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Latino persons with chronic spine pain (CSP) face challenges engaging in physical activity (PA) and minimizing sedentary behavior (SB). This study aimed to objectively characterize PA and identify correlates of PA and SB in Latino persons with CSP. Cross-sectional baseline data from Latino participants who were enrolled in a clinical trial for CSP near the U.S.-Mexico border were utilized. Blockwise regression assessed the association between sociodemographic, clinical, interpersonal, and environmental factors with light PA (LPA), moderate-to-vigorous PA (MVPA), and SB. Participants (N = 154, Mage = 47.5 ± 12.1 years) spent 342.8 ± 111.6 min/day in LPA, 56.1 ± 71.1 min/day in MVPA, and 550.3 ± 140.9 min/day in SB. Seventy-five percent of participants met national PA guidelines. Lower income and higher pain interference were associated with lower LPA (R2 = 9%, p < .05). Younger age and lower income were associated with higher MVPA (R2 = 13%, p < .05). Lower income was associated with lower SB (R2 = 5%, p < .05). Younger age (OR 95% confidence interval [CI] [0.87, 0.98]) and higher exercise self-efficacy (OR 95% CI [1.06, 8.09]) increased the odds of meeting PA guidelines. Participants with CSP exhibited greater levels of LPA, MVPA, and SB compared with prior studies of Latino persons without pain. Sociodemographic variables including age and income were most consistently associated with PA and SB outcomes. Future research is needed to identify other relevant intrapersonal, interpersonal, and environmental determinants of PA and SB in this clinical population. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Wildfire smoke, once rare, is a hazard that populations across the globe are increasingly exposed to repeatedly. Evidence of acute health effects of wildfire particulate matter (PM2.5) is growing, but less is known about long-term effects related to repeated exposures. Using a cohort of 1,250,083 Kaiser Permanente Southern California members aged ≥60, we estimated the association between all-cause mortality and 3-y exposure to five different census tract-level wildfire smoke metrics (mean daily wildfire-specific PM2.5, mean daily wildfire-specific PM2.5 during the peak wildfire week, number of days with daily wildfire-specific PM2.5 > 0 μg/m3, number of weeks with average wildfire-specific PM2.5 > 5 μg/m3, and number of smoke waves). We applied a discrete-time approach with pooled logistic regressions, adjusting for sex, age, race and ethnicity, marital status, smoking status, requiring an interpreter, calendar year, and census tract-level poverty and population density. When comparing those highly exposed (95th percentile) to those minimally exposed (5th percentile), we found an increased odds of mortality across all five wildfire smoke metrics. Mean daily wildfire PM2.5 was the metric most strongly associated with mortality (odds ratio: 1.07; 95% CI: 1.05, 1.09). We observed greater vulnerability to the long-term effects of smoke for individuals under age 75, or with Black or Other racial/ethnic identity, or living in a census tract with higher poverty. Identifying the most harmful long-term wildfire smoke metric and most-at-risk populations can help focus attention for developing effective adaptation strategies in a changing climate.

Debates about optimal saturated fat advice continue. To systematically summarize randomized trial data on reducing or modifying saturated fat intake on cholesterol, mortality, and major cardiovascular events. MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception to July 2025. Eligible trials enrolled adults with or without cardiovascular disease and studied the effect of reducing or modifying saturated fat intake. Standard Cochrane methods. There were 17 eligible trials (66 337 participants). Risk stratified evidence provides low to moderate certainty that reducing saturated fat intake may result in a reduction in all-cause mortality (risk ratio [RR], 0.96 [95% CI, 0.88 to 1.06]), cardiovascular mortality (RR, 0.93 [CI, 0.77 to 1.11]), nonfatal myocardial infarction (MI) (RR, 0.86 [CI, 0.70 to 1.06]), and fatal and nonfatal stroke (RR, 0.83 [CI, 0.58 to 1.19]). For persons at low baseline cardiovascular risk, absolute reductions were below our thresholds of importance (5 and 10 per 1000 persons followed over 5 years for fatal and nonfatal outcomes, respectively); for those at high risk, the benefits were above our thresholds, suggesting there may be important absolute reductions. The effects were more pronounced when replacing saturated fat with polyunsaturated fat for nonfatal MI (RR, 0.75 [CI, 0.58 to 0.99]; P for interaction = 0.05; moderate credibility of subgroup effect based on Instrument to assess the Credibility of Effect Modification Analyses assessments). Data were limited on the replacement of saturated fat with monounsaturated fat or protein. Trials varied considerably in their efficacy in reducing saturated fat intake and in their replacement macronutrients and concomitant dietary interventions, and new trials are needed to clarify uncertainty. For persons at low cardiovascular risk, reducing or modifying saturated fat intake has little or no benefit over a period of 5 years. Among persons at high cardiovascular risk, low- to moderate-certainty evidence was found for important reductions in mortality and major cardiovascular events, particularly for MI, with respect to replacing saturated fat with polyunsaturated fat. None. (PROSPERO: CRD42023387377).

The U.S. Preventive Services Task Force expanded lung cancer (LC) screening eligibility in 2021 (USPSTF-2021) by decreasing the minimum number of smoking pack-years from 30 to 20. Underrepresented minorities still experience disparities in screening eligibility. To evaluate screening eligibility and prognostic performance of alternative smoking duration-based criteria versus USPSTF-2021 (primary outcome) and risk-based screening using the recalibrated Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012update) model (secondary outcome) across diverse racial and ethnic groups. Prospective, population-based Multiethnic Cohort linked to SEER (Surveillance, Epidemiology, and End Results) registries. California and Hawai'i, with recruitment from 1993 to 1996. 105 261 adults aged 45 to 75 years with a history of smoking. Hypothetical eligibility and prognostic performance (sensitivity and specificity) in detecting 6-year LC. Under USPSTF-2021, 24.0% of the cohort would be eligible for screening; a 30-year smoking duration yielded the closest eligibility rate (27.5%). Compared with USPSTF-2021, the 30-year duration criteria would reduce eligibility gaps across all races relative to Whites, most notably in African Americans (30.4% vs. 28.8% for Whites under duration-based; 21.4% vs. 30.2% for Whites under USPSTF-2021) and Latinos (25.1% vs. 28.8% for Whites under duration-based; 15.7% vs. 30.2% for Whites under USPSTF-2021). Prognostic sensitivity to identify LC within 6 years increased across all races under the 30-year duration criteria, although specificity decreased commensurately. At matched overall eligibility (27.5%), a risk-based PLCOm2012update 6-year threshold of 1.1% improved both sensitivity and specificity in the overall cohort. However, it widened the eligibility gap between Latinos and Whites (14.4% vs. 31.3%) and demonstrated lower sensitivity in Latinos than duration-based criteria (59.7% vs. 69.8%). Cohort geography and enrollment period may limit generalizability. Overdiagnosis was not measured. Compared with USPSTF-2021, the 30-year duration-based criteria could reduce the eligibility gaps among African Americans and Latinos relative to Whites while improving 6-year LC detection sensitivity across all races. National Institutes of Health.

Heart failure with preserved ejection fraction (HFpEF) and unstable angina (UA) often coexist in clinical practice, constituting a high-risk cardiovascular phenotype with a markedly increased incidence of major adverse cardiovascular events (MACEs). The identification of high-risk patients within this population is crucial for reducing complications, improving outcomes, and guiding clinical decision-making. This study aimed to develop and externally validate predictive models based on machine learning algorithms to estimate the risk of MACEs in patients with coexisting UA and HFpEF, and to construct an online risk calculator to support individualized prevention strategies. This multicenter cohort study included 4459 patients with both HFpEF and UA admitted to 7 hospitals across eastern, central, and western China between January 1, 2015, and December 31, 2021. Patients were divided into the derivation cohort (n=2923) and external validation cohort (n=1536) based on geographic regions. Clinical, laboratory, and imaging data were extracted from electronic medical records. Key predictors were identified using a hybrid feature selection method combining least absolute shrinkage and selection operator and Boruta algorithms. A total of 33 survival models were developed, including a variety of machine learning algorithms and survival analysis models. The model with the best concordance index (C-index) performance was deployed as a web-based risk calculator. Additionally, we assessed other performance indicators of the best-performing model, including the area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, recall, F1-score, Brier scores, calibration curves, and decision curve analysis. Using a combination of the least absolute shrinkage and selection operator regression and the Boruta algorithm, 7 key predictors were identified: diabetes mellitus, blood platelet count, triglyceride, systemic inflammatory response index, triglyceride-glucose-BMI, N-terminal pro-brain natriuretic peptide, and atherogenic index of plasma. The surv.xgboost.cox model was used to predict MACEs in patients with UA and HFpEF due to its superior C-index. The model demonstrated the following performance metrics in the external validation cohort: a C-index of 0.788; cumulative/dynamic area under the curve of 0.81; and area under the curve values at 20, 30, and 40 months of 0.809 (95% CI 0.745-0.873), 0.784 (95% CI 0.745-0.824), and 0.807 (95% CI 0.776-0.838), respectively. The model exhibited satisfactory calibration and clinical utility in predicting 40-month MACEs. Model interpretability was enhanced using Shapley Additive Explanations for survival analysis to provide global and individual explanations. Furthermore, we converted the surv.xgboost.cox-based model into a publicly available tool for predicting 40-month MACEs, providing estimated probabilities based on the predictive indicators entered. We developed a surv.xgboost.cox-based predictive model for MACEs in patients with the dual phenotype of HFpEF and UA. We implemented this model as a web-based calculator to facilitate clinical application.

One in 4 Veterans who receive care through the Veterans Health Administration has type 2 diabetes (T2D). Dietary carbohydrate restriction can promote weight loss and improve blood glucose control, but Veterans taking certain medications (eg, insulin) may experience serious complications (eg, hypoglycemia) without adequate support and monitoring. This study aims to develop and evaluate the feasibility, acceptability, and clinical effectiveness of a pilot low-carbohydrate (LC) nutrition counseling program guided by continuous glucose monitoring (CGM) for Veterans with T2D receiving insulin (ie, LC-CGM). This is a pragmatic, nonrandomized, pre-post quality improvement pilot program. Eligible patients were Veterans with T2D who were prescribed ≥3 daily injections of insulin. The 24-week LC-CGM program consisted of virtual visits with a registered dietitian (RD) and clinical pharmacy practitioner (CPP); CGM data were used to guide tailored nutrition counseling and de-escalation or cessation of glucose-lowering medications. To evaluate changes from baseline, intention-to-treat analyses were conducted for all enrollees, with separate analyses for program completers. Primary outcomes were program feasibility and acceptability (ie, program enrollment and completion rates and mean number of RD and CPP visits). Secondary outcomes included mean weight change, percent weight loss, achievement of ≥5% and ≥10% weight loss, change in glucose-lowering medication use, and change in laboratory measures (eg, hemoglobin A1c [HbA1c]). Program evaluation occurred from March 19, 2021, to May 3, 2024. Among 43 Veterans referred to the LC-CGM program, 38 (88%) enrolled. Most were men (37/38, 97%), white (29/38, 76%), with an average age of 63.7 (SD 9.6) years. Mean BMI and HbA1c were 38.1 (SD 5.8) kg/m2 and 7.8% (SD 1.3). Of 38 enrollees, 27 (71%) completed the program. Enrollees averaged 9.5 (SD 3.3) RD visits and 12.8 (SD 4.7) CPP visits. In intention-to-treat analyses, mean weight change was -11.5 kilograms (SD 8.7; 95% CI -14.4 to -8.6), corresponding to 9.5% weight loss (SD 7.2; 95% CI -14.9 to -4.2), with 58% (22/38) achieving ≥5% weight loss and 32% (12/38) achieving ≥10% weight loss. Overall, use of glucose-lowering medications decreased from 3.5 (SD 0.8) per patient at baseline to 2.4 (SD 0.9) per patient at 24 weeks (P<.001), with 72% (26/36) of Veterans discontinuing short-acting insulin and 50% (18/36; P<.001) discontinuing long-acting insulin. Use of glucagon-like peptide-1 receptor agonists increased from 39% (15/38) at baseline to 61% (23/38) at 24 weeks (P=.02). Among program completers (n=27), mean percent weight loss was -11.8% (SD 6.5) and median HbA1c decreased by 0.7% (95% CI -0.9 to -0.3; P=.001). This pilot program provides preliminary evidence that supports feasibility, acceptability, and clinical effectiveness among Veterans with T2D. Additional research is needed to rigorously test longer-term clinical and cost-effectiveness among a larger cohort of eligible Veterans.

Increased appetite and weight gain are common adverse effects of glucocorticoid therapy in patients with systemic lupus erythematosus (SLE). Concerns about appearance-related changes due to weight gain can reduce medication adherence. Moreover, the complex interplay among glucocorticoids, mood changes, sleep disturbances, and appetite can influence eating behaviors. Daily data collection using ecological momentary assessment and analysis of interrelations may help clarify these dynamics. Furthermore, real-time feedback based on daily eating behavior may help patients regulate appetite and eating patterns. Accordingly, we developed Mogu!☆Log, a smartphone-based app that enables daily self-reporting of eating behaviors, appetite, and mood and provides graphical feedback on meal frequency and perceived control over eating. This paper presents a protocol for a pilot randomized controlled trial designed to evaluate the effects of real-time feedback on eating behaviors using the Mogu!☆Log app among patients with newly diagnosed SLE who had started glucocorticoid therapy. This multicenter study recruited Japanese patients with newly diagnosed SLE who had started glucocorticoid therapy across 15 hospitals with rheumatology services. Participants were randomly assigned in a 1:1 ratio to two groups: (1) the immediate feedback group, which receives graphical feedback on meal frequency and perceived control over eating starting from day 1, and (2) the delayed feedback group, which uses the same app without feedback for the first 14 days and begins receiving identical feedback from day 15. Participants enter data daily from day 1 to day 21 after randomization. The primary outcome is the mean number of meals on day 14 after glucocorticoid initiation. Secondary outcomes include the loss-of-control-over-eating score and a 5-item visual analog scale-based appetite score, both recorded on day 14. Between-group mean differences will be analyzed using 2-tailed t tests. The target sample size is 60. In an embedded observational "study within a trial," linear mixed models will examine whether glucocorticoid dose influences appetite scores through mood and sleep changes. We hypothesized that participants receiving immediate feedback will have fewer meals on day 14, reduced loss of control over eating, and better appetite scores. The study received funding in April 2019, April 2022, and April 2024. Recruitment began in October 2024, and 17 participants had been enrolled as of May 2025. Data collection is expected to be completed by March 2027; data analysis has yet to begin. Results will be submitted for publication and reported to the University Hospital Medical Information Network (UMIN) registry in the summer of 2027. This pilot trial will provide foundational data on the feasibility and efficacy of smartphone-based real-time feedback in managing glucocorticoid-induced appetite increase in patients with SLE. These findings may contribute to the growing body of literature on app-based interventions for medication-related adverse effects.

Many patients experience a gradual decline in health before seeking hospital care, with subtle changes in vital signs such as increased heart rate or decreased mobility. Recognizing deviations from baseline vital signs can support clinical decision-making, especially admission decisions. Smart devices (ie, smartphones, smartwatches, and activity trackers) track health metrics like heart rate and step count, offering new opportunities to estimate illness severity and track deterioration early. This study aimed to assess the feasibility of using heart rate and step count measurements from smart devices (ie, smartphones, smartwatches, and activity trackers) to enhance the evaluation of patients presenting with acute illness in emergency settings. We conducted an international multicenter prospective observational study using the flash mob study design in 34 hospitals in the Netherlands (n=17), the United Kingdom (n=7), Denmark (n=9), and Switzerland (n=1) in May 2024. Researchers collaborated with patients to complete questionnaires upon an acute care (ie, emergency department, acute medical unit, same day emergency care) visit and extracted physiological data from their smart devices. Among patients with an acute care visit (n=1137), 40% (n=452) had a smart device with health data. These patients tended to be from a higher educational level and in relatively good health. Only half had retrievable heart rate or step count data, resulting in a usable data set for 20% (n=209) of the total study population. Analysis showed a significant increase in heart rate (P<.001) and a decrease in step count (P<.001) in the days preceding their hospital visit. Both heart rate (P=.04) and step count (P=.04) on the day before presentation were significantly associated with disposition. Our study demonstrates the feasibility of using a patient's personal smart device to monitor vital signs in the days leading up to an acute care visit. In a selected patient group, significant changes in heart rate and step count were observed prior to hospital presentation, suggesting that disposition may be predicted using data collected from the patient's own device. High-risk patient groups, who might benefit the most from digital health monitoring, are currently underrepresented among device users.

Driving under the influence of alcohol (DUIA) and cannabis (DUIC) continues to increase. Given the increased number of states with cannabis legalization in recent years, updates on driving under the influence (DUI) prevalence and risk factors are needed to inform targeted prevention and intervention efforts aimed at reducing substance-impaired driving. We used data from the 2021-2023 U.S. National Survey on Drug Use and Health (N = 139,524 individuals age 18 years and older) for self-reported DUI. After presenting the prevalence of alcohol, cannabis, and other substance use and DUI, we used binary logistic regression models to examine sociodemographic and clinical correlates of DUIA and DUIC, and a multinomial logistic regression model to examine DUIC but no DUIA (DUIC-NA) and both DUIA and DUIC (DUIA&C), compared to DUIA but no DUIC (DUIA-NC). Among those who used alcohol in the past year, 8.6% had DUIA; among those who used cannabis, 20.6% had DUIC. Among those who reported DUIA and/or DUIC, 47.9% had DUIA-NC, 34.0% had DUIC-NA, and 18.1% had DUIA&C. Any severity of alcohol and cannabis use disorder, initiation of substance use during adolescence, mental health problems, risk propensity, self-recognition of substance use problem, and criminal justice involvement were associated with DUIA and DUIC. Age 65+, relative to age 18-25, was also a risk factor for DUIC among those who used cannabis. Compared to DUIA-NC, DUIC-NA was higher among residents of medical cannabis legal states. Substance use treatment, including mental health screening and treatment, is the most important DUI prevention approach. As cannabis use rises among older adults, prevention strategies must increasingly include this group. States with legalized medical cannabis suggest a need for complementary public safety measures.

Pregnancy is a crucial stage characterized by an increased demand for various nutrients. The role of micronutrients becomes especially important during pregnancy and infancy to support neurodevelopment. Micronutrient deficiencies are prevalent in low- and middle-income countries due to socioeconomic disparities, limited dietary diversity, and barriers to quality antenatal care. This results in women of reproductive age and developing offspring being disproportionately affected. Despite extensive research, evidence remains fragmented, leading to a lack of comprehensive synthesis. This scoping review aims to explore the existing evidence on the role of maternal micronutrient status during pregnancy influencing neurodevelopmental outcomes in infants. Additionally, it will assess the prevalence and distribution of specific micronutrient deficiencies and identify their sociodemographic determinants within South Asian countries. This scoping review uses an iterative, three-step search strategy to identify both published and gray literature. Initially, a targeted search using relevant keywords was developed for PubMed to locate studies investigating maternal micronutrient status or supplementation during pregnancy (women aged 15-49 y) and associated neurodevelopmental outcomes in offspring up to two years of age. The search was sequentially narrowed by geographic region (South Asian countries), study design, human studies, English-language publications, and clinical trials. In the second stage, this search strategy will be adapted and implemented across additional electronic databases, including MEDLINE, Embase, Google Scholar, Cochrane Library, OpenGrey, JSTOR, and Wiley, as well as trial registries such as ClinicalTrials.gov and PROSPERO. Further, supplementary hand-searching of relevant journals will be conducted. The third step involves applying a snowballing technique to review the bibliographies of initially identified papers. Two reviewers will independently conduct study selection and data extraction using standardized forms. Quality assessment will use Joanna Briggs Institute critical appraisal checklists. Quantitative findings (study characteristics, exposure definitions, outcome measures) will be summarized with descriptive statistics and visualized in structured tables and charts, and qualitative findings will be coded inductively to develop themes pertinent to the review questions. We will integrate evidence through a convergent narrative synthesis to contextualize how maternal micronutrient deficiencies are influenced by sociodemographic factors and how these relate to infant neurodevelopment. The review will adhere to PRISMA-ScR reporting guidelines. The initial database search was completed on July 3, 2025. Title and abstract screening is in progress, and final synthesis and reporting are anticipated by January 2026. This review aims to summarize the available evidence on maternal micronutrients and infant neurodevelopment in South Asia, identify major gaps and inconsistencies in the data, and highlight opportunities for focused research and multisectoral action. The findings will help guide the next phases of the South Asia Collaborative for Maternal Micronutrients and Infant Neurodevelopment (SACMIND) collaborative project, which will include qualitative studies, biomarker assessments, and designing interventions.

Digital technologies are reshaping health care, making digital health literacy (DHL) a critical competency for navigating online health information. Although widely conceived and measured as a unidimensional measure of DHL, the literature increasingly supports a multidimensional framing of the eHealth Literacy Scale (eHEALS). Studies propose alternative factor structures that can better inform population-level interventions, but these studies have not accounted for the ordinal nature of eHEALS response data. This study aimed to identify and validate an alternate multidimensional structure of eHEALS accounting for its ordinal response scale. Data were drawn from the 2022 GetCheckedOnline community survey of consenting English-speaking British Columbia residents aged ≥16 years who reported sexual activity in the past 12 months. Participants were recruited through geo-targeted digital advertisements, community outreach, and in-person recruitment at public events, and community locations. DHL was measured using eHEALS, with responses collected on a 5-point Likert scale. Descriptive statistics summarized eHEALS responses using means, medians, and IQRs. Exploratory and confirmatory factor analyses were used to assess the scale's structure using polychoric correlations and standard model fit indices. Reliability and validity were evaluated using polychoric ordinal alpha, average variance extracted, and composite reliability, with missing data addressed via multiple imputation. Overall, 1657 participants met inclusion criteria with a mean age of 33.0 (SD 11.77, 95% CI 32.4-33.6) years. Among these 47.3% (95% CI 44.9%-49.7%) identified as women, 30.4% (95% CI 28.1%-32.6%) identified as racialized minorities, 80.5% (95% CI 78.5%-82.3%) reported easy internet access, and 32.2% (95% CI 30.0%-34.5%) had a bachelor's degree or higher. Across eHEALS items, median scores were 4.0 (IQR 1.0-2.0) with excellent internal consistency (polychoric ordinal α=.92). Exploratory factor analysis supported a 3-factor solution explaining 65.7% of the variance, demonstrated through confirmatory factor analysis (χ²17=71.7, P<.001, root-mean-square error of approximation=0.059, standardized root-mean-square residual=0.026, comparative fit index=0.969, Tucker-Lewis Index=0.948). The final model included Information Navigation (standardized loadings=0.765-0.917), Resource Appraisal (0.825-0.892), and Confidence in Use (0.803 for both items), with composite reliability (0.784-0.900), and average variance extracted (0.503-0.738) supporting construct validity. This study confirms a multidimensional structure of eHEALS, identifying Information Navigation, Resource Appraisal, and Confidence in Use as key dimensions of DHL. This revised model enhances measurement precision, enabling more accurate identification of populations with limited DHL and informing the development of targeted, equity-oriented interventions. Future research should aim to confirm this multidimensional structure in more diverse populations and explore how distinct DHL domains influence access to digital health services in various contexts. Additionally, ongoing scale development must adapt to account for the role of emerging technologies, including artificial intelligence and social media algorithms in health care.

Racism is an underlying cause of health inequities and is entrenched in health systems, disproportionately affecting marginalized groups. Advancing health equity requires reimagining health systems to uproot racism from health-related policymaking. Racism, in its systemic, cultural, and interpersonal forms, remains a significant threat to health equity, a barrier to reform, and a public health crisis. This review draws lessons from US social movements-including tobacco control, sexual and gender minority rights, criminal justice reform, civil rights, and reproductive justice-to identify effective strategies for change. Drawing on key theories, typologies, and insights from the literature, we examine how organizing, messaging, and mobilization have shaped narratives, have fostered public will, and have driven policy reform. Prior movements can serve as a guide for the development and implementation of a social change movement aimed at addressing racism in public health.

People with kidney failure on chronic hemodialysis (HD) require sustainable vascular access. The AV Access trial is a randomized controlled trial comparing clinical and patient-reported outcomes in adults ≥ 60 years old on HD with a central venous catheter, randomized to receive either a surgical arteriovenous (AV) fistula or graft. Patient enrollment in the trial initially progressed slower than anticipated. We designed a cross-sectional qualitative substudy to identify facilitators and barriers to patient enrollment in the AV Access trial. We conducted qualitative focus groups and semi-structured interviews of site investigators and providers, and semi-structured interviews of patients who had been approached for enrollment in the AV Access trial. We performed hybrid inductive-deductive thematic analysis of transcripts. We analyzed transcripts from two focus groups (one with four vascular surgery physician investigators and one with four nephrology physician investigators) and 44 individual interviews with vascular surgery physician investigators (n=2), nephrology physician investigators (n=2), vascular surgery providers (n=9), nephrology providers (n=10), and patients (n=21). Participants identified themes related to clinical site selection, buy-in from clinical teams, patient referral processes to vascular surgery, and processes to recruit patients to enroll in the trial. Subthemes included barriers related to patients receiving care from providers external to the study team, pervasive biases from the "Fistula First" initiative, limited patient knowledge of the importance of AV access, and a need for additional information provided to patients to support informed decision-making about trial participation. Enrollment in the AV Access trial was hindered by multi-level barriers. Some of these may be mitigated through collaborative patient education surrounding the importance of access placement, as well as provider-directed education to increase buy-in and enhance engagement. These findings can inform the design and implementation of future randomized controlled trials concerning surgical AV access outcomes.

More than half of the states in the United States have implemented laws or policies requiring transgender athletes to participate in athletics aligned with their sex assigned at birth. President Trump signed Executive Order 14201, Keeping Men Out of Women's Sports, on February 5, 2025, expanding these restrictions to recipients of federal education funding. The order also made it official policy to oppose transgender women athletes participating in women's sports "as a matter of safety, fairness, dignity, and truth." Restricting trans adolescents' physical activity may exacerbate health disparities within this marginalized population. Allowing participation in categories aligned with gender identity could alleviate these disparities. The trans athlete debate primarily focuses on testosterone's effects on performance. This article argues against exclusion based on testosterone, emphasizing sex and gender as social constructs and the complexity of determining eligibility in binary gender categories. It reviews racial/ethnic and age changes in the size of the trans population since 2014. It provides foundational knowledge on sex differences in physical performance and reviews testosterone's role in superior male performance. The article critiques research on performance differences between trans and nontrans athletes, highlighting limitations in generalizing findings from adult studies to youth. Health care professionals must advocate for trans athletes by confronting restrictive policies and promoting inclusive sports participation. Policy recommendations are provided to implement these conclusions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Many mobile health (mHealth) apps focus on promoting physical activity (PA) and healthy eating (HE). However, there is limited empirical evidence regarding their effectiveness in initiating and sustaining behavior change, particularly among children and adolescents. Considering that behavior is influenced by social contexts, it is essential to take core settings like family dynamics into account when designing mHealth apps. The purpose of this study was to further develop and refine the SMARTFAMILY (SF) app targeting PA and HE in a collective family-based setting by enhancing design and usability, as well as by adding gamification aspects, health literacy, and just-in-time adaptive interventions to the first version of the app. The SF2.0 app, based on behavior change theories and techniques, was developed, implemented, and evaluated. The app was used in a collective family setting, with family members using it individually and cooperatively. In a cluster-randomized controlled trial, the intervention group (IG) used the app for 3 consecutive weeks, while the control group (CG) received no treatment. Primary outcomes included PA measured through self-reports and accelerometry, as well as self-reported fruit and vegetable intake (FVI) for HE. Secondary outcomes included intrinsic motivation, behavior-specific self-efficacy, and the Family Health Climate. A follow-up assessment (T2) was conducted 4 weeks after the postmeasurement (T1) to assess intervention effects. Multilevel analyses were performed in R (R Foundation for Statistical Computing), considering the hierarchical structure of individuals (level 1) within families (level 2). Overall, 55 families (28 CG, 105/209; 27 IG, 104/209 participants) were recruited for the study. In total, 3 families (3 CG, n=12) chose to drop out of the study due to personal reasons before T0. Overall, no evidence for meaningful and statistically significant increases in PA was observed in favor of the IG of our physically active sample. However, the app elucidated positive effects in favor of the IG for FVI diary (T0-T1; P=.03), joint PA (T0-T1; P=.02 and T0-T2; P<.001), and joint family meals (T0-T1; P=.004). The SF2.0 trial evaluated an mHealth intervention designed to promote PA and HE within families. Despite incorporating a theoretical foundation, several behavior change techniques based on family life, and gamification and just-in-time adaptive intervention features, the intervention did not significantly increase PA levels among physically active participants. FVI, joint PA, and joint meals were improved within the IG. Previous studies on digital health interventions have produced mixed results, and family-based mHealth interventions remain rare, with limited focus on whole-family behavior and randomized controlled trials. To enhance intervention effectiveness, future app development could consider incorporating even more advanced features and should focus on inactive participants. Further research is needed to better understand intervention engagement and tailor mHealth approaches for primary prevention efforts. German Clinical Trials Register DRKS00010415; https://www.drks.de/search/en/trial/DRKS00010415. RR2-10.2196/20534.

BackgroundCAD (Computer Aided Design) designers spend long hours in front of visual displays, using specialized automotive design software. In addition to musculoskeletal disorders that may result from prolonged static activities, these individuals are also exposed to high mental workloads.ObjectiveThis study aims to assess the effect of office strain levels on the mental workload and musculoskeletal disorders of the design department.MethodsThis descriptive-analytical study included 48 cases, consisting of the occupation of CAD designing from the computer design department, and 48 control participants, comprised of non-computer users. It assessed musculoskeletal disorders using the CMDQ (Cornell Musculoskeletal Discomfort Questionnaire), ergonomic risk with the ROSA (Rapid Office Strain Assessment), and mental workload with the NASA-TLX (NASA Task Load Index). Data were analyzed using SPSS version 22.ResultsIn the case group, 37.5% were categorized as high risk for strain, compared to 31.25% in the control group. 27.08% of participants experienced an unacceptable level of mental workload according to NASA-TLX criteria, while only 17.71% were within the acceptable level. Significant relationships were found between office strain, musculoskeletal disorders, and mental workload, with a direct correlation between ROSA, NASA-TLX, and CMDQ scores (<0.011).ConclusionsThe most significant factors influencing office strain and mental workload among the occupation of CAD designing include ergonomic conditions in the workplace, duration of computer use, temporal demand, and the nature of job tasks. Factors such as health status, physical characteristics, and work experience are crucial in determining the intensity of mental workload and office strain.

Interprofessional collaboration across sectors is a major challenge for the health and care workforce. Collaboration often remains weak, as fragmented services cannot match complex needs. Working with the underlying professional, organisational, and administrative boundaries may help to address the challenge, but we know little about how managers and professionals do this. This study examines how boundary work can strengthen interprofessional collaboration, based on the introduction of mental health teams in three Danish municipalities. A qualitative case study was conducted involving three intersectoral teams consisting of health and social care professionals in Central Denmark Region. Data collection included observations of interactions, 27 semi-structured interviews with users, professionals, and middle managers, and three focus group interviews. Key themes and dynamics in boundary work were identified using thematic network analysis. Findings indicate that boundary work by management established shared frameworks for interprofessional collaboration, such as weekly board meetings and risk categorization systems. In two municipalities, these frameworks fostered collaborative boundary work among professionals, agreeing on how to share information and adjust care plans collectively. However, in the third municipality, professionals competed to defend existing boundaries, hindering the introduction of new collaborative practices. Working with boundaries can help to address the challenge of interprofessional collaboration across sectors by combining top-down and bottom-up strategies by managers and professionals. However, implementation needs fine-tuning to existing professional hierarchies and local organisational contexts. Managers also need to acknowledge the limits of steering boundary work, which thrives on autonomy in daily interactions among professionals.

Chronic diseases represent one of the most significant challenges for Public Health in Italy, involving approximately 24 million people and generating an annual cost of more than 66.7 billion euros. Among these, arterial hypertension affects 31% of the population, and it is the leading risk factor for cardiovascular diseases. However, the management of arterial hypertension presents several challenges, including inconsistencies in care pathways, poor integration between healthcare settings, and low therapeutic adherence. This document aims to share the findings of a national-level project that defined the recommended care pathway for managing hypertensive patients, identified potential areas for improvement, and proposed supporting solutions, including a list of indicators for evaluation and monitoring. The key areas for improvement, particularly the promotion of therapeutic adherence and the strengthening of communication between community-based and hospital services, serve as a foundation for optimizing the management of this condition and fostering more effective collaboration among the various stakeholders and levels of care within the healthcare system.

Methamphetamine (MA) is widely abused worldwide and has long been a major social concern. To provide basic information for comparing MA toxicokinetics in humans, we analyzed changes in the serum and urinary concentrations of MA and its metabolites in mice and compared the toxicokinetic profiles at the toxic dose with those at the therapeutic dose. Mice were administered therapeutic (1.5 mg/kg) or toxic (15 mg/kg) doses and blood and urine samples were collected. The serum concentrations of MA and its metabolite amphetamine (AMP), as well as the urinary concentrations of MA and its metabolites-AMP, p-hydroxymethamphetamine (OHMA), p-hydroxyamphetamine (OHAMP), and norephedrine (NEP) -were measured using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The serum AUC0-24 values for MA and AMP were approximately 16 and 41 times higher, respectively, in the toxic dose group than those in the therapeutic dose group. The urinary AMP and OHAMP excretion levels were approximately 3.6 and 2.2 times higher, respectively, in the toxic dose group. The urinary [AMP] / [MA] ratio at all collected points and [AMP] / [OHMA] ratio in the 0-24 h sample were significantly higher in the toxic than in the therapeutic dose group. The results obtained from this study suggest that the metabolism of AMP to OHAMP and NEP was saturated during intoxication. Furthermore, the determination of whether a toxic dose had been administered within 24 h or after 24 h would be possible through a joint evaluation of the urinary [AMP] / [MA] and [AMP] / [OHMA] ratios.

Health disparities in sleep medicine are associated with underdiagnosis and undertreatment of sleep disorders, despite their well-established impact on health. This study aims to clarify regional disparities in continuous positive airway pressure (CPAP) therapy prescriptions across prefectures in Japan and to examine the association between the number of sleep specialists and CPAP prescription rates. This is an ecological study, investigating the association between the number of sleep specialists and CPAP insurance claims across 47 Japanese prefectures, using publicly available open data. Multiple linear regression was used to assess the impact of sleep specialists on CPAP prescriptions, adjusting for covariates such as proportion of population aged 65 and over, obesity rates, and heart disease prevalence. The number of CPAP insurance claims per 1,000 population ranged from 35.0 to 65.3, with a 1.87-fold variation. The number of sleep specialists per million population varied substantially, from 0 to 35.8. Multivariable regression analysis revealed that the number of CPAP prescriptions was significantly associated with the number of sleep specialists (β = 0.32, B = 0.37, 95% CI: 0.04-0.71, p = 0.03), and the prevalence of heart disease (β = 0.39, B = 561.9, 95% CI: 55.7-1068.2, p = 0.03). The present study showed regional disparities in sleep medicine in Japan and a positive association between the number of sleep specialists and CPAP prescriptions, which highlighted the importance of enhancing the certification systems for sleep specialists to address regional health inequities in sleep medicine.

Chronic kidney disease (CKD) is one of the leading causes of global morbidity, and early diagnosis is essential to prevent complications. Estimated glomerular filtration rate (eGFR) is a key biomarker for assessing renal function. However, its value is influenced by various factors, including circadian variations. Previous studies have documented a circadian rhythm in eGFR, but population-level investigations using the cosinor method have not been conducted. We conducted a retrospective study in two hospitals in Spain (Toledo and Lorca) between 2017 and 2019. The circadian rhythm of eGFR was studied by fitting it to a cosine function, analyzing the effects of age and CKD stage. The results showed a statistically significant circadian rhythm in both populations, with the acrophase occurring at the beginning of the active phase of the day. The amplitude of the rhythm decreased in older patients (70-85 years) while patients with advanced CKD had lost their circadian rhythm entirely. This study, for the first time, uses the cosinor method to demonstrate the existence of a population-level circadian rhythm of eGFR. The cosinor analysis was performed on different CKD stages and ages, revealing the existence of significant rhythms, although none at advanced ages or post G1 CKD stage. The loss of circadian variability in advanced CKD emphasizes the importance of considering these rhythms in clinical practice to improve the diagnosis and management of kidney disease.

Type 2 diabetes (T2D) involves progressive loss of functional β-cell mass. In a zebrafish insulin-resistant model (zMIR), overnutrition triggers islet inflammation and nocturnal β-cell death. The cell death is prevented by the cyclophilin D (Ppid) inhibitor, cyclosporin A (CsA). Reducing mitochondrial ROS with mito-TEMPO or mitochondrial calcium with Ru360 protects β cells, further implicating the mitochondrial permeability transition pore (mPTP) in β-cell loss. The timing of β-cell death coincides with lower mitochondrial antioxidant gene expression, indicating diurnal mitochondrial vulnerability. Global ppid-/- preserves β-cell mass without altering islet inflammation or macrophage recruitment. Conversely, β-cell-specific PPID re-expression restores-and exacerbates-β-cell loss, which remains CsA-sensitive. These findings identify Ppid as a β-cell-intrinsic mediator of overnutrition-induced β-cell loss.

There is an increased awareness on the higher hypecoagulability risks in patients with Cushing's syndrome (CS) but management remains controversial. Here, we present four illustrative cases of CS that exemplify some "grey areas" on venous thromboembolism (VTE) prevention-when to start, how long to continue, what to use, and when to stop. The cases span: initiation of prophylaxis at diagnosis of active CS; periprocedural management around inferior petrosal sinus sampling; peri-operative prophylaxis after transsphenoidal surgery (TSS); and discontinuation decisions in medically controlled disease. We synthesise current evidence and expert practice and recommend considering low-molecular-weight heparin at diagnosis of active CS, continuing through surgery, and extending for approximately three months after biochemical remission in selected patients to address the highest-events risk window. Based on recent data, we discourage routine use of graduated compression stockings for VTE prevention. Though bleeding complications appear uncommon, they need to be carefully considered on an individualized basis. Finally, scenarios where prophylaxis can be safely discontinued once eucortisolaemia is achieved are outlined. This case-anchored framework translates heterogeneous data into actionable guidance and highlights priorities for prospective evaluation.

Efforts to constrain the negative environmental impacts of excess nitrogen (N) and phosphorus (P) are costly and challenging, due in part to inconsistent reporting of nutrient sources at temporal and spatial scales relevant for local decision making. To meet this challenge, the U.S. Environmental Protection Agency's National Nutrient Inventory provides estimates of major agricultural, urban, atmospheric, and natural nutrient fluxes for the contiguous United States at county and HUC12 scales annually from 1987 (from 1950 for agriculture) to 2017. Since the late 1980s, total N emissions and atmospheric N deposition have declined 22% and 15%, respectively, despite increased agricultural emissions. Over the same period, municipal wastewater N and P loads remained largely stable, despite population increases, through wastewater treatment upgrades and the phaseout of phosphorus-containing detergents. Improved agricultural efficiency allowed for dramatic increases in agricultural production and crop harvest since 1987 (∼25% for N and P), with little change in surplus nutrients left on fields. Overall, a combination of innovative technologies and management has stemmed or even decreased major sources of nutrient pollution to the environment over the last several decades, representing an important shift that, if continued, may contribute to improved air, land, and water quality and human health.

The electrical conductivity of biofilms plays a critical role in advancing bioelectronics for energy and environmental applications, yet the underlying mechanisms remain poorly understood. Previous studies proposed interheme electron transfer between hemes 5 and 10 in the outer-membrane deca-heme cytochrome (OMC) MtrC as the rate-limiting step in the biofilm electron conduction of Shewanella oneidensis MR-1. However, the strong interheme electron coupling in MtrC suggests that interprotein interactions may represent the primary barrier to biofilm electron conduction. Here, we investigated the biofilm electron conduction mechanism with a focus on interprotein electron transfer in S. oneidensis MR-1. Conductive currents and their temperature dependence were measured for estimating the thermal activation energy (Ea) by using indium tin-doped oxide (ITO) interdigitated electrodes in wild-type and mutant biofilms. While deletion of periplasmic cytochromes had a negligible impact on Ea, the deletion of OmcA or MtrC increased Ea 3-fold, revealing that interprotein interactions, particularly between OmcA and MtrC, dominate biofilm electron transfer over clonal OMC interactions. Furthermore, suppressing outer-membrane fluidity dramatically increased Ea, while interheme exciton coupling negligibly changed in the OMCs, confirming the critical role of protein diffusion and collision on the outer membrane. Flavin binding to OmcA or MtrC reduced conduction currents attributable to heme centers but enhanced those assignable to noncovalently bound flavins, suggesting that flavin occupancy blocks hemes 2 and 7, which serve as key interprotein electron transfer sites. These findings provide a mechanistic foundation for engineering highly conductive biofilms through targeted protein interface optimization, offering new avenues for the development of bioelectronic technologies.

The main objective of the present study was to determine fluorine (F) in different types of infant and toddler formulas (ITFs) and to assess the dental fluorosis risk (DFR) using the Monte Carlo simulation method and Crystal Ball software. Three types of ITFs-including SFL, FOFL, and TFL-from ten well-known and widely consumed brands of each type (a total of 30 brands) were selected. For each brand, three samples were collected (90 samples in total), and the F content was measured using the fluoride ion-selective electrode (ISE) method. DFR assessment was performed both for raw ITFs and for the scenario of simultaneous consumption with reconstitution water (RW). The findings indicated that, regardless of F levels in RW, the estimated daily intake (EDI) of F for all brands and all three types of ITFs was below the permissible levels established by the U.S. Environmental Protection Agency (EPA), the European Food Safety Authority (EFSA), and the American Dental Association (ADA), set at 60, 100, and 120 µg/kg bw/day, respectively. Based on EPA guidelines, the hazard quotient for dental fluorosis risk (HQ-DFR) for all brands and ITF types was lower than the threshold level (HQ = 1). When RW containing 0-1.5 mg/L F was assumed for formula preparation, HQ-DFR values increased significantly with higher F concentrations in RW, exceeding the permissible level in some scenarios. However, considering the higher EDI values recommended by EFSA and ADA, and acknowledging that the acceptable standard range for F concentration in drinking water used as RW is 0.5-1.5 mg/L, it can be concluded that the consumption of ITFs available in the Saudi market, together with drinking water within the standard F range, results in an acceptable DFR level for the health of infants and young children.

The respiratory disease pandemic has heightened interest in breathomics. Exhaled breath condensate (EBC), which is a noninvasive and information-rich biofluid, holds great promise for personalized health management. However, insufficient collection and limited analytical versatility remain major challenges for wearable EBC analysis. Here, the bioinspired design and performance of a wearable face mask for efficient sampling (0.86 μL min-1 per well) and in situ electrochemical monitoring of four biomarkers (alcohol, NO2-, NH4+, and pH) in EBC are reported. The face mask sensor platform consists of a multistage thermoelectric cooling module, a bionic superhydrophobic self-cleaning cover, an expandable 4 × 4 electrode array, and an electrochemical microsystem readout circuit. The surface temperature rapidly decreases to 12.5 °C within 1 min, reaching the exhaled vapor dew point to ensure rapid condensation. A wettability-gradient interface, constructed by a patterned superhydrophobic micro/nanostructured PDMS cover and hydrophilic electrode regions, effectively guides the biofluid into the sensor regions and stably fixes it even under 180° rotation. The usability of this system is demonstrated by tracking metabolic responses in healthy participants following alcohol and high-protein food intake, as well as by enabling continuous dynamic monitoring of four biomarkers in EBC. This wearable EBC analysis system offers a versatile strategy for real-time breath analysis and may help personalized respiratory healthcare, metabolism tracking, and environmental exposure analysis.

BackgroundWith the increasing workforce, especially in unfavorable working environments, for example, indoor working in kitchens, thermal stress has been a major problem. The effects of thermal stress are that it can reduce the efficiency of workers, thereby raising their body temperature and causing irritability, restlessness, and negligence to safety instructions.ObjectiveCooling vests (CV) are used to mitigate these effects. This study aimed to assess the effect of CVs on performance, thermal strain, and physiological responses of personnel in an industrial company restaurant.MethodsThe current cross-sectional, descriptive-analytical study recruited 60 staff working in restaurants exposed to heat above the permissible level. Initial measurements of heat stress indices, physiological parameters, and performance were taken before starting work. The same measurements were repeated during and after an 8-h work shift. Secondly, ice gel cooling vests were provided to the staff, and the same indices were re-measured.ResultsThe results demonstrated that restaurant workers were subjected to thermal stress higher than the allowable limit. Cooling with ice gel vests significantly improved the Wet Bulb Globe Temperature (WBGT) - Heat Stress Index (HSI) thermal stress index, physiological indicators (heart rate, respiratory rate, deep ear temperature), and performance. This study suggests using CVs to improve physiological indicators and reduce thermal stress and ameliorate performance in restaurant settings.ConclusionsThermal stress in restaurant workers imposes a high thermal load, leading to increased cognitive demands. The study showed that the use of CVs would considerably alleviate physiological indicators of thermal discomfort and thus improve workers' productivity. CVs are recommended as an intervention to reduce thermal stress and to ameliorate the working environment for restaurant workers.