Transposable elements insert non-randomly into host genomes, generating mutations whose consequences depend on the tissue and developmental stage in which transposition occurs. We analyzed 3.2 million de novo Mutator (Mu) insertions across maize leaf, root, pollen, and endosperm to map target site preferences and their tissue specificity at fine-scale resolution. Insertions clustered into 29,408 genomic hotspots near gene 5' ends, collectively capturing 85% of events while covering just 1.9% of the genome. The vast majority of hotspots were consistently targeted across tissues, indicating that Mu insertion-site preference is largely constitutive rather than tissue-regulated. A minority (∼5%) showed significant tissue-associated variation in Mu activity; this variation was correlated with tissue-specific gene expression, but the relationship was imperfect: some tissue-associated hotspots overlapped broadly expressed genes, while other constitutively active hotspots overlapped genes with tissue-specific expression. These discrepancies indicate that gene expression alone is insufficient to predict Mu insertion-site preference, pointing to additional genomic or chromatin determinants. Together, our results provide a genome-wide, locus-level map of Mu targeting and a quantitative framework for understanding how developmental and genomic context shapes transposon target site preference.
Caulobacter crescentus is a gram-negative bacterium that produces the anionic sphingolipid ceramide diphosphoglycerate that can substitute for the lipopolysaccharide component of the outer membrane. ccna_01210 is a gene in the operon for ceramide diphosphoglycerate synthesis and encodes for the enzyme, CpgD. CpgD is a magnesium-dependent CTP:phosphoglycerate cytidylyltransferase that catalyzes the synthesis of CDP-glycerate, and a pyrophosphate byproduct. CpgD displays substrate specificity for the nucleotide CTP and a preference for 2-phospho-D-glycerate over other phosphoglycerate enantiomers and isomers. Here, we present five high resolution structures for CpgD in various catalytic states that rationalize the specificity and preference of CpgD for its two substrates. This includes structures of apo CpgD, a CpgD-CTP-Mg 2+ ternary complex, and three CpgD-CDP-glycerate-pyrophosphate-Mg 2+ product bound complexes. The structures reveal CpgD nucleotide specificity is mediated by favorable hydrogen bonding interactions with the cytosine nucleobase of CTP, while the preference for 2-phospho-D-glycerate occurs due to favorable van der Waals interactions with the 2D enantiomer and unfavorable steric clashes with the 2L enantiomer. A catalytic mechanism involving a pentacoordinate transition state is proposed based on the observed stereochemical inversion of the α-phosphate in the substrate CTP in comparison to the α-phosphate of the product CDP-glycerate. Overall, this provides insights into the catalytic mechanism, nucleotide specificity, and enantiomeric substrate preference of the cytidylyltransferase CpgD that participates in a unique pathway of bacterial sphingolipid synthesis.
As Chinese entertainment media become increasingly popular among Thai adolescents, more and more students engage with such content on YouTube outside of school. However, the relationships among content preferences, perceived usefulness, behavioral intention, and self-perceived learning effectiveness have been insufficiently examined. This study combines the Technology Acceptance Model (TAM) and Uses and Gratifications Theory (UGT) to examine these associations in 266 secondary school students (aged 13-19) from two schools in Thailand. Structural equation modeling with bootstrap-based mediation testing was used to analyze data. The results indicate that Chinese Media Content Preference (CMCP) positively predicted Perceived Usefulness (PU) (β = 0.593, p < 0.001), PU positively predicted Behavioral Intention to use YouTube to learn Chinese (BI) (β = 0.642, p < 0.001), CMCP directly positively predicted BI (β = 0.353, p < 0.001), and BI positively predicted self-perceived Learning Effectiveness (LE) (β = 0.766, p < 0.001). PU partially mediated the relationship between CMCP and BI, with an indirect effect comprising 74.22% of the total effect. Overall, the results suggest that content-level gratification can be a significant external antecedent within the TAM framework, with perceived usefulness as the key mechanism linking content preference to use intention. The research provides implications for Chinese-language teachers and content developers who want to utilize entertainment media to teach language.
Women's low involvement in household decisions is an important cause of the persistence of gender inequality in developing countries, as it constrains women's access to resources and opportunities. Despite its importance, little is known about the behavioral mechanisms behind women's low involvement. Guided by a simple theoretical model, we hypothesize that women may refrain from participating in household decisions to avoid spousal conflict, the likelihood of which increases with spousal differences in risk preferences. Using survey data from both spouses of 675 couples in rural Tanzania, we find that spousal differences in risk preferences are associated with a lower likelihood that spouses make decisions jointly and a higher likelihood that decisions are made by the husband alone. These relations are stronger in couples where women are more conflict-averse.
Social media has emerged as an important tool for disseminating information to medical students; however, their platform preferences and usage purposes remain unclear. We conducted a multicenter web-based survey of medical students from eight Japanese medical schools in 2025, assessing their overall social media use, platform preferences by purpose, daily usage time, and the perceived usefulness of social media for career decision-making. A total of 1,515 students participated in this study. YouTube (71.6%), Instagram (65.1%), and X (43.7%) were frequently used platforms, whereas Facebook (1.9%) was rarely used. Platform use differed by academic year: YouTube use was significantly higher among early-year students, whereas X use was significantly more common among advanced-year students (P = 0.043 and P < 0.001, respectively). Overall, 763 respondents (50.4%) perceived social media as useful for career decision-making, with X being used most frequently for this purpose, followed by YouTube and Instagram; this perception was significantly more common among the early-year students (P = 0.005). These findings provide valuable insights for educators and professional organizations seeking to engage medical students through social media. Understanding these trends is especially important as Japan faces a shortage of surgeons.
Tuberculosis (TB) in the United States disproportionately affects non-U.S.-born individuals. While testing this population for TB infection is recommended, little is known about individuals' willingness to take treatment for latent TB infection (LTBI). To address this gap, we conducted a pilot preference survey among individuals from countries with high TB incidence. Cross-sectional survey supported by language concordant community health workers. Federally qualified health center, serving a primarily Asian immigrant community, in San Francisco. Adults eligible for risk-based LTBI testing based on place of birth seeking primary care. Perspectives on TB disease, risk of reinfection, and willingness to accept treatment if diagnosed with LTBI conditional on different factors, such as side effects, costs, and other treatment burden. Among 60 participants, the median age was 48 years (interquartile range 35-63 years), 52% were women, and 100% spoke Chinese. Infecting others (n=35, 58%), risk of death (n=30, 50%), and potential isolation (n=25, 42%) were the most worrisome consequences of TB disease. Reinfection risk, risk of liver damage, cost, TB progression risk, clinic visits, and blood draws were most often considered moderately or very important when deciding whether to take LTBI treatment (n=53 to 57, 88-95%). While most participants (n=56, 93%) were willing to take treatment if diagnosed with LTBI even at a 10-year TB progression risk below 1% and willing to accept a risk of liver damage (n=41, 68%), less than half would accept LTBI treatment if there were any associated cost (n=28, 47%). Finally, many participants had concerns about their reinfection risk after completing LTBI treatment (n=34, 57%). Amongst surveyed participants, TB disease and its consequences such as hospitalization, death and infecting others were worrisome, and participants had a high level of willingness to take treatment if diagnosed with LTBI. Future assessments of how people weigh tradeoffs regarding LTBI diagnosis and treatment could inform interventions to increase LTBI treatment acceptance and completion.
An athletic depiction of the female physique has risen in popularity recently, mirrored by a surge in techniques such as high-definition liposuction to achieve increased abdominal definition. Nonetheless, the perceived ideal degree of female abdominal etching remains unreported. The objective of this study was to discern a diverse population's preferences for varying degrees of female abdominal etching and to understand demographic trends. A photo-realistic rendering of a female trunk displayed 3 levels of abdominal etching: basic, moderate, and extreme contour. Participants rated each image individually on a 7-point Likert scale and ranked the 3 images side-by-side from least to most attractive on Amazon Mechanical Turk, a crowdsourcing platform. Nine hundred seventy-six responses were analyzed. Basic contour received the highest attractiveness median (interquartile range) score of 6.0 (2.0), moderate contour at 5 (2.0), and extreme contour at 4 (4.0) (P < .001). Compared with extreme contour, respondents had 4.33 times the odds of rating basic contour a 7.0 (P < .001). Compared with extreme contour, respondents had 14.6 times the odds of ranking basic contour as the most attractive (P < .001). Compared with moderate contour, respondents had 39.2 times the odds of ranking extreme contour least attractive (P < .001). Overall, 73% found basic contour most attractive, 11% found moderate contour most attractive, and 16% found extreme contour most attractive (P < .001). Respondents across demographics viewed less contoured female abdomens as more attractive than highly contoured abdomens. For image description, please refer to the figure legend and surrounding text.
Conventional wisdom-and much of the trust literature-assumes that consumers prize benevolence in human experts but competence in AI. We put this stereotype to a stringent test through two 2 × 2 between‑subjects experiments (Study 1: N = 328; Study 2: N = 329) that manipulated benevolence (high vs. low) and competence (high vs. low) in health advertisements featuring either a human or an AI nutritionist. PROCESS Models 4 and 7 evaluated a dual‑mediation pathway in which perceived health benefits and trust linked experimental cues to adoption (purchase) intention. Results overturned the stereotype. Across all cue combinations, ads featuring human nutritionists outperformed their AI counterparts on perceived benefits, trust, and adoption intention. The human advantage widened under low‑benevolence or low‑competence conditions and narrowed-yet persisted-when both cues were high. Mediation analyses confirmed that source effects operated sequentially through perceived benefits and trust. These findings expose the limits of competence signaling for overcoming algorithmic aversion in healthcare contexts. To approach parity with human advisers, AI nutritionists must demonstrate not only technical skill but also convincing cues of benevolence, suggesting new design imperatives for AI‑enabled health communication.
C. elegans, a bacterivore living in microbially-complex environments, harbors a characteristic community of gut bacteria that contribute to its health and fitness. What determines which environmental bacteria end up as commensals is largely unknown in C. elegans , as in other animals. Previous work found that gut Pantoea isolates supported rapid worm development and infection resistance, while environmental congenerics were inferior. Notably, worms were preferentially attracted to the more beneficial gut isolates. Using bioactivity-guided fractionation and gas chromatography-mass spectrometry analysis, we identified bacterially derived isoamyl alcohol (IAA) as a secreted volatile attractant underlying this preference. Screening of worm mutants implicated AWC sensory neuron-associated genes in preferential attraction to beneficial Pantoea and established a causal link between IAA sensing and colonization by beneficial strains. While IAA sensing was important for initial colonization, gut-associated Pantoea strains ultimately outcompeted environmental congenerics over time, indicating that microbiome assembly is shaped by two complementary processes: host behavioral preference for high-IAA producers and bacterial competitive fitness within the gut. While IAA is a product of leucine metabolism and may function as a nutritional cue, we found that it could also directly enhance host infection resistance, suggesting an additional role in modulating host physiology. Finally, knockout analysis identified a bacterial branched-chain amino acid aminotransferase homolog as important for IAA production. Together, these findings identify bacterial volatile sensing as an important and underexplored mechanism shaping microbiome composition and its contributions to host fitness.
Long-acting regimens (LAR) offer promising alternatives for people with HIV, enhancing autonomy and convenience. Understanding preferences for LAR is essential to guide policy and implementation. This systematic review and meta-analysis examined willingness among adults with HIV to switch from daily oral antiretroviral therapy (ART) to LAR. Following PRISMA guidelines, we included studies of adults with HIV using daily oral ART reporting willingness to switch to existing or hypothetical LAR. The primary outcome was the proportion willing to switch. Articles were searched in PubMed and Embase up to October 2024. Risk of bias was assessed using the RoB-PrevMH tool. A random-effects meta-analysis with a generalized linear mixed model synthesized willingness for LAR. Subgroup analyses explored heterogeneity. Alternative LAR were summarized descriptively. Searches identified 2,038 records, of which 22 studies were included. Most studies were conducted in Europe or North America (96%). Willingness to switch to any LAR was 70% (95%CI: 59-79%; I2 = 97.9%). Furthermore, two-monthly intramuscular injections were the most frequently investigated LAR, with a pooled willingness of 60% (95%CI: 42-76%; I2 = 97.5%). No study-level characteristics explained heterogeneity. Limited studies investigated willingness for alternative LAR. The majority of people with HIV expressed willingness to switch to LAR, with two-monthly intramuscular injections being the most commonly investigated formulation. Substantial heterogeneity persisted, suggesting that LAR preferences are highly context dependent. Evidence on alternative LAR, including tablets, implants and intravenous infusions, is limited. Low- and middle-income countries were underrepresented, highlighting the need for geographically diverse research to better understand context-specific preferences and thereby inform treatment policy.
Palivizumab is an FDA-approved monoclonal antibody for preventing severe respiratory syncytial virus (RSV) infections in high-risk children. However, its real-world safety profile, particularly beyond clinical trial populations, remains incompletely characterized. This study aimed to systematically analyze adverse events (AEs) associated with palivizumab using two decades of data from the FDA Adverse Event Reporting System (FAERS) to identify known, novel, and rare safety signals. This study aimed to characterize the post-marketing safety profile of palivizumab and identify AE signals using 20 years of FDA Adverse Event Reporting System (FAERS) data. A retrospective pharmacovigilance study was conducted using FAERS data from Q1 2004 to Q2 2024. Duplicate reports were removed, and palivizumab-related AE reports (primary suspected drug) were extracted. AEs were standardized via MedDRA v27.0 and categorized by system organ classes (SOCs) and preferred terms (PTs). Disproportionality analyses, including reporting odds ratio (ROR), proportional reporting ratio (PRR), multi-item gamma Poisson shrinker (MGPS), and Bayesian Confidence Propagation Neural Network (BCPNN), were used to detect signals, with predefined criteria for signal validation. Among 21,558,936 total FAERS reports, 14,120 (0.065%) palivizumab-related AE cases were included, predominantly in infants aged 28 days-23 months (45.92% of all cases); 51.74% of cases with known sex were male. The most frequent serious outcome was hospitalization (60.98%), followed by death (12.12%). Three system organ class-level positive signals were identified, including two novel signals (Infections and infestations; Congenital, familial and genetic disorders). The strongest preferred term-level positive signals were RSV-related events, with novel signals including infantile spitting up, post-tussive vomiting, oligodipsia, and Kawasaki's disease. This 20-year real-world study confirms known AEs of palivizumab and identifies novel signals, particularly in infection-related and congenital disorder categories. These findings do not establish causality but highlight the need for prospective studies to validate associations, guiding safer clinical use in high-risk pediatric populations.
All-atom simulations of RNA using molecular dynamics have the promise of modeling conformational preferences, folding thermodynamics, conformational change kinetics, and binding affinities of small molecule therapeutics. These simulations rely on a force field, a set of equations and parameters that model the potential energy as a function of conformation using classical mechanics. One popular force field for RNA is Amber OL3, with the most recent iteration derived in 1999 and with subsequent updates to backbone dihedral parameters. The Amber force field, while frequently used, is known to have limitations; for example, it does not properly stabilize native structures against alternative structures. Here, we provide a new approach to fitting the non-bonded parameters for the force field, specifically atom-centered point charges for electrostatics and the Lennard-Jones parameters. The parameters are fit to quantum mechanics (QM) interaction energies calculated with symmetry-adapted perturbation theory (SAPT), including embedded point charges to represent the electrostatic field from solvent and adjacent nucleotides. In this pilot study with a limited set of fitting data, we use the Amber ff99 equations and atom types unchanged. With the revised parameters, we observe improvement in the stability of native structures relative to alternative structures. Native tetraloop conformations, which unfold with the Amber OL3 force field, are stable on the microsecond timescale with our new force field parameters. We also see improvement in the conformational preferences of tetramers. Crucially, A-form helices are still well-modeled, but we observe additional flexibility in an internal loop that is not consistent with NMR data. Overall, we provide evidence that this new approach to fitting RNA force field parameters to SAPT interaction energies with native-structure context represented as embedded point charges is promising. It offers a flexible solution for revising the equations in future work or for extension to other molecules that interact with RNA, such as proteins and small molecules. We call this new set of force field parameters Amber RNA.ROC26.
Preoperative antibiotics are currently recommended before sacral neuromodulation (SNM), but no guidelines exist for postoperative prophylaxis. The objective of this study was to evaluate the cost-effectiveness of 3 antibiotic strategies for preventing SNM infections requiring explantation. A decision analysis model (TreeAge Pro) compared (1) intravenous preoperative and oral postoperative antibiotics (PrePostAbx), (2) intravenous preoperative antibiotics without postoperative antibiotics (PreAbxOnly), and (3) no antibiotics either preoperatively or postoperatively (NoAbx). Model inputs included SNM success/continuation, risk of antibiotic side effects, infection and explanation rates, and reimplantation±repeat infection. Modeled costs (2022 USD) included antibiotics ±side effects, explantation due to infection, and reimplantation. Effectiveness was reported as quality-adjusted life years (QALYs) over a 1-year horizon. Monte Carlo simulation (n=10,000) addressed uncertainty, and net monetary benefit (NMB) was used for comparison due to similar, nonnormally distributed QALYs. PrePostAbx had the highest median costs ($28,848), $25 more than PreAbxOnly ($28,823). NoAbx had the lowest costs ($28,784) and the highest QALY (0.95) when accounting for antibiotic side effects (PrePostAbx and PreAbxOnly QALY=0.91). In 70.2% of 10,000 iterations, NoAbx was dominant, with lower costs and higher QALYs. At a willingness-to-pay threshold of $100,000, NMBs were similar (PrePostAbx=$62,158; PreAbxOnly=$62,176; NoAbx=$66,216). Utilizing a baseline infection rate of 3.23%, NoAbx was preferred. However, if infection rates exceed 5%, NoAbx would no longer be cost-effective. For infection rates <5%, omitting antibiotics for SNM is preferred, offering the lowest costs and the highest quality of life. Although abandoning all antibiotics is potentially controversial, PreAbxOnly is cost-effective compared with PrePostAbx due to lower costs, reduced side effects, and reduced antimicrobial resistance.
Hypertension control in older adults depends on sustained self-management, yet education strategies often overlook heterogeneity in barriers and capacities. To examine hypertension-related knowledge, behaviors, and educational needs in Chinese adults aged 60 years and older, identify determinants of regular blood pressure (BP) monitoring, and derive management profiles for targeted intervention. A cross-sectional questionnaire survey was conducted among Chinese adults aged 60 years and older recruited from community-based and outpatient clinical settings in Shanghai (n = 316). Descriptive analyses summarized knowledge, behaviors, barriers, and preferred formats. Multivariable logistic regression identified factors associated with regular BP monitoring. K-means clustering and principal component analysis were used to define management profiles. While 76.3% knew the ideal BP range, only 53.2% reported regular monitoring, despite 75.3% owning a home device. Older age predicted lower monitoring likelihood (OR = 0.944 per year, 95% CI 0.901-0.988, p = 0.013). Absence of a home monitor (OR = 0.113, p < 0.001) and lack of knowledge of standardized measurement procedures (OR = 0.212, p < 0.001) were strong negative predictors, whereas conceptual BP knowledge was not. Top education priorities were low-salt diet (69.3%) and older-adult-appropriate exercise (68.0%). Major barriers included information overload (64.6%) and technical terminology (56.6%). Face-to-face consultation was most preferred (81.3%). Five profiles showed marked heterogeneity (all P_FDR < 0.001). The High-knowledge/regular-monitoring profile had the lowest non-regular monitoring (29.2%). The Low-monitoring/low-resource profile had the highest non-regular monitoring (83.6%) and knowledge deficit (27.3%). The Medication-problem profile showed the most adherence problems (37.0%). Among Chinese adults aged 60 years and older, regular BP monitoring appears to be influenced more by operational capability than by conceptual awareness. Profile-guided, barrier-aware education may enhance the precision and scalability of hypertension self-management in similar community-based and outpatient care settings. https://www.chictr.org.cn/, ChiCTR2600116499.
BackgroundRemote nurse triage services are increasingly delivered through call centers to manage demand for urgent and unscheduled care. These encounters typically rely on decision-support tools, but safe and efficient outcomes also depend on how nurses interpret patient information and make decisions about the most appropriate level of care. Despite the growth of tele-triage, nurse decision-making in this context remains underexplored.ObjectiveTo examine factors shaping triage decisions and outcomes in the U.S. Department of Veterans Affairs' (VA) national tele-triage and urgent care program.MethodsWe conducted semi-structured interviews with 39 participants, including triage nurses, nurse managers, and virtual urgent care providers, across six VA regions. Interviews explored decision-making processes, perceived challenges, and coordination between nurses and providers. Transcripts were coded and analyzed thematically.ResultsFour categories of factors influenced triage decisions: (1) technology-decision-support tools structured encounters but were limited by usability issues and risk-averse design; (2) professional training and judgment-nurses varied in critical thinking and remote assessment skills; (3) organizational priorities-policies emphasizing safety and liability restricted decision-making discretion; and (4) patient factors-preferences, beliefs, and situational constraints shaped acceptance of virtual care. Participants described tensions between efficiency and safety, and providers thought some Veterans' symptoms were more appropriately treated through primary care, reflecting institutional pressures.ConclusionsVA's tele-triage process is shaped by decision-support tools, nurse expertise, organizational priorities, and patient preferences. Algorithms provide structure, but effective triage depends on nurses' ability to interpret recommendations in context. As call center-based tele-triage expands, ensuring technology supports rather than constrains clinician judgment will be essential for safe, efficient, and patient-centered care.
Due to the COVID-19 pandemic, in 2020 the medical community modified residency and fellowship interview processes to a virtual-only format. The 2023 application cycle marked the first year that any gynecologic oncology fellowship interviews returned to an in-person format with two programs conducting in-person interviews. This study evaluated the perspectives of gynecologic oncology fellowship applicants on in-person and virtual interview formats to inform programs' decision-making around future interview cycles. Applicant lists from three gynecologic oncology fellowship programs were compiled from the 2023 application cycle. An anonymous survey regarding applicant perspectives on the interview process was electronically distributed. There was a 56% (47/86) response rate. Applicants applied to a median of 50 programs (IQR 42-60), accepted 24 interviews (IQR 20-32), declined 4 interviews (IQR 2-9), and attended 24 interviews (IQR 17-24). Thirty (64%) applicants attended at least one in-person interview. Among the 30 applicants who experienced both interview formats, in-person interviews resulted in a better understanding of the program's geography, culture, and hospital facilities (p < 0.0001). Applicants who attended in-person interviews were more satisfied with their interview experience, found it easier to interpret body language, and were better able to connect with other applicants and form personal connections with interviewers (p < 0.0001). Of applicants who experienced both formats, 53% preferred in-person format. Applicants who participated in both interview formats reported higher satisfaction and connected better with other applicants and interviewers with in-person interviews; however, there was only a slight (53%) preference for in-person format.
Recurrent dislocation following revision total hip arthroplasty (THA) remains a major clinical challenge. Dual-mobility (DM) constructs and constrained liners (CLs) are commonly used to improve stability; however, direct comparative evidence remains limited. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Multiple databases were searched from January 2000 to October 2025 for studies comparing DM constructs and CLs in revision THA. The primary outcomes were dislocation and aseptic re-revision, while secondary outcomes included implant survivorship, patient-reported outcome measures (PROMs), patient- and construct-related risk factors, and non-revision complications. Due to heterogeneity in study designs, results were synthesized descriptively. Ten comparative observational studies comprising 2,046 revision hips (1,237 DM and 809 CL) were included. DM constructs were associated with lower reported dislocation and aseptic re-revision rates compared with CLs. Five-year re-dislocation-free survivorship ranged from 78% to 85% across comparative cohorts. In registry-based analyses, the 10-year cumulative aseptic re-revision rate was 8.6% for DM and 13.1% for CLs. PROMs, assessed using the modified Harris Hip Score (mHHS), improved similarly in both groups. No included comparative study reported primary cost or cost-utility data. However, external economic models suggest potential cost-effectiveness advantages with DM constructs. These benefits were driven primarily by lower complication rates and fewer re-revisions. In revision THA, DM constructs are consistently associated with lower postoperative instability compared with CLs in comparative observational studies. Evidence regarding reductions in aseptic re-revision is heterogeneous, reflecting competing failure mechanisms and the limitations of non-randomized data. Economic implications remain uncertain due to the absence of primary cost-utility analyses. Implant selection should therefore be individualized, and high-quality prospective comparative studies with standardized outcome reporting are needed to define optimal construct selection in revision THA.
Culturally and religiously responsive mental mobile health (mHealth) apps may improve access to and acceptability of mental health support among migrant communities; however, evidence to inform their design remains limited. This formative study investigated mental health perceptions, digital health information-seeking, and mental mHealth app use among first-generation Arabic-speaking migrants in Australia, with the aim of informing culturally adapted mental mHealth app design. An online survey was conducted among 219 first-generation Arabic-speaking migrants in Australia (aged 18-75 years), recruited from non-clinical community settings. The survey assessed attitudes toward mental health, awareness and use of mental mHealth apps, acceptance of app-based support, and desired features. Open-ended questions provided qualitative insights into cultural and religious preferences. Strong cultural and religious influences on mental health perceptions were observed, including high agreement regarding the role of divine will and religious practices. While most participants (76.3%) used the internet to seek mental health information, awareness (45.7%) and use (6.4%) of mental mHealth apps were low. Participants expressed high acceptance of mental mHealth apps that are free, user-friendly, confidential, and professionally developed. Highly valued features included culturally informed behavioural activation, mindfulness and religious practices (such as Dua'a and Tadabbur), and educational content incorporating Quranic verses and prophetic narratives. Information on crisis services and local multicultural mental health providers was also considered essential. Qualitative findings supported the inclusion of faith-based community features and religious motivational content, with several participants emphasising the importance of optional rather than mandatory religious elements. There is a clear demand for mental mHealth apps tailored to the cultural and religious needs of first-generation Arabic-speaking migrants in Australia. Formative evidence from this study highlights the importance of culturally and religiously congruent design, practical support features, confidentiality, and flexibility to accommodate individual preferences when developing mental mHealth interventions.
Childhood maltreatment and adolescent mental health problems are unequally distributed, with the highest burdens among marginalised groups including females and those experiencing socioeconomic disadvantage. However, little is known about how the psychological consequences of maltreatment vary across intersecting social positions (e.g., socioeconomically disadvantaged females). Prior quantitative work has largely focused on average differences across a limited number of groups, obscuring non-additive intersectional patterning. Because social realities are structured by overlapping systems of privilege and oppression (e.g., relating to gender, socioeconomic position, ethnicity, age, and place), we leveraged recent methodological advances to address this gap. Accordingly, this study aimed to (i) map inequalities in adolescent emotional problems and the effects of maltreatment across intersectional positions; and (ii) describe the extent to which inequalities in emotional problems reflect additive and non-additive (intersectional) effects. Data were analysed from 19 590 students aged 11-16 years who participated in the OxWell 2023 Student Survey in England, United Kingdom. Within a random-coefficient Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), individuals were nested in 180 intersectional strata defined by combinations of social positions relating to gender, ethnicity, household poverty, school year group, and school-level deprivation (also entered as additive main effects). Emotional problems (Revised Child Depression and Anxiety Scale; RCADS-11) were regressed on maltreatment exposure (Short Childhood Maltreatment Questionnaire) as the primary effect of interest. Stratum-specific predicted emotional problems and maltreatment effects were estimated, and between-stratum variance was partitioned into additive and residual non-additive components. Maltreatment was associated with higher levels of emotional problems, with stratum-specific increases ranging from +3.20 to +6.14 scale points. Socioeconomically disadvantaged females and individuals who selected 'other' or 'prefer not to say' for gender showed the highest levels of emotional problems and among the strongest maltreatment effects. Between-stratum inequalities in emotional problems were largely accounted for by maltreatment exposure and the additive contributions of the included social positions. However, residual non-additive effects were also evident, particularly among individuals exposed to maltreatment, where 5.25% of between-stratum variance remained unaccounted for by additive effects (compared with 3.46% among those not exposed). In this large community sample of adolescents in England, the detrimental effects of maltreatment on emotional problems appear pervasive but not uniform across intersectional social positions. Applying an intersectional MAIHDA framework suggests that inequalities in adolescent emotional problems largely reflect additive social patterning, with additional non-additive contributions suggestive of intersectional dynamics that are more pronounced with maltreatment exposure. These findings motivate deeper investigation into the social-structural mechanisms that shape vulnerability and resilience in adolescence, and support the need for trauma-informed, equity-focused interventions and policy action to reduce unequal exposure to maltreatment and the contexts that amplify its harms.
To determine the association between the duration of the third stage of labor and postpartum hemorrhage (PPH), and to identify an appropriate time threshold for performing manual removal of the placenta (MROP). A retrospective cohort study was conducted in women who underwent vaginal delivery with an uncomplicated third stage of labor. Data were retrieved from a digital obstetric database, including consecutive records of singleton pregnancies delivered vaginally at ≥24 weeks of gestation. Cases with excessive bleeding or emergency placental removal before completion of the third stage were excluded. During a 13-year study period, 13 653 cases were eligible for analysis, comprising 13 509 cases managed expectantly and 54 undergoing MROP. The median duration of the third stage was 5 min, and <1% of cases exceeded 40 min. The duration of the third stage was an independent risk factor for increased blood loss (523 ± 376 vs. 239 ± 161 mL after and before 30 min, respectively; P < 0.001), higher PPH rates, and greater need for blood transfusion. When the third stage exceeded 30 min, MROP resulted in significantly greater median blood loss compared with expectant management (500 vs. 400 mL, P = 0.018) and a higher rate of PPH (62.96% vs. 38.58%, P < 0.001), whereas the duration of the third stage was significantly shortened (38 vs. 50 min, P < 0.001). Blood loss increased with prolonged third-stage duration, with a markedly higher risk of PPH after 30 min. In cases with an uncomplicated third stage, expectant management is preferable within the first 30 min. Beyond this point, either expectant management or MROP may be considered on an individualized basis, with appropriate preparedness for PPH.