Short and disrupted sleep is related to perceptions of neighborhood in pregnant African American women of low socioeconomic status.

African American women experience disproportionate cardiovascular disease risk, and altered central hemodynamics signal early vascular aging. For African American mothers, concern about their children's exposure to racism represents a salient psychosocial stressor, but its vascular consequences are unclear. We examined whether greater racism‑related Concern for Children (CFC) was associated with adverse longitudinal changes in central hemodynamics. African American mothers aged 30-46 years (n=236) underwent assessments of central systolic blood pressure (cSBP), augmentation index (AIx), pulse pressure amplification (PPA), and pulse wave velocity (PWV; n=205) at baseline and 4±1 years later. CFC was measured continuously (range 0-24) and categorically (high vs. low). Multivariable linear regression models examined associations between CFC and changes in central hemodynamics, adjusting for baseline values and sociodemographic, clinical, and psychosocial covariates. Logistic regression evaluated CFC and odds of newly developed high‑risk PPA (PPA<1.3). In fully adjusted models, greater CFC was associated with larger increases in AIx (b=0.30, 95% CI [0.11, 0.48]; P=0.002). At follow‑up, women with high CFC had AIx values 3.9 percentage points higher than those with low CFC (P=0.005). CFC was also associated with declining PPA (b=‑0.003, 95% CI [‑0.005, ‑0.001]; P=0.024) and greater odds of newly developed high‑risk PPA (OR=1.08, 95% CI [1.01, 1.15]; P=0.033). No associations were observed for cSBP or PWV. Greater racism‑related concern for children is associated with signs of early vascular aging in African American mothers, highlighting the cardiovascular consequences of racism‑related maternal stress.

Gestational diabetes (GDM) and hypertensive disorder of pregnancy (HDP) disproportionallyaffect the health of Black women during pregnancy and after birth. These conditions have mostly been examined separately and have largely focused on individual-level risk factors. We used an adapted socioecological model (SEM) to explore risk and protective factors for GDM and HDP among Black women beyond the individual level of influence. We searched MEDLINE, Embase, CINAHL Complete and Scopus databases for articles published through November 2023. Studies were included if they had samples of ≥ 50% Black women or stratified data by race and included measures of effect of interpersonal, community/environmental, or societal factors. We used PRISMA 2020 reporting guidelines and narratively synthesized the results by level of the SEM. We used QualSyst to assess the quality of included studies. Nineteen studies met all our inclusion criteria; 10 examined societal factors making it the most examined socioecological level, six examined community/environmental factors, and three examined interpersonal level factors. Only three studies included outcomes of both GDM and HDP. Intimate partner violence was the only significant risk factor for both GDM and HDP. Although several risk factors were explored, protective factors have not been examined to the same extent and warrant further investigation. Findings from this review can be used to inform more comprehensive assessment tools for identifying patients at increased risk for adverse pregnancy outcomes. Limitations of our review include the inability to determine causality due to study designs and the inability to conduct a meta-analysis due to heterogeneity of findings.

County-Level Outliers in Risk-Adjusted Preterm Birth Among Young Women in the United States.

In recent decades, there have been concurrent secular trends in decreasing age at menarche and increasing prevalence of obesity. To describe temporal trends and age-period-cohort effects in the association between age at menarche and adult BMI using population-representative data from the U.S. National Health and Nutrition Examination Survey (NHANES, 1999-2018). Self-identified female participants ≥ 18 years completed a Reproductive Health Questionnaire and physical examination. Age at menarche (continuous, years) was self-reported, and body mass index (BMI) (continuous, kg/m2) was calculated using measured height and weight. Age at menarche and adult BMI were characterised using descriptive statistics by age (at the time of the survey), period (NHANES data collection cycle), and birth cohort (10-year intervals). Linear regression was used to assess the association between age at menarche and adult BMI, overall and stratified according to age, period and cohort. Of 23,923 NHANES participants ≥ 18 years between 1999 and 2018, mean adult BMI was greatest among individuals who self-reported age at menarche ≤ 11 years (30.9 kg/m2 ± 8.1). Mean adult BMI was highest among individuals with earlier ages at menarche across age, period, and cohort. In linear regression analyses, there were greater increases in adult BMI per 1-year decrease in age at menarche among individuals who reported earlier ages at menarche (β 1.80 kg/m2, 95% CI 1.44, 2.16), with larger associations among younger age groups and recent birth cohorts. The present work characterises secular trends in decreasing age at menarche and increasing obesity prevalence to demonstrate age and cohort effects in the association between age at menarche and adult BMI. Identification of these age and cohort effects helps detect populations at risk and informs obesity prevention strategies, highlighting age at menarche as a valuable early-life indicator of obesity risk across the life course.

Most studies on the impact of vitamin D on sex hormones focus on specific populations, such as older males, Asian males, or those with certain health conditions. Limited evidence exists on the relationship between vitamin D and sex hormones in American women. This cross-sectional analysis used National Health and Nutrition Examination Survey (NHANES) data to explore the association between serum vitamin D levels and sex hormones levels in women. Data from NHANES (2021-2023) were analyzed. Participants were categorized by serum vitamin D levels: Deficient (<50 nmol/L), Insufficient (50-74.99 nmol/L), and Adequate ( ≥ 75 nmol/L). One-way ANOVA and Chi-square tests were used for comparisons, and linear regression evaluated associations. Our analysis specifically focused on a subset of 3181 women aged 18 years and older (18-80 years). Women in the adequate vitamin D group had lower body mass index (BMI) (29.16 vs. 32.10 kg/m², p < 0.001), lower total testosterone (24.10 vs. 32.28 ng/dL, p < 0.001), progesterone (139.05 vs. 229.73 ng/dL, p < 0.001), estrone sulfate (687.10 vs. 1023.08 pg/mL, p < 0.001), and dehydroepiandrosterone sulfate (DHEAS) (66.41 vs. 100.56 µg/dL, p < 0.001) compared to the deficient vitamin D group. They also had higher sex hormone-binding globulin (SHBG) (70.37 vs. 58.55 nmol/L, p < 0.001), follicle-stimulating hormone (FSH) (50.30 vs. 23.99 mIU/mL, p < 0.001), and luteinizing hormone (LH) (26.39 vs. 16.64 mIU/mL, p < 0.001) compared to the deficient vitamin D group. Linear regression revealed that higher serum vitamin D was inversely associated with 17α-hydroxyprogesterone (Beta = -0.85, P = 0.023), androstenedione (Beta = -0.181, p < 0.001), anti-Müllerian hormone (Beta = -0.238, p < 0.001), DHEAS (Beta = -0.204, p < 0.001), total testosterone (Beta = -0.080, P = 0.042), while showing a positive association with follicle-stimulating hormone (Beta = 0.260, p < 0.001) and luteinizing hormone (Beta = 0.208, p < 0.001). Serum vitamin D levels were negatively associated with testosterone and estradiol in American women, particularly in older individuals.

Triple-negative breast cancer (TNBC), an aggressive subtype with poor prognosis, is of higher frequency in African American women and women of Sub-Saharan African origin. In France, legal constraints on obtaining health data on race, ethnicity, or nationality in cancer registries and medical records make it difficult to estimate the frequency of TNBC according to women’s origins. These constraints result from a historical “universalist” approach to French citizenship which prohibits the routine collection of ethnoracial data. An anonymous, statistical survey we conducted from a single-hospital case series of 780 women with breast cancer followed in a university hospital in Paris showed that TNBCs were at least 3 times more common in patients born in Sub-Saharan Africa than in patients born in France. The former consulted at a more advanced stage of the disease than the latter. The results of an ethnographic study of African women in the Paris region with breast cancer, conducted for several years, highlighted some explanatory factors: low breast cancer awareness, perceived causes distinct from biomedical etiology, the weight of shame and secrecy, prior recourse to local healing, difficulties in communicating with health professionals and navigating the healthcare system. Although considered a public health priority, TNBCs are an emblematic example of the limits produced by French race and ethnicity blindness in public health, epidemiology, prevention and health care.

African American women are disproportionately exposed to childhood maltreatment and intimate partner violence (IPV). We examined two dimensions of self-esteem as potential mediators of the childhood maltreatment-IPV association in 232 African American women living below the federal poverty threshold. Three childhood maltreatment subtypes correlated with exposure to physical IPV. Four childhood maltreatment subtypes correlated with exposure to nonphysical IPV and lower self-esteem according to women's self-perceptions (Self) but not their beliefs about how others view them (Other). Lower self-esteem on each dimension was associated with greater exposure to physical and nonphysical IPV. Mediation analyses with bootstrapping revealed that both dimensions of self-esteem were significant mediators. Findings suggest that culturally responsive interventions that bolster self-esteem may mitigate the effects of childhood maltreatment on African American women's relationships.

Interpersonal invisibility is a consequential form of stigmatization but is not well-understood. Existing work has largely focused on who feels invisible (between-person effects) rather than when people feel invisible (within-person effects). Five studies (N = 3,575) examine when people feel invisible. In Studies 1 and 2, Black, East Asian, and White American men and women report how invisible they feel to men and women motivated to protect themselves or to seek a romantic partner. Studies 3, 4, and 5 additionally explore invisibility to same- and other-race people. Results show that invisibility is dynamic: Participants report that they are invisible to some people and not to others, depending on the combination of their own race and gender with the race, gender, and goals of the other person. These findings speak to theories of invisibility and constitute a critical development in our understanding of when and why people feel invisible to others.

This research paper explores the concept of “motherless mothering” among Black women, highlighting the unique challenges faced by those who have lost their mothers prior to becoming mothers themselves. Notably, nearly 40% of Black children experience the death of a parent by age 20, with maternal loss representing a significant portion of these cases. Grounded in the understanding that parental death disproportionately affects Black individuals, this study explores the emotional, psychological, and social consequences faced by Black women navigating the transition to motherhood without a maternal figure. Qualitative data were collected through a questionnaire, resulting in three key findings: participants’ experiences with feelings of abandonment, entrapped grief, and discussing the lack of supportive services for motherless mothers. To address these issues, this paper introduces the Parent-Parental Loss (PPL) framework, a new model developed by the study’s first author to elucidate and support the unique experiences of motherless mothers. By investigating the intersections of grief, motherhood, and communal structures, and applying the PPL framework, this study seeks to advance understanding of Black women’s lived experiences as motherless mothers.

ABSTRACT In Eveleen Mason's Hiero-Salem (1889), a little-known American utopian novel, feminist politics are undergirded by a religion focused on Divine Motherhood. While this connection between “God as a mother”, and feminist social vision, is not unique among literary utopias of the late nineteenth and early twentieth century, Mason's is unusual for drawing on esoteric religion to ground its socio-political ethic – a mystical mode of spirituality that could often be obscure and otherworldly. Here it is shown that Mason's “revelation” of divine motherhood entails a politics of women's emancipation and public leadership, and the reconfiguring of society as a feminist co-operative. Moreover, Hiero-Salem models a strikingly diverse utopian community in terms of race, ethnicity, national background and religious practice, which contrasts with the white supremacy and nativism assumed in most white American women's feminist utopian texts of the period – albeit with limitations. Mason's feminism and multi-culturalism are grounded in the esoteric religious principle of uniting differences (gendered, racial etc) to create the ideal humanity in which the divine is realised. Mason's novel is here reclaimed as a meaningful contribution to the utopian genre, and to late-nineteenth-century debates on religion, feminism, and modern American nationhood.

Compared to European American women, African American women are more likely to be diagnosed with triple-negative breast cancer (TNBC). This difference may be partially due to genetic factors. This study aims to investigate associations of African ancestry and risk variants with TNBC among African American women. We used data from 2,335 TNBC cases, 8,159 estrogen receptor (ER)-positive cases, and 9,814 controls included in the African-ancestry Breast Cancer Genetics (AABCG) Consortium. The proportion of African ancestry (%AFR) and local ancestry were estimated using samples from the 1000 Genomes Project as reference. Logistic regressions were performed for case-control (TNBC vs. control) and case-case (TNBC vs. ER-positive) comparisons, adjusted for age, study, genotype principal components 2-5, body mass index, and reproductive factors. Local ancestry-aware association analyses were conducted in 12 TNBC risk loci to identify ancestry-specific risk variants. In case-control analyses, no statistically significant association was found between %AFR and TNBC risk after adjustment for potential confounders. However, TNBC cases had a significantly higher mean % AFR (mean = 0.811, standard deviation, SD = 0.104) compared to ER-positive cases (mean = 0.798, SD = 0.110, P < 0.001). Females with %AFR of ≥ 95% had 1.62 times higher odds (95% confidence interval, CI: 1.16-2.25) of having TNBC rather than ER-positive breast cancer, compared to those with %AFR of 55.0-64.9%. Local ancestry-aware association analyses identified seven subtype-informative variants in or near MDM4, RP11-19E11.1, TERT, MRPL36, TCF7L2, C11orf65, and ANKLE1. All of them were significantly associated with TNBC as compared with ER-positive cases, and six of them were also associated with TNBC risk in case-control analyses. Large allelic odds ratios of 1.25 or higher were found in association with TNBC risk or subtype classification. The risk allele frequency for five of them is substantially higher in haplotypes of African ancestry than those of European ancestry. These findings support a significant role of African-ancestry specific genetic factors in determining breast cancer subtypes and highlight the need for future research to uncover possible pathways driving TNBC susceptibility.

Hypertension and preeclampsia are clinically distinct, yet biologically related conditions characterized by vascular dysfunction and elevated cardiovascular risk. Although genome-wide association studies (GWAS) have identified loci associated with blood pressure traits and preeclampsia, the functional mechanisms linking shared variants to gene regulation and clinical phenotypes remain unclear. We integrated GWAS summary statistics for hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and preeclampsia to identify shared variants (p ≤ 1×10⁻⁴). Cis-expression quantitative trait loci (eQTL) analyses were performed in whole blood using RNA-seq data from 180 African American women. Significant associations (FDR ≤ 0.05) were evaluated for replication across vascular, metabolic, and endocrine tissues in the Genotype-Tissue Expression (GTEx) project. Associations between gene expression and blood pressure traits were also assessed. We identified 4,792 shared GWAS variants, of which 4,663 were tested in eQTL analyses, yielding 1,837 significant variant-gene associations across 78 genes. Replication in GTEx confirmed 645 associations involving 24 genes, many showing cross-tissue regulatory effects. Three genes (C4B, HLA-C, and HLA-DQB1) demonstrated convergent evidence across GWAS, gene regulation, and expression-trait analyses. C4B expression was positively associated with hypertension and SBP, while HLA-C showed consistent negative associations with hypertension, SBP, and DBP. HLA-DQB1 expression was specifically associated with DBP, suggesting trait-specific effects. These findings highlight immune-related pathways as key mediators linking hypertension and preeclampsia. Integrating genetic, transcriptomic, and phenotypic data provides a framework for identifying functionally relevant loci and advancing mechanistic insights into cardiometabolic and pregnancy-related disorders. Shared genetic variants across hypertension, blood pressure traits, and preeclampsia converge on immune regulatory genes linking gene regulation to clinical phenotypes. GWAS summary statistics for hypertension, SBP, DBP, and preeclampsia were intersected to identify 4,792 shared variants, of which 4,663 were tested in cis-eQTL analyses in whole blood from 180 African American women ( left ). Shared variants regulate immune-related genes through cis-eQTL effects, yielding 1,837 associations involving 78 genes (FDR ≤ 0.05). Three convergent genes emerged: C4B (upregulated), HLA-C (downregulated), and HLA-DQB1 (upregulated), with 645 associations involving 24 genes replicated across eight tissues in GTEx ( center ). Expression-trait analyses confirmed that C4B expression was positively associated with hypertension and SBP, HLA-C expression was negatively associated with hypertension, SBP, and DBP, and HLA-DQB1 expression was specifically associated with DBP. These genes implicate complement activation, antigen presentation, and adaptive immunity as shared mechanisms contributing to vascular dysfunction in both hypertension and preeclampsia. eQTL indicates expression quantitative trait locus; FDR, false discovery rate; GTEx, Genotype-Tissue Expression project; SBP, systolic blood pressure; DBP, diastolic blood pressure; APC, antigen-presenting cell; TCR, T-cell receptor; MHC, major histocompatibility complex.

Asian American women represent a significant portion of the healthcare workforce, but there has been little research on their experiences of workplace bias, such as microaggressions and discrimination. To describe the experiences of Asian American women healthcare workers (HCWs) on the issues of race, gender, and workplace bias within healthcare organizations. Semi-structured qualitative interviews were conducted via video-conferencing from July 2022 to March 2023. Twenty-five participants who self-identified as Asian American women and worked in the Pacific Northwest were interviewed. Participants held a variety of professional roles, such as nursing assistants (CNAs), medical assistants (MAs), nurses (RNs), advanced practice providers (APPs), and physicians. They were employed in various medical and surgical specialties and worked in both clinics and hospitals in urban and rural settings. The types of workplace bias experienced by Asian American women HCWs, their impact on participants, and how participants coped with these experiences were recorded through one-on-one interviews with study authors. These interviews were transcribed and analyzed using an inductive approach to thematic analysis. Participants reported a variety of interpersonal microaggressions and organizational discrimination with impacts on their wellbeing and career trajectories. Microaggressions included underestimation of a participant's role and competence, stereotypes of homogeneity, assumption of foreignness, and hypersexualization. Participants reported developing a variety of coping strategies to deal with microaggressions and organization-level discrimination. Asian American women HCWs commonly reported facing challenges of racism and sexism and experiencing heightened stress from workplace bias. Healthcare organizations need a greater understanding of these challenges to support women HCWs of color and boost retention of healthcare professionals with diverse backgrounds.

The use of virtual prenatal care is rising, but its effect on the content of care is largely unknown. We examined prenatal care screenings for pregnant women in the United States during the COVID-19 pandemic (2020-2021) and assessed differences in those screenings by mode of prenatal care (ie, any virtual prenatal care vs exclusively in-person care). We used Pregnancy Risk Assessment Monitoring System Phase 8 data. Our analytical sample included mothers who gave birth in 2020 and 2021, received prenatal care, and answered both the mode of prenatal care question and all prenatal care screening questions (N = 22 991). The analytical sample included 28 study sites across the United States. Mothers who used any virtual prenatal care had greater adjusted odds than mothers who used in-person care only of being screened about their knowledge of gestational weight gain (adjusted odds ratio [AOR] = 1.18; 95% CI, 1.08-1.30), cigarette use (AOR = 1.26; 95% CI, 1.02-1.54), alcohol use (AOR = 1.23; 95% CI, 1.01-1.49), intimate partner violence (IPV) (AOR = 1.72; 95% CI, 1.54-1.92), depression (AOR = 1.65; 95% CI, 1.46-1.86), substance use (AOR = 1.41; 95% CI, 1.26-1.59), HIV testing (AOR = 1.33; 95% CI, 1.22-1.46), planned breastfeeding (AOR = 1.55; 95% CI, 1.34-1.78), and planned postpartum birth control (AOR = 1.42; 95% CI, 1.27-1.60). The greatest benefit of virtual prenatal care may be for screening of IPV. However, we cannot definitively attribute increased odds of screenings to virtual care. Further investigation is warranted.

Birth defects can cause significant morbidity and mortality. We examined the prevalence of maternal characteristics and risk factors associated with birth defects and examined their associations with prepregnancy multivitamin/folic acid (MVF) intake and diabetes. Data from 22 jurisdictions participating in the Pregnancy Risk Assessment Monitoring System (PRAMS) survey (2017-2022) of women with recent live births were used. Distributions were calculated for: prepregnancy health factors (MVF intake, diabetes status, obesity, smoking, alcohol use) and for participant characteristics (age, race/ethnicity, educational attainment, pregnancy intention, federal poverty level). Log-binomial regression was used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for the associations between selected characteristics and MVF intake and diabetes. Associations between pregnancy intention and MVF intake stratified by selected characteristics were also examined. Finally, differences in longitudinal MVF intake across jurisdictions were assessed. Almost half (48.2%) of women reported no prepregnancy MVF intake; before pregnancy, 52.0% were overweight or had obesity, 57.9% used alcohol, 15.2% smoked, and 3.1% had diabetes. Prepregnancy MVF intake was associated with increased age (≥ 30 years vs. 25-29: aPRs > 1.10), higher educational attainment (graduate degree vs. ≤ high school: aPR = 1.32, 95% CI: 1.17, 1.49), and intended pregnancies (aPR: 1.50, 95% CI: 1.42, 1.58). Diabetes status was not associated with MVF intake or pregnancy intention. Prevalence of risk factors for birth defects was high, and differences exist across groups of women. Findings from this study can help inform public health interventions on risk factors that may help improve birth outcomes.

The risk of contralateral breast cancer (CBC) is higher in Asian American and Hispanic breast cancer survivors than in non-Hispanic White survivors. We investigated the role of immigration and social factors in CBC. A pooled cohort (N = 4,269) of Asian American and Hispanic women diagnosed with stage I to III first primary breast cancer (FBC) from 1993 to 2009 was linked with the California Cancer Registry; 131 Asian American and 135 Hispanic women with CBC diagnosed >180 days after FBC diagnosis were identified. We assessed associations of multilevel immigration and social factors (birthplace, language preference, education, socioeconomic status (SES), and other neighborhood characteristics) with the risk of CBC overall and by race/ethnicity and age at FBC diagnosis (<50, ≥50 years). We also assessed the mediating effect of FBC stage. CBC risk was higher for Hispanic women with Spanish versus English language preference (HR = 1.43; 95% confidence interval, 1-2.05). Neighborhood factors (ethnic enclaves, racial/ethnic composition, SES) were not associated with CBC risk in either racial or ethnic population. For stage II/III versus stage I FBC, odds ratios associated with non-US versus US birthplace (Asian American and Hispanic) and Spanish versus English language preference (Hispanic) ranged from 1.28 to 1.42. There was no evidence that FBC stage mediated the associations between immigration and social factors and CBC risk. Non-English language preference may be associated with higher CBC risk in Hispanic women but not in Asian American women. Hispanic women with a Spanish language preference may benefit from interventions addressing challenges in access to care and treatment that adversely affect CBC risk.

In 2016, prenatal HIV testing in the United States was integrated into a new obstetric panel with other recommended tests. We examined prenatal screening rates for HIV and the impact of the introduction of the new obstetric panel on HIV testing rates among commercially insured pregnant women. We used MerativeTM MarketScan® Research Databases to identify pregnant women aged 15-49 years and calculated annual rates of testing with the new obstetric panel (80081), old obstetric panel (80055), individual prenatal laboratories plus HIV tests, and total HIV testing in the United States from 2011-2022. We used generalized multivariable Poisson regression model to explore the factors associated with the utilization of the new panel code and binomial logistic regression-based inverse probability weighting to estimate the impact of the new obstetric panel code on HIV testing rates. Overall HIV testing among pregnant women increased from 75.3% in 2011 to 90.0% in 2022. The use of the new panel rose from 10.1% in 2016 to 32.1% in 2017. The introduction of panel 80081 led to HIV screening in approximately an additional 4.9% of all pregnancies that otherwise would not have been tested. Among pregnant women with private insurance in the United States, the implementation of obstetric panel 80081 significantly increased HIV testing since its introduction in 2016, which is now at 90% of pregnancies. However, there remain some missed opportunities for prevention and care. Bundling prenatal tests for ease of ordering represents an effective approach to reach public health goals.

African American (AA) women face disproportionate cardiovascular disease (CVD) risk due to adverse social determinants of health (SDoH), including lower socioeconomic status (SES). Physical activity (PA) and plasma extracellular vesicles (EVs) modulate CVD risk, but their relationships with SDoH remain unclear. This study examines associations between SDoH, PA, and plasma EVs in a Washington, DC-based cohort of at-risk AA women. Participants (N = 24, Age: 57 ± 12, BMI: 35 ± 6, ASCVD: 9 ± 5) joined the Step It Up Community-Engaged, Digital Health Physical Activity Intervention pilot study. EVs were isolated from fasting plasma samples. Multivariable regression, adjusted for BMI and ASCVD 10-year risk, showed that neighborhood socioeconomic deprivation (NSD) was associated with decreased EV size (β=-0.49, p = 0.01), while higher daily step count was associated with increased EV size (β = 0.48, p = 0.02). EV miRNA cargo, including miR-1246, miR-28-5p, and miR-765, showed distinct expression patterns with EV size, NSD, and PA. In vitro, endothelial cell (EC) barrier integrity directly correlated with miR-28-5p (r = 0.73, p = 0.007) and miR-765 (r=-0.58, p = 0.049). EC migration correlated negatively with miR-28-5p (r=-0.67, p = 0.02). Findings highlight smaller EV size associated with high NSD and low PA, suggesting miR-28-5p may be a biomarker or mediator for CVD pathogenesis. PA interventions may mitigate adverse SDoH effects and establish EV miRNA cargo as biomarkers and/or intervention mediators.

The interplay between loneliness, cortisol, and NK cell function: The role of cortisol in NK cell dysfunction.