搜索结果：living

Limited health literacy (HL) has been associated with many adverse health outcomes. Limited HL contributes to adverse outcomes; however, evidence on effective strategies to enhance it remains limited. In this study, we examined HL prevalence in the general Finnish and migrant origin populations and investigate which sociodemographic, health-related, and migration-related factors are associated with limited HL. Data were collected from 2022 to 2023 as part of the cross-sectional population surveys Terve Suomi and MoniSuomi. The analysis included individuals aged 20-74 years (n = 9717), with HL assessed using the HLS19-Q12. Logistic regressions were used to investigate the association between population, sex, age, living alone, region of residence, education, economic activity, income difficulties, language skills, length of residence, and self-rated health (SRH) with limited HL. A prevalence of limited HL was observed in 15% (95% CI: 13.2-15.9) of the general population and 42% (95% CI: 40.1-43.4) of the migrant-origin population in Finland. Across both groups, limited HL was more likely among individuals with a migration background, unemployment or student status, income difficulties, living alone, lower educational attainment, and average or poor SRH. Among migrants, limited HL was additionally associated with less-than-excellent proficiency in Finnish or Swedish. Limited HL is much more prevalent among the migrant-origin population, highlighting substantial disparities linked to socioeconomic disadvantage, living circumstances, and language proficiency. Earlier efforts to promote HL following migration and greater language inclusion is needed.

Engaging knowledge users, including patient partners and health-system partners, in embedded health services research is increasingly recognized as essential for strengthening the relevance of research and improving the quality and equity of health services and is foundational to the success of team science. Existing engagement frameworks, however, often capture experiences at single time points and do not fully reflect relational dimensions over time such as trust, reciprocity, shared decision-making, and equity which can impact the outputs and outcomes of partnered research. There remains limited evidence describing how engagement unfolds or what conditions support or hinder meaningful, equitable partnerships in research. This study will address this gap by examining the ripple effects of a long-standing researcher-knowledge user partnership and identifying the relational and structural factors that sustain it. This qualitative, participatory study will be guided by critical patient-oriented research (cPOR), an approach that centres equity, shares power, and structurally situates lived/living experiences throughout the research process. In alignment with cPOR principles, patient partners and health-system partners are co-researchers across all stages of the study from inception through to development of data collection tools and will partner in analysis and interpretation. The study will be conducted within the Lung Health Equity Advisory Committee, a partnership co-established to address inequities in lung health, where patient partners, clinicians, policymakers, program implementers, and researchers have worked together since 2020. Data collection will be informed by patient engagement tools, such as the Engaging with Purpose Patient Engagement Framework, to assess experiences across five pillars: Co-Build, Support, Mutual Respect, Inclusiveness, and Impact, using document analysis and annual surveys. Analysis will be guided by the theoretical concept of ripple effects, to explore how engagement processes, outputs, and outcomes accumulate and influence subsequent phases of work. Data will be analysed using combined deductive-inductive content analysis, with triangulation across all data sources. Preliminary findings will be synthesized with partners through Ripple Effects Mapping (REM), a participatory approach that supports collective interpretation, visualization of impact pathways, and opportunities for continuous improvement. This study offers a novel approach to understanding the experiences and impact of long-standing research-knowledge user partnerships that are not bound by a specific project or timeline. By exploring this relational approach to engagement, we will generate nuanced insights into how knowledge-user engagement is built, experienced, and adapted over time within an equity-oriented partnership. The exploration of ripple effects is expected to strengthen real-time learning and partnership dynamics while offering a transferable model for other research teams seeking to embed iterative, partner-guided improvement into engagement practices that are sustained over time. Working closely with patients, community members, and people who plan and deliver healthcare helps make research more useful and can improve the quality and fairness of care. However, most ways of exploring engagement practices capture people’s experiences as snapshots at different points in time, and do not adequately unpack how aspects such as trust, shared decision-making, and fairness may impact long-standing relationships. This study will help fill this gap by looking at how engagement is experienced over time in a long-standing partnership and by identifying the relationship and system factors that help support meaningful and impactful partnerships.This study will use an approach that focuses on equity, shared decision-making, and lived/living experiences. Patient partners and health-system partners who have been working together since 2020 in the Lung Health Equity Advisory Committee to improve lung health outcomes for all have co-designed this study and research approach. They will help analyse and understand the results. We will collect information from project documents and surveys and work together to create a ripple effects map that visually traces how engagement activities, relationships, and collective decision-making contribute to outcomes and development of novel projects over time.This study will help us better understand how sustained partnerships are built, experienced, and can be improved over time. It will also provide a model that other research teams can use to understand and sustain how they work with partners for greater impact.

As antiretroviral therapy (ART) coverage has matured in sub-Saharan Africa, the clinical profile of people living with HIV has shifted from acute opportunistic disease toward chronic neuropsychiatric morbidity. Few high-volume African HIV programmes have systematically described the full neuropsychiatric diagnostic architecture captured in their routine electronic records. We characterised the neuropsychiatric diagnoses recorded at Mildmay Uganda, an urban HIV centre serving approximately 14,500 active patients. We conducted a descriptive analysis of routinely collected, de-identified electronic health-record data extracted from the ClinicMaster electronic medical record on 25 April 2026. Records with at least one ICD-10-coded neuropsychiatric diagnosis between 31 October 2017 and 23 April 2026 were grouped into nine clinically defined diagnostic categories using a pre-specified code list (Supplementary Table S1). Analyses were conducted at two levels: a record level (all 1,137 records) and a patient-index level (one earliest record per patient, n&#x2009;=&#x2009;581). The design was cross-sectional and descriptive; no longitudinal follow-up, incidence or time-to-event analyses were undertaken. Proportions are reported with 95% Wilson confidence intervals where patients were the independent unit. Missing data were quantified rather than imputed. The dataset comprised 1,137 records from 581 patients (median 1 record per patient, IQR 1 to 2, maximum 13). Patients were 60.6% female (352/581) with a median age of 44 years (IQR 35 to 52). At the record level, four groups accounted for 90.6% of records: major depressive disorder (302; 26.6%), opportunistic CNS infection (293; 25.8%), HIV-attributed and other organic CNS disorders (256; 22.5%) and bipolar spectrum disorder (179; 15.7%). At the patient-index level, opportunistic CNS infection was the most common index presentation (206; 35.5%, 95% CI 31.7 to 39.4). A clinically coherent ART-duration gradient separated opportunistic CNS infection (median 0.2 years on ART at diagnosis) from chronic neuropsychiatric diagnoses recorded after several years of treatment (Kruskal-Wallis p&#x2009;<&#x2009;0.001). Among the 406 index patients with viral-load data (69.9%), 82.5% (95% CI 78.5 to 85.9) were suppressed below 1,000 copies/mL. Record-level viral-load completeness ranged from 51.0% (2020) to 87.0% (2019) across the observation period, with an overall availability of 76.5% (870/1,137). CD4 count at ART initiation was unavailable for all records. These routine data document a measurable treatment-era shift from acute CNS opportunistic disease toward chronic neuropsychiatric diagnoses among people living longer on ART. The findings are descriptive and hypothesis-generating, constrained by reliance on clinician-assigned ICD-10 codes. With standardised neuropsychiatric assessment, this routine-data platform can support prospective brain-health research and mental-health service integration in urban Ugandan HIV care.

Pregnant women with gestational diabetes mellitus (GDM) face complex challenges in managing their condition, especially in low-resource settings with limited healthcare and social support. Digital health interventions show promise, but their real-world applicability in rural contexts remains underexplored. This study explores the experiences of women using an online intervention for GDM self-care in Thai Binh, Vietnam. A qualitative study was conducted between February and December 2024 involving 21 pregnant women diagnosed with GDM. Participants were enrolled in a digital self-care program and interviewed in-depth during late pregnancy (29-39 weeks of gestation). The study drew on ethnographic methods, including attention to women's contexts and the use of fieldnotes. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Participants reported improved self-management of GDM through healthier diets, increased physical activity, and regular glucose monitoring. Five main themes emerged: (1) making healthy food choices with family and peer support, (2) learning and practicing blood glucose self-monitoring with guidance, (3) engagement in physical activity encouraged by others, (4) emotional well-being supported by social relationships, and (5) challenges affecting women's acceptance of the online intervention. Professional support enhanced trust in medical advice, while the peer-support component fostered motivation, companionship, and emotional resilience. The intervention also encouraged family involvement in care. Online interventions that combine expert guidance with peer and family support can support women to manage the physical and mental aspects of living with GDM. This hybrid model shows promise for broader application in low- and middle-income countries. Further research is recommended to assess long-term impacts and scalability. NCT05744856 (Registration Date 20230215 and Last Update Posted 20240430).

Team Orange is a Japanese national dementia initiative, established under the government's National Framework for Promotion of Dementia Policies. It connects people living with dementia (PLWD) and their families with trained community volunteers ("Orange Supporters") who provide practical daily assistance and foster local support networks. By 2023, the initiative had expanded to nearly 1,900 teams and 33,000 supporters nationwide. Despite this growth, the perceived benefits of these roles among Orange Supporters remain largely unexplored. This study examined the benefits of Team Orange through supporters' lived experiences in Sapporo, Japan. A qualitative content analysis was conducted with 16 Orange Supporters recruited via purposive sampling from eight community hubs in Sapporo, Japan. Semi-structured interviews were conducted between December 2024 and March 2025. Data collection and analysis continued until data saturation was reached. Two main themes were identified. The first, "Lessons learned in Team Orange by Orange Supporters," comprised four categories: (1) Respecting the personhood of PLWD and their families, (2) Understanding and supporting diverse needs, (3) Discovering the strengths of PLWD and their families, and (4) Promoting community inclusion through collaboration. The second theme, "Comprehensive benefits of Team Orange identified by Orange Supporters," included three categories: (1) Increased dementia awareness in daily life, (2) Empowerment through interdependent contribution, and (3) Enhanced emotional well-being from the activities. Team Orange appears to function as a platform through which supporters develop positive perceptions and practical skills for interacting with PLWD, while experiencing personal empowerment and enhanced emotional well-being. As a culturally embedded, policy-driven model unique to Japan, Team Orange offers transferable insights for the development of dementia-friendly community initiatives internationally, with implications for improving care, promoting social engagement, and reducing social isolation-related health risks among older adults.

Sphere packings in circular cylinders have attracted substantial research interest, among which the discovery of chiral helical structures is the most iconic. However, recent experimental results on zebrafish do not match the known packing structures in circular cylinders. To account for the inherent imperfections of biological tubes, we take elliptic cylinders as the canonical deformation of circular cylinders and investigate the densest packings of hard spheres in them using simulation, theory, and experiments. Starting from the chiral structures in circular cylinders, we demonstrate that even a weak cross-sectional deformation can trigger entirely new phases, including ones that either eliminate global chirality or significantly complicate the chiral structures. This reveals the significant effect of cylindrical anisotropy. The new helical phases under anisotropic confinement remain chiral and develop hierarchical periodic structures, which are difficult to obtain by simulations but are predicted by our newly developed theory for helical phases in elliptic cylinders. The theory also predicts double oscillated-chain phases without chirality, which perfectly match the simulations. Our work offers fresh insights into understanding packings in anisotropic cylinders, which will help researchers to design new materials and to understand many living systems.

Acute decompensated heart failure (ADHF) remains a leading cause of hospitalization and short-term death despite quadruple guideline-directed therapy. Early, pragmatic risk stratification at admission is essential. To identify independent predictors of in-hospital mortality in ADHF within the four-pillar era and to derive a simple bedside score (ICARUS). A retrospective cohort study was conducted of hospitalized adults, consecutively selected, with acute decompensated heart failure (de novo or chronic). Pre-specified candidate predictors were categorized with clinically informed cutoff and entered into multivariable logistic regression (backward selection). Model fit and discrimination were assessed using the Hosmer-Lemeshow test and the area under the receiver operating characteristic curve (area under the curve [AUC]), respectively. Coefficients were scaled to create a points-based score. Among 1588 patients (median age 68 years; 69.3% male; median left ventricular ejection fraction [LVEF] 30%), in-hospital mortality was 4.28% (68/1,588; 95% confidence interval [CI] 3.34-5.39). Independent risk factors were diabetes (odds ratio [OR] 1.81), the New York Heart Association III-IV (OR: 1.97), the Minnesota Living with Heart Failure Questionnaire &#x2265; 41 (OR: 2.09), atrial fibrillation (OR: 2.29), hyperkalemia K+ > 5.5 mmol/L (OR: 2.63), and systolic blood pressure &#x2264; 110 mmHg (OR: 3.14). Protective factors were &#x3b2;-blocker use at admission (OR: 0.38), implantable device (OR: 0.22), and in-hospital sodium-glucose cotransporter 2 inhibitor therapy (OR: 0.27). The model showed good model fit (Hosmer-Lemeshow p = 0.997) and strong discriminative ability (AUC 0.81). The ICARUS points system performed similarly (AUC: 0.792; 95% CI 0.738-0.845), with stepwise increases in mortality across strata. Nine readily obtainable variables accurately stratified in-hospital mortality risk in ADHF. The ICARUS score is a pragmatic bedside tool, integrating clinical status and modern therapy, with a good goodness-of-fit and discrimination. La insuficiencia cardiaca aguda descompensada (ICAD) sigue siendo una de las principales causas de hospitalizaci&#xf3;n y de muerte a corto plazo, pese al uso de la terapia cu&#xe1;druple dirigida por gu&#xed;as. Por ello, es esencial una estratificaci&#xf3;n temprana y pr&#xe1;ctica del riesgo de ingreso. Identificar predictores independientes de mortalidad intrahospitalaria en la ICAD en la era de los cuatro pilares y derivar un puntaje cl&#xed;nico simple (ICARUS). Se realiz&#xf3; un estudio de cohorte retrospectivo con adultos hospitalizados, seleccionados consecutivamente, con insuficiencia cardiaca aguda descompensada (de novo o cr&#xf3;nica). Los predictores predefinidos se categorizaron con puntos de corte cl&#xed;nicamente relevantes y se ingresaron en un modelo de regresi&#xf3;n log&#xed;stica multivariable mediante selecci&#xf3;n hacia atr&#xe1;s. El ajuste y la discriminaci&#xf3;n del modelo se evaluaron mediante la prueba de Hosmer-Lemeshow y el &#xe1;rea bajo la curva ROC (AUC). Los coeficientes se escalaron para construir un puntaje. Se incluyeron 1588 pacientes (mediana de edad 68 a&#xf1;os, el 69.3% hombres, mediana de FEVI 30%). La mortalidad intrahospitalaria fue del 4.28% (68/1588; IC 95%: 3.34-5.39). Los factores de riesgo independientes fueron la diabetes (OR: 1.81), la clase III-IV de la NYHA (OR: 1.97), el puntaje MLHFQ &#x2265; 41 (OR: 2.09), la fibrilaci&#xf3;n auricular (OR: 2.29), la hiperpotasemia > 5.5 mmol/l (OR: 2.63) y la presi&#xf3;n arterial sist&#xe9;mica &#x2264; 110 mmHg (OR: 3.14). Los factores protectores fueron el uso de &#x3b2; bloqueador al ingreso (OR: 0.38), la presencia de dispositivo implantable (OR: 0.22) y el uso intrahospitalario de inhibidores de SGLT2 (OR: 0.27). El modelo mostr&#xf3; un excelente ajuste (Hosmer-Lemeshow p = 0.997) y buena discriminaci&#xf3;n (AUC: 0.81). El sistema de puntos ICARUS present&#xf3; un desempe&#xf1;o similar (AUC: 0.792; IC 95%: 0.738-0.845) y evidenci&#xf3; incrementos escalonados de mortalidad entre los estratos. Nueve variables f&#xe1;cilmente disponibles permiten estratificar con precisi&#xf3;n el riesgo de mortalidad intrahospitalaria en la ICAD. El puntaje ICARUS es una herramienta pragm&#xe1;tica a la cabecera del paciente que integra el estado cl&#xed;nico las terapias modernas, con un buen ajuste y una buena capacidad discriminativa.

To evaluate changes in adolescent sexual and reproductive health (SRH)-related hospital encounters post-Dobbs and compare by state abortion policies. We conducted a retrospective cohort study of adolescent pediatric hospital encounters from June 2021 to December 2024 and used an interrupted time series analysis to measure the impact of Dobbs on SRH outcomes. Encounters included any hospital encounter of patients aged 11 to 18 years from 42 children's hospitals nationwide. SRH outcomes included pregnancy diagnosis, sexually transmitted infection (STI) testing and diagnosis, emergency contraception (EC) provision, or abortion, based on billing codes. Of 3&#x2009;448&#x2009;158 pediatric hospital encounters, 1&#x2009;584&#x2009;397 (45.9%) occurred in abortion-restricted states. In abortion-restricted states, there was an increase in pregnancy diagnosis during encounters at the time of Dobbs (June 2022) (odds ratio [OR], 1.26; 95% CI, 1.02-1.55; P&#x2009;=&#x2009;.029). Encounters with STI testing (OR, 0.99; 95% CI, 0.99-1.00; P&#x2009;=&#x2009;0.027), STI diagnoses (OR, 0.98; 95% CI, 0.97-1.00; P&#x2009;=&#x2009;.017), and EC (OR, 0.98; 95% CI, 0.96-1.00; P&#x2009;=&#x2009;.028) decreased post-Dobbs compared with pre-Dobbs in restricted states. Of 1&#x2009;863&#x2009;761 (54.1%) pediatric hospital encounters in permissive states, pregnancy encounters decreased pre-Dobbs (OR, 0.98; 95% CI, 0.96-1.00; P&#x2009;=&#x2009;.021) and then slightly increased post-Dobbs (OR, 1.03; 95% CI, 1.01-1.05; P&#x2009;=&#x2009;.006), whereas STI trends in testing and diagnosis remained stable across all 3 time periods. In abortion-restricted states post-Dobbs, we found a 26% increase in the odds of pregnancy-related encounters, as well as a decrease in STI testing, diagnosis, and EC administration. Further efforts are needed to offset the disparate risk for outcomes for youth living in abortion-restricted states.

Post-operative weight-bearing strategies after surgical fixation of ankle fractures remain controversial. This prospective observational pilot study aimed to evaluate whether an early weight-bearing (EWB) protocol influences weight-bearing symmetry during static stance and clinical and functional recovery compared with a restricted weight-bearing protocol. Thirty-three patients undergoing surgical fixation for ankle fractures were allocated to either EWB (n = 17) or restricted weight-bearing (RWB) (n = 16) according to surgeon preference and fracture characteristics. Clinical, radiographic, and gait analysis outcomes were assessed at 6 weeks, 3 months, and 6 months postoperatively. The primary outcome was weight-bearing symmetry during bipodalic static stance. Secondary outcomes included subjective return to balance, independence in activities of daily living (ADL), and return to work. Data were analyzed using nonparametric tests. At 6 weeks, the EWB group demonstrated significantly greater weight-bearing symmetry during static stance compared to the RWB group (eyes open, p = 0.048; eyes closed, p = 0.044). Patients in the EWB group also showed higher rates of subjective return to balance (76% vs 31%, p = 0.009) and ADL independence (82% vs 50%, p = 0.049). No significant differences were observed in return to work (p = 0.805). No complications were observed in either group. In this small observational cohort, early weight-bearing was associated with improved early weight-bearing symmetry and functional recovery without observed complications. These findings should be interpreted cautiously, due to the study design and sample size and require confirmation in larger controlled studies.

Neurogenesis, a critical process implicated in diverse brain disorders, is greatly diminished in the adult human brain, complicating direct investigations into its mechanistic role in disease. In the olfactory epithelium (OE), olfactory sensory neurons (OSNs) maintain homeostasis via continual neurogenesis throughout life, providing a niche to investigate neurogenesis in vivo. However, the molecular mechanisms underlying this process and its similarities to brain neurogenesis remain largely unknown. Here, we performed single-nucleus RNA-seq on specimens of human OE from 6 living adult donors, yielding high-quality transcriptomes representing 145,720 cells. Integrating with two independent OE single-cell transcriptomics datasets, different developmental stages of OSNs were identified, including neural precursor cells (globose basal cells, GBCs), as well as immature and mature OSNs. We inferred trajectories and assessed the transcriptional and regulatory dynamics of OSN development. Genes and transcription factors (TFs) involved in regulating neuronal differentiation and neurogenesis were highly expressed in GBCs and early immature OSNs, but were downregulated in mature neurons. OSNs and cortical excitatory neurons exhibited convergence during early developmental stages, including dynamically expressed genes, TFs, biological processes, and polygenic enrichment for psychiatric disorders. In addition, expression trajectory alignment between OSNs and cortical excitatory neurons (CENs) revealed that OSNs could partially track the expression dynamics of autism spectrum disorder (ASD) risk genes in CENs. Overall, cells in the neuronal lineage of the OE represent a potential proxy to study gene programs involved in neurogenesis in the human brain, providing an accessible model for investigating neurodevelopmental dysfunction in psychiatric disorders.

Non-Hispanic Black Americans have a greater risk of stroke than other racial and ethnic groups in the United States. However, race is primarily a sociopolitical construct associated with differential access to power related to inequities in social, economic, and political resources. Racial differences in stroke incidence may be explained by this power differential. We sought to examine the relationship between Black business ownership, viewed as an economic resource that facilitates racial power, and stroke risk factors. This was a cross-sectional analysis using data from the pooled 2017 and 2019 Selected Metropolitan/Micropolitan Area Risk Trends of the Behavioral Risk Factor Surveillance System; 2017 Annual Business Survey; 2015-2019 American Community Survey; and 2019 Small Business Policy Index. Black business ownership was estimated at the micropolitan or metropolitan statistical area (MMSA) level as a continuous measure defined as: (1) (Black-owned firms/ non-Black-owned firms)/ (Black population/ non-Black population), BBO1; and (2) (Black-owned firms/ White-owned firms)/ (Black population/ White population), BBO2. MMSAs with scores greater than 1 represented places where Black residents were overrepresented as business owners relative to their share of the local population. We examined the relationship between the Black business ownership ratios (BBO1 and BBO2) and self-reported stroke risk factors (hypertension, diabetes, smoking, cholesterol) among non-Hispanic Black residents (N&#x2009;=&#x2009;31,149). Multivariate logistic regression models controlled for participant age, gender, income, education, region, and state-level business friendliness. In multivariate logistic regressions, a one-point increase in BBO1 was associated with lower odds (95% CIs) of self-reported hypertension (0.48 [0.29-0.81]), diabetes (0.51 [0.35-0.75]), and hypercholesterolemia (0.70 [0.51-0.96]), but not associated with smoking (1.14 [0.60, 2.19]). A one-point increase in BBO2 was associated with greater odds of smoking (1.90 [1.26-2.87]), but was not associated with hypertension, diabetes, and hypercholesterolemia. Among Black individuals, living in a community with a higher prevalence of Black business ownership was linked to lower levels of stroke biological risk factors. However, it may also be associated with higher levels of stress-related behaviors, such as smoking. Policies that create an environment conducive to Black businesses may also create environments that reduce racial disparities in vascular risk factors and consequent disease burden.

Early detection of heavy metal stress in plants is essential for effective environmental monitoring, particularly in contaminated urban areas. This study evaluated whether remote sensing combined with simplified anatomical diagnostics can provide a rapid and reliable method for detecting chromium (Cr) and nickel (Ni) stress in common urban weed species. Five species were selected: Trifolium pratense, Rumex acetosa, Alcea rosea, Amaranthus retroflexus, and Plantago lanceolata. Visible plant injuries were assessed using Evans Blue staining and image-based anatomical analysis, which enabled distinguishing between living, partially damaged, and dead cells. Multispectral observations using a MicaSense RedEdge-M camera allowed calculation of the Normalized Difference Vegetation Index (NDVI) to detect stress-related changes in photosynthetic apparatus. The studied species differed in their capacity to accumulate and translocate Cr and Ni. Metal bioaccumulation was low in all species (bioconcentration factor&#x2009;<&#x2009;1), with the highest Ni accumulation observed in Plantago lanceolata. Translocation of both metals was the greatest in Trifolium pratense and Amaranthus retroflexus. Hydrogen peroxide levels increased in roots and leaves of all species, particularly in Alcea rosea. Despite the absence of visible injuries, microscopic anatomical changes were detected in T. pratense and R. acetosa, while NDVI values differed between sites. In summary, this study indicates that no simple relationship was found between physiological stress parameter values and NDVI. It is important to emphasize the need for continued research under controlled conditions with specific doses of PTEs salts. This should clearly demonstrate the relationship between plant physiological responses to stress and the results of multispectral observations.

Life-course factors, including parity, are well linked to fertility. However, the moderating role of educational aspirations, controlling for confounders, remains unclear. This study examines how educational aspirations, alongside life-course, normative, and contextual factors, shape fertility intentions in urban Tehran. Guided by an integrated conceptual framework and using data from the 2025 Tehran Survey of Fertility Intentions (n&#x2009;=&#x2009;1,999 married women&#x2009;<&#x2009;45), this study employs descriptive and bivariate analyses to examine fertility intention patterns and multinomial logistic regression to identify key determinants. Trends are assessed using age-matched data from a 2012 survey of women&#x2009;<&#x2009;36. Overall, 78% of respondents either intended to stop childbearing or were uncertain. Short-term intentions were concentrated among younger and childless women, while older and higher-parity women mainly intended to stop. Between 2012 and 2025, short-term intentions rose slightly, stopping declined, and uncertainty increased. Multivariate results show that age and parity increase the odds of stopping or uncertainty (vs. intending another child), while later age at marriage reduces both. Educational aspirations have no direct effect but attenuate parity effects on stopping (OR&#x2009;=&#x2009;0.53; CI: 0.38-0.75) and uncertainty (OR&#x2009;=&#x2009;0.51; CI: 0.32-0.79). Higher religiosity is associated with lower stopping intentions. Living in middle- and high-status districts increases stopping, while middle-status districts are associated with greater uncertainty. Fertility intentions in Tehran are polarized, with considerable uncertainty at early parities shaped by life-course dynamics and future aspirations. Policies should prioritize early childbearing transitions and better align education, employment, and family formation rather than relying solely on pronatalist incentives.

Millions of people worldwide are living with movement and sensory impairments owing to spinal cord injury, stroke and other neurological conditions. Here we report a double neural bypass (DNB), a hybrid neuroprosthetic system designed to restore both immediate and lasting gains in movement and sensation after a severe, complete spinal cord injury. The DNB links an intracortical brain-computer interface with targeted and patterned neuromodulation of the spinal cord and cortex. This allows brain signals associated with movement intention to directly control the movement of the user's own hand in real time while also promoting long-term sensorimotor recovery-even after the system is turned off. The DNB system uses recurrent artificial neural networks and reinforcement learning for fine grasp control, together with patterned spinal cord stimulation and activity-informed intracortical microstimulation ('cortical mirroring') to promote neuroplasticity and durable recovery of function. In a participant with chronic C4 sensory/C5 motor complete tetraplegia, this hybrid approach enabled recovery of functional abilities including self-feeding and manipulation of delicate objects, while also producing significant and persistent improvements in elbow flexion and wrist tactile sensation. These findings demonstrate the potential of combining a sensorimotor neuroprosthesis with targeted brain and spinal neuromodulation to restore clinically relevant function in severe paralysis.