Summary Background Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly's proclamation of the Second Decade of Action for Road Safety (2021–30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. Methods As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). Findings In 2023, there were 50·9 million (95% UI 46·1–56·1) road injury incident cases, 1·34 million (1·04–1·58) deaths, and 75·3 million (59·8–89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10–39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9–39·7) and mortality decreased by 32·3% (6·1–49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7–56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1–7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9–947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Interpretation Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. Funding Gates Foundation.

Background: Sudden death is an unexpected natural fatal event that may arise from both cardiac and noncardiac causes. Differentiating true primary cardiac pathology from incidental or secondary myocardial changes remains a major challenge in forensic evaluation, particularly in clearly noncardiac sudden deaths. Aim: The aim of this study was to assess histopathological changes in the heart in cases of sudden death of cardiac and noncardiac origin and to compare the distribution of these findings across different certified causes of death. Additionally, the study aimed to evaluate the frequency and potential forensic relevance of these cardiac alterations. Materials and Methods: A retrospective cross-sectional analysis was conducted on 78 medico-legal autopsy cases of sudden death examined at the Department of Forensic Medicine in Bosnia and Herzegovina (2016–2025). Paraffin-embedded cardiac tissue was evaluated histologically by three independent pathologists, while cases involving unnatural causes of death or significant autolysis were excluded. Results: Cardiac-origin deaths accounted for 76.9% of cases and were more common in males. Individuals who died from cardiac causes were significantly older than those with noncardiac causes (58.7 ± 19.2 vs. 45.7 ± 16.8 years; P = 0.012). Cardiac-origin deaths predominated in middle-aged and older adults, whereas noncardiac sudden deaths occurred more frequently in younger individuals. Myocardial infarction and scar tissue were significantly associated with cardiac-origin deaths (P = 0.017 and P = 0.038). Hypertrophy and dispersed fibrosis increased progressively with age. Conclusion: Cardiac sudden deaths were more frequent and mainly associated with chronic myocardial changes rather than acute ischemia. Middle-aged individuals were the most vulnerable group, highlighting the need for improved cardiovascular risk assessment and prevention.

Background: The significance of imaging right-heart thrombus via echocardiography in acute pulmonary embolism (PE) patients, as well as its management, remains uncertain. Methods: In this retrospective, observational, multicenter, and multinational registry of consecutive acute PE patients, we compared 100 patients in whom thrombus was visualized in the right heart during echocardiographic evaluation with 2635 patients without visualization of thrombus. The co-primary endpoints were all-cause in-hospital mortality and PE-related mortality. Secondary endpoints included the prevalence of severe PE at admission (intermediate–high and high-risk PE), the frequency of thrombolytic therapy administration, and mortality among patients who received thrombolysis. Results: All-cause and PE-related mortality were higher in patients with thrombus in the right heart (31.0% vs. 9.6%, and 25.8% vs. 5.6%, p < 0.001, respectively). Patients with right-heart thrombi had a more severe PE presentation than those without (74.0% vs. 45.3%, p < 0.001). In patients treated with thrombolysis, all-cause mortality was higher in patients with right-heart thrombi (35.5% vs. 12.7%, p < 0.001). In the multivariable Cox regression analysis adjusted for ESC mortality risk, age, presence of syncope, atrial fibrillation, and hypoxemia, patients with thrombus in the right heart had a significantly higher risk of all-cause and PE-related death compared to patients without thrombus (HR 2.60, 95% CI 1.753–3.859, p < 0.001, and HR 3.287, 95% CI 2.056–5.253, p < 0.001, respectively). Conclusions: Visualization of thrombus in transit through the right heart is associated with higher all-cause and PE-related mortality, independent of PE severity and the use of thrombolytic therapy.

Background/Objectives: This study investigates the correlation between substantia nigra (SN) hyperechogenicity, detected via transcranial sonography (TCS), and retinal thinning in patients with Parkinson’s disease (PD). Methods: In this cross-sectional study, 86 PD patients (172 eyes) underwent clinical assessment (UPDRS, Hoehn–Yahr), TCS for SN area measurement, and optical coherence tomography (OCT) for retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), and macular thickness analysis. Results: PD patients exhibited significant thinning of the GCIPL, average RNFL, and central macular thickness compared to healthy controls (p < 0.001 in all instances). Pathological SN hyperechogenicity (>0.19 cm2) was detected in 85.9% of patients with a preserved temporal bone window (71 out of 86). A significant negative correlation was found specifically between the SN echogenic area and central macular thickness (r = −0.248, p = 0.003). Patients with pathological SN findings had a significantly thinner central macula (p = 0.006) compared to those with a normal SN, while no significant correlations were observed between the SN area and RNFL or GCIPL. Conclusions: These findings demonstrate a specific correlation between SN hyperechogenicity and central macular thinning. While RNFL and GCIPL effectively differentiate PD from controls, the central macula might serve as a promising biomarker candidate reflecting SN changes. Further longitudinal studies are required to evaluate the role of these combined markers in the PD diagnostic algorithm.

Successful speech communication in multi-talker scenarios requires a skillful combination of sustained attention and rapid attention switching. While the neurophysiology literature offers detailed insights into the neural underpinnings of sustained attention, there remains considerable uncertainty on how attention switching takes place. In this study, using EEG recordings from normal-hearing adults in an immersive multi-talker environment, we measured the neural encoding of two competing speech streams amid background babble. Participants were cued to switch attention between streams every 15–30 s. Neural tracking was assessed via Temporal Response Functions (TRF), confirming reliable decoding of attentional focus. Our results indicate asymmetric disengagement and engagement processes during attention switches, where the neural tracking of the new target stream emerges before disengaging from the previous target, revealing a transient simultaneous encoding of two speech streams. That transition was closely mirrored by a reduction in EEG alpha power, informing on the cognitive effort during different phases of the attention switch. We then isolated cortical activity reflecting lexical prediction mechanisms to determine how lexical context is updated after an attention switch, comparing four context-accumulation strategies that were constructed using Large Language Models. Our findings elucidate both the temporal and contextual mechanisms underlying auditory attention shifts, pointing to the possibility that listeners carry out a reset in lexical context after switching attention. By focusing on dynamic attentional reallocation, this study offers insights into the brain’s capacity for flexible speech processing in complex listening environments.

The introductory section defines the concepts of graphomotor skills and hearing impairment.The aim of this study was to examine the characteristics of graphomotor skills in children with hearing impairments compared to hearing children. Additionally, one of the objectives was to investigate whether there are differences in graphomotor skills depending on the quality of hearing, as well as to identify the factors that influence these skills.For assessment purposes, the Diagnostic Set for Testing Speech, Language, Reading, and Writing Abilities in Children –Diagnostic Material for Identifying Specific Difficulties in Reading and Writing wasused, focusing on variables related to graphomotor skills. Descriptive statistics, optimal scaling regression analysis, and linear regression analysis were employed for statistical data processing.The study revealed that hearing participants achieved statistically significantly better results in graphomotor skills compared to participants with hearing impairments.The degree of hearing impairment affects the graphomotor skills of children with hearing impairment, while educational conditions and gender did not show any influence on these skills. Age also impacts the graphomotor skills of children with hearing impairment.These findings provide insight into the specific needs of children with hearing impairments and emphasize the importance of individualized education, taking into account the unique characteristics of each child with hearing impairment.Keywords: graphomotor skills, graphomotor development, children with hearing impairment

Digital narratives, particularly animated films, are increasingly recognized as powerful educational tools capable of fostering empathy and promoting inclusive values among school-age children. This study examined how viewing the animated film Jonathan from Seagull Mountaincontributes to the development of empathy and understanding of diversity among primary school students in Bosnia and Herzegovina. A mixed-methods design was employed, integrating quantitative and qualitative data collection and analysis.The sample comprised 214 students aged 9 to 15 years from four cities (Tuzla, Sarajevo, Zenica, and Mostar), while a purposive subsample of 32 students participated in four focus groups. Data were collected through a structured post-viewing questionnaire and semi-structured focus group discussions. Quantitative data were analyzed using descriptive statistics, while qualitative data from focus group transcripts were analyzed through thematic analysis. Results indicate that the film elicited positive emotional responses in the majority of participants, with 78.6% expressing a desire to help the protagonist and 78.0% reporting increased motivation to support peers who are different from them. Girls demonstrated markedly higher levels of affective empathy than boys, with the most pronounced difference recorded on the item relating to sadness over the protagonist's exclusion (86.5% vs. 53.6%). Thematic analysis identified five main themes: emotional experience of the narrative, development of empathy and acceptance of diversity, peer support and moral responsibility, symbolic elements, and student recommendations for more inclusive school practices. The findings confirm the potential of digital narratives as a pedagogical tool for developing empathy and inclusive attitudes among primary school students. Keywords:digital narratives, empathy, inclusion, animated film, primary school students

The aim of this study was to examine the impact of perceived stress levels on anxiety and depression among parents of children with disabilities. The study included a sample of 104 parents of children with different types of disabilities, of whom 85.6% were mothers and 14.4% were fathers. The Perceived Stress Scale (PSS-10) was used to assess the level of perceived stress, the Generalized Anxiety Disorder Scale (GAD-7) was used to assess anxiety, and the Patient Health Questionnaire (PHQ-9) was used to assess depression. Data were analyzed using descriptive statistics and linear regression analysis. The results indicated the presence of a moderate level of anxiety (M = 11.17; SD = 4.53), a moderately severe level of depression (M = 15.92; SD = 6.60), and a high level of perceived stress (M = 28.73; SD = 5.11) among parents of children with disabilities. Linear regression analysis showed that the level of perceived stress was a statistically significant predictor of anxiety (R² =0.25; p < 0.001) and depression (R² = 0.27; p < 0.001). The obtained findings indicate that higher levels of perceived stress contribute to higher levels of anxiety and depression among parents of children with disabilities. The study results highlight the need for the development of systematic psychological and social support for parents of children with disabilities in order to preserve their mental health. Keywords:perceived stress, anxiety, depression, parents of children with disabilities, mental health, psychological burden

BACKGROUND Fractures in older adults arise from complex interactions between bone fragility, falls, and comorbid conditions. This study aimed to map the comorbidity environment of osteoporosis (M80/M81) by sex and age, and assess whether osteoporosis is systematically coded at the time of fracture-related hospitalization across fracture types. METHODS We conducted a nationwide retrospective analysis of Austrian inpatient data collected for insurance claims between 2003 and 2014, including 1,705,684 hospitalized patients aged 50-79 years. Comorbidity network analysis was used to characterize sex- and age-specific diagnoses co-occurring with osteoporosis (ICD-10: osteoporosis with pathological fracture M80 and osteoporosis without pathological fracture M81). In paralell, fracture-centered networks were constructed for major fracture types (S22, S32, S42, S52, S62, S72) to assess whether osteoporosis was systematically coded during fracture related hospitalizations. Sex-specific odds ratios (ORs) were calculated to compare comorbidity associations between males and females across three age groups (50-59, 60-69, 70-79 years). RESULTS Across all age groups, females exhibited substantially broader M81-associated comorbidity networks than males, with the number of linked diagnoses increasing from 142 to 245 to 330 in females and from 76 to 137 to 164 in males between ages 50-59, 60-69, and 70-79 years, respectively. Fracture-centered analyses showed that across age groups, fractures were embedded within multimorbidity networks rather than forming isolated diagnostic links with osteoporosis. Hip fractures (S72) showed the strongest co-occurrence with osteoporosis diagnoses, particularly in females aged ≥60 years, whereas upper limb fractures - forearm (S52), wrist and hand (S62), and humerus (S42) - showed no osteoporosis diagnoses among significant co-diagnoses in any age group despite these fractures being considered early fragility fractures. In patients aged 50-69 years, male fracture networks showed stronger co-occurrence with trauma-related and alcohol-related diagnoses, while in older age groups networks in both sexes increasingly included neurodegenerative, cardiovascular, respiratory, and renal diseases. In sex-stratified analyses, the co-occurrence between osteoporosis without pathological fracture (M81) and osteoporosis with pathological fracture (M80) was consistently stronger in males than in females across all ages (e.g. OR 63.74 vs 18.53 at 50-59 years). CONCLUSIONS Osteoporosis is not systematically coded across all fracture types in routine hospital data. Upper limb and thoracic fractures were rarely recorded alongside osteoporosis diagnoses despite being recognized as potential fragility fractures. These patterns suggest under-recognition of osteoporosis at the time of fracture, particularly in younger patients and in males.

The aim of the study was to examine the level of knowledge and awareness of healthcare professionals regarding feeding, sucking, and swallowing disorders, as well as their understanding of the role of speech and language therapists in the diagnosis and treatment of these disorders. The study was conducted on a sample of 51 healthcare professionals from public and private healthcare institutions in the Una-Sana Canton, using a questionnaire specifically designed for the purposes of this research.According to the results, 56.9% of respondents had received formal education on dysphagia, while only 27.5% had undergone training in the field of pediatric feeding disorders. Clinical experience with dysphagia was reported by 64.7% of respondents, whereas experiencewith pediatric feeding disorders was reported by 25.5%. Although 68.6% of respondents reported being familiar with the distinction between the terms “dysphagia” and “feeding disorders,” only 29.4% demonstrated a professionally grounded understanding of these concepts.Participation in diagnostic procedures related to pediatric feeding disorders was reported by 9.8% of respondents, while 7.8% reported participation in therapeutic interventions. In cases of dysphagia, 35.3% of respondents reported involvement in diagnostic procedures, whereas 17.6% participated in therapeutic treatment. Only 7.8% of respondents identified the speech and language therapist as a key member of the multidisciplinary team.Respondents also assessed the strengthening of knowledge on pediatric feeding disorders and dysphagia as being of high professional importance. The results indicate significant gaps in knowledge, education, and clinical involvement among healthcare professionals, particularly regarding the recognition of the roleof speech and language therapists, while respondents simultaneously express a high level of readiness for further professional development. These findings highlight the need for continuous and systematic education, as well as for strengthening interprofessional collaboration.Keywords: dysphagia; pediatric feeding disorders; healthcare professionals’ knowledge and competencies; speech-language pathology; multidisciplinary team

Vocal fold nodules (VFNs) are the main cause of paediatricdysphonia. Voice therapy is regarded as the preferred treatment approach for VFNs in children. The aim of this study was to evaluate voice characteristics before and after voice therapy using acoustic analysis. Thirty female patients with VFNs were enrolled in this study. Each patient underwent voice therapy conducted by an experienced voice therapist twice a week. Acoustic voice assessments were performed before and after the therapeutic intervention. Acoustic analyses were performed using computerized acoustic voice analysis. Post-therapy findings demonstrated a consistent and statistically significant improvement across multiple acoustic parameters. Significant reductions were observed in jitter and shimmer measures, as well as in noise-related acoustic parameters such as the noise-to-harmonics ratio, suggesting improved stability and efficiency of vocal fold vibration. Fundamental frequency showed a slight decrease following therapy. Overall, these findings indicate a more stable, less perturbed, and acoustically improved voice signal after intervention. The findings of this study suggest the effectiveness of voice therapy in improving acoustic voice parameters in children with VFNs. The observed improvements highlight the importance of early and structured behavioral intervention in pediatric dysphonia and reinforce the role of acoustic analysis as a valuable tool for objective assessment of therapeutic outcomes. Keywords: vocal fold nodules, dysphonia, voice therapy, acoustic analysis.