The 10-year risk of recurrent atherosclerotic cardiovascular disease (ASCVD) events in patients with established ASCVD can be estimated with the Secondary Manifestations of ARTerial disease (SMART) risk score, and may help refine clinical management. To broaden generalizability across regions, we updated the existing tool (SMART2 risk score) and recalibrated it with regional incidence rates and assessed its performance in external populations. Individuals with coronary artery disease, cerebrovascular disease, peripheral artery disease, or abdominal aortic aneurysms were included from the Utrecht Cardiovascular Cohort-SMART cohort [n = 8355; 1706 ASCVD events during a median follow-up of 8.2 years (interquartile range 4.2–12.5)] to derive a 10-year risk prediction model for recurrent ASCVD events (non-fatal myocardial infarction, non-fatal stroke, or cardiovascular mortality) using a Fine and Gray competing risk-adjusted model. The model was recalibrated to four regions across Europe, and to Asia (excluding Japan), Japan, Australia, North America, and Latin America using contemporary cohort data from each target region. External validation used data from seven cohorts [Clinical Practice Research Datalink, SWEDEHEART, the international REduction of Atherothrombosis for Continued Health (REACH) Registry, Estonian Biobank, Spanish Biomarkers in Acute Coronary Syndrome and Biomarkers in Acute Myocardial Infarction (BACS/BAMI), the Norwegian COgnitive Impairment After STroke, and Bialystok PLUS/Polaspire] and included 369 044 individuals with established ASCVD of whom 62 807 experienced an ASCVD event. C-statistics ranged from 0.605 [95% confidence interval (CI) 0.547–0.664] in BACS/BAMI to 0.772 (95% CI 0.659–0.886) in REACH Europe high-risk region. The clinical utility of the model was demonstrated across a range of clinically relevant treatment thresholds for intensified treatment options. The SMART2 risk score provides an updated, validated tool for the prediction of recurrent ASCVD events in patients with established ASCVD across European and non-European populations. The use of this tool could allow for a more personalized approach to secondary prevention based upon quantitative rather than qualitative estimates of residual risk. The updated and geographically recalibrated SMART2 risk score.

Research productivity has been linked to a country’s intellectual and economic wealth. Further analysis is needed to assess the association between the distribution of research across disciplines and the economic status of countries. By using 55 years of data, spanning 1962 to 2017, of Elsevier publications across a large set of research disciplines and countries globally, this manuscript explores the relationship and evolution of relative research productivity across different disciplines through a network analysis. It also explores the associations of those with economic productivity categories, as measured by the World Bank economic classification. Additional analysis of discipline similarities is possible by exploring the cross-country evolution of those disciplines. Results show similarities in the relative importance of research disciplines among most high-income countries, with larger idiosyncrasies appearing among the remaining countries. This group of high-income countries shows similarities in the dynamics of the relative distribution of research productivity over time, forming a stable research productivity cluster. Lower income countries form smaller, more independent and evolving clusters, and differ significantly from each other and from higher income countries in the relative importance of their research emphases. Country-based similarities in research productivity profiles also appear to be influenced by geographical proximity. This new form of analyses of research productivity, and its relation to economic status, reveals novel insights to the dynamics of the economic and research structure of countries. This allows for a deeper understanding of the role a country’s research structure may play in shaping its economy, and also identification of benchmark resource allocations across disciplines for developing countries.

Trans individuals (e.g. trans men and women, non-binary, gender fluid) are at higher risk for mental health concerns, in part due to marginalization. Previous work has documented the effects of social support and community engagement on health outcomes. However, individuals’ perceptions of community engagement effects may point to opportunities for intervention. This mixed methods study examines trans individuals’ perceived effects of participating in trans communities on health outcomes. Semi-structured in-person interviews were conducted with 20 individuals, and 60 individuals participated in cross-sectional online surveys. Perceived discrimination had a strong negative association with self-assessed mental health. Effects of participation included a) positive: contextualization and normalization of experience, self-appraisal, safety, and relief; and b) neutral/negative: energy drain and stigmatization. Effects of not participating included loneliness, depression, isolation, hiding identity, and losing resources. Both discrimination and non-participation in trans communities had negative effects on mental health. Though community participation is often discussed as positive for marginalized populations, it may be important to include possible negative effects (such as energy drain) in research.

Sonic seasoning refers to the way in which music can influence multisensory tasting experiences. To date, the majority of the research on sonic seasoning has been conducted in Europe or the USA, typically in a within-participants experimental context. In the present study, we assessed the applicability of sonic seasoning in a large-scale between-participants setting in Asia. A sample of 1611 participants tasted one sample of chocolate while listening to a song that evoked a specific combination of cross-modal and emotional consequences. The results revealed that the music’s emotional character had a more prominent effect than its cross-modally corresponding attributes on the multisensory tasting experience. Participants expressed a higher buying intention for the chocolate and rated it as having a softer texture when listening to mainly positive (as compared to mainly negative) music. The chocolates were rated as having a more intense flavor amongst those participants listening to ‘softer’ as compared to ‘harder’ music. Therefore, the present study demonstrates that music is capable of triggering a combination of specific cross-modal and emotional effects in the multisensory tasting experience of a chocolate.

The purpose of this study is to determine how consumer perceptions of brand ethical behavior can affect their commitment to brands during turbulent times. A study of the effects of perceived ethical behavior of brands in Colombia during the initial months of the COVID-19 outbreak was conducted in May 2020 in Bogota, Colombia, to ascertain customer perception of brand ethical actions during the first 2 months of the COVID-19 outbreak. A Bayesian model was developed to assess the impact of brands' ethical behavior on brand recognition benefits, brand image, and brand commitment. The selection of the initial months of the outbreak for this project was important because the COVID-19 pandemic had the potential to augment consumer perception of brands' ethical actions at a pivotal moment in consumers' lives. Our findings demonstrate that customers expressed a positive perception of brands' ethical actions during the early months of the pandemic, which resulted in high commitment intention to these brands in the model examined. The findings highlight the critical nature of the perception of ethical behavior in the eyes of customers during a major global health crisis. More than ever, organizations must commit their brands to fully live out their publicly expressed ethical principles and continuously monitor consumer perceptions of brand attributes and behaviors associated with ethical actions regardless of market conditions. Commitment to living the brand's stated ethical principles can be demonstrated via branding activities in ways that can be especially welcomed by customers during turbulent times. The insights mentioned in this article are crucial for brands already present in South America or exploring expansion into these regions. The findings provide compelling evidence of the impact of ethical actions on consumer commitment to brands, suggesting that brands must now, more than ever, stay in touch with their customers and truthfully live the ethical values they transmit to customers.

Background: Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. Objective: The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2). Methods: Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. Results: A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor’s office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. Conclusions: This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps.