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Timely and accurate diagnosis is a critical aspect of malaria surveillance, treatment, and intervention campaigns. Currently, field malaria diagnostics rely almost primarily on light microscopy and rapid diagnostic tests. However, both methods miss a significant proportion of asymptomatic patients and perform poorly in low transmission settings. In this review, we present tools that have been used by U.S. Naval Medical Research Unit (NAMRU) SOUTH and its collaborators during the last 40 years for various aspects of malaria research, including clinical trials, outbreak response, and epidemiologic surveillance in South and Central America. Overall, the current and future toolbox for malaria diagnostics needs to be carefully evaluated and tailored to the malaria transmission dynamics in each focus to maximize its effectiveness and achieve the goal of malaria elimination.

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Infectious diseases (IDs) contribute to major causes of mortality and chronic morbidity in Central and South America. Interest in improving general understanding, prevention, and treatment options motivates the U.S. Department of Defense to establish and run overseas ID institutions to enhance force health protection. One of 6 Department of Defense overseas ID institutions, U.S. Naval Research Medical Unit (NAMRU) SOUTH, has safely and ethically conducted biomedical research, ID surveillance, and medical countermeasure testing and evaluation in Peru and surrounding countries. In its over 40-year history, NAMRU SOUTH medical research collaborations have achieved many milestones leading to critical ID information sharing, funding, services, and education mutually beneficial to the U.S. and regional partners in Latin America.

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INTRODUCTION: Inflammation is hypothesized to be a pivotal factor influencing muscle function, with C-Reactive Protein (CRP) serving as a common biomarker of inflammation. However, the literature pertaining to the relationship between CRP and muscle mass remains scant, particularly among representative adult populations in the United States. The present study aimed to delve into the association between serum CRP levels and muscle mass among American adults, leveraging data from the National Health and Nutrition Examination Survey (NHANES) conducted from 1999 to 2006. METHODS: A cohort of 13,518 participants, representative of the US adult population, underwent dual-energy X-Ray Absorptiometry (DXA) to assess Appendicular Skeletal Muscle Mass (ASM) and had their CRP levels measured. Muscle mass was defined using ASM adjusted by Body Mass Index (ASM/BMI) criteria. Employing weighted logistic regression models, restricted cubic spline analysis, and subgroup analyses, the authors examined the association between serum CRP and low muscle mass. RESULTS: After meticulously adjusting for various covariates, the present findings revealed a positive association between serum CRP levels and the risk of low muscle mass in American adults (OR = 1.07, 95 % CI 1.01‒1.14, p = 0.016). Notably, an inverse J-shaped relationship was observed, with serum CRP inflection points of 0.273 mg/dL for the overall population, 0.172 mg/dL for males, and 0.296 mg/dL for females. Subgroup analysis further demonstrated that factors such as gender, race, educational level, smoking status, congestive heart failure, stroke, renal weakness/failure, coronary heart disease, diabetes, hypertension, vigorous physical activity, moderate physical activity, and muscle strengthening activities did not significantly impact this positive correlation (all p for interaction values > 0.05). CONCLUSIONS: This nationally representative cross-sectional study provides robust evidence of an inverse J-shaped association between serum CRP levels and the risk of low muscle mass in adults in the United States, with a critical inflection point of 0.273 mg/dL. These findings may inform future research and clinical strategies aimed at mitigating the negative effects of inflammation on muscle mass and function in the adult population.

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Cumulating evidence suggests that nature-based interventions may alleviate depression, but the association between engagement in nature-based activities and specific depressive symptoms remains unknown. We conducted a cross-sectional study to investigate how Major Depressive Disorder (MDD) symptom criteria relate to engagement in nature-based recreation (any nature-based activities, forest-based activities, gardening, nature-based adventure activities) among American (n = 606), Spanish (n = 438), and Brazilian (n = 448) adults (≥ 18 years old). People who reported engaging in any nature-based activities at least once per month reported experiencing all nine symptom criteria for MDD (e.g., anhedonia, feeling depressed or hopeless, sleep problems, trouble concentrating, and suicidal ideation) at lower rates than those who did not participate in nature-based recreation as frequently. Results were relatively consistent across countries and types of nature-based activities, suggesting that many forms of nature-based recreation are negatively correlated with the nine symptom criteria for MDD. The associations tended to be weaker overall among Spanish respondents. Nature-based recreation appeared to have a stronger inverse relationship with suicidal ideation than with other depressive symptoms. The cross-sectional design of this study limits the causal interpretation of the observed associations. If future experimental studies confirm our findings, practitioners across different countries can consider recommending participation in nature-based recreation to alleviate their clients' MDD symptoms.

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This paper discusses the increasing trend of direct-care physicians taking on teaching roles in community hospitals, both in the United States and Brazil. It highlights the challenges faced by these physicians, who often lack formal pedagogical training and dedicated time for teaching. The text emphasizes the need for structured support, faculty development programs, and collaboration with academic centers to ensure the quality of education in these settings. It also underscores the potential benefits of this model, such as increased access to medical training in underserved areas and a more hands-on learning experience for students. Overall, the document calls for a thoughtful and comprehensive approach to integrating direct-care physicians as educators, ensuring that this practice benefits both the physicians themselves and the quality of medical education.

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The study analyses scientific knowledge circulation between Brazil and the United States, drawing on Rockefeller Foundation's funding to Escola Paulista de Medicina to modernize medical training. The chosen initial chronological landmark is 1956, when the foundation started funding the Brazilian institution, and the final year is 1962, deadline for spending the grants. The study's sources are dossiers collected at Rockefeller Archive Center, analyzed drawing on the evidential paradigm. The conclusion is that when the philanthropic agency decided to finance the school, the latter was already part of an international network of knowledge circulation, and its medical training modernization comprised investments in basic sciences, clinical practice, and the defense of full-time departments.

Analisa-se a circulação do conhecimento científico entre Brasil e EUA, a partir dos financiamentos da Fundação Rockefeller à Escola Paulista de Medicina para modernizar o ensino médico. O marco cronológico inicial escolhido é 1956, quando a fundação inaugurou o financiamento à instituição brasileira, e o final é 1962, ano-limite para gastar os valores disponibilizados. As fontes utilizadas são dossiês coletados no Rockefeller Archive Center e analisados a partir do paradigma indiciário. Conclui-se que, quando a agência filantrópica decidiu financiar a escola, esta já integrava uma rede de circulação internacional de conhecimentos, e que a modernização do ensino médico na instituição foi marcada por investimentos nas ciências básicas, em clínica médica, e com a defesa de departamentos em tempo integral.

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PURPOSE: The availability of drugs and national public policies for patients with rare cancers, including sarcomas, varies in different parts of the world. METHODS: In this manuscript, we have conducted a comprehensive analysis to evaluate rare cancer policies in Latin American countries' national policy documents. Additionally, we have reviewed the approvals for sarcoma drugs in selected Latin American countries and compared them with US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approvals. RESULTS: The documents reviewed showed a lack of explicit focus on rare cancers, with no mention in 70% of the countries analyzed. Drug approval data reveal that in the last 15 years, the FDA and EMA have approved 19 and 13 drugs for sarcoma, whereas their Latin American counterparts, namely ANVISA, ANMAT, and COFEPRIS, approved six, eight, and seven drugs, respectively. CONCLUSION: Our data suggest that improving rare cancer and sarcoma care in Latin America requires enhanced collaboration for better rare cancer policies.

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In the management of reservoirs, different forms of infrastructure (such as dams, hydropower units, information) are functionally interdependent and often managed by different types of actors to form a social-ecological-technological system. Such interdependence also occurs because institutions (understood as rules that guide and constrain actor behavior) exist to indicate how infrastructures should be managed. We apply institutional analysis and social network analysis to identify how functionally interdependent infrastructures and actors are connected by formal rules created to manage reservoir operations in Argentina (Ameghino Dam, Chubut) and the United States (Coyote Valley Dam, California). Using Exponential Random Graph Models and motif analysis we develop and test hypotheses about which types of patterns of rule-mediated interdependence are more likely to occur in the management of reservoir operations as well as how contextual features, such as the socio-political environment and the types of actors involved, influence rule-mediated interdependence in social-ecological-technological systems. We find that the type of actors involved and the socio-political context in which rules are designed shape the patterns of rule-mediated interdependencies. These findings shed light on and call for more attention to the role that formal rules play in shaping infrastructure management across socio-political contexts.

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BACKGROUND: There is scarce data on the prognostic value of frailty in patients with Takotsubo cardiomyopathy (TCM). This study aimed to assess the association between frailty and in-hospital outcomes in patients with TCM. METHODS: Adult admissions with TCM were included using the 2016-2019 National Inpatient Sample database. The primary outcome was in-hospital mortality and secondary outcomes included cardiogenic shock, in-hospital cardiac arrest, stroke/transient ischemic attack (TIA), length of hospital stay, and total charges. Frailty was assessed using the hospital frailty risk score (HFRS), and admissions were divided into two groups: low risk and intermediate/high risk of frailty. Logistic regression was used to estimate odds ratios (OR) with their 95% confidence intervals (CI). RESULTS: A total of 32 360 patients were included; the median age was 67 (58-76) years and 90% were female. The median HFRS was 2.6 (1.1-5.3). In the adjusted models, in-hospital mortality was significantly higher in the intermediate/high risk of frailty group (OR 3.60, 95% CI 2.16-6.02) compared to the low-risk group. Similarly, admissions with intermediate/high risk of frailty had a significantly higher risk of cardiogenic shock (OR 3.66, 95% CI 2.77-4.80), in-hospital cardiac arrest (OR 2.57, 95% CI 1.55-4.24), and stroke/TIA (OR 5.68, 95% CI 3.51-9.20). There was a significantly higher hospital charges and length of hospital stay in the intermediate/high-risk group. In the restricted cubic spline regression models, the frailty score was nonlinearly associated with all outcomes. CONCLUSIONS: Our results suggest that frailty is useful as a prognostic factor for in-hospital events in patients with TCM.

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Neighborhood factors and the built environment (e.g., sidewalks, bike lanes and public transportation) are important social determinants of mental health. Yet scarce research explores their impact on Latinx mental health in Colonias (unincorporated, rural communities with limited access to basic utilities like water and electricity) along the U.S.-Mexico border. Secondary analysis of baseline data from a promotora-led, physical activity intervention in Colonias examined relationships between neighborhood environment and mental health among Spanish-speaking Latinas (N = 620) mostly born in Mexico (86%). The Physical Activity Neighborhood Environment Scale (PANES) assesses the perceived neighborhood environment such as neighborhood safety, infrastructure, and access to destinations. Multivariate linear regressions assessed associations between the PANES, the Built Environment Index (BEI), stress (PSS-10) and depression (CESD-10), controlling for age, marital status, education, income, and nativity. Most participants (90%) reported moderate to high stress (PSS ≥ 14), and approximately 30% were at risk for clinical depression (CESD ≥ 10). Analyses indicated that higher PANES total scores were significantly associated with lower depression (ß = -0.88, p < 0.05) and stress (ß = -1.67, p < 0.001). Similarly, higher BEI total scores were significantly associated with lower stress (ß = -0.53, p < 0.001). Individual BEI items, including greater housing density (ß = -1.26) and neighborhood access to recreation facilities (ß = -0.97), were significantly associated with lower depression scores (p < 0.05). The built environment had a significant impact on mental health among Latinas residing in Colonias. Neighborhood density and access to recreation facilities were particularly important, potentially serving as protective factors for mental health. Investment in the built environment in Colonias could improve mental health.

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OBJECTIVE: To characterize the association between maternal ethnicity and infant survival to discharge without major morbidity. STUDY DESIGN: This is secondary analysis of a prospective cohort of infants born <27 weeks of gestation at National Institute of Child Health and Human Development Neonatal Research Network centers from 2006 through 2020. The primary outcome was survival to discharge without major morbidity (sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia grade 3, intracranial hemorrhage grade ≥3, periventricular leukomalacia, and advanced retinopathy of prematurity). Outcomes were compared by ethnicity and adjusted for center, perinatal characteristics, and sociodemographic characteristics. RESULTS: Of 14 029 subjects, 2155 (15%) were Hispanic, 6116 (44%) non-Hispanic Black, and 5758 (41%) non-Hispanic White. Infants of Hispanic mothers had the lowest survival to discharge without major morbidity (Hispanic 523/2099 [25%], non-Hispanic Black 1701/5940 [29%], non-Hispanic White 1494/5597 [27%], P = .002). Adjusted odds of survival without major morbidity differed between Hispanic and non-Hispanic Black (adjusted odds ratio [aOR] 0.80, 95% CI 0.69-0.93), but not between Hispanic and non-Hispanic White infants (aOR 1.07, 95% CI 0.92-1.25). At 2 years, children of non-Hispanic White mothers had the lowest incidence of neurodevelopmental impairment (Hispanic 544/1235 [44%], non-Hispanic Black 1574/3482 [45%], and non-Hispanic White 1004/3182 [32%], P < .001). Odds of impairment were greater for Hispanic than non-Hispanic White children (aOR 1.25, 95% CI 1.05-1.48) but did not differ between Hispanic and non-Hispanic Black children (aOR 0.88, 95% CI 0.74-1.04). CONCLUSIONS: In a multicenter cohort, infants of Hispanic mothers had lower odds of survival to discharge without major morbidity than infants of non-Hispanic Black mothers and similar odds of survival without major morbidity as infants of non-Hispanic White mothers. GOV ID: Generic Database: NCT00063063.

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Brazilians are a rapidly growing immigrant population in the United States (U.S.), yet little is known about their mental health and access to mental healthcare. Our goal was to access associations between the pursuit of- and access to-mental healthcare with mental health status and socio-demographic characteristics among Brazilian immigrant women. We conducted an online survey of Brazilian women aged 18 or older who reported being born in Brazil and currently residing in the U.S. We recruited respondents via Brazilian cultural media, community organizations serving Brazilian immigrants, and social media. We assessed respondents' perceived access to mental healthcare, self-reported mental health (CES-D-10), and socio-demographic characteristics and conducted multivariable logistic regression. Our analysis included 351 participants. Half (52%) had CES-D-10 scores indicating high levels of depressive symptomatology. A third (33%) reported seeking care for their mental health in the past 12 months, 87% of whom reported obtaining care. Results of multivariable logistic regression determined that respondents who sought mental healthcare were more likely to have higher CES-D-10 scores (OR = 1.09, 95% CI 1.03-1.15), very low incomes (<$10,000 per year; OR = 0.34, 95% CI 0.12-0.96), and were marginally more likely to have a primary care provider (OR = 2.11, 95% CI 1.00, 4.46). We found that despite a high level of depressive symptomology, only one-third reported accessing care. While difficulty accessing care for mental issues is a widespread issue, our findings suggest that efforts are needed to ameliorate mental health issues for Brazilian women to reduce systemic, interpersonal, and individual barriers to seeking care among the 13% who sought healthcare but were unable to receive it.

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OBJECTIVE: This study investigated how a disruptive mood dysregulation disorder (DMDD) diagnosis influences treatment selection and sequencing in children with attention-deficit/hyperactivity disorder (ADHD). STUDY DESIGN: This multicenter, population-based, retrospective cohort study analyzed data from TriNetX Research Network (June 2013 through July 2024). Youth with ADHD (without DMDD) formed the control cohort (n = 631 295). Youth with ADHD + DMDD (n = 24 723) formed the study cohort. Odds ratios (ORs) and relative risks were calculated to analyze associations. RESULTS: Compared with controls, ADHD + DMDD cohort was more likely to be composed of non-Hispanic ethnicity and exhibited higher rates of psychiatric comorbidities, inpatient and emergency service utilization, and billed psychotherapy (ORs range 1.25-6.95). Youth with ADHD + DMDD were more likely to receive ADHD medications (ORs range 1.55-4.80), as well as antidepressants, mood stabilizers, and antipsychotics (ORs range 5.05-13.16). Hispanic youth with DMDD utilized more psychotropics but less psychotherapy, while White youth used all services more. Before the use of non-ADHD medications for aggression, only 25% of ADHD + DMDD youth had a therapy code, and around 11% showed evidence of optimization of ADHD medication. After a DMDD diagnosis, treatment rates for other psychotropics increased more than those for central nervous system stimulants. CONCLUSIONS: In youth with ADHD, a DMDD diagnosis is associated with increases in the spectrum of pharmacological and nonpharmacological treatments deployed with patterns varying by race and ethnicity. Antipsychotic and mood stabilizer prescriptions increased most prominently, often before receiving psychotherapy services or efforts to optimize ADHD medication. Future research should address disparities in DMDD treatment patterns and identify the optimal treatment sequences for DMDD.

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INTRODUCTION: Migrant women in transit face high risk of developing mental health problems such as depression and anxiety, driven by gendered social-structural factors including violence, social isolation, migration uncertainty, limited access to services and gender inequities. Although migrant women who endure such conditions have high need for mental health prevention, few evidence-based interventions are tailored to this population. Moreover, while women and children's mental health are interconnected, few mental health interventions address parenting needs. The aim of this study is to pilot-test a novel parenting and mental health prevention intervention for migrant mothers with young children (MMC) in Tijuana, Mexico, including (a) assessing acceptability; (b) estimating effect sizes on symptoms of depression, anxiety, and parenting stress; (c) identifying which theory-based mechanisms of action predict changes in outcomes; and (d) identifying factors associated with differential intervention response. METHODS AND ANALYSIS: 'Mamá Empoderada' (Mom Power) is a theory-based, trauma-informed group intervention to promote mental health and responsive parenting among mothers with young children (0-5 years). This is an evidence-based intervention that has been previously evaluated in the USA and has been recently adapted for Spanish-speaking mothers. We have recently adapted this intervention for MMC in Mexico and will conduct a pilot randomised controlled trial (RCT) of the intervention with MMC (n=100; Ntreatment=50; Ncontrol=50). The intervention group (IG) will receive 10 group and three individual sessions addressing attachment-based parenting skills, linkage to resources (eg, food, shelter), social support, and self-care and resilience over a 5-week period. The control group will receive standard of care programming and will be offered participation in the intervention following completion. Both groups will complete baseline and exit surveys, as well as follow-up surveys at 2, 4 and 6 months postintervention. Statistical analyses will compare primary (ie, symptoms of depression and anxiety; parenting stress) and intermediate outcomes (eg, resilience, service utilisation) by exposure to intervention condition. ETHICS AND DISSEMINATION: This study is approved by the San Diego State University and El Colegio de la Frontera Norte Institutional Research Boards. Findings will inform a larger trial to evaluate intervention efficacy. In collaboration with our community partners, results will be disseminated via peer-reviewed publications; presentations; and plain-language reports, infographics, and presentations to community, clinical, and policy audiences. If efficacious, this intervention is highly promising as a novel, low-cost, and feasible model that could be implemented in border settings in Mexico, the USA and elsewhere. Amid rising population displacement and prolonged and traumatic migration journeys, this study addresses an urgent need for scalable and tailored mental health prevention for MMC in border contexts. TRIAL REGISTRATION NUMBER: NCT06468046.

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BACKGROUND: A better understanding of correlates of sugary drink consumption is essential to inform public health interventions. This study examined differences in perceived healthiness of sugary drinks and related social norms between countries, over time, and sociodemographic groups and associations with sugary drink intake. METHODS: This study used annual cross-sectional data from the International Food Policy Study from 2018 to 2021 in Australia, Canada, the United Kingdom, the United States, and Mexico. Analyses examined perceived healthiness of eight beverage types and two types of perceived social norms (descriptive, injunctive) that discourage sugary drink consumption. The 24-item Beverage Frequency Questionnaire was used to estimate beverage intake in the past 7 days. Logistic regression models examined trends over time in odds of perceiving each beverage type as unhealthy and agreeing with social norms discouraging sugary drink consumption, across countries and sociodemographic characteristics. Negative binomial regressions examined associations between perceived healthiness, social norms and consumption. RESULTS: Energy drinks, regular soft drinks, and diet soft drinks were most frequently perceived as unhealthy in all countries, while water and 100% juice were least frequently perceived as unhealthy. Participants in Mexico had higher odds of perceiving 100% juice, chocolate milk, and iced tea as unhealthy in 2021 compared to 2018 (AOR = 1.71 99%CI 1.10-2.64; AOR = 2.69, 99%CI 1.70-4.26; AOR = 1.79, 99%CI 1.15-2.76; respectively), with little change in other countries. Agreement with social norms discouraging consumption of sugary drinks was higher in Mexico than in other countries. Trends in social norms over time were mostly stable, except in Mexico where participants had higher odds of agreeing with both norms in 2020 compared to 2018 (AOR = 1.27, 99%CI 1.09-1.48 for a descriptive norm and AOR = 1.27 99%CI 1.09-1.49 for an injunctive norm). In most countries, perceiving a beverage as unhealthy and agreeing with social norms discouraging consumption of sugary drink were associated with lower sugary drink consumption, with varying strength of associations across countries and beverage types. CONCLUSIONS: Shifts over time in social norms and perceived healthiness observed in Mexico and associations with intake of sugary drinks in most countries suggest that targeted interventions to change norms and perceptions could help reduce sugary drink consumption.

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BACKGROUND: Timely palliative and hospice care, along with advanced care planning, can reduce avoidable high-intensity care and improve quality of life at the end of life (EoL). OBJECTIVE: We examined patterns of care at EoL and evaluated predictors of high-intensity care at EoL among adults aged 18-64 with cancer. METHODS: Using data from the Puerto Rico Central Cancer Registry-Health Insurance Linkage Database, we examined 1359 patients diagnosed with cancer in 2010-2019, who died of cancer between 2017 and 2019 at 64 years and younger, and who were enrolled in Medicaid or private health insurance in last 30 days before death. We used composite measures for high-intensity and recommended EoL care using claims-based indicators in the last 30 days before death. Multivariable logistic regression was used to examine predictors associated with high-intensity EoL care. RESULTS: About 70.3% of young and middle-aged Hispanic cancer patients received high-intensity EoL care, whereas only 20.6% received recommended EoL care. Patients without recommended EoL care were more likely to receive high-intensity EoL care (aOR=4.23; 95% CI=3.18-5.61). High-intensity EoL care was more likely in female patients (aOR=1.43; 95% CI=1.11-1.85) and patients with hematologic cancers (aOR=1.91; 95% CI=1.13-3.20) and less likely in patients who survived >12 months after cancer diagnosis (aOR=0.55; 95% CI=0.43-0.71). CONCLUSIONS: A high proportion of Hispanic adults with cancer in Puerto Rico receive high-intensity EoL care and have unmet needs at EoL. Tailored interventions can reduce high-intensity EoL care and increase recommended EoL care. Recommended EoL care can ease pain, reduce distress, honor personal preferences, and cut unnecessary medical costs.

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OBJECTIVE: To evaluate predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators to diagnose pediatric malnutrition (AAIMp) and the Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) in regard to pediatric patient outcomes in US hospitals. STUDY DESIGN: A prospective cohort study (Clinical Trial Registry: NCT03928548) was completed from August 2019 through January 2023 with 27 pediatric hospitals or units from 18 US states and Washington DC. RESULTS: Three hundred and forty-five children were enrolled in the cohort (n = 188 in the AAIMp validation subgroup). There were no significant differences in the incidence of emergency department visits and hospital readmissions, hospital length of stay (LOS), or health care resource utilization for children diagnosed with mild, moderate, or severe malnutrition using the AAIMp tool compared with children with no malnutrition diagnosis. The STRONGkids tool significantly predicted more emergency department visits and hospital readmissions for children at moderate and high malnutrition risk (moderate risk - incidence rate ratio 1.65, 95% CI: 1.09, 2.49, P = .018; high risk - incidence rate ratio 1.64, 95% CI: 1.05, 2.56, P = .028) and longer LOS (43.8% longer LOS, 95% CI: 5.2%, 96.6%, P = .023) for children at high risk compared with children at low risk after adjusting for patient characteristics. CONCLUSIONS: Malnutrition risk based on the STRONGkids tool predicted poor medical outcomes in hospitalized US children; the same relationship was not observed for a malnutrition diagnosis based on the AAIMp tool.

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OBJECTIVE: To characterize how social adversities influence disease control in children with celiac disease (CeD). STUDY DESIGN: We conducted a cross-sectional analysis of data from 325 eligible children ≤18 years old with CeD enrolled between 2015 through 2023 into iCureCeliac, a patient-centered US registry for CeD. We evaluated the associations between financial insecurity, social stigmatization, decreased health knowledge, and mental health comorbidity with 2 validated patient-reported outcomes on disease activity and gluten-free diet adherence: celiac symptom index and CeD adherence test, respectively. We used multivariable logistic and linear regression analysis to adjust for race, primary spoken language, and socioeconomic status. RESULTS: Among 325 children with available financial insecurity data, the median age was 11 years (IQR 8, 15), 67% were female, and 88% were White. In multivariable logistic regression, the odds of elevated disease activity among children with financial insecurity, social stigmatization, decreased health knowledge, and mental health comorbidity were 2.6 (95% CI 0.9, 8.0; P = .09), 2.8 (95% CI 1.6, 5.1; P < .001), 4.8 (95% CI 2.4, 9.8; P < .001), and 1.9 (95% CI 1.1, 3.3; P = .03), respectively. For insufficient dietary adherence, the respective odds were 1.6 (95% CI 0.5, 4.7; P = .43), 3.3 (95% CI 1.7, 6.5; P < .001), 2.9 (95% CI 1.5, 5.7; P = .002), and 2.3 (95% CI 1.2, 4.2; P = .01). Statistically significant associations in logistic regression aligned with results of linear models. CONCLUSIONS: Social stigmatization, decreased health knowledge, and mental health comorbidity were associated with worse disease control in pediatric CeD. Targeted interventions aimed at addressing these social adversities may improve disease activity and dietary adherence.

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BACKGROUND: The second phase of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) transitioned from scaling up HIV prevention and treatment to promoting sustainability and capacity building for programs monitoring performance and evaluating key program indicators. We assessed the success of a monitoring and evaluation (M&E) curriculum designed to build capacity in three PEPFAR-supported countries. METHODS: We customized M&E trainings based on country-specific epidemic control priorities in Ethiopia, Guatemala, and Cameroon. The M&E curriculum included five modules and three evaluation activities to assess impact: (i) in-person pre-post confidence assessment surveys (CAS), (ii) in-person pre-post knowledge tests (PPKT), and (iii) electronic 6-12 months post-training translating knowledge into practice (TKP) surveys. Pre- and post-training results were compared within and across countries and triangulation with the qualitative data evaluated overall success. RESULTS: Among 188 participants attending M&E trainings, 154 (82 %) responded to CAS and 165 (88 %) participants from Ethiopia and Cameroon completed PPKT. Overall CAS scores between pre- and post-test improved [Score mean difference:1.5-1.9]. PPKT indicated statistically significant knowledge gained. One out of five TKP respondents provided direct application examples from the M&E training. CONCLUSION: While feedback was predominantly positive overall, revisions were recommended for three of the five modules. Developing a customizable and adaptable M&E curriculum may sustain countries' ability to monitor their progress towards epidemic control.

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Objectives. To describe progression, content, and stringency of state legislation regulating indoor tanning and association with state government political party leadership. Methods. Trained research assistants used legal mapping methods to code legislative bills on indoor tanning introduced in US states, the District of Columbia, and Puerto Rico. We calculated composite scores on the stringency of age restrictions and of warnings, operator requirements, and enforcement. We evaluated associations of the political party of the legislative sponsor and legislature majority. Results. Between 1992 and 2023, 184 bills were introduced in 49 of 50 states and DC (56 laws were enacted, and 126 bills failed). An under-18 ban was enacted in 22 states and DC. Party affiliation of the bill sponsor and legislature majority combined to affect bill passage and age restrictions. Conclusions. In many states, it took several years and proposed bills before a law on indoor tanning was enacted. Enacted bills were more stringent than failed bills. Public Health Implications. Increasing support for stringent regulations on indoor tanning is evident and may motivate other states or the federal government to prohibit minors from using indoor tanning facilities. (Am J Public Health. 2025;115(2):191-200. https://doi.org/10.2105/AJPH.2024.307894).