Articles

<b>Background:</b> Antimicrobial resistance (AMR) is a major global public health threat that compromises the effectiveness of antimicrobial therapy. Nurses play a critical role in antimicrobial stewardship (AMS); however, evidence regarding their knowledge, attitudes, and practices (KAP) in the Philippine setting remains limited. <b>Objective:</b> To determine the knowledge, attitudes, and practices regarding antimicrobial stewardship among bedside nurses employed in selected tertiary hospitals in Baguio City, Philippines, and to examine the relationships between selected socio-demographic characteristics and AMS competencies. <b>Methods: </b>A quantitative descriptive cross-sectional correlational study was conducted among 119 bedside nurses from two tertiary hospitals in Baguio City. Data were collected using a modified, validated self-administered questionnaire. Descriptive statistics summarized respondents' characteristics and KAP scores. The Shapiro–Wilk test assessed normality. Univariate linear regression examined associations between socio-demographic characteristics and KAP outcomes. Statistical significance was set at p < 0.05. Results: Most respondents demonstrated moderate knowledge, highly positive attitudes, and favorable antimicrobial stewardship practices. Greater knowledge was significantly associated with better stewardship practices. Likewise, positive attitudes were positively associated with stewardship practices. Previous antimicrobial stewardship education and selected socio-demographic characteristics were associated with improved KAP outcomes. <b>Conclusion:</b> Bedside nurses demonstrated positive attitudes and favorable antimicrobial stewardship practices despite moderate knowledge levels. Strengthening competency-based antimicrobial stewardship education may enhance nurses' participation in stewardship initiatives and improve patient safety while contributing to national and global efforts to combat antimicrobial resistance.

<b>Background:</b> <i>Gallibacterium</i><i> </i><i>anatis</i> is an opportunistic pathogen, mainly associated with infections in poultry. Infections in humans have only been described four times (in France and China). <b>Case presentation:</b> We report the case of a 62-year-old non-immunocompromised male patient with a gastric bypass in his medical history, presenting with cholecystitis in whom <i>Gallibacterium</i><i> </i><i>anatis</i> was isolated from the blood, besides an <i>Escherichia coli</i>. Identification of the <i>G. </i><i>anatis</i> was achieved using MALDI-TOF MS and confirmatory 16s RNA sequencing. The patient was successfully treated with piperacillin-tazobactam, resulting in clinical improvement. In the context of impaired host defenses due to acute cholecystitis with an <i>E. coli</i> bacteremia, it is conceivable that <i>G. </i><i>anatis</i> entered the bloodstream through bacterial translocation from the gastrointestinal tract. <b>Conclusion:</b><b> </b>This case highlights the importance of advanced identification techniques and awareness of rare pathogens in clinical practice. <i>Gallibacterium</i><i> </i><i>anatis</i>, particularly drug-resistant strains, may represent a potential infectious agent and should therefore be considered in diagnostic work-up.

<b>Background: </b>Cystatin C (CysC) predicts adverse outcomes in heart failure (HF), yet its prognostic value relative to underlying renal function remains undefined. We aimed to determine the association between serum CysC and 1-year readmission risk in HF patients stratified by chronic kidney disease (CKD) status. <b>Methods:</b> This retrospective cohort study analyzed 2,008 hospitalized HF patients. Based on CKD status, patients were categorized into non-CKD and CKD groups. Serum CysC levels were analyzed as both continuous variable and in tertiles. The association with 1-year readmission was assessed using multivariable Cox proportional hazards models. <b>Results:</b> Overall, each 1 mg/L increase in CysC was independently associated with an 11% higher risk of re-admission (adjusted HR: 1.11, 95% CI: 1.01-1.23, p=0.003). A significant interaction with CKD status was found (p=0.003). In the non-CKD group, elevated CysC (>1.98 mg/L) was associated with a 51% increased risk (adjusted HR: 1.51, 95% CI: 1.18-1.92, p=0.001), with a non-linear threshold effect identified at 0.998 mg/L. Conversely, no significant association was observed in CKD patients (adjusted HR: 0.96, 95% CI: 0.82-1.12, p=0.576). <b>Conclusions:</b> Elevated serum CysC is a potent predictor of 1-year readmission in HF patients without CKD, but not in those with established CKD. Its prognostic utility is therefore highly dependent on renal context, highlighting its greatest value in patients without advanced renal dysfunction.

<b>Background: </b>In Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease, central nervous system infections are uncommon, affecting about 1% of cases. However, diagnosis is often challenging due to overlapping autoimmune and infectious features, nonspecific neurological symptoms, and limited diagnostic specificity, which may delay appropriate treatment and worsen outcomes. <b>Case Report:</b> An 80-year-old male with a five-year history of systemic lupus erythematosus (SLE) presented with a two-day history of generalized weakness that subsequently progressed to recurrent focal seizures and later to generalized seizures accompanied by a profound decline in consciousness. Despite adequate administration of antiepileptic and sedative therapy, persistent seizure activity was observed. Meningitis Panel evaluation confirmed herpes simplex virus type 1 (HSV-1) encephalitis, complicated by severe systemic inflammation, anemia, thrombocytopenia, renal dysfunction, and respiratory acidosis findings indicative of multi-organ failure. Magnetic resonance imaging of the brain revealed bilateral asymmetric hyperintense lesions involving the insular regions, medial temporal lobes, and frontal cortices, consistent with viral encephalitis. The patient underwent comprehensive intensive care management, including intravenous antiviral, antimicrobial, corticosteroid, and supportive therapies. However, his clinical condition progressively deteriorated, culminating in death on the fourth day of hospitalization. <b>Discussion: </b>This case illustrates the diagnostic and therapeutic complexity of herpes simplex virus type 1 (HSV-1) encephalitis in a patient with systemic lupus erythematosus (SLE), a rare but fatal complication. In immunocompromised individuals, atypical clinical and cerebrospinal fluid findings may obscure diagnosis and delay treatment. Immunosuppressive therapy and underlying immune dysregulation further increase vulnerability to opportunistic infections and multi-organ failure. Early recognition of viral encephalitis in SLE patients with acute neurological symptoms is therefore crucial to optimize outcomes. <b>Conclusion:</b> Encephalitis in SLE is a rare but serious complication with overlapping autoimmune and infectious features. Early recognition and timely antiviral immunosuppressive therapy are essential to improve outcomes.

<b>Background:</b> Morris syndrome, also known as androgen insensitivity syndrome (AIS), is a disorder of sex development caused by mutations in the androgen receptor gene in individuals with a 46,XY karyotype. The syndrome is typically diagnosed during adolescence due to primary amenorrhea, and early detection in childhood is uncommon. Prompt recognition is clinically important to guide multidisciplinary management and reduce the risk of gonadal malignancy.<b> Case Description:</b> We report the case of a one-year-old phenotypic female presenting with an irreducible, painful right inguinal hernia. Ultrasound suggested bilateral inguinal hernias containing ovary-like structures. During emergency surgical exploration, bilateral testes were unexpectedly identified within the inguinal canals. The testes were reduced into the abdominal cavity, and herniotomy with anterior wall repair was performed bilaterally. External genital examination revealed normally developed labia but absence of the hymenal ring and vaginal opening. The postoperative course was uneventful. Despite referral for karyotype analysis and multidisciplinary follow-up, the parents did not return for further evaluation. <b>Conclusion:</b> This case highlights the rare intraoperative diagnosis of Morris syndrome in early childhood. Awareness of AIS is essential for pediatric surgeons managing inguinal hernias in phenotypic females. Early detection allows timely planning of gonadectomy and long-term multidisciplinary management, minimizing the risk of malignant transformation of undescended testes and optimizing patient outcomes.

Background:</b> Within contemporary medical education systems dominated by the biomedical paradigm, medical students commonly experience a decline in empathy alongside uncertainty in professional identity formation. Narrative medicine, as an educational approach designed to bridge objective technical reasoning and subjective human experience, has been proposed as a response to this humanistic crisis. However, the psychological mechanisms underlying its effects, the boundaries of existing empirical evidence, and strategies for systematic implementation remain insufficiently clarified. <b>Content:</b> Drawing on a comprehensive review of the literature, this article elucidates two core theoretical mechanisms through which narrative medicine operates. First, through the cycle of attention, representation, and affiliation combined with reflective practice, narrative medicine facilitates the coordinated development of cognitive empathy and emotional resonance. Second, through narrative integration, it supports learners in transforming fragmented clinical experiences into coherent professional identities. A synthesis of empirical studies published over the past decade indicates that well designed narrative medicine curricula can enhance reflective capacity, communication skills, and a sense of professional meaning, although their effectiveness is substantially moderated by curricular intensity, pedagogical modality including digital and multimodal approaches, and cultural context. <b>Conclusion:</b> The integration of narrative medicine currently faces structural barriers, including limited curricular space, the scarcity of standardized assessment tools, and insufficient faculty development. Future efforts should adopt implementation science frameworks to shift from isolated elective offerings toward longitudinal spiral curricula, develop multidimensional evaluation strategies, and explore the use of emerging technologies such as artificial intelligence and virtual reality in narrative pedagogy. These efforts may establish narrative medicine as a foundational pathway for cultivating physicians with core humanistic competencies.

<b>Background: </b>The construction industry is one of the most hazardous sectors worldwide, with workers consistently exposed to risks from prolonged contact with hazardous materials. This study evaluates the effectiveness of wearable technologies in improving safety and health monitoring among construction workers in Nigeria. <b>Methodology</b>: A quantitative cross-sectional survey was conducted among 370 construction workers, site managers, and safety officers across Nigeria using an online questionnaire hosted on Google Forms. The study employed purposive sampling to ensure representation across job roles, experience levels, and project types. Data were collected on awareness, usage, benefits, challenges, and improvements associated with wearable technology. Data was analysed using SPSS version 28. <b>Results</b>: Findings showed that awareness of wearable technology was low (32.4%), and only 34.1% reported personal utilisation. Smart vests (32.7%), noise monitoring devices (32.4%), and smartwatches (32.4%) were the most common devices used. Benefits cited included reduced accident occurrences (28.4%) and enhanced well-being (24.6%), while barriers included cultural/language issues (32.7%) and technological limitations (22.4%). Overall, 48.6% reported improvement in safety and health monitoring. Logistic regression showed that wearable technology use significantly improved safety and health monitoring (AOR = 5.937, p < 0.001), with commercial project workers reporting higher odds of improvement (AOR = 7.495, p = 0.001). <b>Conclusion</b>: Wearable technology significantly enhances safety and health monitoring in Nigeria’s construction industry, particularly for experienced workers and commercial projects. Targeted interventions addressing awareness, training, and accessibility are crucial to overcoming barriers and maximizing its impact.

<b>Background:</b> Tuberculosis (TB) in the elderly poses significant diagnostic and therapeutic challenges due to immunosenescence, comorbidities, and atypical clinical presentation. This study evaluates the epidemiological and clinical characteristics of TB in patients aged ≥65 years. <b>Methods:</b> A retrospective descriptive study was conducted including all TB cases reported between 2020 and 2024. Data from the National Tuberculosis Program were analyzed for demographic characteristics, clinical form, bacteriological confirmation, comorbidities, and treatment outcomes. <b>Results:</b> Of 1,335 TB cases, 352 (26.4%) occurred in individuals aged ≥65 years. Pulmonary TB accounted for 80.7% of cases. Men represented 63.4% of patients, and 56.8% lived in urban areas. Bacteriological confirmation was achieved in 82% of pulmonary cases, and treatment success exceeded 85%. Diabetes mellitus (26.5%) and arterial hypertension (31%) were the most common comorbidities. An increase in TB cases was observed in the post-COVID-19 period. A significant association was found between age and clinical form of TB (p < 0.001). <b>Conclusions:</b> Elderly individuals constitute a substantial proportion of TB cases and frequently present with chronic comorbidities. Despite diagnostic challenges, favorable treatment outcomes were achieved, highlighting the need for integrated and early management strategies in this population.

<b>Background:</b> The sacroiliac joint (SIJ) plays a crucial role in transmitting axial loads and maintaining pelvic stability. Sacroiliac joint arthropathy (SIJA) accounts for 10%–30% of low back pain cases but remains underrecognized due to overlapping pain referral patterns and nonspecific imaging findings. Diagnosis relies primarily on characteristic pain distribution and provocative maneuvers, with image-guided intra-articular block serving as the diagnostic gold standard. This study aimed to characterize the clinical profile of block-confirmed SIJA, emphasizing referral pain distribution, triggering position, and provocative test responses<b>. Methods:</b> A cross-sectional study was conducted on 98 patients with diagnostic block–confirmed SIJA at Siloam Hospital Lippo Village, Indonesia. Demographic data, referral pain sites, sitting duration, and results of FABER, compression, and distraction tests were analyzed descriptively. <b>Results:</b> The mean age was 52.07 ± 14.17 years, with 72.4% females. Referral pain most frequently involved the lower back (28.6%) and thigh (28.6%), with occasional extension to the groin (8.2%) or calf (4.1%). Over half of patients (55.1%) reported sitting more than six hours daily. Pain was predominantly triggered during sit-to-stand transitions (85.7%) and while sitting (74.5%). SIJ tenderness (98.0%) and FABER positivity (75.5%) were most consistent. <b>Conclusion:</b> The dominant referral pain in SIJA involves the lower back and posterior thigh. Sit-to-stand transition is the most frequent triggering position, while FABER testing demonstrates the highest diagnostic yield among provocative maneuvers. These consistent patterns may serve as practical clinical indicators to improve diagnostic accuracy in suspected SIJ-related pain.

<b>Background:</b> Sleep deprivation is increasingly prevalent among young adults due to academic, occupational, and social demands, making them susceptible to circadian disruption. Executive functioning—encompassing working memory, inhibitory control, and cognitive flexibility is essential for academic and professional success. This meta-analysis quantifies the effect of sleep deprivation on executive functioning in healthy young adults. Practical Implications: These findings highlight the need for evidence-based interventions such as university-level sleep education programs, flexible academic scheduling, and workplace policies promoting adequate sleep to optimize cognitive performance and productivity among young adults. <b>Methods: </b>Following PRISMA 2020 guidelines, PubMed, Scopus, PsycINFO, and Web of Science were searched (January 2000–March 2024) for studies assessing acute (<6 hours sleep or ≥24 hours total deprivation) or chronic (<6 hours/night over multiple days) sleep deprivation in young adults. Outcomes included validated executive function tests (e.g., Stroop, N-Back). Random-effects meta-analysis (Hedges’ g) was conducted using R (version 4.3.2) with metafor/meta packages. Heterogeneity (I², Q-test), sensitivity (leave-one-out), and publication bias (funnel plot, Egger’s test) were evaluated. <b>Results: </b>Out of 2,478 screened studies, 39 met inclusion criteria (n=4,578). Sleep deprivation had a moderate-to-large detrimental effect on executive functioning (Hedges’ g = -0.62, 95% CI [-0.78, -0.45], p<0.001). Subdomain analysis revealed greatest impairment in working memory (g = -0.71), followed by inhibitory control (g = -0.59) and cognitive flexibility (g = -0.49) (all p<0.001). Moderate heterogeneity was present (I² = 58%), with results robust to sensitivity analysis. Egger’s test indicated no significant publication bias (p=0.22). <b>Interpretation</b><b>: </b>Sleep deprivation significantly impairs executive functioning in young adults, especially working memory. Interventions improve sleep may enhance cognitive performance and should be integrated into public health strategies and educational policies. Future research should assess chronic restriction and individual vulnerability factors.

<b>Background:</b> Building Information Modelling (BIM) improves safety planning in construction by enabling visualization and simulation to identify and reduce risks. However, its adoption in Nigeria is limited. This study examines the application of BIM in enhancing safety and environmental performance on construction sites in Nigeria. <b>Methodology:</b> A quantitative cross-sectional survey was conducted using a structured online questionnaire distributed to professionals in Nigeria’s construction industry. A purposive sampling method was employed to target respondents with relevant BIM experience. Data were analysed using SPSS version 28, applying descriptive statistics, chi-square tests, and logistic regression at a 5% significance level. <b>Result:</b> Findings show that BIM was fully adopted by 7.0% of organizations, with only 19.8% of respondents using it to identify safety hazards during planning. While 76.8% reported no notable safety benefit, 19.5% identified improved risk management as the key benefit. Most respondents (80.2%) reported no noticeable environmental benefits. Among those who did, improved energy efficiency was the most cited benefit (16.4%). Respondents with 10 or more years of experience were significantly more likely to report enhanced safety and environmental outcomes (AOR = 4.555; p = 0.003) and adequate BIM utilization (AOR = 3.255; p = 0.023). Those with intermediate BIM experience were also more likely to report high enhancement (AOR = 2.857; p = 0.039) and effective tool use (AOR = 2.881; p = 0.050). <b>Conclusion:</b> This study revealed that BIM has the potential to improve construction outcomes in Nigeria if supported by training, experience, and structured implementation.

<b>Background</b><b>:</b><b> </b>Resting-state functional MRI (rsfMRI) provides insights into large-scale brain network organization associated with cognitive control, emotion regulation, and attentional processes. The ventral attention network (VAN) is a key salience-driven network that supports attentional re-orienting to behaviorally relevant stimuli. However, little is known about how VAN resting state functional connectivity varies by demographic, socioeconomic, psychosocial, and behavioral factors during early adolescence. <b>Objective</b><b>:</b><b> </b>To examine associations between VAN rsfMRI connectivity and multiple demographic, socioeconomic, psychosocial, and behavioral characteristics. <b>Methods</b><b>:</b><b> </b>Data came from the baseline and early follow-up waves of the Adolescent Brain Cognitive Development (ABCD) Study. The analytic sample included youth with high-quality baseline rsfMRI data and complete socioeconomic and psychosocial measures. The primary outcome was mean resting-state functional connectivity within the VAN across subcortical and cortical regions of interest (ROIs). Bivariate correlations were computed between VAN connectivity and demographic (age, sex, puberty, race/ethnicity), socioeconomic (income, parental education, marital status, neighborhood income), psychosocial (trauma, discrimination, financial difficulty), trait (impulsivity), and behavioral variables (body mass index, depression, suicide, prodromal symptoms, and substance use). Unadjusted bivariate correlations and adjusted logistic regressions were used for data analysis. <b>Results</b><b>:</b><b> </b>VAN connectivity showed small but significant correlations with multiple contextual factors. Higher household income, parental education, and neighborhood affluence were associated with greater connectivity, whereas Black race and Hispanic ethnicity were related to lower connectivity. Youth reporting higher discrimination and financial difficulty exhibited weaker VAN connectivity. Greater VAN connectivity was negatively associated with impulsive reward-driven trait (drive), prodromal symptoms, BMI, and marijuana and alcohol use. Associations between VAN connectivity and suicide, depression, marijuana use, and alcohol use remained significant in age and sex adjusted models. <b>C</b><b>onclusions</b><b>:</b><b> </b>VAN connectivity reflects subtle neural correlates of socioeconomic and psychosocial context in early adolescence. Our results underscore the importance of integrating structural and contextual factors in interpreting brain-behavior associations across diverse populations. These findings are suggestive of stable socioeconomic and psychosocial correlates of network efficiency.

<b>Background:</b> Adolescence is a critical developmental stage for the emergence of major depressive disorder (MDD). Structural and diffusion neuroimaging studies have highlighted the anterior cingulate cortex (ACC) as a key region implicated in emotion regulation, stress reactivity, and mood processing. However, few studies have examined whether microstructural characteristics of the ACC, reflected by mean diffusivity (MD) within gray matter–white matter (GM–WM) contrast regions, are associated with depression in early adolescence. <b>Objective:</b> To examine whether mean diffusivity (MD) within the GM–WM contrast of the left caudal anterior cingulate cortex (ACC) is associated with a past diagnosis of MDD among adolescents in the Adolescent Brain Cognitive Development (ABCD) Study, after accounting for demographic, socioeconomic, and adversity-related factors. <b>Methods:</b> Data were drawn from adolescents with diffusion MRI–derived mean diffusivity measures and diagnostics. The independent variable was mean diffusivity (MD) of the GM–WM contrast in the left caudal ACC. The primary outcome was past MDD diagnosis based on structured psychiatric assessments. Covariates included age, sex, socioeconomic status (SES), and exposure to adverse childhood experiences (ACEs). Logistic regression models tested the association between ACC MD and past MDD. A secondary model evaluated the relationship between ACC MD and past suicide attempt. <b>Results:</b> Mean diffusivity of the left caudal ACC was associated with the odds of past MDD, independent of age, sex, SES, and adversity exposure. In contrast, ACC mean diffusivity was not associated with a history of suicide attempt. <b>Conclusions:</b> Increased mean diffusivity in the caudal ACC may indicate microstructural alterations associated with depressive vulnerability in adolescence. ACC tissue integrity may serve as a sensitive neural correlate of early-onset depression.

Background:</b> Electronic cigarette (e-cigarette) use among adolescents is a growing public health concern, particularly in low-income and Black communities. However, little is known about how social determinants of health shape e-cigarette perceptions in this population. <b>Aims:</b> This study examined social determinants associated with perceptions of e-cigarette safety among Baltimore high school students. <b>Methods:</b> A cross-sectional survey (CEASE Youth: School Survey) was conducted with 604 Baltimore high school students aged 14–20. Participants completed a questionnaire assessing perceptions of e-cigarette safety, as well as parental education, race/ethnicity, parental employment, household composition, and community tobacco use. <b>Results:</b> Higher parental education was associated with lower perceived e-cigarette safety among students. Students in higher grades also reported lower perceived e-cigarette safety. In contrast, male students—particularly those in upper grades—were more likely to perceive e-cigarettes as safe. Race/ethnicity, household composition, parental employment, and community tobacco exposure were not associated with perceived e-cigarette safety. <b>Conclusion:</b> Higher parental education, female gender, and being in higher grades were associated with perceiving e-cigarettes as unsafe. These findings highlight the need for targeted interventions to address vaping perceptions among youth in urban settings.

<b>Background: </b>Tobacco control policies nationwide have contributed to a substantial decline in cigarette and tobacco use, with particularly sharp reductions observed in states such as California that have implemented restrictive bans, strong prevention measures, and high excise taxes. While these policies have led to overall decreases in tobacco use, progress has not necessarily been distributed equally across racial groups. Understanding long-term trends by race is critical for addressing equity gaps in tobacco prevention and control. Evidence suggests that some racialized groups may experience slower or delayed declines, raising concerns about equity in public health gains. <b>Methods: </b>We analyzed data from the California Health Interview Survey (CHIS) spanning 2003–2023. Trends in current smoking were examined separately for non-Latino Black and non-Latino White adults. We also assessed current use of flavored tobacco products, given California’s statewide ban enacted in 2021. Changes were evaluated in both absolute terms (percentage point declines) and relative terms (percent reduction from baseline). <b>Results: </b>Smoking prevalence declined from 17.2% in 2003 to 5.2% in 2023 among White adults and from 19.9% to 9.0% among Black adults. This represents a 12.0 percentage point (69.8%) decline for Whites compared with a 10.9 percentage point (54.8%) decline for Blacks. For flavored tobacco use, prevalence decreased from 8.0% to 4.7% among White adults but only from 11.9% to 10.8% among Black adults. This corresponds to a 3.3 percentage point (41.3%) decline for Whites compared with a 1.1 percentage point (9.2%) decline for Blacks. <b>Conclusions: </b>Although both Black and White adults in California experienced reductions in smoking over the past two decades, White adults showed larger declines in both absolute and relative terms. Disparities were even more pronounced for flavored tobacco use, where declines were minimal among Black adults despite the statewide ban. These findings suggest that Black populations in California may have been left behind by tobacco control progress, especially regarding flavored products. Given the history of targeted marketing by the tobacco industry, the role of flavors in increasing dependence, and reduced access to cessation resources in Black communities, targeted policies and culturally tailored interventions are needed to ensure equitable reductions in tobacco use. Greater attention to flavored tobacco in Black communities may help narrow these disparities and advance California’s tobacco endgame goals.

<b>Background:</b><b> </b>Traditional foods, once carriers of cultural identity and heritage, are being quietly replaced as globalization and modern ideals redefine the choices of younger generations. This ethnographic study investigated the cultural meaning and symbolism of <i>Tuei</i>, an indigenous maize-based beverage, among the Fante people in the Central Region of Ghana. The study aimed to document how <i>Tuei</i> is rooted in Fante social and ceremonial life, exploring its role as a symbol of identity, continuity, and tradition. <b>Methods:</b> A qualitative approach with semi-structured interviews were done with 7 participants involving one cultural expert, three elders, and three local producers. <b>Results:</b> The findings revealed that <i>Tuei</i> has a significant role in rites of passage such as marriages, funerals, and naming ceremonies, where it functions as a marker of status and social cohesion. It was daily used as a gesture of hospitality and symbol of community unity. Additionally, the study found that the nutritional benefits of <i>Tuei</i> was rich in essential nutrients from maize, which contribute to energy provision and digestion. Some participants also reported its traditional use in promoting digestive health and general well-being. Again, <i>Tuei</i> was influenced by modernization which has reduced its consumption among younger generations and elite groups. <b>Conclusions:</b> The study concluded with recommendations to strengthen these preservation efforts through educational initiatives, the integration of <i>Tuei</i> into cultural festivals, and ongoing community engagement to ensure the continuity of this cultural practice.

<b>Background: </b>Socioeconomic status (SES) is widely associated with improved health, behavioral, and educational outcomes. However, emerging research suggests that these benefits are not uniformly experienced across populations or contexts. The theory of Marginalization-related Diminished Returns (MDRs) has primarily focused on racial and ethnic disparities, showing that individuals from racially marginalized groups often experience weaker protective effects of SES. There is a lack of evidence on geography—particularly rural residence—as a moderator of SES effects. <b>Objective:</b> This review explores how place, especially rural contexts in the U.S., shapes the extent to which SES translates into improved outcomes. We extend the MDRs framework to include place-based and geography-based marginalization, arguing that even among non-Hispanic White populations, rural residence can lead to diminished returns on education, income, and other forms of capital. <b>Content:</b> Drawing on theoretical models such as Fundamental Cause Theory and Bronfenbrenner’s Ecological Systems Theory, and synthesizing empirical findings from studies of academic achievement, substance use, and educational aspirations, this review highlights how structural disadvantages in rural areas weaken the effectiveness of individual and family-level resources. <b>Conclusion: </b>Rural health and educational disparities are not solely due to a lack of resources but may also reflect systemic conditions that erode the value of existing resources. Policy interventions must be place-aware and address the contextual constraints that limit opportunity. Future research should more explicitly test how geography moderates the effects of SES across a range of outcomes and populations.

<b>Background:</b> Sexual and gender minority (SGM) youth are at elevated risk for adverse mental health and substance use outcomes. Stressors such as family conflict, discrimination, and trauma have been suggested as possible mediators of these disparities. <b>Aims:</b> This study examined whether family conflict, discrimination, and trauma mediate the associations between SGM identity and adverse outcomes, including suicide attempt, major depressive disorder (MDD), nicotine use, and marijuana use. <b>Methods:</b> Participants were children from the Adolescent Brain Cognitive Development (ABCD) study. SGM identity was reported at baseline, while outcomes included past MDD and suicide attempts as well as future nicotine and marijuana use. Structural equation modeling (SEM) was used to test both direct and indirect pathways linking SGM identity to mental health and behavioral outcomes. <b>Results:</b> No significant mediation was found through family conflict, discrimination, or trauma. Instead, effects of SGM identity were primarily direct: SGM youth had higher odds of past suicide attempts and MDD, as well as future marijuana use, but not future nicotine use. Stressor variables, however, were independently associated with outcomes. Discrimination predicted all outcomes; trauma was positively associated with suicide, nicotine, and marijuana use but not MDD; and family conflict predicted all outcomes except MDD. <b>Conclusion:</b> Family conflict, discrimination, and trauma did not mediate SGM disparities in mental health and substance use, but each emerged as an independent predictor of risk. These findings highlight the complexity of mechanisms underlying SGM-related disparities and suggest the need for future research to explore additional pathways and contextual influences.

<b>Background:</b> Tobacco endgame, defined as elimination of commercial tobacco sales The U.S. tobacco control landscape is a complex, adaptive system shaped by diverse stakeholders, evolving products and regulations, shifting social norms, and the strategic countermeasures of a powerful industry. Managing such complexity requires more than isolated interventions—it demands a coordinated, enterprise-wide approach that accounts for dynamic interactions, feedback loops, and emergent risks. <b>Objective:</b> Drawing on complex systems thinking, Zachman enterprise architecture model, and public health best practices, we conceptualize tobacco control as an evolving enterprise progressing through six interconnected phases: (1) Conception &#x26; Initiation, (2) Policy &#x26; System Design, (3) Implementation &#x26; Operation, (4) Evaluation &#x26; Adaptation, (5) Consolidation &#x26; Endgame Transition, and (6) Sustainment or Sunset. Each phase incorporates governance structures, performance benchmarks, and transition criteria designed to manage interdependence and reduce systemic vulnerabilities. <b>Results:</b> The lifecycle framing emphasizes how tobacco control in the U.S. can evolve as a complex, adaptive enterprise—integrating public health objectives with legal, operational, and cultural change processes. This model supports strategic sequencing, cross-sector alignment, and risk mitigation against emergent industry tactics, enabling a resilient and measurable pathway to the endgame. <b>Conclusions:</b> Seeing tobacco control as a complex enterprise that operates under a lifecycle model may offer a roadmap for achieving and sustaining the tobacco endgame. Using this approach may enhance policy coherence, resource efficiency, and adaptability, ensuring tobacco endgame is achieved.

<b>Background:</b> Chronic kidney disease (CKD) affects over 35.5 million US adults. Serum α1-acid glycoprotein (α1-AGP), an acute-phase protein, exhibits anti-inflammatory properties in animal models, but its association with CKD in younger women remains underexplored. This study investigated the relationship between serum α1-AGP and CKD risk in US women aged 20–49 years. <b>Methods:</b> This nationally representative cross-sectional study used data on female adults in the US aged 20–49 years from the National Health and Nutrition Examination Survey 2015–2018 cycles. 2,137 individuals were included in the study after excluding individuals without serum α1-AGP, urine albumin, and creatinine data. Multivariate logistic regression models evaluated the association between serum α1-AGP and CKD. Moreover, we performed stratified and interaction analyses to see if the relationship was stable in different subgroups. <b>Results:</b> Among 2,137 participants (mean age 34.6 years, mean eGFR 111.7 mL/min/1.73 m²), CKD prevalence was 8.8% (n=188). Higher serum α1-AGP levels were associated with lower CKD risk in the fully adjusted model (OR 0.37, 95% CI 0.16–0.84, P = 0.017), with a dose-response trend across quartiles (P = 0.041). The association was stronger in women aged 40–49 years (OR 0.20, 95% CI 0.05–0.76) and Mexican Americans (OR 0.07, 95% CI 0.01–0.56), though interaction terms were not significant (P > 0.05). <b>Conclusions:</b> Higher serum α1-AGP levels are associated with lower CKD prevalence in young women, suggesting a protective role. Longitudinal studies are needed to confirm causality and explore α1-AGP as a biomarker for CKD risk stratification.