Stroke remains a leading cause of death and disability across the Americas, disproportionately affecting low- and middle-income countries. According to the 2023 Global Burden of Disease (GBD) Study, the Americas recorded approximately 1.2 million incident strokes and 15.7 million prevalent cases. This narrative review synthesizes epidemiological evidence on stroke trends in the Americas, with emphasis on disparities in healthcare access. We integrated estimates from the GBD, peer-reviewed studies and national surveillance systems. Although age-standardized stroke rates declined after 1990, recent analyses demonstrate a concerning resurgence, particularly among younger adults. Stroke incidence, prevalence, and disability burden vary widely across countries. Latin America and the Caribbean show higher incidence but lower prevalence than high-income settings, reflecting limited access to acute care and higher case fatality. Socioeconomic and racial inequities drive delayed treatment and poorer functional outcomes. Over 75% of stroke burden is attributable to modifiable risk factors. Urgent system-level action is needed. O acidente vascular cerebral (AVC) permanece como uma das principais causas de morte e incapacidade nas Américas, afetando de forma desproporcional os países de baixa e média renda. De acordo com o estudo Global Burden of Disease (GBD) 2023, as Américas registraram aproximadamente 1.2 milhão de casos incidentes de AVC e 15.7 milhões de casos prevalentes. Esta revisão narrativa sintetiza evidências epidemiológicas sobre as tendências do AVC nas Américas, com ênfase nas desigualdades no acesso à assistência em saúde. Foram integradas estimativas do GBD, estudos revisados por pares e sistemas nacionais de vigilância. Embora as taxas de AVC padronizadas por idade tenham diminuído após 1990, análises recentes demonstram uma preocupante retomada do aumento, particularmente entre adultos mais jovens. A incidência, prevalência e carga de incapacidade por AVC variam amplamente entre os países. A América Latina e o Caribe apresentam maior incidência, porém menor prevalência em comparação com países de alta renda, refletindo acesso limitado ao cuidado agudo e maior letalidade. Desigualdades socioeconômicas e raciais contribuem para atrasos no tratamento e piores desfechos funcionais. Mais de 75% da carga de AVC é atribuível a fatores de risco modificáveis, ressaltando a necessidade urgente de ações em nível de sistema de saúde. El accidente cerebrovascular (ictus) sigue siendo una de las principales causas de mortalidad y discapacidad en las Américas, afectando de manera desproporcionada a los países de ingresos bajos y medianos. Según el estudio Global Burden of Disease (GBD) 2023, las Américas registraron aproximadamente 1.2 millones de casos incidentes de ictus y 15.7 millones de casos prevalentes. Esta revisión narrativa sintetiza la evidencia epidemiológica sobre las tendencias del ictus en las Américas, con énfasis en las desigualdades en el acceso a la atención sanitaria. Se integraron estimaciones del GBD, estudios revisados por pares y sistemas nacionales de vigilancia. Aunque las tasas de ictus ajustadas por edad disminuyeron después de 1990, análisis recientes muestran una preocupante reaparición del aumento, particularmente entre adultos más jóvenes. La incidencia, la prevalencia y la carga de discapacidad por ictus varían ampliamente entre los países. América Latina y el Caribe presentan una mayor incidencia, pero una menor prevalencia en comparación con los países de altos ingresos, lo que refleja un acceso limitado a la atención aguda y una mayor letalidad. Las desigualdades socioeconómicas y raciales contribuyen a retrasos en el tratamiento y a peores resultados funcionales. Más del 75% de la carga del ictus es atribuible a factores de riesgo modificables, lo que subraya la necesidad urgente de acciones a nivel de los sistemas de salud.
Accurately assessing dietary intake in children and adolescents is essential for understanding dietary patterns and informing public health strategies. In Latin America, rapid nutrition transitions and increasing childhood obesity highlight the need for culturally appropriate, validated dietary assessment tools (DATs). However, methodological challenges and limited regional data hinder effective dietary surveillance. This scoping review identified and characterised DATs used among children and adolescents (5-18 years) in Latin America, examining tool types, features, validation and regional coverage. Following Joanna Briggs Institute and PRISMA-ScR guidelines, comprehensive searches were conducted in EMBASE, Web of Science, PubMed, and LILACS (April 2024) in English, Spanish, and Portuguese. Eligible studies included original research developing, validating, or applying DATs in Latin American populations. Of 13,946 records screened, 105 reports met the inclusion criteria. Brazil and Mexico contributed the most studies, while six countries (Paraguay, El Salvador, Nicaragua, Panama, Honduras, and Belize) had none. Forty-three DATs were identified, 77% of which were food frequency questionnaires (FFQs). Half targeted adolescents, 39% children, and 11% both groups. Most were interviewer-administered (58%) and applied in person (49%), with only 19% conducted online, reflecting regional digital limitations. Validation was reported for 70% of tools, primarily against 24 HR. The DAT landscape in Latin America remains dominated by FFQs and traditional administration methods, with limited use of digital platforms. Developing age-appropriate, validated and culturally adapted digital DATs is essential to strengthen dietary surveillance and guide effective nutrition policies across the region.
In Latin America, entrepreneurship has traditionally been analyzed through administrative and economic lenses, often overlooking its sociological implications. This study re-conceptualizes entrepreneurship as a social ordeal analyzing how individuals navigate structural constraints, labor informality, and neoliberal mandates within the framework of the sociology of individuation. Following PRISMA 2020 guidelines, a Mixed Methods Systematic Review (MMSR) with a convergent design was conducted on a corpus of 74 articles (2020-2025). Quantitative descriptive analysis (SPSS) and qualitative interpretative analysis (MAXQDA) were integrated to triangulate thematic trends, geographical distributions, and discursive patterns. The findings reveal an epistemological diversity in regional production: Brazilian literature critiques the "uberization" of work, while Mexican research emphasizes resilience and adaptation. Colombia recognizes entrepreneurship as subsistence perspective. A predominant trend toward group-level analysis identifies entrepreneurship as a collective survival strategy rather than individual innovation. Furthermore, entrepreneurship acts as a social escape valve of the workforce in informality, where autonomy is a forced management of precariousness. The study proposes understanding entrepreneurship as a social ordeal, generating a model to increase the comprehension of the phenomenon in Latin America, where individual agency exists in permanent tension with structural inequalities. The model illustrates that this ordeal is unequally distributed by non-elective attributes (class, gender, and geography) and is socially produced through varied regional lenses, from functionalist resilience to critical perspectives. Under neoliberal rationality, the "entrepreneurial spirit" serves as a culturally represented discourse that transfers systemic risk to the subject, legitimizing self-exploitation as a form of "freedom." Ultimately, the ecosystem forces complex individuation processes, where the subject must tactically rely on informal support to negotiate their existence against a precarious reality. Entrepreneurship in Latin America is a manifestation of mandatory individuation. To mitigate the solitude of this structural social ordeal, public policies must transition from promoting individual competition to strengthening collective support networks and social guarantees that spread the risks linked to motivations originating in need and entrepreneurial ecosystems in development.
Stroke remains a leading cause of death and disability throughout the Americas, disproportionately impacting low-and middle-income countries and underserved populations. In this review, we examine the status of stroke prevention in the Americas. Prevention is essential, yet unequal access to healthcare has led to major disparities - especially among rural populations, ethnic minorities, and lower socioeconomic status. Models like the WHO HEARTS Program demonstrate that evidence-based programs can be tailored to local contexts. Telehealth and digital tools play a critical role in empowering patients, educating communities, and supporting healthcare workers. Despite growing efforts, challenges persist due to health inequities, gaps between policy and implementation, and underinvestment. Strengthening prevention will support countries in achieving the United Nations Sustainable Development Goals, targeting a one-third reduction in premature deaths from non-communicable diseases by 2030. This paper outlines effective strategies for implementing stroke prevention, emphasizing healthy lifestyles, early detection of risk factors, and system-level interventions. O Acidente Vascular Cerebral (AVC) permanece como uma das principais causas de morte e incapacidade em todas as Américas, impactando desproporcionalmente os países de baixa e média renda e as populações vulneráveis. Nesta revisão, examinamos o estado atual da prevenção do AVC nas Américas. A prevenção é essencial; contudo, o acesso desigual aos cuidados de saúde resultou em disparidades significativas – especialmente entre populações rurais, minorias étnicas e indivíduos de baixo nível socioeconômico. Modelos como o Programa HEARTS da OMS demonstram que programas baseados em evidências podem ser adaptados aos contextos locais. A telessaúde e as ferramentas digitais desempenham um papel fundamental na capacitação dos pacientes, na educação das comunidades e no apoio aos profissionais de saúde. Apesar dos esforços crescentes, os desafios persistem devido às iniquidades em saúde, às lacunas entre a política e a implementação, e ao subfinanciamento. O fortalecimento da prevenção apoiará os países no alcance dos Objetivos de Desenvolvimento Sustentável das Nações Unidas, visando uma redução de um terço nas mortes prematuras por doenças crônicas não transmissíveis até 2030. Este artigo apresenta estratégias eficazes para a implementação da prevenção do AVC, enfatizando estilos de vida saudáveis, a detecção precoce de fatores de risco e intervenções em nível sistêmico. El ataque cerebrovascular sigue siendo una de las principales causas de muerte y discapacidad en las Américas, afectando de manera desproporcionada a los países de ingresos bajos y medianos, así como a las poblaciones desatendidas. En esta revisión, examinamos el estado de la prevención del accidente cerebrovascular en las Américas. La prevención es esencial; sin embargo, el acceso desigual a la atención sanitaria ha provocado disparidades importantes, especialmente entre las poblaciones rurales, las minorías étnicas y los grupos de nivel socioeconómico bajo. Modelos como la Iniciativa HEARTS de la OMS demuestran que los programas basados en evidencia pueden adaptarse a los contextos locales. La telesalud y las herramientas digitales desempeñan un papel fundamental en el empoderamiento de los pacientes, la educación de las comunidades y el apoyo a los trabajadores de la salud. A pesar de los crecientes esfuerzos, persisten los desafíos debido a las inequidades en salud, las brechas entre la política y la implementación, y la inversión insuficiente. El fortalecimiento de la prevención apoyará a los países en el logro de los Objetivos de Desarrollo Sostenible de las Naciones Unidas, con la meta de reducir en un tercio las muertes prematuras por enfermedades no transmisibles para el año 2030. Este artículo describe estrategias efectivas para implementar la prevención del accidente cerebrovascular, enfatizando los estilos de vida saludables, la detección temprana de factores de riesgo y las intervenciones a nivel sistémico.
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly prescribed for diabetes and obesity management. The medication-driven weight loss (mdWL) induced by GLP-1RAs may lead to facial hollowing, laxity, and wrinkle accentuation. Minimally invasive strategies are needed to restore facial harmony in this population. To evaluate the effectiveness of poly-L-lactic acid (PLLA-SCA) and hyaluronic acid fillers for facial rejuvenation in women undergoing GLP-1RA-induced mdWL. This retrospective, multicenter, real-world case series included 15 women (aged 30-50 years) from four Latin American countries who used GLP-1RAs for mdWL and were treated with PLLA-SCA and hyaluronic acid filler injections. Outcomes were assessed through clinical photos at baseline and around 85-100 days (D90) using the Facial Laxity Rating Scale (FLRS), Wrinkle Severity Rating Scale (WSRS), Global Aesthetic Improvement Scale (GAIS; participant and investigator assessments), and a satisfaction questionnaire. Safety events were recorded. Participants achieved 17.9% weight reduction from baseline. At D90, FLRS scores decreased from 4.5 (SD 2.2) to 2.6 (SD 1.8; p<0.001), and WSRS scores from 3.1 (SD 1.5) to 1.9 (SD 1.0; p=0.003). Eight patients (53%) reduced FLRS by ≥2 points, and 11 of 13 patients (85%) with baseline WSRS >1 showed improvement. All participants reported aesthetic improvement (pGAIS), with 40% rating "exceptional improvement". Investigator GAIS confirmed improvement in 100% of cases. At D90, 87% were satisfied or very satisfied. No serious adverse events occurred; transient ecchymoses and edema resolved spontaneously within 72 hours. The combined use of PLLA-SCA and hyaluronic acid fillers is an effective strategy to correct facial skin laxity, volume loss, and smooth nasolabial fold and wrinkles following GLP-1RA-induced mdWL with a satisfactory safety profile. These findings suggest that a combined injectable approach may be beneficial to address the aesthetic impact of mdWL in real-world clinical practice among Latin Americans.
Native Americans have historically used roots, shoots, and seeds of Lomatium species for various dietary and medicinal purposes. Lomatium foeniculaceum is a perennial parsley or biscuitroot species endemic to the Great Plains and western U.S. Its seeds are reported to be used as a "love medicine," a unique use compared to other Lomatium species, which are primarily used as a root food and for broad health improvement. We harvested L. foeniculaceum plants from their natural habitat throughout the year and analyzed tissue and seasonal variations in their chemical composition to elucidate the relationship between traditional usage and the plant's metabolism and time of year, and how this might relate to its traditional usage. This species grew vegetatively from March to May and flowered in May and June. The aerial tissues senesced in July, and the root remained dormant from July to March. Leaves and flowers contained significantly higher levels of metabolites than roots. We detected two major essential oil constituents, (E)- and (Z)-ligustilide, and the furanocoumarin, bergapten, at high levels in leaves and flowers. L. foeniculaceum is an uncommon species accumulating less-stable E-form at higher concentrations than the Z-form. This characteristic essential oil composition is probably related to the fragrance of flowers and seeds. On the other hand, the roots of this species contained lower levels of bioactive compounds and nutrients, which, coupled with their toughness and stringiness, make them less desirable as food than those of other Lomatium species.
As part of the Selaginellaceae treatment on the "Lycophytes and Ferns of Venezuela," led by Alan R. Smith (UC), ten new Selaginella species from northern South America, primarily found in Venezuela, are described. These include S. cataniapensis Valdespino, sp. nov., S. cultellifolia Valdespino & C.López, sp. nov., (also present in Colombia), S. guaramacalensis Valdespino & C.López, sp. nov., S. liesneri Valdespino, sp. nov., S. mawarinumensis Valdespino & C.López, sp. nov., S. monoloba A.R.Sm. ex C.López, Valdespino & Mostacero, sp. nov. (also present in Colombia), S. mostaceroi Valdespino & C.López, sp. nov., S. plagiochiloides Valdespino & C.López, sp. nov., S. tricula A.R.Sm. ex Valdespino & C.López, sp. nov., and S. turingiana Valdespino, sp. nov. Additionally, S. anemosyra Valdespino, nom. et stat. nov., is described and recognized at the species level, based on S. flabellata var. latifrons A.Braun. The new species are diagnosed using comparative morphology and contrasted with morphologically similar and closely related species. For each taxon, we provide illustrations from digitized herbarium material and scanning electron micrographs, along with preliminary conservation assessments using the IUCN categories and criteria. ResumenComo parte del tratamiento de las Selaginellaceae para “Lycophytes and Ferns of Venezuela”, liderado por Alan R. Smith (UC), se describen diez nuevas especies de Selaginella del norte de América del Sur, principalmente de Venezuela. Estas incluyen S. cataniapensis Valdespino, sp. nov., S. cultellifolia Valdespino & C.López, sp. nov. (también presente en Colombia), S. guaramacalensis Valdespino & C.López, sp. nov., S. liesneri Valdespino, sp. nov., S. mawarinumensis Valdespino & C.López, sp. nov., S. monoloba A.R.Sm. ex C.López, Valdespino & Mostacero, sp. nov. (también presente en Colombia), S. mostaceroi Valdespino & C.López, sp. nov., S. plagiochiloides Valdespino & C.López, sp. nov., S. tricula A.R.Sm. ex Valdespino & C.López, sp. nov., y S. turingiana Valdespino, sp. nov. Además, se describe y se reconoce a nivel de especie S. anemosyra Valdespino, nom. et stat. nov., basada en S. flabellata var. latifrons A.Braun. Las nuevas especies se diagnostican mediante la morfología comparativa y se contrastan con especies morfológicamente similares y estrechamente relacionadas. Para cada taxón, proporcionamos ilustraciones de material de herbario digitalizado y micrografías electrónicas de barrido, junto con evaluaciones preliminares de conservación basadas en las categorías y criterios de la UICN.
Triatoma sanguisuga is the most widely distributed triatomine vector in North America, occurring in at least 23 U.S. states across and capable of transmitting Trypanosoma cruzi to humans. Historical morphological variability led to the description of several subspecies, but their taxonomic validity has remained unresolved. We integrated molecular (cytochrome b, n=58; ITS-2, n=23) and morphometric (18 characters, n=82 specimens) data to reassess species boundaries within T. sanguisuga sensu lato. Four species-delimitation methods (GMYC, ABGD, mPTP, hierBAPS) consistently identified four divergent mitochondrial lineages with K2P distances of 4.5-8.8%. Florida specimens formed a distinct, strongly supported clade (Group 1; K2P >7.5% from other groups) corresponding to T. sanguisuga var. ambigua (Neiva, 1911). Linear discriminant analysis achieved 100% classification accuracy between Florida and non-Florida morphotypes, with synthlipsis width providing the strongest diagnostic character (AUC >0.96). Based on concordant genetic and morphological evidence, we revalidate Triatoma ambigua (Neiva, 1911) stat. nov. as a distinct species within a newly defined T. sanguisuga complex and designate a lectotype from the Instituto Oswaldo Cruz collection. Sampling focused primarily on Florida; additional sampling in adjacent southeastern states is needed to characterize geographic boundaries. These findings have implications for Chagas disease vector surveillance in the southeastern United States.
Patient experience maps are valuable tools for raising awareness of the patient journey, identifying resource gaps, enhancing access to essential services, and ultimately improving patient outcomes. Here, we describe the development of a metabolic dysfunction-associated steatohepatitis (MASH) patient journey map and its refinement through collaboration with a group comprising eight patient advocates and one person living with MASH, collectively known as the MASH Patient Organizations Who Enable Results (POWER) Council. The patient journey map aimed to identify challenges and unmet needs for people with MASH and to understand the specific experiences of various patient subpopulations. We identified gaps in symptom management, patient-healthcare professional communication, timely diagnoses, access to care, coordination between specialists, and understanding of the impact of MASH on patients' and caregivers' daily lives. These gaps were further compounded in those with severe MASH, particularly Hispanic/Latino populations. These findings highlight the challenges and unmet needs faced by people living with MASH and their caregivers.
[This corrects the article DOI: 10.3389/fpsyt.2022.977361.].
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Population admixture is a frequent outcome of range expansion among plants, animals, and fungi, and drives rapid genome diversification and adaptation. The globalization of winemaking has introduced domesticated European Saccharomyces cerevisiae wine strains into North America, promoting admixture between distantly related lineages. However, the degree that admixture has shaped biological diversity and adaptation within S. cerevisiae remains unclear. Here, we integrate population genetics, high-throughput phenotyping, and gene-trait mapping to characterize the evolutionary impact of S. cerevisiae admixture in North American wine regions. Whole-genome surveys of wine and oak-associated S. cerevisiae strains isolated from California reveal regional diversification of wine strains, with a subset clustering within the Pacific West Coast Wine (PWCW) clade. The PWCW clade is an admixed population derived from Wine/European and North American oak strains first described in Canada. Phylogenetic analyses further suggest that admixture within the PWCW clade has been driven by recent east-west dispersal of a North American Oak lineage into California. Solid-agar phenotyping revealed key wine and oak-associated traits selected for within PWCW clade strains, including stress resistance, nitrogen utilization, and temperature tolerance, while high-throughput microvinifications showed strong association between phylogenetic placement, fermentation completeness, and metabolite production. Genome-wide association identified loci underlying adaptive phenotypes, including copy number variation and chromosomal rearrangements linked to key stress resistance traits. Collectively, these results uncover ongoing adaptation and admixing between North American S. cerevisiae strains, as driven by winemaking practices, and advance our understanding into how admixture influences genome evolution and adaptation.
Public health messaging often falls short of the needs of underserved and minority communities, missing the mark on translating information that captures cultural, linguistic, or community relevance to influence health behaviors. Rapid community translation (rapid-CT) is an adaptation of the Boot Camp Translational method for community engagement in translating medical evidence into community health promotion messages and interventions. This paper describes the dissemination of materials from a rapid-CT of messages promoting COVID-19 vaccination among children and adults, boosters, and Long COVID messages. This project engaged five disproportionately impacted Colorado communities: urban and rural Latino/a/x, urban Black/African American, rural African immigrant, and urban American Indian/Alaska Native communities to conduct three cycles of about 6 week each of rapid-CT over 2021-2022. Each cycle of rapid-CT was led by 2 trained facilitators, usually one academic and one community partner. The process involved: (1) determining the role of partners and fostering partnerships; (2) describing the innovation, rationale, and evidence; (3) identifying the intended audience, message, timing, and format for dissemination; (4) selecting the communication and distribution channels; (5) identifying barriers and facilitators to dissemination, and (6) evaluating and refining the dissemination process. Dissemination was examined via tracking spreadsheet and impact was examined through surveys (recollection of seeing the materials, attitudes about COVID vaccinations, and vaccine status) and team de-briefing. We engaged 126 unique community members and 15 facilitators. Within each cycle, rapid-CT communities co-created distinctive campaigns including messages, materials, and dissemination strategies. Each rapid-CT group identified anticipated and actual barriers and facilitators to the dissemination of messages and materials. Each group also demonstrated impact with metrics ranging from views of online videos or marketing materials to distributions of items promoting the message (e.g., 1,000 stickers distributed), although capacity to assess impact was a varied and the changing evidence and related to COVID-19 vaccination presented challenges. Rapid-CT was effective for engaging communities in co-creating distinct messages and communication strategies tailored to their community's needs and populations. Rapid-CT is well-suited to message creation for dynamic public health emergencies. Future use of Rapid-CT should set clear expectations for time commitment of community partner and establish prospective evaluation plans in addition to community-developed plans.
Nontuberculous mycobacteria (NTM) are emerging opportunistic pathogens with an increasing global incidence. However, epidemiological data and treatment outcomes remain limited in Türkiye. This study aimed to evaluate the clinical characteristics, species distribution, and treatment outcomes of NTM infections in a tertiary center in Türkiye. A retrospective analysis was conducted of patients diagnosed with NTM infection between 2021 and 2025 in the Department of Infectious Diseases and Clinical Microbiology. The diagnosis was established according to the American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) criteria. Demographic characteristics, risk factors, radiological findings, microbiological profiles, antimicrobial susceptibility patterns, treatment regimens, and clinical outcomes were analyzed. Fourteen patients were included in the study. The mean age was 50.1 ± 13.8 years, and nine patients were male. Underlying risk factors were present in eight patients, including human immunodeficiency virus (HIV) infection (n = 4), malignancy (n = 3), bronchiectasis (n = 1), and chronic obstructive pulmonary disease (COPD) (n = 1). The most frequently identified species were Mycobacterium kansasii (n = 5) and Mycobacterium abscessus (n = 5), followed by Mycobacterium avium, Mycobacterium simiae, Mycobacterium gordonae, and Mycobacterium lentiflavum (n = 1 each). Pulmonary involvement was observed in 10 patients, with nodular lesions in nine and bronchiectasis in five. Among isolates with available antimicrobial susceptibility results (n = 13), susceptibility to clarithromycin, moxifloxacin, linezolid, and amikacin was observed in 12 isolates, whereas resistance was most frequently detected to ciprofloxacin (n = 10) and trimethoprim-sulfamethoxazole (n = 9). Of the 12 patients who initiated treatment, complete clinical response was achieved in nine and partial response in one; two patients with malignancy died before treatment initiation. M. kansasii and M. abscessus were the most frequently identified NTM species in this cohort. Favorable treatment outcomes were observed when therapy was guided by antimicrobial susceptibility results. Species-level identification and susceptibility testing are essential for optimal disease management and strengthening diagnostic capacity.
Expanding research on aging and cognition in low- and middle-income countries is critical, yet logistically complex. Large, established cohorts, such as the Mexican Teachers' Cohort (MTC; >100,000 women), pose unique opportunities for neurocognitive research in Latin America. We evaluated the feasibility of home-based cognitive assessments in 150 Mexico City MTC participants, equally distributed across ages 55 to 59, 60 to 64, and ≥65. Tests included immediate/delayed word list recall, forward/backward digit span, and semantic verbal fluency. Over 3 weeks, 274 homes were approached; 186 participants (56%) were at the known addresses, and 153 (82%) participated. Participants (median age = 61; 53% college-educated) demographically resembled non-participants. Cognitive scores spanned a broad range, demonstrating no floor/ceiling effects (immediate recall: 3 to 10; delayed recall: 1 to 10; digits forward: 3 to 8; digits backwards: 0 to 6; semantic fluency: 6 to 38 animals). Home cognitive assessments may be feasible for large established cohorts in Latin America. These studies are promising for aging research.
Between January and May 2025, the National Institutes of Health terminated over 2000 grants primarily relating to health equity, particularly for Black, Indigenous, and people of color (BIPOC) and sexual and gender minority (SGM) communities. 600 grants were terminated as part of blanket, institution-wide actions that were purportedly to "combat anti-Semitism." N = 1918 investigators with grant terminations documented in the Grant Witness database were sent a unique link for an online demographic survey. We built logistic regression models to assess the odds of receiving different grant termination types, for BIPOC, SGM, female, and Jewish researchers. 941 investigators participated (49.1% response rate). Nearly half (48.6%) of investigators with equity-related terminations were BIPOC and 60.0% of investigators with gender-related terminations were SGM, including 16.5% who identified as transgender or non-binary. Additionally, 20.5% of investigators with institutional terminations (for purported antisemitism) were Jewish. Among investigators of terminated grants, BIPOC investigators had higher odds of receiving an equity-related termination (aOR = 2.69, 95% CI: 1.71-4.25 for BIPOC women and trans/nonbinary investigators, aOR = 1.82, 95% CI: 1.10-3.02 for BIPOC men) compared to White men. SGM investigators had 11 times higher odds of receiving a gender-related termination (aOR = 11.14, 95% CI: 6.85-18.12) than heterosexual, cisgender investigators, and White women and trans/non-binary investigators had double the odds (aOR = 2.24, 95% CI: 1.25-4.02) of a gender-related termination than cisgender White men. Grant terminations targeting health research for BIPOC and SGM communities have disproportionately targeted the careers of BIPOC, SGM, and female researchers and researchers from disadvantaged backgrounds. Ensuring the health of all Americans will require systematic re-investment in these topics and scientists. The authors received no external funding for this study.
To evaluate the association between hysterectomy and the risk of developing urinary incontinence (UI) based on observational studies. We conducted a systematic search of PubMed, Embase, and Cochrane Library for observational studies from inception to December 14, 2025, using medical subject headings (MeSH) and keywords. The risk of bias and the quality of evidence were assessed using the Newcastle-Ottawa Scale (NOS), the Agency for Healthcare Research and Quality (AHRQ) criteria, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively. To derive overall summary estimates of odds ratios (OR), a random-effects meta-analysis was performed, complemented by subgroup analyses to explore potential effect modifiers. And the presence of publication bias was evaluated through funnel plots and Egger's regression test. This meta-analysis is registered with PROSPERO (CRD42024587774) and follows PRISMA guidelines, including 12 studies with a cumulative total of 146,759 individuals who underwent hysterectomy. The pooled analysis revealed a significant association between hysterectomy and an increased risk of UI, yielding an OR of 1.31, (95% CI: 1.03-1.66, I2 = 88.5%, P = 0.029). Subgroup analyses showed that the risk of UI was notably higher among patients who underwent abdominal hysterectomy (OR = 1.21, 95% CI: 1.10-1.34, I2 = 0.0%, P = 0.000). Furthermore, it was observed that the incidence of UI was particularly elevated in studies conducted in Asia, while no significant association was reported for regions such as Europe and North America. Hysterectomy is associated with an increased risk of urinary incontinence, based on synthesized evidence from observational studies. https://www.crd.york.ac.uk/prospero/, identifier CRD42024587774.
Uterine fibroids are common among reproductive-aged women, with notable racial disparities in disease burden and outcomes. Myomectomy is a fertility-sparing surgical treatment associated with variable transfusion risk. To evaluate racial disparities and identify risk factors for blood transfusion in patients undergoing myomectomy, and to develop a predictive model for high-risk patients. This retrospective cohort study used the American College of Surgeons National Surgical Quality Improvement Project (2018-2022) to identify women aged 18-55 years who underwent myomectomy. Patients with malignancy or bleeding disorders were excluded. Multivariable logistic regression was used to assess transfusion predictors and racial disparities. Incidence and predictors of perioperative blood transfusion; model performance for transfusion prediction. Among 6,154 patients, 604 (9.8%) required transfusion. Non-Hispanic Black patients accounted for 74.3% of transfusion cases (vs. 52.0%, P<0.001) and had over twice the adjusted odds of transfusion compared to Non-Hispanic White patients [adjusted odds ratio (aOR): 2.1, 95% confidence interval: 1.6-2.7]. Preoperative anaemia (aOR: 8.5), abdominal approach (aOR: 4.7), and fibroid burden (>250 grams) (aOR: 2.0) were also significant. The predictive model demonstrated excellent discrimination (area under the receiver operating characteristic curve: 0.79). Non-Hispanic Black patients face higher transfusion risks during myomectomy, even after adjusting for clinical factors. Interventions targeting anaemia and prioritising minimally invasive approaches may reduce these disparities. This study explores recent racial disparities in blood transfusion among myomectomy patients and assesses how these patterns have evolved in recent years using a nationally representative surgical dataset.
Emerging mobile health and STEM engagement platforms are increasingly recognised as catalysts for improving public understanding of biomedical technologies and supporting digitally enabled models of healthcare delivery. The Bionics Bus (https://bionicsbus.org/) is a novel mobile laboratory designed to democratise access to robotics, artificial intelligence, prosthetics and digital diagnostics by delivering hands-on experiences directly to schools, communities and healthcare settings. This study provides the first transatlantic comparison of public attitudes toward the Bionics Bus within the United Kingdom and the United States of America (USA), two countries with contrasting healthcare systems and digital transformation priorities. Using a mixed-methods cross-sectional design, 78 participants completed a survey assessing technology perceptions, healthcare accessibility, enthusiasm for STEM and views on the usefulness and potential of the Bionics Bus. Quantitative analysis demonstrated high levels of excitement and strong recognition of the relevance of technology in healthcare across both countries, with USA respondents more likely to report geographical barriers to accessing healthcare. Thematic analysis revealed shared optimism for the Bus as a tool for education, accessibility and community-based innovation. These findings highlight the potential of mobile biomedical platforms to support digital inclusivity, strengthen science capital and enhance public engagement with technology-enabled healthcare.
Adrenocortical carcinoma (ACC) in children is a rare and aggressive malignancy. Despite representing a small fraction of pediatric adrenal tumors, ACC poses distinct challenges due to its heterogeneous biological behavior, frequent hormone secretion, and the limited availability of standardized, pediatric-specific treatment protocols. Complete surgical resection remains the cornerstone of curative intent therapy, and complete adrenalectomy offers the best chance for long-term survival. Given the aggressiveness of ACC, particularly in advanced disease, adjuvant therapies are often considered to improve outcomes. The aim of this consensus meeting was to bring together international experts to develop international guidance based on the best available evidence and collective clinical experience to harmonize long-term management. A modified three-step Delphi consensus method was used to finalize the statements from an international panel of pediatric ACC experts from four continents (Europe, the Americas, and Asia, and Oceania). An electronic survey was developed by the steering committee (ENSAT Kids) and distributed to the panel. Agreement and disagreement were rated using a six-point Likert scale with the opportunity to provide structured feedback. Consensus was defined a priori as ≥75% agreement. This Delphi process yielded consensus statements for therapy guidance, comprising 12 surgical statements and 68 medical treatment statements, organized by strategy and disease stage. These statements are intended to support clinicians in delivering more consistent and standardized therapeutic strategies for pediatric ACC. Future efforts should prioritize the design and conduct of high-quality, collaborative research studies in order to provide more evidence and therapy improvements.