African American Females Research Articles

Sustained control of recalcitrant chronic spontaneous urticaria after initiation of inflammatory airway diseases treatment: two case reports

BackgroundCurrent classification of chronic urticaria is primarily based on clinical presentation of skin manifestations. Hence, therapeutic treatment is primarily aimed locally for immediate symptom relief. We reason that limiting therapeutic strategies to the skin pathology might be inadequate since cellular activation and inflammation might be triggered remotely.Case presentationIn this series two patients had exhausted all current treatments for recalcitrant urticaria but remained symptomatic. The first case was 26-year-old Caucasian female and the second was 63-year-old African American female. Both cases had frequent breakthrough urticaria requiring frequent pulsating courses of prednisone to control urticaria despite treatment with omalizumab and antihistamines. When inflammatory airway disease was discovered and managed with inhaled corticosteroid, urticaria is controlled much faster without the need of high dose immunosuppression over several years of observation. Coincidentally, autoimmune thyroiditis and anti-immunogobulin-E immunoglobulin-G titers dropped significantly in one case with sustained inhaled corticosteroid therapy.ConclusionsWe suggest a novel approach of controlling remote epithelial site inflammation in these two cases that resulted in sustained-control of urticaria symptoms without the need for systemic corticosteroids or immunosuppressant. The changes of autoimmune antibodies might be the consequences of tolerance breaking from chronic lower airway inflammation as observed in other epithelial inflammatory condition like in celiac disease and rheumatoid arthritis.

Electroconvulsive Therapy in the United States: A 2022 Survey of Practice.

This study aimed to describe current US electroconvulsive therapy (ECT) practice, identify practice changes over time, and inform discussion of practice. Our anonymous survey was open on SurveyMonkey.com from January to June 2022. We sent invitations to providers identified using a Medicare provider database, an advanced PubMed search function, and professional group listservs. Participants were instructed to submit 1 survey per ECT site. We examined frequency of responses, tabulated individual comments, and grouped data for comparison. We received responses from 74 US practice sites encompassing 283 providers. Forty-nine percent (n = 36) of respondents practiced at general academic medical centers, 23% (n = 17) at general medical centers, 16% (n = 12) at freestanding psychiatric hospitals, and 7% (n = 5) at Veterans Affairs medical centers. Proportions of female (29%) and Black or African American (AA) (1%) ECT providers were markedly lower than proportions of female (60%) and Black or African American ECT patients (10%). The median number of treatments for a major depressive episode was 10. The preferred electrode placement was right unilateral (66%, n = 45). The favored dosing strategy was seizure threshold titration. Quantitative outcome measures were used by 89% (n = 66) of sites for depressive symptoms and 84% (n = 62) for cognitive adverse effects. This survey is the first nationwide survey of ECT practice in nearly 40 years. Our results describe changes in practice over time and highlight the need to increase the number of female and Black or African American ECT providers. A comprehensive network of ECT sites could facilitate more frequent nationwide surveys.

Relation Between Locus of Control, Personality Traits and Academic Achievement

As the development of the psychology, people conceive the thought to know themselves in depth and curious the relation and consequence of each personality trait will have and how external factors will affect them. Hence after the idea of locus of control was developed, study over locus of control and other characteristics is endless. This article aims to find the relation between locus of control and personal traits when adding the consideration of academic achievement. The author uses data from a study of a group of elder African American female that has age of 65 and older in U.S. collected in between 1999 and 2000. This article focus on the internal control, also known as agency, represent locus of control and personality traits will be represented by self-esteem and self-efficacy. The academic achievement will be reflected by educated time. The method of this article is using STATA regression analysis to see the correlation between each variable. In conclusion, in general the correlation between self-esteem or self-efficacy and internal control become more and more stronger as the education increase, i.e., for high education group, the higher self-esteem or self-efficacy one has, the more internal control one has. This logic is bidirectional. For additional summary in responding the actual influence to self-esteem or self-efficacy and further extended to locus of control brought by education variable, increasing the education level or academic achievement will improve the mental health and efficiency on working or studying to some extent.

The Relationship Between Live Births and CVD Among African American Women in Jackson Heart Study

Background Previous studies have reported mixed results on the relationship between live births and cardiovascular disease among African American females, with few controlling for an inclusive list of major cardiovascular disease (CVD) risk factors and/or including a large population of African American female participants. Methods To help clarify this issue we examined the relationship between live births and cardiovascular events, including major CVD risk factors in a well-studied, exclusively African American cohort. Data was from 3367 African American women, 21 and older, in the Jackson Heart Study. Myocardial Infraction (MI), Self-reported history of cardiac procedures, Coronary Heart Disease Status/History, Self-reported history of Carotid Angioplasty, Cardiovascular Disease history, and Heart Failure History were obtained from 2000 to 2004 interviews. Live births were self-reported. Chi-square test indicated a significant association between live births and the presence of CVD (p =.000). Logistic regression estimated the relationship between live births and cardiovascular events, adjusting for major cardiovascular risk factors. Results After adjusting for hypertension status, current smoking status, cholesterol status, diabetes status, family history of heart diseases (mother), family history of heart disease (father), age, frequency of alcohol use in the past 12 months, and the average number of drinks per week in the past 12 months, there was no longer a significant relationship between live births and the risk of CVD (AOR 1.012, 95% CI, 1.009-1.015, p=.895). Discussion The unadjusted significant relationship between live births and CVD events disappeared after adjusting for major CVD risk factors, which suggests that an association between live births and CVD is indirect and based on the distribution of CVD risk factors. Conclusion Therefore, we propose more research on the use of live births as a CVD indicator in African American/Black women to ensure that African American/Black women obtain optimum cardiovascular health and make informed reproductive decisions.

Spinal Plasmacytoma Transformed Into Solitary Sacral Amyloidoma: A Case Report

Amyloidoma is a rare complication of plasmacytoma, that can involve the spine and present with compressive neurological symptoms. It is usually a diagnosis of exclusion, and is difficult to differentiate from other plasma cell disorders on imaging. Definite diagnosis requires a tissue biopsy. The treatment requires a multidisciplinary approach, with input from haematology, neurology, neurosurgery, and radiology for the optimum course of action, depending on the patient’s comorbidities and performance status. The authors hereby present a case of solitary sacral amyloidoma in a 52-year-old African American female. Only three other cases of solitary sacral amyloidoma have been reported in the literature.

IMPACT OF THE WALK ON! COMMUNITY WALKING PROGRAM ON PSYCHOSOCIAL ATTRIBUTES OF OLDER AFRICAN-AMERICAN WOMEN

Abstract Walking in a structured community setting can improve function for older adults with functional limitations. In collaboration with others, recreation therapy (RT) and physical therapy (PT) students and faculty implemented the Walk On! program at a community church. Twenty-four African American females initially started the 11-week program and agreed to engage in the research aspect by completing pre/post-tests focused on physical function and quality of life, loneliness, and a geriatric depression scale. The hour-long biweekly intervention included warm up/cool down stretching, music, group motivation, walking around the large multipurpose room, and various balance activity stations interspersed. PT and RT students as well as faculty and community partners provided leadership and encouragement. Results were analyzed for 14 participants who completed all tests, as well as 75% of sessions. Data for the Geriatric Depression Scale and UCLA Loneliness Scale were analyzed using the Wilcoxon Signed Rank test. No statistical differences between pre/post-test scores were found. Visual inspection of GDS scores showed four participant scores increased slightly, meaning reporting more elements of depression, and one score decreased by 50%, indicating a drop from depression to not an issue. No changes were found in the other nine scores. The Loneliness Scale had slight changes for five participants with two increasing and three decreasing slightly. On the SF-36 Health Survey, Vitality increased or fatigue decreased (p=0.009) and Mental health or wellbeing increased (p=0.041). Further research on the psychosocial aspects of the Walk On! program in other populations will be conducted.

Exploring Domestic Violence and Child Abuse in Select Novels of Toni Morrison

Violence against African American females, young and old, is an irresistible concern in the novels of Toni Morrison. Her best fictional pieces, ‘The Bluest Eye’, ‘Beloved’, and ‘God Help the Child’ are the vibrant spotlight of domestic violence and child abuse in variegated natures. Toni Morrison has dealt profusely with all sorts of child maltreatment in her oeuvre. In many of her narratives, Morrison weaves a tangled web of childhood trauma stories, in which all the characters have suffered some kind of abuse like racial discrimination, neglect, witnessing domestic violence, emotional and psychological abuse, molestation, sexual exploitation, verbal abuse, etc. She shows how the child’s exposure to traumatic experiences has far-reaching negative effects on adulthood, such as psychological, emotional, behavioral, and social. Morrison explores the curse of the past, the legacy of slavery and its aftermath, and its hold on the present, through the sociocultural phenomenon. Racism and intra-racial discrimination based on skin color result in childhood trauma. The sexual abuse of Pecola, the girl desiring the bluest eye by her drunken father has been very vividly picturized in the backdrop of racial conflict in ‘The Bluest Eye’. Morrison’s ‘Beloved’ fictionized the gruesome murder of an infant with a jigsaw by her mother, Sethe only to avoid escaping a slave. God Help the Child chronicled the ramifications of child abuse and neglect through the tale of Bride, a black girl with dark skin being born to light-skinned parents. Moreover, magic realism, socio-political aspects, and Toni Morrison’s lucid narratives provide ultra energy promoting her vivid message.

Occurrence of sleep disorders, anxiety, and depression among patients with mild cognitive impairment and Alzheimer’s disease in diverse populations: A large nationwide electronic health record cohort study

AbstractBackgroundPatients affected with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) often experience anxiety, depression, and sleep disturbances. Some of the published studies reported a higher incidence of these disorders in minority populations. The objectives of this study were to characterize the occurrence of sleep disorders, anxiety, and depression among patients with MCI and/or AD, stratified by gender, age and race/ethnicity in the United States clinical practice setting.MethodA retrospective cohort study was conducted using electronic health records and insurance claims from the Optum® Market Clarity database containing data from more than 63 million people in the US insured through Medicare, Medicaid, and other insurance providers. The study included patients diagnosed, utilizing ICD diagnosis codes, with MCI and/or AD between January 2017 and September 2021. Prevalence of depression, anxiety, and sleep disorders, as well as associated medication prescriptions, were identified in the 12 months before and after MCI and/or AD diagnoses. The occurrence of these diagnoses and prescriptions was evaluated stratified by gender, age, and race/ethnicity.ResultA total of 197,346 patients were diagnosed with MCI (56.9% female, mean age of 70.0 [SD 14.8]) and 144,321 with AD (63.9% female, mean age of 79.3 [SD 8.2]) at the baseline. Overall, a large proportion of MCI and AD cases had depression (pre‐MCI diagnosis: 40.3%; post‐MCI diagnosis: 44.8%; pre‐AD diagnosis: 32.2%; post‐AD diagnosis: 38.3%), anxiety (pre‐MCI diagnosis: 36.2%; post‐MCI diagnosis: 40.2%; pre‐AD diagnosis: 26.4%; post‐AD diagnosis: 31.5%), and sleep disorders (pre‐MCI diagnosis: 36.2%; post‐MCI diagnosis: 39.3%; pre‐AD diagnosis: 23.2%; post‐AD diagnosis: 25.4%). Occurrences of depression and anxiety were highest among females. Among individuals with MCI and/or AD, the gap between the proportion experiencing depression and the proportion prescribed an antidepressant was greatest for African American males and females. This was not observed for anxiety and anti‐anxiety medications.ConclusionA large proportion of individuals with MCI and/or AD also had depression, anxiety, and sleep issues. Further understanding of the populations with these comorbidities and their associated prescriptions by different ages, sex, and races/ethnicities is important when supporting patients with MCI and AD.

Multi‐level Factor Analysis of Daily Data to Identify Subsyndromes of Behavioral and Psychological Symptoms

AbstractBackgroundBehavioral and psychological symptoms in dementia (BPSD) are dynamic phenomena with a high amount of intraindividual variability. Many studies have used single‐level factor analysis approaches to identify subsyndromes of BPSD based upon meaningful groupings of co‐occurring symptoms yet, proposed subsyndromes have not been successfully replicated and lack stability over time. This may be due to measurement issues which do not account for dependencies in the data and create temporal misalignment. We applied an innovative multi‐level framework to overcome limitations of prior research to identify subsyndromes of BPSD.MethodsThis study used an intensive longitudinal design in which co‐residing family caregivers to persons living with dementia in the community were recruited to proxy‐report on their care recipient’s daily symptom experiences of 23 different BPSD for 8 consecutive days. A multi‐level exploratory/confirmatory factory analysis was utilized to account for nested data and separate within‐person variances from between‐level factor estimates.ResultsFamily caregivers (N = 70) were on average African American (54%) females (69%) most often caring for a parent with dementia (62%) average 74 years old requiring assistance with 4.5/7 activities of daily living. Data were provided on 79% of sampled days (n = 443 diaries). Exploratory factor analysis identified a 4‐between 3‐within factor structure based on fit statistics and clinical interpretability. The between‐level subsyndromes include wandering/aggression/care resistance (F1), affective/apathy/psychosis/vocalizations (F2), cognitive/ lability/ euphoria/ impulsivity/ compulsions (F3), and hallucinations/uncooperative (F4). Reliability estimates were high: 0.88 (F1), 0.91 (F2), 0.83 (F3), and 0.79 (F4).ConclusionThe between‐level factor structure identified through the multilevel factor analysis framework provide a more valid and reliable estimation of clinical subsyndromes within a population by separating out the variance due to within‐person daily fluctuations. At the between‐level, hallucinations was the only BPSD to cross‐load, which may indicate they are a byproduct of unmanaged depression in the affective/psychosis factor and their own unique subsyndrome. Support for the between‐level subsyndromes can be found in studies on shared neurobiological mechanisms of BPSD. The within‐level factors are similar to structures found in a recent systematic review. We argue these within‐level factors are more representative of symptom clusters, as they are driven by fluctuating contextual factors.

Treatment Outcomes and Prognostic Factors with Lenalidomide, Bortezomib, and Dexamethasone (RVd) Alone Versus Rvd Plus Autologous Stem Cell Transplantation (ASCT) in African American (AA) Patients (Pts) with Newly Diagnosed Multiple Myeloma (NDMM) in the Determination Phase 3 Trial

Background AA pts with NDMM have equal or longer overall survival (OS) vs White pts when treatment access is equal (Fillmore, Blood 2019; Dong, Blood Cancer J 2022). DETERMINATION included one of the largest cohorts of AA pts in prospective NDMM trials (n=132/722, 18.3%). The overall progression-free survival (PFS) difference (RVd-alone vs RVd+ASCT; median 46.2 vs 67.5 months [mos]; hazard ratio [HR] 1.53) was not seen in AA pts (HR 1.07; Richardson, N Engl J Med 2022). Multivariable PFS analyses, overall and by arm, showed that prognostic factors may vary according to treatment received, potentially indicating differences in MM pathobiology; PFS in AA vs White pts was longer with RVd-alone (HR 0.58) but similar with RVd+ASCT (HR 0.95) (Hassoun, EBMT 2023). We build upon this prior work with new analyses to explore outcomes with RVd-alone vs RVd+ASCT in AA and White pts. Methods Pts aged 18-65 y received RVd (3 cycles), stem cell mobilization, then 5 more RVd cycles (RVd-alone: n=357; 66 AA, 268 White) or ASCT and 2 more RVd cycles (RVd+ASCT: n=365; 66 AA, 272 White), and then R maintenance. We analyzed PFS (primary endpoint) by race, with exploration of potentially confounding effects of body mass index (BMI) and sex. Treatment exposure, response, event-free survival (EFS; events: progressive disease [PD], death, non-protocol therapy [NPT]), OS, and safety by race were evaluated. Exploratory genomic analyses in a subset of pts assessed frequency of Duffy-null genotype, a common variant in AA pts associated with lower circulating neutrophil count without increased infection risk that may have a key role in cytokine homeostasis (Jinna, Cells 2022). Results AA pts were younger and more commonly female than White pts, as seen in the GRIFFIN study (Nooka, Blood Cancer J 2022), with higher rates of ECOG PS >0, BMI ≥30, LDH >ULN, and low hemoglobin (panel A). Of 153 samples tested to date, 13 (8.5%) were Duffy-null: 11/17 (64.7%) AA and 2/136 (1.5%) non-AA pts. Median treatment duration from randomization (cycle 2) in AA and White pts, respectively, was 27.5 and 28.7 mos (RVd-alone) vs 36.1 and 36.2 mos (RVd+ASCT); 16% of AA and 13% of White pts discontinued within the first 3 RVd cycles due to adverse events (AEs; 5%/3% of AA/White pts), pt/investigator decision (5%/6%), PD (3%/3%), death (2%/<1%), or other reasons (2%/1%). In the 79%/86% of AA/White pts (RVd+ASCT) who underwent ASCT on study, transplant parameters were similar. 77%/83% of AA/White pts on the RVd-alone arm and 74%/80% on RVd+ASCT started R maintenance; median duration was 43.3/35.8 mos and 45.2/40.4 mos, respectively. In AA/White pts, median % of cycles with mean R dose >10 mg was 78%/88% (RVd-alone) and 83%/58% (RVd+ASCT). At data cut-off, of pts who started maintenance, 35%/25% of AA/White pts on the RVd-alone arm and 35%/29% on the RVd+ASCT arm were ongoing, and 65%/75% and 65%/71% had discontinued (including 37%/57% and 33%/37% due to PD), respectively. AE data are shown in panel B. Odds of achieving ≥CR were greater with RVd-alone vs RVd+ASCT in AA pts and were lower for AA vs White pts on the RVd+ASCT arm (panel B). Median PFS (RVd-alone vs RVd+ASCT) was not reached (NR) vs 61.4 mos (HR 1.07) in AA pts and 44.3 vs 67.2 mos (HR 1.67) in White pts. PFS with RVd-alone vs RVd+ASCT was longer in AA pts with BMI ≥30 (median NR vs 58.6 mos, HR 0.74), but shorter in AA pts with BMI <30 (66.4 mos vs NR, HR 1.86) and White pts with BMI <30 (45.3 vs 82.3 mos, HR 1.78) or ≥30 (41.1 vs 64.4 mos, HR 1.58). The PFS with RVd-alone vs RVd+ASCT was similar in male (HR 1.28) and female (HR 0.90) AA pts but shorter in male (HR 1.47) and female (HR 1.85) White pts. With RVd-alone vs RVd+ASCT, median EFS was 47.7 vs 48.2 mos (HR 0.99) in AA pts and 31.7 vs 46.7 mos (HR 1.30) in White pts; 5-y OS was 83.2% vs 78.7% (HR 0.99) in AA pts and 77.1% vs 80.3% (HR 1.08) in White pts. Among AA/White pts off study treatment, 64%/77% had received NPT; 27%/28% (RVd-alone arm) had received ASCT as NPT. Conclusions Our analyses suggest that PFS, EFS, and OS were similar with RVd-alone and RVd+ASCT in AA pts on this study. Importantly, while outcomes with RVd+ASCT were similar in AA and White pts, exploratory analyses suggest AA pts with high BMI and female AA pts may derive more PFS benefit from RVd-alone. Rates of starting maintenance/NPT use were lower in AA vs White pts, but maintenance duration proved longer in AA pts, with similar rates of grade ≥3 hematologic AEs, including neutropenia; analyses of outcomes by Duffy status are ongoing and will be presented.

Gender and Racial Disparities in Risk and Outcomes of Thrombotic Thrombocytopenic Purpura Admissions: An Analysis of the National Inpatient Sample 2016-2019

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare disorder associated with severe deficiency in ADAMTS13 leading to microangiopathic hemolytic anemia, thrombocytopenia and end organ damage. The purpose of this study is to compare incidence and outcomes of TTP hospitalization between genders and races. Methods: We studied the National Inpatient Sample (NIS) from 2016 to 2019 for hospitalizations with the primary diagnosis of TTP. We fitted a multivariable logistic regression model to compare the risk of TTP amongst different races and genders. The model also accounted for age and comorbidities including solid or hematologic malignancies, history of thrombophilia, obesity, diabetes mellitus, hypertension, hyperlipidemia, chronic coronary artery disease, chronic liver disease, and chronic kidney disease. To compare mortality outcomes, we narrowed our analysis to TTP admissions only and fitted a multivariable logistic regression model with similar parameters. All reported confidence intervals were adjusted for multiplicity using the Bonferroni method. Results: A total of 7845 patients met the inclusion criteria of which 65.4% were female and 34.6% were males. The distribution of age and co-morbidities were different between the different racial groups. On adjusted analysis, females had higher rates of hospitalization due to TTP, with OR 1.32 (95% CI 1.24 to 1.41) compared to males, while there was no significant difference in mortality with OR 0.98 (95% CI 0.76 to 1.28). African American patients had significantly higher rates of hospitalization compared to Caucasian patients with OR of 3.62 (95% CI 3.38 to 3.88), followed by Asian and Hispanic patients respectively. Interestingly, the mortality in the African American patients was lower compared to Caucasian patients with OR of 0.74 (95% CI 0.55 to 0.98). There was no significant difference in mortality in other races. Conclusion: African American patients and females experienced significantly higher rates of hospitalization with TTP. However, African American patients experienced lower mortality. More research is needed to understand the cause behind these differences and modify our diagnostic and management to improve outcomes for patients with TTP.

Eliminating Racial Disparities Among Transplant Patients in Multiple Myeloma after Referral to a Tertiary Center

Introduction: Autologous stem-cell transplantation (ASCT) remains an integral part of therapy for many newly diagnosed and relapsed multiple myeloma (MM) patients. Most tertiary centers rely on age, ECOG status, and multi-organ function evaluation to determine eligibility for ASCT. African Americans (AA) have a higher incidence of monoclonal gammopathy of undetermined significance (MGUS), higher incidence of MM and higher mortality rates than their Caucasian counterparts, mainly due to lower access to care. Furthermore, AA patients are also underrepresented in clinical trials. Studies have shown AA patients have similar to improved progression-free survival (PFS) and overall survival (OS) compared to Caucasian patients when similar therapies are offered to both groups; however, lower rates of transplantation are reported among AA patients. This is likely multifactorial in origin, with varying risk factors, biological influences, and social hindrances leading to racial disparity. We sought to examine the differences in rates of ASCT among African Americans vs Caucasian patients. Methods: We conducted a retrospective chart review of all patients with myeloma referred to our center between 2018 and 2022. Information regarding demographics, referral information, insurance and transplant status obtained for all patients referred and/or transplanted at our center were obtained from this chart review. The diagnosis date was obtained from referral records if they were referred from an outside institution. All patients received therapy at the discretion of treating physicians. Statistics are descriptive. Results: 206 AA patients were referred to our center for transplant evaluation, of which 138 underwent autologous transplantation (67%). Additionally, 141 Caucasian patients were referred to us for transplant evaluation, 98 of which underwent ASCT (69%). The transplant rates were similar across both genders among AA patients, with female AA patients accounting for 49% of all AA transplants. Among Caucasian patients, female patients accounted for 37% of all Caucasian transplants. The median referral delay time was 104 days among AA patients and 85 days among Caucasian patients. The median time from the date of referral to transplant was 128 days for AA patients and 124 days for Caucasian patients. The reasons for non-transplant varied between the two races. For African Americans, the most common reason was medical contraindication followed by patient disinterest in contrast to Caucasian patients, which was patient disinterest followed by medical contraindication. Conclusion: Once referred to a tertiary center, we observed no racial disparities among transplants in AA and Caucasian patients. While the median time from the date of referral to the date of transplant was similar across both groups, we noted an increased referral delay among AA patients.

Conflicting Associations among Bioelectrical Impedance and Cardiometabolic Health Parameters in Young White and Black Adults.

The purpose of this cross-sectional evaluation was to determine the associations between raw bioelectrical impedance and cardiometabolic health parameters in a sample of young non-Hispanic White and African American adults. A total of 96 (female: 52, male: 44) non-Hispanic White ( n = 45) and African American adults ( n = 51) between the ages of 19 and 37 yr (22.7 ± 3.83 yr) completed several fasted assessments including resting systolic blood pressure (rSBP), blood glucose (FBG), blood lipids, and bioelectrical impedance spectroscopy. Bioelectrical impedance spectroscopy-derived measurements included phase angle, bioimpedance index (BI), impedance ratio (IR), reactance index (XCi), fat-free mass (FFM), FFM index (FFMi), and absolute (a) and relative (%) total body water (TBW) and extracellular (ECF) and intracellular fluid (ICF). All bioelectric variables were collected at 50 kHz other than IR (250 kHz/5 kHz). Multiple regressions were conducted and adjusted for sex, age, and body mass index. rSBP was positively, and HDL was inversely, associated with all bioelectrical impedance and absolute hydration variables (all P ≤ 0.050) other than XCi for rSBP and XCi and FFMi for HDL. rSBP ( P < 0.001) was inversely, and HDL ( P = 0.034) was positively, associated with IR. FBG was positively associated with BI, XCi, FFM, TBWa, and ECFa (all P < 0.050). Metabolic syndrome severity was positively associated with BI, FFM, TBWa, and ECFa for women (all P ≤ 0.050) and with ICFa for African American women ( P = 0.016). Given the rapid increase in the prevalence of cardiometabolic health risks among young adults and the broad use of bioelectrical impedance in practice, the conflicting associations we observed in this age group suggest that bioelectrical impedance parameters should be used with caution in the context of cardiometabolic health risks and age.

Racial, Ethnic, and Gender Diversity Among Academic Surgical Leaders in the US

Surgical department chairs remain conspicuously nondiverse despite the recognized importance of diverse physician workforces. However, the extent of diversity among non-chair leadership remains underexplored. To evaluate racial, ethnic, and gender diversity of surgical department chairs, vice chairs (VCs), and division chiefs (DCs) in the US. For this cross-sectional study, publicly accessible medical school and affiliated hospital websites in the US and Puerto Rico were searched from January 15 to July 15, 2022, to collect demographic and leadership data about surgical faculty. Two independent reviewers abstracted demographic data, with up to 2 additional reviewers assisting with coding resolution as necessary. In all, 2165 faculty were included in the analyses. Proportions of racial, ethnic, and gender diversity among chairs, VCs, and DCs in general surgery and 5 surgical specialties (neurosurgery, obstetrics and gynecology, ophthalmology, orthopedics, and otolaryngology). A total of 2165 faculty (1815 males [83.8%] and 350 females [16.2%]; 109 [5.0%] African American or Black individuals; 347 [16.0%] Asian individuals; 83 [3.8%] Hispanic, Latino, or individuals of Spanish origin; and 1624 [75.0%] White individuals as well as 2 individuals [0.1%] of other race or ethnicity) at 154 surgical departments affiliated with 146 medical schools in the US and Puerto Rico were included in the analysis. There were more males than females in leadership positions at all levels-chairs (85.9% vs 14.1%), VCs (68.4% vs 31.6%), and DCs (87.1% vs 12.9%)-and only 192 leaders (8.9%) were from racial or ethnic groups that are underrepresented in medicine (URiM). Females occupied more VC than chair or DC positions both overall (31.6% vs 14.1% and 12.9%, respectively) and within racial and ethnic groups (African American or Black females, 4.0% VC vs 1.5% chair and 0.6% DC positions; P < .001). URiM individuals were most commonly VCs of diversity, equity, and inclusion (DEI, 51.6%) or faculty development (17.9%). Vice chairs of faculty development were split equally between males and females, while 64.5% of VCs for DEI were female. All other VCs were predominantly male. Among DC roles, URiM representation was greatest in transplant surgery (13.8%) and lowest in oral and maxillofacial surgery (5.0%). Except for breast and endocrine surgery (63.6% female), females comprised less than 20% of DC roles. Nearly half of DCs (6 of 13 [46.2%]) and VCs (4 of 9 [44.4%]) had no female URiM leaders, and notably, no American Indian, Alaska Native, or Native Hawaiian or Other Pacific Islander individuals were identified in any surgical leadership positions. While it is unclear whether promotion from VC to chair or from DC to chair is more likely, these findings of similar gender distribution between chairs and DCs suggest the latter and may partially explain persistent nondiversity among surgical chairs. Female and URiM surgical leaders are disproportionately clustered in roles (eg, VCs of DEI or faculty development) that may not translate into future promotion to department chairs.

Epigenetic Profiles of Triple-Negative Breast Cancers of African American and White Females

Triple-negative breast cancer (TNBC) is the most aggressive breast cancer subtype and appears to have disproportionately higher incidence and worse outcomes among younger African American females. To investigate whether epigenetic differences exist in TNBCs of younger African American females that may explain clinical disparities seen in this patient group. This cross-sectional study used clinical, demographic, DNA methylation (HumanMethylation450; Illumina), and gene expression (RNA sequencing) data for US patient populations from publicly available data repositories (The Cancer Genome Atlas [TCGA], 2006-2012, and Gene Expression Omnibus [GEO], 2004-2013) accessed on April 13, 2021. White and African American females with TNBC identified in TCGA (69 patients) and a validation cohort of 210 African American patients from GEO (GSE142102) were included. Patients without available race or age data were excluded. Data were analyzed from September 2022 through April 2023. DNA methylation and gene expression profiles of TNBC tumors by race (self-reported) and age were assessed. Age was considered a dichotomous variable using age 50 years as the cutoff (younger [<50 years] vs older [≥50 years]). A total of 69 female patients (34 African American [49.3%] and 35 White [50.7%]; mean [SD; range] age, 55.7 [11.6; 29-82] years) with TNBC were included in the DNA methylation analysis; these patients and 210 patients in the validation cohort were included in the gene expression analysis (279 patients). There were 1115 differentially methylated sites among younger African American females. The DNA methylation landscape on TNBC tumors in this population had increased odds of enrichment of hormone (odds ratio [OR], 1.82; 95% CI, 1.21 to 2.67; P = .003), muscle (OR, 1.85; 95% CI, 1.44 to 2.36; P < .001), and proliferation (OR, 3.14; 95% CI, 2.71 to 3.64; P < .001) pathways vs other groups (older African American females and all White females). Alterations in regulators of these molecular features in TNBCs of younger African American females were identified involving hormone modulation (downregulation of androgen receptor: fold change [FC] = -2.93; 95% CI, -4.76 to -2.11; P < .001) and upregulation of estrogen-related receptor α (FC = 0.86; 95% CI, 0.34 to 1.38; P = .002), muscle metabolism (upregulation of FOXC1: FC = 1.33; 95% CI, 0.62 to 2.03; P < .001), and proliferation mediators (upregulation of NOTCH1: FC = 0.71; 95% CI, 0.23 to 1.19; P = .004 and MYC (FC = 0.81; 95% CI, 0.18 to 1.45; P = .01). These findings suggest that TNBC of younger African American females may represent a distinct epigenetic entity and offer novel insight into molecular alterations associated with TNBCs of this population. Understanding these epigenetic differences may lead to the development of more effective therapies for younger African American females, who have the highest incidence and worst outcomes from TNBC of any patient group.

Evidence2Practice (E2P): Leveraging Implementation Science to Promote Careers in HIV Research Among Students From Historically Black Colleges and Universities.

The HIV research workforce is not representative of populations most affected by the epidemic. Innovative educational programs are needed to motivate diverse student populations to pursue careers in HIV research. The Duke University Center for AIDS Research Evidence2Practice (E2P) program is a 3-day interactive workshop that introduces students from Historically Black Colleges and Universities (HBCU) to HIV pre-exposure prophylaxis, implementation science, and human-centered design. Participants develop 1-page action plans to increase awareness and uptake of pre-exposure prophylaxis on their campus. The program was evaluated using a partially mixed-method concurrent equal status study design with pre-program and post-program surveys and in-depth interviews. Among the 52 participating students, 44 completed the preworkshop survey, 45 completed the postworkshop survey, and 10 participated in an in-depth interview. Most participants identified as Black or African American and cisgender female. Participating in the E2P program was associated with: (1) an increase in median interest in pursuing a career in HIV research (P < 0.01) and (2) a decrease in median perceived difficulty in starting a career in HIV research (P < 0.01). Several students described that a lack of knowledge about initiating an HIV research career, a perceived lack of qualifications and knowledge about HIV science, and limited experience were major barriers to considering careers in HIV research. The E2P program enhanced HBCU students' interest in careers related to HIV research and improved their self-efficacy to pursue such careers. On-campus educational enrichment initiatives, led by active HIV researchers and clinicians, should be a critical part of diversifying the HIV workforce.

Differences in Perceptual and Attitudinal Body Image Between White and African-American Adults Matched for Sex, Age, and Body Composition.

The purpose of this study was to evaluate the differences in perceptual and attitudinal body image between White and African-American males and females matched for sex, age, BMI, and other body composition components using a combination of 3-dimensional mobile digital imaging analysis (DIA) and the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS). One-hundred non-Hispanic White (n=50) and non-Hispanic African-American (n=50) adults (M=34, F=66) matched for sex, age, BMI, and body composition components completed this cross-sectional study. Participants underwent several anthropometric assessments, completed the MBSRQ-AS, and rated their perceived appearance, ideal appearance, and the appearance they believed a partner would find societally attractive using a state of the art mobile 3-dimensional DIA produced using broad developmental populations. Body image distortion was measured as the perceived minus actual appearance, and body image dissatisfaction was defined as the ideal appearance and appearance a partner would find attractive minus the perceived appearance. Using the DIA, only African-American females demonstrated significant body image distortion (p<0.001); reporting perceived appearances significantly lower their than their actual. Further, AA females demonstrated significantly larger differences between their ideal and perceived appearance (p=0.009), perceived larger bodies as more attractive to a potential partner (p=0.009), and reported higher ratings of appearance evaluation (p=0.001) and body area satisfaction (p=0.011) compared to White females. After accounting for all anthropometric determinants of body image, perceptual and attitudinal body image differs between White and African-American adults with differences supporting larger body size acceptance for African-American individuals, particularly African-American females.

Manipulation Under Anesthesia and/or Lysis of Adhesions After Anterior Cruciate Ligament Reconstruction in Female Basketball Players: Does Race Play a Role?

Background: Arthrofibrosis can limit function and return to sport after anterior cruciate ligament (ACL) reconstruction. Previously reported risk factors for developing arthrofibrosis after ACL reconstruction include female sex, age <18 years, time from injury to surgery <28 days, concomitant meniscal repair, prolonged immobilization, and genetic factors. There is a lack of evidence regarding whether race plays a significant role. Hypothesis: The risk of undergoing manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA) after primary ACL reconstruction with bone–patellar tendon–bone (BTB) autograft in female basketball players is higher in African American players than in White players. Study Design: Case-control study; Level of evidence, 3. Methods: Using a computerized relational database, the authors identified competitive female basketball players who underwent primary ACL reconstruction with BTB autograft by the senior author over a 13-year period. Data previously entered from examinations and surgical findings were reviewed retrospectively. Univariate statistics and multivariable logistic regression were used to assess the relationship between undergoing subsequent MUA and/or LOA and study predictors. Results: A total of 186 knees (114 African American knees and 72 White knees) met inclusion criteria. The overall rate of MUA and/or LOA was 8.6%. Thirteen African American knees (11.4%) and 3 White knees (4.2%) underwent MUA and/or LOA for treatment of arthrofibrosis. No study predictor was found to have a statistically significant relationship with the rate of MUA and/or LOA on univariate analysis. However, when controlling for body mass index and previously described risk factors (age <18 years, time from injury to surgery ≤28 days, and concomitant meniscal repair) in the logistic regression model, the authors found that MUA and/or LOA was more likely in African American (odds ratio, 4.01 [95% CI, 1.01-15.92]; P = .049) than in White female players and in patients who underwent ACL reconstruction within 28 days of injury (odds ratio, 4.01 [95% CI, 1.18-13.57]; P = .026) compared with those with surgery delayed beyond 28 days. Conclusion: In female basketball players, the present study found a statistically significantly increased risk for undergoing MUA and/or LOA after primary ACL reconstruction with BTB autograft in African American females compared with White females and in patients who underwent ACL reconstruction within 28 days of injury.

African Americans and Activism

This study aimed to investigate the relationship between psychological well-being and PTSD symptoms in relation to activism orientations among African Americans. Additionally, the study explored the moderating roles of activist self-identity and length of activism involvement in these relationships. A national sample of 298 African American adults was examined, and the following findings were observed: African Americans with a greater inclination toward conventional activism reported higher levels of psychological well-being. Those who self-identified as activists displayed a nearly fourfold decrease in PTSD symptoms. Moreover, older African Americans showed decreased PTSD symptoms and increased psychological well-being compared to younger adults, while African American females reported higher levels of psychological well-being compared to males. Neither high-risk activist orientation nor activist self-identification significantly contributed to the prediction of PTSD symptoms or psychological well-being. Additionally, African American females and older adults with longer durations of involvement in activist organizations reported higher levels of psychological well-being. These findings emphasize the importance of considering age, sex, and duration of activist involvement as contributing factors in understanding variations in mental health. The clinical and community implications of these findings are further discussed.

Examining Trends in Kidney Cancer Mortality by Gender and Race in the United States: A 20-Year Analysis

Abstract Background Kidney cancer (KC) is a significant contributor to cancer mortality worldwide, with gender, racial, and ethnic disparities impacting outcomes. While previous studies have investigated the outcomes of diverse patient populations, gaps in knowledge remain. The incidence of KC has been rising steadily, and it is essential to understand the patterns of mortality to identify and address disparities in healthcare. Therefore, this study aimed to investigate trends in age-adjusted mortality rates (ASMR) by gender, race, and ethnicity in the US at national levels. Methods The Center for Disease Control Wonder database was used to extract national KC mortality data (ICD-10 C64) from 1999-2020. ASMR and 95% confidence intervals (CI) were extracted based on gender and race reported per 100,000 population. Absolute percentage changes were calculated. Joinpoint Command Line Version 4.5.0.1 was used to apply a Joinpoint regression analysis and calculate Average Annual Percentage Change (AAPC). IRB approval was not needed as CDC is an open-source database with de-identified information. Results Over twenty years, 284,224 KC deaths were reported, with an overall decrease in ASMR in recent years. Males had significantly higher ASMR throughout the study period, with a lower decrease than females. Female mortality rates for all racial and ethnic groups declined over the study period, with the largest decrease observed in American Indian/Alaskan Native females (-34.3%). However, American Indian/Alaskan Native females still had the highest mortality rates in 2020. Asian females had the lowest mortality rates throughout the study period, but they only decreased slightly (-8.3%). African American and white females had similar mortality rates that decreased by 25% and 22.2%, respectively. Among males, there was a general decline in mortality rates across all racial and ethnic groups, with the largest decrease observed in American Indian/Alaskan Native males (-44.3%). Despite having lower mortality rates than most other groups, White males had the highest age-adjusted mortality rate (ASMR) of 5.7 in 2020 due to the lack of significant decline. When considering the average annual percentage change (AAPC) over the entire period, the decline in mortality rate was statistically significant for all groups except Asian females. The AAPC ranged from -2.1% for American Indian/Alaskan Native females to -0.4% for Asian females. The steepest decline was observed in American Indian/Alaskan Native males (-2.1%), followed by American Indian/Alaskan Native females (-1.8%) and African American females (-1.7%). Conclusions In conclusion, our study highlights significant gender, racial, and ethnic disparities in kidney cancer mortality rates in the US. Our study underscores the importance of targeted interventions to reduce mortality rates among American Indian/Alaskan Native populations, who consistently had the highest mortality rates in kidney cancer throughout the study period. Additionally, our findings highlight the need for continued attention to male mortality rates at the gender level. The results of this study can inform healthcare policies and practices that aim to address the disparities in kidney cancer mortality rates and ultimately improve the health outcomes of all populations. CDMRP DOD Funding: no