The 2024 revised criteria introduced an integrated framework for staging Alzheimer disease (AD) across biological and clinical dimensions. However, how this criterion characterizes clinical and biological features in populations outside the original development setting, particularly in non-Western and specialized clinic settings, remains insufficiently described. We consecutively enrolled 1,214 memory clinic participants who underwent both amyloid-PET and tau-PET imaging. Among amyloid-positive (A+) individuals, clinical stages (0-6) and biological stages (A-D) were assigned according to the 2024 criteria. Participants were classified as typical (concordant stages), susceptible (clinical > biological), or resilient (clinical < biological). Plasma p-tau217 was measured in 379 A+ participants. Associations were examined using generalized linear models adjusted for relevant covariates, with false discovery rate correction for multiple comparisons. Among the 1,214 participants, 818 were amyloid positive, comprising 412 (50.4%) typical, 330 (40.3%) susceptible, and 76 (9.3%) resilient individuals. Plasma p-tau217 increased progressively across advancing tau PET stages (p for trend <0.001), with significantly higher levels in stage D (1.31 pg/mL) compared with stage A (0.56 pg/mL, q = 0.029) and stage C (0.95 pg/mL, q = 0.013). Compared with the typical group, resilient individuals demonstrated superior cognitive performance (e.g., Mini-Mental State Examination [MMSE]: β = 8.56, q < 0.001), higher educational attainment (>9 years: 74.1% vs 45.1%, q = 0.020), and greater AD-signature regional cortical thickness (t = 3.033, q = 0.005) and volume (t = 3.209, q = 0.003). Conversely, susceptible individuals exhibited inferior cognitive scores (e.g., MMSE: β = -8.29, q < 0.001), reduced cortical thickness (t = -2.872, q = 0.005), and volume (t = -2.751, q = 0.007) in AD-signature regions and a numerically higher burden of vascular risk factors. In a large cohort from a specialized tertiary memory clinic, clinical-biological stage discordance under the 2024 AD criteria was common among amyloid-positive individuals. Distinct cognitive, educational, biomarker, and neuroanatomic profiles characterized susceptible, typical, and resilient subgroups. In addition, plasma p-tau217 showed a stepwise increase across tau PET stages, supporting its utility as a blood-based marker of tau pathology severity. These findings support the clinical relevance of the revised staging framework and may inform future refinements of AD diagnostic guidelines. This study provides Class II evidence that the 2024 revised biological and clinical criteria for AD demonstrate clinical utility in a Chinese cohort from a specialized tertiary memory clinic.

Mapping violence across time: A person-centered typology of childhood IPV exposure and later-life educational outcomes.

In a purely meritocratic society, educational outcomes would reflect ability and only ability. Vocabulary size is a common measure of cognitive ability that predicts educational outcomes but is confounded with socioeconomic circumstances (SEC). In preregistered analyses of the nationally representative UK Millennium Cohort Study data (N = 15,576), we used a series of multiple linear and logistic regression analyses to investigate the predictive value of age-5 vocabulary for age-16 educational outcomes and assess whether socioeconomic circumstance moderated this relation. We show that age-5 vocabulary strongly predicted age-16 educational attainment, even after adjusting for both SEC and caregiver vocabulary (OR = 1.62, 95% CIs = [1.52; 1.72]; β = .22, 95% CIs = [0.19; 0.24]). SEC also predicts educational attainment (OR = 2.05, 95% CIs = [1.92; 2.19]), and modifies the association between vocabulary and educational attainment, whereby a larger vocabulary was most advantageous for those in middle SEC groups (interaction term OR = 1.09 [1.03; 1.15]). Early child vocabulary is a strong predictor of children's educational outcomes - even when controlling for proxy measures of the home environment and genetics. Nonetheless, children who enter school with strong vocabulary skills but disadvantaged socioeconomic circumstances still have only about a 50/50 chance of gaining gateway qualifications at age 16.

Potentially traumatic events (PTEs) are associated with cardiovascular disease (CVD) in aging populations. Despite sex differences in PTE exposure and CVD incidence, no study has examined sex-specific associations between PTEs and CVD in the same sample of middle-aged and older adults. Using data from the Health and Retirement Study, we examined lifetime exposure to 18 PTEs across three domains: early life adversity, lifetime trauma, and perceived discrimination and CVD (stroke or heart disease). We used Cox proportional hazards regression to calculate crude and adjusted (race/ethnicity, age, and educational attainment) hazard ratios (aHRs) and 95% confidence intervals (CI). Among 12,272 HRS participants, nearly 80% reported experiencing at least one PTE. Within domains, child abuse and serious accident or illness had the strongest associations with CVD for men, aHR=1.26, 95% CI [1.04, 1.52], aHR=1.68, 95% CI [1.53, 1.85], respectively, and women, aHR=1.35, 95% CI [1.17, 1.56], aHR=1.80, 95% CI [1.64, 1.97], respectively. Sex differences were noted for perceived discrimination-for men, the strongest association was between being prevented from moving into other housing and CVD, aHR=1.52, 95% CI [1.08, 2.14], and for women, the strongest association was between being denied health care and CVD, aHR=1.43, 95% CI [1.08, 1.90]. For both sexes, experiencing a higher number of PTEs was associated with an increased rate of CVD. Differences among men and women in these results offer insight into opportunities for prevention and targeted clinical interventions in this age group.

To determine a cutoff score for the Social Connectivity of Mothers with People in the Community Scale (SCMPCS) and revalidate the scale using additional psychosocial indicators. A cross-sectional analysis used baseline data from one arm of a randomized trial including 259 mothers with children under 3 years of age in Sapporo City, Japan. Reliability and structural validity were reassessed using Cronbach's alpha and confirmatory factor analysis. Parenting isolation was operationally defined as the absence of support from informal, community-based, and formal sources and used as the reference classification for ROC analysis. Predictive validity was examined using logistic regression adjusted for maternal age, educational attainment, daycare use, and perceived economic status. Criterion-related validity was evaluated using Mann-Whitney U tests. The SCMPCS showed good internal consistency (α = 0.85) and acceptable model fit (CFI = 0.90, RMSEA = 0.073). ROC analysis identified a cutoff of 30 or lower with moderate discriminatory ability (AUC = 0.73; sensitivity = 0.92; specificity = 0.50). Mothers at or below the cutoff had higher odds of meeting the operational reference classification of parenting isolation (OR = 11.94, 95% CI: 2.74-52.03) and reported lower self-efficacy and capacity to receive support, greater loneliness, and poorer well-being. The SCMPCS demonstrated stable psychometric performance, and the validated cutoff may support broad preventive screening to identify mothers who may need further assessment and early follow-up. Rather than serving as a diagnostic threshold, this cutoff may help maternal and child health services provide timely preventive support.

Unmet need for family planning continues to be a critical barrier to achieving reproductive health goals in Bangladesh, despite advancements in health infrastructure and services. This study examines trends and determinants of unmet need for family planning among married women of reproductive age using data from the Bangladesh Demographic and Health Surveys (BDHS) spanning 2011 to 2022. We analysed nationally representative BDHS datasets from 2011, 2014, 2017-18, and 2022 (n=16,551; 16,795; 18,885; 18,987 married women aged 15-49). Unmet need (spacing/limiting) was the binary outcome. We described trends and subgroup differences, tested bivariate associations (χ2), and fitted separate multivariable logistic regressions for each survey year to estimate adjusted odds ratios (95% CIs). Division-level disparities were mapped, and a Blinder-Oaxaca decomposition (2022) quantified the explained versus unexplained components of rural-urban gaps. Over the past 12years, the unmet need for family planning has consistently decreased; however, notable disparities persist across geographic divisions, wealth quintiles, and educational attainment. Women with minimal education and rural residency were likelier to report unmet needs; women from affluent homes, metropolitan locations, and those exposed to family planning knowledge via mass media were less likely. These results highlight the need for thorough, context-specific interventions to close the gaps in family planning programs, guaranteeing proper access and advancement towards sustainable development goals in reproductive health.

Despite decades of evidence demonstrating that cervical cancer screening prevents morbidity and mortality, approximately one in four eligible Americans remains overdue for screening. Screening gaps are unevenly distributed, disproportionately affecting uninsured individuals, those with lower income or educational attainment, rural residents, and racial and ethnic minority populations. In this commentary, we highlight that perceived out-of-pocket costs for cervical cancer screening-rather than actual costs-remain a salient and modifiable barrier to screening among low-income, underscreened women, even in the context of Affordable Care Act (ACA) provisions. Optimizing cervical cancer prevention requires attention not only to initial screening uptake but also to completion of the full screening continuum, including timely follow-up after abnormal results. Recent policy developments-including the US Supreme Court affirmation of the ACA preventive services mandate, elimination of cost-sharing for patient navigation beginning in 2026, expansion of coverage for diagnostic follow-up starting in 2027 for insured individuals, and endorsement of self-collected human papillomavirus testing-create an unprecedented opportunity to reduce financial and logistic barriers to completion of cervical cancer screening. However, realizing the population-level and equity benefits of these advances will require deliberate implementation strategies that emphasize transparent communication about patient out-of-pocket costs, integration of navigation services, and follow-up pathways. See related article by Isaacson et al., p. 1158.

Childhood adversity and adolescent motherhood: A cross-sectional study of trauma, partner age gaps, and parenting in the Dominican Republic.

School active commuting is a key behavior to promote physical activity in children, yet limited evidence exists in Chile. This study examined its prevalence and associated factors among Chilean schoolchildren. A cross-sectional study was conducted using data from the Chilean National Physical Activity and Sports Habits Survey, including a subsample of 1137 children aged 5-10 years derived from a nationally representative survey. School active commuting was defined as the dependent variable. Independent variables included sex, area of residence, socioeconomic status (SES), caregiver's education, self-rated health, leisure activities, and home-based physical or sedentary behaviors. About one in three children (35%) reported commuting actively to school. Boys showed higher participation than girls, and active commuting was more common among children from lower SES households and among those whose caregivers had lower educational attainment. Children who preferred physical activities during leisure time were also more likely to commute actively. No differences were observed by geographic area, self-rated health, or home-based activity levels. Schools and local communities should work together to ensure safe, equitable, and accessible environments that support active commuting. Active commuting remains low in Chilean children, emphasizing the need for multisectoral policies to promote physical activity and reduce inequalities.

Exploring the role of digital inclusive finance in narrowing gender income inequality: an analysis of the mediating effect of educational attainment

Time trends and projections of binge drinking, tobacco use and their co-occurrence in Brazilian adults from 2006 to 2030.

Impact of soil lead on children's urinary levels and parent-reported learning disabilities in areas of diffuse contamination.

Patient-clinician communication impacts the well-being and medical outcomes of cancer survivors. However, there is a gap in current literature regarding patient-specific factors influencing optimal communication between people with cancer and their clinicians. To better understand factors associated with optimal clinician communication among cancer survivors, survey responses from the Health Information National Trends Survey Surveillance, Epidemiology, and End Results database were analyzed using logistic regression. Of the 1123 cancer survivors responding to the survey, 46% (n = 518) were males, 87% identified as white (n = 973), and the average age was 71 years. Patient-clinician communication was reported to be best when patients asked questions (73%) and poorest when dealing with feelings of uncertainty (47%). Descriptive analyses demonstrated differences in selected communication domains among Hispanic participants and racial minority groups. However, race and ethnicity were not independently associated with patient-clinician communication in adjusted analyses. Higher educational attainment and shorter time since diagnosis were associated with optimal patient-clinician communication experiences. Descriptive analyses suggested differences in overall communication score distributions across racial and ethnic groups; however, race and ethnicity were not independently associated with patient-clinician communication in adjusted analyses.

This study examined whether playing soccer in high school was associated with higher rates of mental health problems in early to middle adulthood. Longitudinal cohort study. The National Longitudinal Study of Adolescent to Adult Health ("Add Health") databases were analyzed. There were 221 individuals (53.8% women) who participated in high school soccer (without participating in football) and 2388 (67.2% women) who denied participating in soccer or any contact sports during high school. N/A. This study includes longitudinal data from individuals assessed at Wave I (n = 6503; median age = 15), Wave III (median age = 22), Wave IV (median age = 29), and Wave V (n = 4196; median age = 38). We compared those who played soccer with those who did not engage in contact sports on several mental health outcomes. When comparing those who played high school soccer with those who did not play contact sports, there were no differences in the proportion who had a lifetime diagnosis of depression, lifetime diagnosis of anxiety or panic disorders, suicidal ideation in the past year, psychological counseling in the past year, or current depressed mood at Waves III, IV, or V (all P -values > 0.05). In addition, we matched soccer players to control participants on biologic sex, race, and educational attainment to control for potential confounds; the results were similar and nonsignificant. Individuals who played soccer in high school did not have an increased rate of mental health difficulties at multiple follow-up time points during early to mid-adulthood.

'A gendered family affair'? Examining the role of partners', parents', and parents-in-law's education in preventive healthcare use among older men and women.

A decade of change: Comparative findings from the 2015, 2020, and 2025 APIC MegaSurveys on the infection prevention workforce.

Florida has the second-highest rate of acute hepatitis C virus (HCV) infection cases in the United States. However, HCV care cascade outcomes among individuals seeking care in Florida emergency departments (EDs) remain unknown. To assess HCV care cascade outcomes and identify HCV infection predictors among individuals tested for HCV in Florida EDs. This retrospective study used electronic health records (2016-2023) linked to the Agency for Healthcare Research and Quality on Social Determinants of Health regional data. Adults aged 18-79 years tested for HCV infection in Florida EDs. Outcomes included the proportions of individuals completing each HCV care cascade step: (1) HCV screening; (2) HCV diagnosis; (3) linkage to care; and (4) treatment initiation. A multivariable logistic regression model was used to identify predictors of HCV infection. Among individuals seeking care in EDs, 4.98% (n=18,444) were tested for HCV, of whom 4.97% were confirmed HCV-positive. Among HCV-positive individuals, 11.24% were linked to care, and 2.84% initiated treatment. Significant predictors of HCV infection included having Medicaid insurance (OR=1.53, 95% CI: 1.14-2.07) or being uninsured (OR=2.88, 95% CI: 2.02-4.12), coinfection with human immunodeficiency virus (OR=28.99, 95% CI: 22.31-37.67), opioid injection drug use (OR=3.62, 95% CI: 2.76-4.75), opioid overdose (OR=3.89, 95% CI: 2.32-6.52), and residing in communities characterized by lower educational attainment (fourth quartile OR=1.95, 95% CI: 1.27-2.98). Significant gaps persist across the HCV care cascade among individuals tested in Florida EDs. Innovative public health interventions are needed to support these vulnerable populations.

• Difference-in-differences analyses show that refugee arrivals may reduce political trust in host communities. • The negative effect is stronger among people with lower education. • It is important to mitigate negative consequences of arrivals in host communities to uphold political legitimacy. Previous research shows that the arrival of forcibly displaced people may have a considerable impact on the economy and on livelihoods within host communities. This is particularly the case in many African countries, which host many of the world’s refugees, but may have limited capacity to handle sudden influxes of people. Yet the bulk of research on refugee arrivals and public opinion is conducted in wealthy, Western contexts. In this article, we start addressing this gap by assessing the effect of forced displacement on trust in national and local authorities. Theoretically, we draw on the literatures on the consequences of forced migration and political trust. Empirically, we rely on seven rounds of georeferenced Afrobarometer data (N = 228,242) combined with data on migrant settlements from the UNHCR People of Concern database to estimate a set of difference-in-differences regression models. We also test whether individual educational attainment moderates the effect of displacement. We find that camp establishment reduces both forms of political trust, and the effect is more pronounced among host community members with less education. This underscores the importance of human development in bolstering the host community’s coping capacity when new camps are established.

In South Korea, apartment security jobs are commonly held by older men. The high prevalence of chronic conditions in this population, combined with the job's long hours and shift work, may increase risks of job stress and cardiovascular disease. This study aimed to identify individual and work environment factors that influence job stress among middle-aged and older security workers with hypertension. A cross-sectional study used self-reported questionnaires to collect data from 146 security workers with hypertension at 45 apartment complexes in South Korea. The data were analyzed through descriptive analysis and multilevel modeling. Higher educational attainment, lower sleep satisfaction, and lower social support were significantly (p < .05) associated with increased job stress, as were a lack of dedicated break areas and a higher number of households per worker. This study identified significant individual and workplace factors influencing job stress among older Korean security workers with hypertension. Education level, sleep satisfaction, and social support were key personal factors. The number of assigned households per security worker and the availability of break areas were critical workplace factors. These findings highlight the need for targeted interventions that address both personal and workplace conditions to manage job stress effectively. Age-sensitive policies are essential to reducing job stress. Providing rest areas, adjusting workloads, and fostering a supportive work culture can alleviate environmental stressors. Tailoring roles based on education and physical ability and providing health education on sleep hygiene and effective break use may reduce fatigue and stress.

The goal of this paper is to identify environmental, behavioral, and genetic predictors and early midlife correlates of problematic alcohol Use (PAU) patterns from adolescence to early midlife. The data are from 1463 twin individuals (60.5% female) in the population-based FinnTwin12 cohort born 1983-1987. PAU was assessed at ages 14, 22 and 37 using symptoms of alcohol use disorder (AUD) obtained from psychiatric interviews, mmMAST scores, and the AUDIT. Self-reported health and well-being were assessed at age 37. A behavioral and environmental risk index (BERI) was created by summing six risk factors: low socioeconomic status in childhood, family history of AUD, childhood externalizing and internalizing behaviors, adolescent substance use, peer substance use, and stressful life events in adolescence. The twins' genetic predispositions were indexed using polygenic scores for externalizing behavior (PGSEXT), PAU (PGSPAU), and depression (PGSMDD). Twins were classified into four PAU groups: Never (n = 599, reference), Remitted (n = 480), Persistent (n = 271), and Late-onset (n = 113). When included in the same model, both BERI and PGSEXT were significantly associated with Remitted PAU, while BERI scores and PGSPAU were significantly associated with Persistent PAU. Compared to the Never PAU group, individuals in the Persistent and Late-onset PAU groups reported lower educational attainment, poorer physical health, lower relationship satisfaction, lower life satisfaction, a worse financial situation, more depressive symptoms, recurrent pain, and sleep problems, and were less likely to be partnered or have children. Persistent PAU was associated with the most negative outcomes in early midlife, and childhood and adolescent risk factors and genetic risk as indexed by PGSPAU were strong predictors of group membership. Late-onset PAU may be the result of novel stressors in adulthood, given the lack of association with childhood and adolescent environmental risk or genetic risk.