What combination of interventions and actors will achieve large-scale, long-term reductions in firearm-related deaths and other harm? The epidemic of firearm harm fits the MDE definition and is progressing through the five stages of an MDE. Phase 1. Firearms marketing accelerated rapidly when the focus shifted from marksmanship, sportsmanship, and hunting to themes of self-defense, home protection, patriotism, and masculinity. Phase 2. Evidence of harm at the population level has linked firearm ownership or possession to significant increases in suicide deaths, homicide, femicide, and gun-related injuries. Phase 3. Firearms industry resistance has used "corporate playbook" strategies to downplay the evidence of preventable harm, discredit public health, and influence the passage of favorable legislation. Phase 4. Decades of action by government, academia, and civil society have produced an array of mitigation interventions shown to reduce firearm-related suicides, homicides, and other harm. Jurisdictions that have implemented these measures have been able to achieve significant, sustained decreases in firearm-related deaths, while some high-burden areas that have declined to implement such measures and have enacted permission policies have experienced notable increases in firearm-related deaths. Phase 5. The firearms market has evolved through consumer demand for "non-lethal" alternatives (i.e., TASERs, rubber bullets) and through company expansion of overseas sales and pursuit of new technologies (i.e., "smart guns," magazine safeties). High rates of firearm-related deaths and injuries are not inevitable. By treating the firearm harm epidemic as the market-driven problem it is, drawing on insights from other MDEs strategies, substantial reductions in violence may be achievable across the United States. States and cities have significantly reduced gun violence without infringing Second Amendment rights. The greatest unmet challenge now is generating increased engagement in gun safety among states and communities still experiencing high levels of preventable firearm deaths and related harms.

Proximal humerus fractures (PHFs) are among the most common fractures in elderly patients, yet there is insufficient evidence from randomized controlled trials (RCTs) to determine the most appropriate interventions for their management. This study presents the long-term results of the first prospective RCT comparing surgical treatment with reverse shoulder arthroplasty (RSA) versus nonoperative treatment in displaced PHFs in elderly patients. Patients from a previously published RCT of 62 patients, in which RSA was compared with nonoperative treatment, were followed up long term. All patients were aged 80 years or older with 3- or 4-part displaced PHFs. Functional (Constant, Disabilities of the Arm, Shoulder and Hand questionnaire, Short Form 12 [SF-12], and visual analog scale) and radiographic outcomes were assessed. From the initial series, 12 patients treated conservatively and 17 with RSA were included, with mean ages of 88 and 92 years (P = .004) and mean follow-up of 7.4 and 7.6 years (P = .171), respectively. Functional outcomes for RSA versus conservative treatment were as follows: Constant 62/51 (P = .039), Disabilities of the Arm, Shoulder and Hand questionnaire 16/25 (P = .069), SF-12 Physical 42/43 (P = .808), SF-12 Mental 59/60 (P = .690), and visual analog scale 1.5/1.4 (P = .274). All nonoperatively treated fractures healed in malposition, but none required revision to RSA. Among patients treated with RSA, one required revision surgery due to prosthesis dislocation. These results suggest that long term treatment with RSA for displaced 3- or 4- part PHF provides better functional outcomes compared to nonoperative treatment. This difference is attributed to the deterioration of functional outcomes of the nonoperative treatment over time.

A novel rGO-coated, TiO2-decorated yolk-shell-like SiO2@C microsphere (STC@rGO) is synthesized and serves as a separator modification layer. In this system, a dual-oxide system of SiO2 and TiO2 is synergistically integrated with a dual-carbon framework consisting of carbon microspheres and rGO. The STC@rGO-modified separator efficiently suppresses polysulfide shuttling and accelerates reaction kinetics through the synergistic effects of physical confinement, chemical adsorption, and catalytic conversion toward polysulfides. The cells employing this modified separator achieve a discharge capacity of 453.2 mAh g-1 at 10 C with a 90% high sulfur loading. After 600 cycles at 1 C, the discharge capacity is maintained at 445.7 mAh g-1, with a capacity decay rate of only 0.059% per cycle. Even at a high areal sulfur loading of 3.35 mg cm-2, the cell still exhibits stable cycling performance. This study confirms the effectiveness of dual oxides and the dual-carbon framework in enhancing rate and cycling performance, providing new insights for the development of high-performance separator materials for Li-S batteries.

BackgroundPeople living with Alzheimer's disease often require support from their relatives, who may face emotional and physical challenges in their role. Up to 90% of people living with cognitive impairment experience unmet needs such as wandering.ObjectiveThe aim of the study was to analyze the narrative of relatives of people living with Alzheimer's disease experiencing unsatisfied behavioral needs and whether this has a relationship with levels of burden.MethodsRelatives who cared for a family member with Alzheimer's disease at home participated in a structured interview with a psychologist and completed the Zarit Burden Interview to assess caregiver burden. An analysis was conducted of the frequency of words used in the relatives' responses to the question "What is your experience of your loved one's wandering?".ResultsA total of 15 relatives participated in the study. Relatives with higher levels of burden related to their role as caregivers were more likely to use words such as "disorder" (on average once per interview), "problem" (on average three times per interview), and "difficulty" (on average twice per interview), than people with low levels of burden. For people with low levels of burden, the word "need" appeared as a significant expression (on average four times per interview).ConclusionsRelatives who experience less burden are more likely to understand the reasons behind their loved ones' need or desire to wander. They are less likely to perceive this behavior as a problem and restrict the person's freedom of movement for their own safety.

Frailty is a heterogeneous aging phenotype that represents accumulated biological vulnerability among very old adults. How frailty relates to key late-life transitions at advanced ages remains incompletely understood. We examined the longitudinal association between frailty status and a composite endpoint of incident long-term care insurance certification (level ≥ 2) or death, and assessed whether circulating biomarkers (growth differentiation factor-15 [GDF-15] and N-terminal pro-B-type natriuretic peptide [NT-proBNP]) provided information beyond frailty. In this cohort study, 992 community-dwelling adults aged 85-89 years in Japan, classified using physical frailty criteria at baseline as either robust, prefrail, or frail, were followed up to 7.5 years. Risk over time was compared using Kaplan-Meier methods, and Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs). Kaplan-Meier curves showed clear separation across the frailty groups. In multivariable models, prefrail and frail status were associated with a higher risk of the composite endpoint (aHRs 1.62 and 2.13 vs. robust, respectively). After adjusting for frailty status and covariates, higher GDF-15 and NT-proBNP levels were independently associated with greater risk. The GDF-15 association was adequately described by a linear term, whereas NT-proBNP showed evidence of nonlinearity with a steeper gradient toward the upper range. As a supportive summary of risk stratification, 5-year discrimination changed only modestly after adding biomarkers. Frailty strongly stratified the risk of major late-life transitions, and baseline GDF-15 and NT-proBNP may help characterize residual biological heterogeneity beyond frailty, with contrasting dose-response patterns.

Psychosocial well-being relates to lower cardiovascular risk, and a healthy lifestyle may contribute to this association. Prior research has focused on aging adults, although health behaviors are usually consolidated in early adulthood. This longitudinal study assessed the association between two psychosocial well-being indicators and subsequent healthy lifestyles in young adults. Participants (n = 799; agemean = 30.6 years) in the Nicotine Dependence in Teens Study completed items to derive the emotional vitality score, a flourishing scale, and covariates in 2017-2020. Data on selected outcomes (i.e., smoking, sleep, physical activity, alcohol intake, diet quality), collected in 2017-2020 and 2020-2021, were combined into a lifestyle score used categorically (≥ 4 healthy behaviors) and continuously (0-5 scores). Associations between psychosocial well-being indicators and lifestyle up to 4 years later were modeled using logistic and linear regressions. In model 3 adjusting for sociodemographic, health-related, and depression covariates, higher likelihood of a healthy lifestyle (≥ 4 healthy behaviors) was observed with flourishing (OR = 1.56, 95%CI = 1.02-2.40), but the CI for emotional vitality included the null (OR = 1.62, 95%CI = 0.93-2.81). Both well-being indicators were similarly associated with continuous lifestyle scores (e.g., model 3, per 1-SD unit: βflourishing = 0.13, 95%CI = 0.06-0.21; βemotional vitality = 0.10, 95%CI = 0.02-0.17). Further controlling for baseline lifestyle attenuated associations (model 4; βflourishing = 0.10, 95%CI = 0.03-0.18; βemotional vitality = 0.06, 95%CI = -0.02 to 0.14). When assessing behaviors separately, both well-being indicators were associated with healthy diets and sleep only. Flourishing and emotional vitality may promote healthy behaviors among young adults and be considered in prevention strategies aiming to foster healthy lifestyles in this age group.

The study investigated the lifetime prevalence of intimate partner violence among women aged 20 to 69 years residing in the urban area of São Leopoldo (RS) and associated factors. This was a population-based cross-sectional study in which 1,113 women were interviewed. The outcome was self-reported lifetime intimate partner violence, and sociodemographic, physical and mental health, and behavioral variables were assessed. A stratified analysis by age group was performed. The prevalence of intimate partner violence in the sample was 17.9% (95%CI 15.6-20.1). In the adjusted analysis, the outcome was associated with lower socioeconomic status, a history of sexually transmitted infections, and the presence of common mental disorders. In the stratified analysis, women aged 20-39 years had a 13.7% (95%CI 10.5-16.8) lifetime prevalence of intimate partner violence, with nearly three times the likelihood among those with common mental disorders. Among women aged 40 years or older, the prevalence was 20.7% (95%CI 17.6-23.8), with those in the lowest socioeconomic class, who were single, divorced, or widowed, who self-reported sexually transmitted infections, and who had common mental disorders being more likely to experience the outcome. Secondary intersectional analyses revealed a higher prevalence of intimate partner violence among Black or Brown women with low educational attainment (PR = 1.67; 95%CI 1.14-2.45) and White women with low educational attainment (PR = 1.58; 95%CI 1.14-2.19), compared to white women with higher educational attainment. The study demonstrated a high lifetime prevalence of intimate partner violence, reinforcing the need for public policies that improve women's socioeconomic conditions, as well as integrated gender-based violence prevention programs that incorporate mental health care in the support provided to victims.

The Indian subcontinent is home to the wild species Cyperus scariosus R. Br. (Cyperaceae). The rhizome, called nagarmotha, has long been used traditionally in perfumery and medicine. The purpose of this study was to examine variations in the yield, chemical composition, and physical characteristics of the essential oils of C. scariosus, which grow wild throughout the Indian subcontinent. Chromatographic and spectroscopic methods were used to analyze essential oils from 26 samples collected in 10 different states. The study found that the essential oil composition and quantity varied greatly, ranging from 0.32&#xa0;&#xb1;&#xa0;0.02 to 1.05&#xa0;&#xb1;&#xa0;0.05%. A total of 107 chemical components, accounting for 81.0%-91.6% of the rhizome essential oils, were identified. Major components of the rhizome essential oils were cyperene (6.3%-32.0%), cyperotundone (3.1%-26.8%), mustakone (0.2%-13.3%), caryophyllene oxide (0.1%-13.1%), valencene (<0.05%-11.8%), isopatchoula-3,5-diene&#xa0;+&#xa0;&#x3b1;-copaene (0.3%-8.6%), nootkatone (0.1%-7.8%), rotundene (1.8%-7.4%), and &#x3b2;-selinene (<0.05%-7.1%). In addition, the aerial portion of the plant, which is regarded as agro-waste showed the presence of drimenol (5.3%-23.8%), hexadecanoic acid (15.9%-22.3%), phytol (3.0%-9.7%), caryophyllene oxide (6.3%-8.6%), hexahydrofarnesyl acetone (2.2%-6.2%), cyperotundone (0.4%-3.7%), heptadecanal (0.6%-3.3%), mustakone (0.2%-1.6%), and cubebol (0.2%-1.0%) along with other thirty minor constituents. The results can serve as a valuable tool in verifying the authenticity of cypriol oil.

Long-term resistance training may influence cardiovascular health, but evidence in women, particularly in the context of aerobic activity and sedentary behavior, remains limited. This study sought to examine the association between long-term resistance training and risk of major cardiovascular disease (CVD) in women, and to evaluate joint associations with aerobic activity, sedentary television viewing, and key training-related characteristics. We conducted a prospective cohort study among 117,025 women from the Nurses' Health Study (N = 45,669; 2002-2020) and Nurses' Health Study II (N = 71,356; 2003-2017), with up to 5 repeated assessments of physical activity. Resistance training was reported every 4 years, and time-varying cumulative averages were calculated to represent long-term exposure. The primary outcome was incident major CVD, defined as nonfatal or fatal myocardial infarction (MI), stroke, coronary artery bypass grafting, or percutaneous coronary intervention. Over a mean of 14.5 years of follow-up (1,630,964 person-years), 5,459 incident major CVD events occurred. Compared with no resistance training, women performing &#x2265;2 h/wk had a 20% lower risk of major CVD (HR: 0.80; 95% CI: 0.69-0.92; P for trend = 0.007), and each additional 1 h/wk was associated with a 5% lower risk (HR per 1 h/wk: 0.95; 95% CI: 0.92-0.99). The inverse association was stronger for MI (HR for &#x2265;2 h/wk vs none: 0.56; 95% CI: 0.41-0.76) but not evident for stroke (HR: 0.99; 95% CI: 0.80-1.23). Women who met recommendations for aerobic activity (&#x2265;15 metabolic equivalent of task hours per week), resistance training (&#x2265;1 h/wk), and low sedentary television viewing (<2 h/d) had a lower risk of major CVD (HR: 0.60; 95% CI: 0.53-0.69), than those meeting aerobic and low sedentary television viewing recommendations but not resistance training (HR: 0.73; 95% CI: 0.67-0.80). Greater consistency in maintaining resistance training (&#x2265;75% of follow-up) and engaging in both upper and lower limb training were associated with stronger inverse associations. In this large prospective study of U.S. women, consistent resistance training, especially when integrated with recommended levels of aerobic activity and reduced sedentary television viewing, was associated with a substantially lower risk of major CVD, particularly MI.