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Access to maternity services for women asylum seekers and refugees: A transnational document analysis of international, European regional, and United Kingdom governance.

Women asylum seekers and refugees face persistent barriers to maternity care (antenatal, intrapartum and postnatal care) across high-income countries, yet the upstream governance shaping access remains under-examined. Although legally distinct, both groups share protection-seeking experiences and are addressed jointly in governance documents. This study examined and synthesised how international (macro), European regional (meso), and United Kingdom (UK, micro) governance documents frame and operationalise maternity service access. Sixty-four documents were analysed using the READ framework. Inductive analysis of macro and meso documents identified six access dimensions: universal coverage; cultural and linguistic adaptation; rights-based approaches; multi-agency collaboration; data, monitoring and accountability; and quality of care. These dimensions structured assessment of UK governance, with jurisdictions rated strong, moderate or weak. Alignment was fragmented: Wales, Scotland and Northern Ireland exempted asylum seekers from charging, whereas England retained charging provisions. Multi-agency collaboration was consistently articulated, yet none of the 35 UK government documents focused on maternity access for this population, and none required outcome monitoring disaggregated by asylum or refugee status. UK governance appears coordinated in form but fragmented in substance. UK-wide minimum standards and routine recording of these data, with safeguards against immigration-related use, could strengthen coherence and accountability and improve visibility of inequities.

Refugees

Hysteroscopic platelet-rich plasma and medically assisted reproduction outcomes: a systematic review and SWOT analysis.

BACKGROUND: Platelet-rich plasma (PRP) has been proposed as an adjuvant treatment in reproductive medicine. While most evidence refers to blind intrauterine instillation, subendometrial administration under hysteroscopic guidance allows targeted delivery under direct visualisation. This systematic review aimed to synthesise the available evidence on hysteroscopic PRP administration and its impact on clinical medically assisted reproduction (MAR) outcomes. METHODS: A systematic search was conducted from inception to December 2025 across major databases. Studies were included if they evaluated hysteroscopic PRP administration in women undergoing MAR, comparing reproductive outcomes between treated and control groups. RESULTS: Out of 142 records, 3 studies met the inclusion criteria. Study populations were heterogeneous and included women with refractory thin endometrium and/or a history of implantation failure. Hysteroscopic PRP administration protocols varied in timing, technique, and dosage. In a prospective case-control study, hysteroscopic intraendometrial PRP injection at a depth of 2-3 mm in the four uterine walls, using an ovum aspiration needle, on days 11-13 of the cycle prior to euploid frozen embryo transfer (ET), was associated with higher implantation (IR), clinical pregnancy (CPR), and live birth rates (LBR) compared with standard therapy. Conversely, no significant differences in CPR, miscarriage rate, or LBR were observed in an observational study evaluating a single intraendometrial PRP injection (35-40 mL, 2-3 mm depth), administered via endoscopic needle on days 6-8 of the menstrual cycle preceding frozen ET, alone or after electrical impulse therapy. A randomised controlled trial in women undergoing intrauterine insemination reported a significant improvement in CPR following hysteroscopic subendometrial PRP instillation in the four uterine walls (1.0 mL each). CONCLUSIONS: Current literature on hysteroscopic PRP administration in reproductive medicine is limited, and robust conclusions cannot yet be drawn. Well-designed randomised controlled trials with standardised protocols are needed to clarify its clinical role.

Humans

Nutrition and Diet-Related Training and Curriculum in the US Predoctoral Dental Programs.

PURPOSE: Nutrition and diet are vital for oral and systemic health. It is unclear how well US predoctoral dental programs prepare students in nutrition screening and counseling. This study analyzed US dental school curricula on these topics. METHODS: A cross-sectional online survey was sent to the publicly available email addresses of 67 of 72 academic dental deans at US Commission on Dental Accreditation-accredited dental schools. Items assessed availability, modes and hours of instruction, curricular topics, clinical integration, and instructors. Descriptive statistics summarized responses. RESULTS: A total of 21 academic deans responded, for an overall response rate of 29%. Most (85%) of responding academic dental deans reported that nutrition and diet education was mandatory, with none treating it as optional. Of these schools, 83% offered both classroom and clinical training, while 17% provided only didactic teaching. Didactic hours varied; 42% reported 10 or fewer hours. Foundational nutrition topics were common, although dietary guidelines such as MyPlate were reported less often (66%). Oral health-related nutrition content was broadly covered, with all respondents reporting instruction related to caries, erosion, periodontal disease, and oral dysfunction. Counseling content was less consistent, particularly public health nutrition (67%) and the impact of oral dysfunction on diet and nutrition (72%). CONCLUSION(S): Most responding academic dental deans report including nutrition and diet education in their curricula. However, it remains uncertain whether these topics are incorporated at schools that did not participate in the survey. Variability in curricular time, counseling, and teaching highlights the need for clearer competencies and more clinical training. Improving this could better prepare future dentists for common dietary risks affecting oral and systemic health.

dental caries

Direct Initiation of Long-Acting Cabotegravir Plus Rilpivirine in People with HIV and Suboptimal Virologic Suppression: A Randomized Trial.

BACKGROUND: Long-acting injectable cabotegravir plus rilpivirine (LA CAB+RPV) is approved for virally suppressed people with human immunodeficiency virus (HIV), but evidence for its use in those with persistent viremia and adherence challenges remains limited. METHODS: We conducted a multicenter, open-label, randomized study involving oral antiretroviral therapy (ART)-experienced people with HIV who had been diagnosed with HIV for at least 12 months and a most recent HIV-1 RNA level of at least 200 copies per milliliter. Participants with resistance-associated mutations to CAB or RPV were excluded. Eligible participants were randomly assigned in a 1:1 ratio to receive immediate LA CAB+RPV or to continue standard oral therapy until Week 24 (delayed switch group). The primary endpoint was the proportion of participants with an HIV-1 RNA level of less than 200 copies per milliliter at Week 24. RESULTS: Of 61 randomized participants, 45 met eligibility criteria and were included in the analysis; 91% were male, and the median baseline HIV-1 RNA was 35,000 copies/mL. At Week 24, viral suppression was achieved in 88.0% (22/25) in the immediate LA group versus 55.0% (11/20) in the delayed switch group (relative risk for failure to achieve viral suppression, 0.27; 95% CI, 0.08-0.86; p = 0.026). The effect of LA CAB+RPV was sustained through Week 52. CONCLUSIONS: Among people with HIV and viremia associated with adherence challenges, immediate initiation of LA CAB+RPV resulted in higher rates of viral suppression than continued oral ART, supporting its use beyond populations with stable suppression.

HIV

Satisfaction with clinical practice environments among early-career health professionals in South Africa: Findings from the WiSDOM cohort study.

BACKGROUND: The work or practice environments of health professionals play a central role in their retention in the healthcare system and their ability to provide quality patient care. The aim of the study was to examine and compare the satisfaction of early-career health professionals in the WiSDOM (Wits longitudinal Study to Determine the Operation of the labour Market among its health professional graduates) study with their clinical practice environments (CPEs) in South Africa, and the factors influencing their satisfaction. METHODS: WiSDOM, a prospective longitudinal cohort study, consists of eight health professions: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists, and physiotherapists. Every year we collect information on the cohort's involvement in direct patient care, their perceived workload, availability of medicines and equipment for patients in their care, and their satisfaction with the clinical practice environment (CPE).We used Stata&#xae;19 for analysis. We used panel linear regression to investigate factors associated with the cohort's satisfaction with their clinical practice environments from 2018 to 2024, and logistic regression to evaluate the association between CPE and intention to leave in 2024. RESULTS: In 2024, the mean age of the cohort was 30.9 (&#xb1; 2.0), the majority were female (74.4%) and working in urban areas (92.7%). In 2024, 59.7% of the overall cohort reported a heavy workload compared to 69.2% in 2018. Over the follow-up period, reported problems with the availability of medicines or equipment were worse in the public sector and in rural areas, compared to the private sector and urban areas respectively.The cohort's satisfaction score with the CPE was 6.7 out of 10 in 2018 and 6.9 in 2024. The predictors of CPE were year of follow-up, health profession, employment sector, and geographic location. Nurses (&#x3b2;=-1.2; 95% CI -1.7, -0.7; p&#x2009;<&#x2009;0.001), and pharmacists (&#x3b2;=-0.7; 95% CI -1.1, -0.4; p&#x2009;<&#x2009;0.001) scored their CPE significantly lower compared to the other professional groups. Health professionals in the public sector (&#x3b2;=-1.1; 95% CI -1.3, -0.9; p&#x2009;<&#x2009;0.001) and in rural areas (&#x3b2;=-0.6; 95% CI -0.9, -0.3; p&#x2009;<&#x2009;0.001) were less satisfied with their CPE compared to those in the private sector and urban areas respectively. Dissatisfaction with the CPE was significantly associated with intention to leave the workplace and the profession. CONCLUSION: The study findings underscore the need for positive clinical practice environments for early-career health professionals in South Africa both as a health workforce and patient safety imperative.

South Africa

Effects of continuous isomaltulose-containing gummy intake on interstitial glucose and salivary hormones during an 18-hole golf round: a randomized, double-blind controlled pilot study.

BACKGROUND: Golf is a prolonged, moderate-intensity sport requiring sustained physiological stability to manage cumulative stress and maintain performance. Although carbohydrate intake is commonly used to reduce fatigue, rapidly absorbed sugar-induced rapid blood glucose fluctuations may induce volatile arousal and latent metabolic stress. Isomaltulose, a slow-digesting disaccharide, provides a steadier glucose supply compared with sucrose. This exploratory pilot study examined the effects of isomaltulose intake on physiological stress markers, glycemic dynamics, and subjective responses during a competitive 18-hole golf round. METHODS: Twenty-three male collegiate golfers were randomized to either the isomaltulose group (ISO; n&#x2009;=&#x2009;12) or the sucrose group (CON; n&#x2009;=&#x2009;11) in a double-blind controlled trial. Participants consumed gummies containing isomaltulose or sucrose immediately after each hole (12.1 g carbohydrate per hole; total carbohydrate intake: 217.5 g). Primary outcomes were salivary stress markers [cortisol, testosterone, and dehydroepiandrosterone sulfate (DHEAS)] levels. Secondary outcomes included interstitial glucose concentration measured via continuous glucose monitoring, subjective assessments (i.e. sleepiness, relaxation, and concentration), and golf performance (18-hole score). Between-group comparisons at each time point were conducted using planned Welch's t-tests. RESULTS: No significant between-group differences were observed for 18-hole score (p&#x2009;=&#x2009;0.38) or mean interstitial glucose concentration (p&#x2009;=&#x2009;0.20). However, exploratory analyses revealed distinct hormonal variations; salivary DHEAS and testosterone levels were higher in the ISO group during the latter half of the round (p&#x2009;<&#x2009;0.05), whereas both declined in the CON group. Regarding glycemic variability, the ISO group demonstrated a more stable glucose profile with a medium effect size for lower standard deviation (ISO: 14.7&#x2009;&#xb1;&#x2009;1.9 vs. CON: 16.7&#x2009;&#xb1;&#x2009;4.6 mg/dL; d&#x2009;=&#x2009;0.58), although this difference was not significant. Conversely, subjective outcomes diverged; the CON group reported significantly greater subjective arousal (wakefulness and relaxation) (p&#x2009;<&#x2009;0.01) relative to the ISO group. CONCLUSIONS: In conclusion, continuous intake of isomaltulose-containing gummies during an 18-hole golf round was associated with differences in selected physiological markers, including DHEAS and testosterone concentrations. However, these findings were not accompanied by improvements in objective golf performance outcomes compared with sucrose-containing gummies. Isomaltulose may influence glycemic dynamics and hormonal responses during prolonged golf play; however, the practical significance of these effects remains exploratory. Further studies with larger sample sizes and appropriate repeated-measures frameworks are needed to determine whether such physiological changes translate into meaningful performance or recovery benefits.

Humans

A homogeneous immunoassay based on AlphaLICA technology for detecting florfenicol residues in animal-derived foods.

Florfenicol (FF), a broad-spectrum amide antibiotic widely used in livestock, poultry, and aquaculture, poses potential threats to food safety and public health due to its residual accumulation. In this study, a novel homogeneous immunoassay based on Amplified Luminescent Proximity Homogeneous Assay (AlphaLICA) technology was developed for the first time for rapid screening of FF residues in milk and egg matrices. By covalently immobilizing the FF-BSA conjugate and goat anti-mouse IgG onto luminescent and photosensitive microspheres, respectively, the method achieved wash-free, homogeneous quantitative detection through a competitive immunoreaction. Under optimized conditions, the assay exhibited a linear range of 0.2-16.2 ng mL-1, with a limit of detection of 9.7 pg mL-1 and a limit of quantification of 183 pg mL-1. The intra- and inter-batch coefficients of variation ranged from 3.08% to 5.70% and 2.44% to 7.09%, respectively. Spike recovery rates in milk and egg matrices ranged from 93.18% to 107.17% (RSD &#x2264; 5.57%). Cross-reactivity with 11 other common antibiotics, including chloramphenicol and thiamphenicol, was below 0.1%, demonstrating excellent specificity. Comparative analysis with a commercial ELISA kit showed high consistency (r2 = 0.9332, p < 0.001). With high sensitivity, strong specificity, simple operation, and a detection time of only 10 min, this method provides a reliable technical platform for high-throughput, rapid monitoring of FF residues in milk and egg matrices.

Journal Article

Micro- and nanoplastics-induced neurotoxicity: a CNS-centered, evidence-graded adverse outcome pathway framework based on systematic weight-of-evidence assessment.

Micro- and nanoplastics (MPs/NPs) are ubiquitous anthropogenic particulate pollutants posing emerging threats to human neurological health. Severe heterogeneity in particle physicochemical properties, environmental aging status, exposure paradigms and experimental platforms has created persistent mechanistic uncertainties in MP/NP neurotoxicology, hindering reliable hazard characterization and risk translation. Here, we systematically consolidate empirical toxicological evidence and construct a dedicated central nervous system (CNS)-targeted adverse outcome pathway (AOP) network integrated with rigorous weight-of-evidence (WoE) grading to elucidate the hierarchical, particle-specific toxic cascades underlying MP/NP-induced neural injury. Our synthesis overturns the conventional linear toxicity paradigm, demonstrating that MPs/NPs trigger neurotoxicity via a complex multi-input mechanistic network. We definitively establish oxidative stress as a robust early convergent key event-rather than a universal molecular initiating event-orchestrating ROS overproduction, lipid peroxidation, mitochondrial dysfunction, and neuroinflammation to propagate neuronal damage. This core module is driven by five distinct particulate upstream triggers: particle-biomolecule interfacial perturbation, corona-facilitated cellular internalization, plastic-associated chemical leaching, aging-derived free radical reactivity, and gut-borne systemic neurotoxic signaling. Downstream pathogenic outcomes encompass glial overactivation, neurotransmitter dyshomeostasis, autophagy-lysosome dysfunction, metabolic reprogramming, regulated neuronal cell death, and behavioral impairments. Tiered WoE analysis confirms strong validation for early oxidative/inflammatory cascades, moderate support for gut-brain axis crosstalk and intracellular trafficking disruption, and nascent evidence for synaptic dysfunction and neurodegeneration-linked proteostatic defects. Extrapolation to human health risk remains constrained by the frequent use of high-dose exposure paradigms, limited validated data on internal dosimetry in the human brain, discrepancies between effective concentrations in experimental models and environmentally relevant human tissue burdens, and insufficient causal validation of distal adverse outcomes. We highlight key research priorities including aged mixed-particle exposure systems, leachate-controlled assays, quantitative internal dose evaluation, and mechanistic intervention verification. This evidence-stratified AOP framework resolves longstanding mechanistic ambiguities in particulate neurotoxicity, providing a standardized, causality-based foundation for future mechanistic exploration and health risk assessment of global plastic pollution.

Adverse outcome pathway

Sequential laparoscopic percutaneous extraperitoneal closure for inguinal hernia during NICU/GCU hospitalization in low birth weight infants.

BACKGROUND: Inguinal hernia is common in low birth weight infants and carries a risk of incarceration. Although laparoscopic percutaneous extraperitoneal closure (LPEC) is widely used in pediatric patients, the safety of sequential LPEC during NICU/GCU hospitalization remains unclear. This study evaluated the safety and feasibility of sequential LPEC during NICU/GCU hospitalization. METHODS: We retrospectively reviewed infants who underwent LPEC between September 2018 and July 2024. Infants aged&#x2009;&#x2264;&#x2009;6 months diagnosed with inguinal hernia and treated with sequential LPEC during hospitalization were included. For comparison, infants aged&#x2009;&#x2264;&#x2009;6 months with a history of NICU/GCU hospitalization who were diagnosed with inguinal hernia after NICU/GCU discharge and underwent LPEC were identified. RESULTS: Among 302 patients, 13 met the inclusion criteria. One patient required postoperative reintubation, postoperative testicular atrophy occurred in three patients, and no hernia recurrence was observed during a median follow-up of 48 months. Compared with infants diagnosed after NICU/GCU discharge, the sequential LPEC group had significantly lower gestational age, lower birth weight, lower body weight at surgery, and more comorbidities, whereas postoperative outcomes were comparable. CONCLUSION: Sequential LPEC during continuous NICU/GCU hospitalization is feasible and can be safely performed in low birth weight infants with appropriate technical refinements.

Humans

Structured robotic colorectal training in a non-tertiary NHS hospital: a 502-case consecutive cohort implementation study.

Robotic-assisted colorectal surgery has expanded rapidly across NHS practice in the UK. Structured unit-wide training pathways are essential for safe technology adoption, yet published outcome data from non-tertiary hospitals remain limited. This study describes the implementation and feasibility of a unit-wide robotic colorectal program at a high-volume non-tertiary hospital, reporting outcomes across 502 consecutive resections performed by eight consultant surgeons and presenting these in the context of nationally published benchmarks. A retrospective cohort study of 502 consecutive robotic colorectal resections performed at York Teaching Hospital between May 2022 and December 2025. Eight consultant surgeons (A-H) participated in a structured four-phase training pathway incorporating simulation training, proctored cases, complexity-based case progression, and formal credentialing. Primary outcomes were 30-day mortality, unplanned return to theatre (RTT), and anastomotic leak (AL). Anastomotic leak was calculated using only patients who underwent anastomosis as the denominator. Procedure-stratified and individual surgeon outcomes with 95% confidence intervals were reported. Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to evaluate learning curves. Outcomes are presented descriptively alongside nationally published reference data; no formal statistical comparison against national benchmarks was performed. 502 robotic colorectal resections were performed. Mean patient age was 70.0 &#xb1; 11.3&#xa0;years; 58.4% were male. Median ASA grade was III. The indication was malignancy in 89.2% of cases. Length of stay was non-normally distributed and is therefore reported using median and interquartile range in the revised analysis. Key outcomes: - 30-day mortality: 1.0% (5/502; 95% CI 0.4-2.3%) - Unplanned return to theatre (RTT): 5.2% (26/502; 95% CI 3.6-7.5%) - Anastomotic leak (AL): 3.3% (15/450; 95% CI 2.0-5.5%; denominator = patients with anastomosis) - 30-day unplanned readmission: 5.0% (25/502; 95% CI 3.4-7.2%) - Conversion to open surgery: 3.6% (18/502; 95% CI 2.3-5.6%) - Lymph node yield &#x2265;12: 91.3% of cancer resections - R0 resection rate: 95.1% of cancer resections All primary outcomes fell within or below the published reference ranges used for descriptive context. RA-CUSUM trajectories were heterogeneous: no surgeon crossed the predefined upper control limit, but several curves showed later upward movement. Accordingly, the analysis is interpreted as safety surveillance rather than evidence of uniform performance improvement. RA-CUSUM monitoring showed that no surgeon crossed the predefined upper control limit; however, heterogeneous trajectories precluded a claim of uniform performance improvement.

Humans

Development and Validation of a Predictive Model for Identification of Cognitive Impairment Risk in Older Adults with Subjective Cognitive Decline&#xff1a;A Longitudinal Study.

BACKGROUND: Subjective cognitive decline (SCD) is a transitional state between objective cognitive impairment and cognitively intact mental status, providing a critical window for implementing preventive interventions to delay objective cognitive decline. AIMS: We aimed to develop a predictive model for SCD progression in older adults with mild cognitive impairment (MCI). This model will facilitate the identification of risk factors and establishment of targeted interventions for community-based SCD management. METHODS: Data from the China Health and Retirement Longitudinal Study (CHARLS) was utilized in this study, extracting 18 indicators. Potential predictors selected through univariate Cox regression and LASSO regression analyses were sequentially incorporated into a multivariable Cox regression model. A nomogram was constructed to establish a predictive model. Model validation encompassed Area Under Curve (AUC) metrics for discriminative capacity, complemented by quantitative assessments using calibration curve analysis for precision verification and decision curve analysis (DCA) for clinical utility evaluation. RESULTS: A total of 1099 older adults with SCD were included in the final analysis, of whom 114 (10.3%) developed MCI. Multivariable Cox regression identified residence, marital status, educational level, social participation, gait speed, and baseline cognitive function. The model demonstrated time-dependent AUC values of 0.885, 0.830, 0.839, and 0.836 in the training set when evaluating discriminative capacity at 2-, 4-, 7-, and 9-year, respectively. The predictive model showed excellent predictive ability according to AUC, calibration curve, and DCA. CONCLUSIONS: A predictive model was created to estimate the risk of developing MCI in older individuals with SCD, offering clinician-actionable intervention benchmarks for preventive care.

Humans

PGPR inoculation and growth enhancement of crops cultivated in hydroponic systems.

Plant growth-promoting rhizobacteria (PGPR) are ubiquitous rhizosphere microorganisms that promote plant health through various mechanisms. Although the study of PGPR inoculants in soil has been done for ages, their application in hydroponic systems has received relatively limited attention. This review identifies PGPR inoculants that are commonly used in hydroponics, methods of application, and their effects on plant growth and nutrient use efficiency. Literature shows that PGPR inoculants improve plant performance in controlled hydroponic systems through the production of growth-stimulating substances, nitrogen fixation, and improved nutrient acquisition. However, the plant growth responses are highly variable depending on the composition of nutrient solutions, environmental factors, crop and microbe species, and the type of hydroponic system. The review identifies various challenges of PGPR inoculation in hydroponic systems and future research directions to address the current gaps. Generally, the productivity of hydroponic systems can be enhanced through advanced inoculation strategies and the development of suitable carrier materials to improve inoculant survival, viability, and functions. Emphasis should also be placed on designing system-specific microbial consortia and Synthetic communities that are tailored to the unique ecological conditions of hydroponic systems.

Hydroponics

Biomonitoring of industrial heavy metal pollution via enzymatic and metabolic responses in desert ants (Cataglyphis savignyi) and beetles (Tentyrum sp) as bioindicators.

The current work seeks to evaluate the effectiveness of Cataglyphis saviginyi and Tentyrum sp as indicators of pollution in the city's main industrial regions by analyzing their enzymatic activity and primary metabolites. Soil samples were collected at each site under investigation to analyze soil characteristics and heavy metal content. C. saviginyi and Tentyrum sp were collected across four consecutive seasons (2023-2024) to investigate enzymatic (GPT, GOT, ALP, ACP, LDH) and metabolic (lipid, protein, carbohydrate) biomarkers. The physicochemical properties of the soil differed substantially between the industrial areas and the control site. Soil heavy metal buildup was highest at industrial sites (1 and 4) compared to the control site, with the order being Zn&#x2009;>&#x2009;Cr&#x2009;>&#x2009;Cd&#x2009;>&#x2009;Cu. Heavy metal pollution indices were determined. Increased industrial activity from metal industries, ceramics, and chemical painting companies defines this area, as seen by the high Cdeg, mCd, PI, and PLI values derived for industrial sites 1 and 4. While C. saviginyi and Tentyrum sp deconcentrated and released Cr, Cd, and Zn into the soil via the biological accumulation factor (BAF), Cu acted as a macro-concentrator. Compared with the control site, industrial environments were shown to increase levels of GPT, GOT, LDH, ACP, protein, and carbohydrates in C. saviginyi. However, lipid and ALP activity was suppressed. at industrial sites, Tentyrum sp carbohydrate content was higher than at control sites, but GPT, GOT, ALP, ACP, LDH, protein, and lipid activities were all suppressed. Consequently, enzymatic and metabolic biomarkers proved to be sensitive indicators for assessing industrial heavy metal pollution in desert ecosystems.

Animals

Citizenship Status and Contraceptive Method Use Among Latinx, Asian and Pacific Islander (API) Women in California.

Citizenship status confers rights and access to healthcare, yet little is known about how it impacts contraception use and type of method use. This study examined the role of citizenship status on contraceptive use among reproductive-aged (18-44 years), cis-gender Latinx and Asian and Pacific Islander (API) women. This study used the 2017-2020 waves of the California Health Interview Survey (CHIS). Inclusion criteria included cisgender, heterosexual Latinx and API women of reproductive age (18-44 years) who were at risk of becoming pregnant (N&#x2009;=&#x2009;3,027). Participants were classified into the following categories based on their citizenship status: non-citizens without a green card, legal permanent residents (LPRs), naturalized citizens, and U.S.-born citizens. We conducted bivariate analyses using Pearson's chi-square tests and multivariable analyses using adjusted binomial logistic regressions to assess associations between citizenship status and use of any modern and reversible method of contraception and type of method used. Models were stratified by race/ethnicity. All analyses were weighted. Three-quarters (75.8%) of the sample were Latinx, 57.5% were U.S.-born citizens, 16.3% were naturalized citizens, 10.6% were LPRs, and 15.7% were non-citizens without a green card. There were no significant differences in the type of contraception method use by citizenship status among Latinx. Among API, naturalized citizens had lower odds of any use and condom use and naturalized citizens and U.S.-born citizens had higher odds of using pill or other hormonal methods and IUD or implant compared to non-citizens without a green card. This study makes important contributions in understanding the role of citizenship status as a social determinant of reproductive health for Latinx and API in California.

Citizenship status

Healthcare Access and Safety Training Gaps Among H-2&#xa0;A Visa Agricultural Workers in Georgia.

The H-2&#xa0;A Temporary Agricultural Workers Program, which supplies seasonal labor essential to U.S. food security, has grown over 230% in the past decade but is excluded from the National Agricultural Workers Survey. Although safety training is federally mandated and H-2&#xa0;A workers are eligible for Affordable Care Act (ACA) marketplace coverage, compliance and healthcare access among these workers remain poorly documented. The aim of this pilot study was to assess workplace safety training, heat acclimatization practices, health insurance awareness and enrollment, and healthcare utilization among H-2&#xa0;A workers in Georgia. In summer 2024, bilingual research assistants orally administered a cross-sectional Spanish-language survey to 51&#xa0;H-2&#xa0;A workers at a South Georgia laundromat, in partnership with the Latino Community Fund Georgia. The survey assessed demographics, occupational characteristics, safety training, heat acclimatization, health insurance awareness and enrollment, and healthcare utilization. Findings are self-reported. Among participants, 41% reported not receiving federally mandated pesticide safety training, and 59% received heat illness prevention training. Heat acclimatization was inadequate for 53% (29% received none). Additionally, 53% did not know the nearest hospital, 43% reported having health insurance, and 25% were unsure of their health insurance status. Overall, 71% had never visited a doctor's office, and of 22 insured workers, only 1 (2%) had used benefits this season. Substantial gaps in workplace safety training, heat acclimatization, and healthcare access were observed in this pilot study, consistent with prior evidence of persistent disparities in this population. Community-based outreach, bilingual health navigation, and market-based labor accountability models warrant further investigation to improve protections for H-2&#xa0;A workers.

Agricultural workers

Sustained effects of auricular point acupressure on chemotherapy-induced neuropathy: a randomized controlled trial follow-up study.

PURPOSE: Chemotherapy-induced neuropathy (CIN) is a persistent condition that impairs function and quality of life. Auricular point acupressure (APA) has shown short-term benefit for CIN, but the durability of these effects after treatment completion is unknown. This study evaluated the sustainability of symptom improvements for 3&#xa0;months following a 4-week APA intervention. METHODS: This prespecified secondary analysis of a randomized wait-list controlled trial compared mobile-supported APA (mAPA) and virtual APA (vAPA) in adults with moderate or greater CIN who received APA during the initial treatment phase (mAPA, n&#x2009;=&#x2009;80; vAPA, n&#x2009;=&#x2009;75). Outcomes at 1, 2, and 3&#xa0;months post-intervention were analyzed using generalized estimating equations with multiple imputation. The primary outcome was CIN severity, measured with an individualized composite outcome (ICO); the secondary outcome was CIN interference. RESULTS: Reductions in CIN severity and interference were maintained throughout follow-up in both groups (all p&#x2009;<&#x2009;.001). ICO scores decreased by 3.10, 3.36, and 3.61 points in mAPA and by 2.88, 2.90, and 3.21 points in vAPA at 1, 2, and 3&#xa0;months, respectively. Benefits were maintained post-treatment, with higher retention in the mAPA group. CONCLUSIONS: Improvements in CIN severity and interference after APA were sustained for up to 3&#xa0;months post-treatment, suggesting a durable benefit as a self-management strategy. Larger studies with longer follow-up and untreated comparison groups are needed. IMPLICATIONS FOR CANCER SURVIVORS: APA may offer survivors a durable, self-administered, nonpharmacologic option for managing CIN well beyond active treatment, without requiring ongoing clinical visits. TRIAL REGISTRATION: ClinicalTrials.gov, ID NCT04920097 registered on 3 June 2021.

Acupressure

A 12-week, double-blind, quasi-randomized, placebo-controlled study to evaluate the efficacy and safety of Coleus forskohlii (Forcslim) on body weight loss.

BACKGROUND: Overweight and obesity have emerged as a global epidemic, significantly impacting human health. Traditional usage and growing scientific evidence suggest that Coleus forskohlii extract (Forcslim) may aid in reducing excess body weight and fat. This study aimed to evaluate the efficacy and safety of Forcslim supplementation in overweight individuals. METHODS: A quasi-randomized, double-blind, placebo-controlled clinical trial was conducted in 60 overweight subjects aged 20-70&#x2009;years over a period of 12&#x2009;weeks. The participants were assigned to receive either Forcslim or placebo. The key outcome measures included body weight, body mass index (BMI), body composition, and anthropometric parameters. Additionally, lipid profile parameters and safety markers (including metabolic, hepatic, and cardiovascular indicators) were assessed throughout the study duration. RESULTS: Compared to the placebo group, the Forcslim group showed significant reductions in waist circumference (-1.83&#x2009;cm; p&#x2009;<&#x2009;0.01) and body weight (-1.93&#x2009;kg; p&#x2009;<&#x2009;0.001). Significant improvements in anthropometric parameters were observed exclusively in the Forcslim group. Furthermore, triglyceride (TG) levels were significantly reduced (p&#x2009;<&#x2009;0.01), while high-density lipoprotein (HDL) levels showed a significant increase (p&#x2009;=&#x2009;0.001). No clinically significant changes were observed in metabolic markers, liver and muscle enzyme levels, heart rate, blood pressure, or reported adverse effects, indicating a favorable safety profile. CONCLUSIONS: Forcslim demonstrated significant anti-obesity effects, including reductions in body weight, waist circumference, and improvements in the lipid profile. These findings suggest that C. forskohlii extract supplementation may serve as a safe and effective alternative to synthetic anti-obesity drugs.

Humans

Physiologic age modifies the association between visceral fat predominance and urinary calcium excretion in adults with nephrolithiasis.

Although adiposity is associated with kidney stone disease, the relationship between abdominal fat distribution and urinary calcium excretion remains unclear. We investigated whether the CT-derived visceral-to-subcutaneous fat ratio (VSR) was associated with 24-hour urinary calcium excretion and whether physiologic age modified this association. This retrospective cross-sectional study included 308 adults with nephrolithiasis who underwent preoperative CT, stone removal, and postoperative metabolic evaluation. Participants were stratified into prespecified younger (men aged&#x2009;<&#x2009;50 years and premenopausal women) and older (men aged&#x2009;&#x2265;&#x2009;50 years and postmenopausal women) physiologic-age groups. Multivariable linear regression assessed the association between VSR and urinary calcium excretion and its modification by physiologic age. Results showed that VSR was not associated with urinary calcium excretion in the overall cohort, but its association differed significantly by physiologic age (P for interaction&#x2009;<&#x2009;0.001). Among younger participants, each 1-unit higher VSR was associated with 2.07 mmol/day greater urinary calcium excretion (95% CI, 1.23-2.90), whereas no significant association was observed in the older group. These findings suggest that the metabolic relevance of visceral fat predominance differs by physiologic age, with a significant association observed only in younger adults. Prospective studies are needed to confirm these findings and determine their clinical implications.

Humans