The Western region of the US has received comparatively less attention in HIV research despite housing several Ending the HIV Epidemic priority areas. Understanding HIV risk and prevention behaviors among men who have sex with men (MSM) in this region is critical. This study examines differences in HIV risk and prevention behaviors among MSM in the Pacific (CA, WA) and Mountain (AZ, NV) sub-regions. We conducted a serial cross-sectional analysis using 2017-2021 data from the American Men's Internet Survey. The sample included MSM with HIV-negative or unknown status. Key outcomes included condomless anal intercourse, substance use, STI diagnoses, HIV/STI testing, and PrEP awareness, willingness and use. Poisson regression models with robust standard errors estimated prevalence ratios and 95% confidence intervals, adjusting for sociodemographics. Among 7423 MSM, 81.3% resided in the Pacific sub-region, 53.0% were aged <30 years and 50.8% were white. Condomless anal intercourse rates were similar across sub-regions, but STI diagnoses (13.0% vs 10.1%, P<0.05) and substance use were higher in the Pacific compared with the Mountain sub-region. HIV testing (55.5% vs 59.8%, P<0.05) and STI testing (39.2% vs 45.7%, P<0.001) were lower in the Mountain sub-region compared with the Pacific sub-region. PrEP awareness was similar, but usage was lower (17.2% vs 23.1%, P<0.001) despite higher willingness (51.8% vs 44.5%, P<0.001) in the Mountain compared with the Pacific sub-region. HIV risk was similar across sub-regions, but disparities in prevention engagement highlight regional barriers. Expanding PrEP access and HIV/STI testing in the Mountain sub-region is critical to achieving Ending the HIV Epidemic goals.

Ultra-processed foods (UPFs) are associated with metabolic disorders, mental health and stress-related behaviors. Chronic stress, marked by sustained cortisol elevation, may influence UPF intake. Hair cortisol is a reliable biomarker of long-term stress and enables a deeper understanding of this bidirectional association. This study aimed to investigate the association between hair cortisol, a biomarker of chronic stress, and UPF consumption in the ELSA-Brasil cohort. A cross-sectional analysis was performed on 2525 participants from the ELSA-Brasil cohort. Hair cortisol levels were categorized as low, normal, and high, and UPF consumption was expressed as the percentage of the total energy intake divided into tertiles. Multinomial logistic regression was performed to examine the association between cortisol levels and UPF consumption after adjusting for sociodemographic and behavioral factors. Individuals with high hair cortisol levels were 61% more likely to be in the second tertile of UPF consumption (13.78-21.60% of total energy intake) compared with the lowest tertile, even after adjustment for confounders. No significant association was observed between high cortisol levels and the highest UPF consumption in any tertile. These findings suggest a non-linear association, in which moderate UPF consumption may provoke a stronger physiological stress response than excessive intake. Moderate UPF consumption is significantly associated with elevated hair cortisol levels, emphasizing the importance of dietary and behavioral interventions to mitigate chronic stress. Reducing UPF intake, promoting increased consumption of unprocessed or minimally processed foods, and stress management strategies can be essential in addressing stress-related health outcomes.

Educational value of YouTube videos on exercise during pregnancy: A cross-sectional analysis.

Association Between Self-Reported Smoking Behaviour and Fuchs Endothelial Corneal Dystrophy: A Cross-Sectional Analysis.

Association of lifestyle and metabolic factors with clinical performance in multiple sclerosis: A cross-sectional study.

There is limited knowledge regarding whether board-certified emergency medicine (EM) physicians have different opioid prescribing rates compared to other physicians working in emergency departments (EDs). This study aims to determine if opioid prescribing rates differ based on board-certification status compared with other physicians practicing in an ED setting. An IRB-approved, cross-sectional analysis was performed on the Medicare Part D Prescribers by Provider and Drug datasets from 2018 to 2020 to determine prescribing rates of EM physicians by board-certification status with the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine. EM physicians prescribing opioids to 11 or more Medicare beneficiaries per calendar year in EDs were included. The average total day supply (TDS) of opioids per beneficiary for the 4 most common opioids (acetaminophen/codeine, hydrocodone/acetaminophen, oxycodone/acetaminophen, tramadol) was estimated using generalized linear models with Poisson distribution, log-link, and individual clustering and compared by board certification in EM status. Incident rate ratios (IRR) were used to describe the association between board certification in EM and the average TDS of opioids. A total of 29,144 physicians were included in the study, with 23,720 (81.4%) board-certified by the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine and 5424 (18.6%) certified by another specialty board (eg, family medicine [48.6%], internal medicine [17.3%]). Physicians working in EDs, who were not board-certified in EM, prescribed a higher average TDS compared with board-certified EM physicians: acetaminophen/codeine (TDS, 10.8 vs 4.0; IRR, 2.7 [95% CI, 2.3-3.2]); hydrocodone/acetaminophen (TDS, 15.2 vs 3.8; IRR, 4.0 [95% CI, 3.7-4.4]); oxycodone/acetaminophen (TDS, 19.8 vs 4.4; IRR, 4.5 [95% CI, 3.8-5.3]); tramadol (TDS, 20.1 vs 5.3; IRR, 3.8 [95% CI, 3.5-4.1]). Board certification in EM was associated with lower opioid prescribing rates. The average TDS of opioids per Medicare beneficiary was lower for board-certified EM physicians compared to non-EM board-certified physicians staffing EDs between 2018 and 2020.

Osteoarthritis (OA) has been linked to obesity, although the specific contribution of visceral fat remains a topic of ongoing investigation. The body roundness index (BRI) has been proposed as a more precise measure of overall and visceral adiposity compared with traditional indices. The potential association between BRI and the risk of OA has not been fully elucidated. Data were obtained from 8803 participants in the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression analysis was applied to evaluate the association between BRI and OA risk. Stratified analyses were conducted across different subgroups, and smoothed curve fitting techniques were used to visualize the results. Weighted logistic regression analysis and smoothed curve fitting demonstrated a U-shaped association between BRI and OA risk, with higher OA risk observed at both low and high extremes of BRI, relative to an inflection point. Stratified analyses indicated that this relationship varied by gender and ethnicity. Women exhibited a stronger association between higher BRI and OA risk compared with men [odds ratio (OR) 1.01 (0.86-1.06) vs. 1.07 (1.03-1.11)]. Lower BRI values appeared to be more protective among women. Minority populations demonstrated higher optimal BRI values compared with Han Chinese populations. No significant modifying effects were identified for other factors beyond gender and ethnicity. A significant U-shaped relationship was observed between BRI and OA risk, with both low and high BRI values associated with increased risk. The association was particularly evident among women and ethnic minority populations. These findings highlight the importance of monitoring visceral adiposity as a modifiable factor in OA risk management. Key Points • A nonlinear U-shaped association exists between body roundness index (BRI) and osteoarthritis risk, with increased risk at both low and high BRI extremes. • The BRI-osteoarthritis relationship is modified by gender and ethnicity, demonstrating a stronger association in women and ethnic minority populations. • BRI may serve as a superior anthropometric indicator for visceral adiposity, offering a practical tool for identifying individuals at elevated risk for osteoarthritis.

Socio-demographic and occupational determinants of poor self-perceived health among seasonal migrant farmworkers: A cross-sectional analysis.

A two decade review of elderly physical abuse in forensic medicine.

Lifestyle factors and DNA methylation-based aging clocks: cross-sectional and longitudinal associations in the Singapore diet and healthy aging cohort.

Violence and suicidal ideation in Brazilian women: The impact of perpetrator type and the moderating role of depression.

A comprehensive activation analysis of fusion-fission cross-sections for 14N +175Lu system

Incidental carotid webs in trauma patients.

The worldwide acceleration of digital transformation in healthcare underscores the need for professionals to continuously adapt and sustain robust digital health competence, shaped not only by individual characteristics and institutional environments but also by broader social, cultural, and geopolitical factors. This study aimed to identify distinct clusters of digital health competence among healthcare professionals across 19 diverse countries and regions, and to examine the factors influencing the development and distribution of these competence clusters. A cross-sectional international survey study was conducted between 2023 and 2024, using a validated survey instrument measuring digital health competence and its influencing factors. Data were collected from healthcare professionals in 19 countries and regions (n=6440; n=5945 used for this study), following a harmonised protocol with shared demographic templates and instruments. K-means cluster analysis was employed to derive digital competence profiles, with comparative analyses conducted to investigate associations between the identified clusters and individual characteristics (e.g., age, education, professional experience). Five distinct clusters of digital health competence were identified: (1) Beginners, (2) Developing Professionals, (3) Emerging Users, (4) Proficient Practitioners, and (5) Pioneers. Higher competence clusters (4 and 5) were associated with younger age, higher education, hospital-based work, and stronger perceived support from management, organisational structures, and colleagues. In contrast, lower-performing clusters reported limited digital engagement and minimal support. Perceived leadership influence, particularly managerial commitment to digital change, was a key differentiator across clusters. The findings demonstrate substantial variation in digital health competence across healthcare professionals internationally. Cluster-specific strategies, such as targeted upskilling, peer mentoring, and leadership engagement, are needed to address competence gaps. The results provide a foundation for policy development and workforce training frameworks aimed at strengthening digital readiness in global healthcare systems. Future research should explore longitudinal competence development and evaluate targeted interventions.

Automated prescription of therapeutic exercise for shoulder impingement syndrome using literature-driven rule generation architecture.

A cross-sectional study of caregiving tasks and mental health outcomes among diverse family dementia caregivers.

The association of obesity and other metabolic disorders with COVID-19 mortality: a cross-sectional analysis of death certificates from Veneto (Italy) and Bavaria (Germany).

Emotional punishment (EP) as a parental discipline method remains underexplored, despite its potential risk for child maltreatment (CM). In Germany, children have a legal right to a violence-free upbringing, yet EP is still partly accepted, and its subtypes, prevalence and risk factors remain insufficiently understood. This study examines the prevalence of EP among German parents, identifies key risk factors, especially parental child emotional abuse (CEA) history, and explores interaction effects. A subsample of 1340 parents from a nationally representative German survey (July-October 2021) reported on EP use, CM history, parental stress, and sociodemographic characteristics. Cross-sectional analyses included descriptive statistics, hierarchical logistic regression models, and exploratory moderation analyses. 61.5% of parents reported using at least one form of EP. Risk factors included female gender (OR=1.414, p<0.01), age (OR=1.015, p<0.001), equivalent income (OR=1.000, p<0.01), parental stress (OR=1.040, p<0.001), child physical abuse (OR=2.239, p<0.001), child sexual abuse (OR=2.135, p<0.05) and CEA history (OR=3.784, p<0.001). Gender (OR=2.404, p<0.05) and age (OR=1.029, p<0.05) moderated the relationship between CEA history and EP use, while parental stress attenuated this effect (OR=0.966, p<0.05). EP use is highly prevalent in Germany and linked to intergenerational cycles of emotional violence. Further research, awareness, and targeted prevention and intervention strategies for high-risk groups are needed.

Diagnostic accuracy in dermatology requires both visual expertise and metacognitive skills such as confidence, calibration, and decision-making under uncertainty. Miscalibration may lead to diagnostic error, unnecessary testing, and unsafe management. Assess how confidence, response time, and decision behavior vary across levels of dermatologic experience and how these factors relate to diagnostic accuracy and efficiency. This cross-sectional study included 68 participants (medical students, resident physicians, and board-certified dermatologists) who completed a multiple-choice diagnostic task with 50 diverse dermatologic images. Participants selected a diagnosis option, rated their confidence, and decided regarding additional inspection. Diagnostic accuracy and confidence increased with experience. Board-certified dermatologists were most accurate when responding quickly, but not after longer deliberation, which did not hold true for residents. Medical students displayed significant overconfidence and poor alignment between confidence and decisions. Across all groups, 12% of melanomas were dismissed/overlooked. Small sample size limits subgroup comparisons. A simulated setting may not fully capture clinical complexity. Metacognitive skills differ by experience and influence diagnostic accuracy and efficiency. Training should support calibration and adaptive decision-making.

Association between antenatal care service utilization and birth preparedness among Tanzanian pregnant women: A cross-sectional study.