African Ethnicity Research Articles

Religious, Cultural, and Sex Influences on Advance Care Directives in Patients Admitted to a Tertiary Care Center in Kenya

IntroductionAdvance care directives (AD) are instructions from patients regarding the care they would prefer if they could not make medical decisions in the future. It is widely recognized that racial and ethnic as well as sex differences, particularly in the West, can influence AD. However, to the best of our knowledge, there is limited understanding of how these factors impact AD in sub-Saharan Africa. MethodsThis prospective cross-sectional study was conducted at the Aga Khan University Hospital, Nairobi. We enrolled patients above the age of 18 years who were admitted to the general medical wards. The data were collected using a structured questionnaire that consisted of questions based on demographics and AD. Descriptive statistics were used to summarize the data, including frequencies and percentages, as well as medians and interquartile ranges. ResultsThe study involved 286 participants, with a median age of 44.0 years (IQR: 37.0 – 52.0). Roughly half of the participants were male (51.7%), and the majority identified themselves as Christians (77.3%) and of African ethnicity (78.3%). Upon further analysis, it was discovered that only 35.3% had an awareness of AD. Notably, individuals from the Hindu religion and Asian ethnicity demonstrated significantly higher knowledge of AD. Furthermore, more males reported having a living will and believed that AD are crucial for patients who could not make independent medical decisions compared to females. ConclusionThis study indicated a lower awareness and knowledge of AD among the participants. Hindus and Asians exhibited higher levels of awareness regarding AD. Considering the diverse religious and cultural backgrounds in our setting, there is a pressing need for strategies to increase awareness surrounding AD.

Feasibility of a Community Healthy Eating and Cooking Intervention Featuring Traditional African Caribbean Foods from Participant and Staff Perspectives.

Culturally appropriate healthy eating resources are intended to help people from different ethnic backgrounds consume diets reflecting government dietary recommendations, yet evidence on use in the target groups is lacking. This study evaluated the feasibility of a new brief culturally appropriate community intervention that aimed to introduce food-based healthy eating and recipe resources featuring African Caribbean foods, which were recently co-developed with people from these ethnic backgrounds. Working with a community organization in the UK, a single-arm study was used to collect verbal data from participants and staff on the acceptability of intervention whilst knowledge, skills and behaviours related to healthy eating were evaluated using pre-, post- and follow-up questionnaires. A total of 30 participants were recruited, and 22 completed all three questionnaires; who were mostly female aged 55 years+ (n = 17) and of African Caribbean ethnicity (45%, n = 10), with 32% (n = 7) reporting no educational attainment. At post-intervention and follow-up, most participants reported high satisfaction (n = 21, 95%) with the intervention sessions and high levels of confidence in using the resources at home within budget. The number of participants who were familiar with the healthy eating guidance featuring Caribbean foods increased from pre- (36%, n = 8) to post-intervention/follow-up (n = 22, 100%) (p < 0.05). Findings suggest the intervention is feasible in a community setting and could help increase awareness and use of culturally appropriate healthy eating guidance amongst a diverse group.

Predictors of incomplete COVID-19 vaccine schedule among adults in Scotland: Two retrospective cohort analyses of the primary schedule and third dose

BackgroundVaccination continues to be the key public health measure for preventing severe COVID-19 outcomes. Certain groups may be at higher risk of incomplete vaccine schedule, which may leave them vulnerable to COVID-19 hospitalisation and death. AimTo identify the sociodemographic and clinical predictors for not receiving a scheduled COVID-19 vaccine after previously receiving one. MethodsWe conducted two retrospective cohort studies with ≥3.7 million adults aged ≥18 years in Scotland. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) of not receiving a second, and separately a third dose between December 2020 and May 2022. Independent variables included sociodemographic and clinical factors. ResultsOf 3,826,797 people in the study population who received one dose, 3,732,596 (97.5%) received two doses, and 3,263,153 (86.5%) received all doses available during the study period.The most strongly associated predictors for not receiving the second dose were: being aged 18–29 (reference: 50–59 years; aOR:4.26; 95% confidence interval (CI):4.14–4.37); hospitalisation due to a potential vaccine related adverse event of special interest (AESI) (reference: not having a potential AESI, aOR:3.78; 95%CI: 3.29–4.35); and living in the most deprived quintile (reference: least deprived quintile, aOR:3.24; 95%CI: 3.16–3.32).The most strongly associated predictors for not receiving the third dose were: being 18–29 (reference: 50–59 years aOR:4.44; 95%CI: 4.38–4.49), living in the most deprived quintile (reference: least deprived quintile aOR:2.56; 95%CI: 2.53–2.59), and Black, Caribbean, or African ethnicity (reference: White ethnicity aOR:2.38; 95%CI: 2.30–2.46).Pregnancy, previous vaccination with mRNA-1273, smoking history, individual and household severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, and having an unvaccinated adult in the household were also associated with incomplete vaccine schedule. ConclusionWe observed several risk factors that predict incomplete COVID-19 vaccination schedule. Vaccination programmes must take immediate action to ensure maximum uptake, particularly for populations vulnerable to severe COVID-19 outcomes.

Seasonal influence on respiratory tract infection severity including COVID-19 quantified through Markov Chain modelling.

Respiratory tract infections (RTI) are a burden to global health, but their characterisation is complicated by the influence of seasonality on incidence and severity. The Re-BCG-CoV-19 trial (NCT04379336) assessed BCG-(re)vaccination for protection from COVID-19 and recorded 958 RTIs in 574 individuals followed over one year. We characterized the probability of RTI occurrence and severity using a Markov model with health scores for four states of symptom severity. Covariate analysis on the transition probability between health scores explored the influence of demographics, medical history, SARS-CoV-2 or influenza vaccinations which became available during the trial, SARS-CoV-2 serology, and epidemiology-informed seasonal influence of infection pressure represented as regional COVID-19 pandemic waves, as well as BCG (re)vaccination. The infection pressure reflecting the pandemic waves increased the risk of RTI symptom development, while the presence of SARS-CoV-2 antibodies protected against RTI symptom development and increased the probability of symptom relief. Higher probability of symptom relief was also found in participants with African ethnicity and with male biological gender. SARS-CoV-2 or influenza vaccination reduced the probability of transitioning from mild to healthy symptoms. Model diagnostics over calendar-time indicated that COVID-19 cases were underreported during the first wave by an estimated 2.76-fold. This trial was performed during the initial phase of the COVID-19 pandemic in South Africa and the results reflect that situation. Using this unique clinical dataset of prospectively studied RTIs over the course of one year, our Markov Chain model was able to capture risk factors for RTI development and severity, including epidemiology-informed infection pressure.

Spectrum of ascending aortic aneurysms at a peri-urban tertiary hospital: an echocardiography-based study.

Thoracic ascending aortic (TAA) aneurysms are an important cause of disability and death and require early detection for effective management. Currently, there is a paucity of data from Africa pertaining to TAA aneurysms. This study describes the spectrum of TAA aneurysms at a peri-urban tertiary hospital. A descriptive retrospective study based on clinical and echocardiographic imaging data of patients with TAA aneurysms from October 2017-October 2022. Advanced strain imaging was performed to measure left ventricular (LV) basal, apical, and global longitudinal strain as well as circumferential strain (CS) of the ascending aorta as a proxy measurement of aortic compliance. The study comprised 139 cases of TAA aneurysms (52.5% females) with a mean age of 50 ± 14.8 years with 45 age and gender matched controls. Most cases (95%) were of African ethnicity. The main etiologies were hypertension (41.7%), HIV (36.6%), connective tissue disease (10.7%), congenital (2.2%) and mixed pathologies (8.6%). Two-thirds of patients (69.7%) presented in heart failure, 10% presented with aortic dissection. Thirty percent of the patients were classified as New York Heart Association (NYHA) class I, 59.7% NYHA II, 8.6% NYHA III and two patients NYHA class IV. Echocardiography revealed enlarged aortic dimensions compared to controls (P < 0.001). TAA aneurysms were complicated by severe aortic regurgitation (AR) in half (50.3%) of patients, moderate AR in 25.8%, and mild AR in 14.3%. The mean LV ejection fraction (46.9 ± 12.7%) was reduced compared to controls (P < 0.001). Aortic CS was reduced compared to controls [4.4 (3.2-6.2) % vs. 9.0 (7.1-13.4) %, P < 0.001]. Aortic stiffness was higher in the aortic aneurysm group compared to controls (15.39 ± 20.65 vs. 5.04 ± 2.09, P = 0.001). LV longitudinal strain (-13.9 ± 3.9% vs. 18.1 ± 6.7%), basal CS (-13.9 ± 5.6% vs. -17.9 ± 5.8%) and apical CS (-8.7 ± 8.5% vs. -30.6 ± 3.8%) were reduced compared to controls (P < 0.001). Most patients were on diuretic and anti-remodeling therapy. Surgery was performed in 29.4% and overall mortality was 7.9%. Mortality for acute aortic dissection was 40%. TAA aneurysms associated with hypertension and HIV are common in this predominantly African female population and are associated with considerable morbidity and mortality. Two-dimensional echocardiography and advanced strain imaging are potential tools for detecting and risk stratifying TAA aneurysms.

Differences in calculated body fat percentage estimated from published equations based on bioelectric impedance analysis in healthy young South African adults.

Adult overweight and obesity, in addition to the intake of saturated fat and total serum cholesterol must be monitored as biological risk factors for non-communicable diseases (NCDs). Bioelectric impedance analysis (BIA) provides data on body fat for use in epidemiological settings. However, optimized equations should be used to calculate percentage body fat (%BF). The purpose of this study was to assess the differences between %BF calculated using different published BIA equations and %BF measured by BIA in young South African adults. In this observational study, differences in calculated %BF were assessed, with different BIA equations retrieved from the literature used in 1128 healthy young adults aged 20-30 years. The %BF (measured by BIA) was compared between equations, between Black and White men and women, respectively. The results showed statistically significant differences in the %BF calculated from published BIA equations when used in young South African adults (χ² = 946, χ² = 2528, χ² = 2088, respectively, p < 0.0001). In Black and White men and women, respectively, %BF levels were significantly higher when calculated by equations, than when measured by BIA (p < 0.0001). There seem to be large discrepancies in estimating %BF by BIA equations and these values cannot be used interchangeably for young South African adults. A South African age, ethnicity and sex-specific BIA equation needs to be developed to accurately estimate %BF in young South African adults.

Spectrum of ascending aortic aneurysms at a peri urban tertiary hospital: an echocardiography-based study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Thoracic ascending aortic (TAA) aneurysms are an important cause of clinical disability that require early detection by imaging methods for rapid and effective management. There is a paucity of data from Africa pertaining to TAA aneurysms. Purpose To describe the spectrum of TAA aneurysms at a Tertiary hospital in Africa. Methods A descriptive retrospective study was conducted based on clinical and echocardiographic imaging data of patients with clinical diagnosis of TAA, from October 2017-October 2022. Advanced strain imaging using speckle tracking echocardiography was performed to determine the circumferential strain (CS) of ascending aorta as a surrogate of compliance. Left ventricular global longitudinal, and basal and apical circumferential strain were also determined. Results The study comprised 139 cases of TAA aneurysms (52.5% females) with a mean age of 50±14.8 years, and 45 age and gender matched normal controls. Majority were of African ethnicity (95%). Main etiologies were hypertension (41.7%), human immunodeficiency virus (HIV) (36.6%), connective tissue disease (10.7%), congenital (2.2%) and mixed pathologies in 8.6% of patients. Two thirds of patients (69.7%) presented in heart failure and 10% of patients presented with aortic dissection. Thirty percent of the patients were in New York Heart Association (NYHA) class I, 59.7% were in NYHA II, 8.6 % in NYHA III and 1.4% of patients in NYHA class IV. Echocardiography revealed enlarged aortic dimensions compared to controls (P=0.00000). TAA aneurysms were complicated by severe aortic regurgitation (AR) in half (50.3%) of the patients, 25.8% had moderate AR and 14.3% of patients had mild AR. The left ventricular ejection fraction was reduced at 46.9±12.7% compared to controls (P=0.0000). Aortic CS was markedly reduced compared to controls (4.5±4.0% vs 10.3±4.37%, P=0.000). Left ventricular longitudinal strain (−13.9±3.9% vs −18.1±6.7%,P=0.000001), basal CS (−13.9±5.6% vs −17.9±5.8%, P=0.00008) and apical CS (−18.7±8.5% vs −30.6±3.8%,p = 0.0016) were all significantly reduced compared to controls. Majority (&amp;gt;50%) of the patients were on diuretic and anti-remodeling therapy for heart failure. Surgery was performed in 29.4% of patients. The overall estimated mortality was 7.9 %. Conclusion TAA aneurysms associated with hypertension and HIV are common in this population, and are associated with considerable morbidity and mortality. CS of the aneurysmal aorta was significantly reduced translating into stiffer aortas, possibly at risk for further dilation and dissection.

Ten-year trends in incidence and prevalence of atrial fibrillation and flutter in Denmark according to demographics, ethnicity, educational level, and area of residence (2009-2018).

Atrial fibrillation is the most common cardiac arrhythmia and a major global health burden. Updated trends in the epidemiology of atrial fibrillation or flutter (AF) are needed. Using the Danish Heart Statistics, we investigated nationwide trends 2009-2018 in incidence rate and prevalence of AF according to age as well as age-standardized incidence rate (ASIR) and prevalence (ASP) of AF according to sex, ethnicity, educational level, and area of residence. Comparing year 2018 to 2009, we calculated stratum-specific ASIR ratios (ASIRR) and changes in ASP. During 2009-2015 the ASIR for AF increased for both men and women, followed by a decline from 2015-2018. Overall, this resulted in a 9% increase among men (ASIRR: 1.09, 95% CI: 1.06-1.12), but no change among women (ASIRR: 1.00, 95% CI: 0.97-1.04). The ASP increased by 29% among men and 26% among women. An increase in ASIR was observed in all ethnic groups except men of Far Eastern ethnicity. Lower educational level was associated with greater increases in both ASIR and ASP. ASIR and ASP differed slightly between the Danish regions but increased in all of them. During 2009-2018 the incidence and prevalence of AF in Denmark increased although the increase in incidence was transient among women. Factors associated with higher incidence were male sex, higher age, Danish and Western ethnicity as well as Middle Eastern/North African ethnicity among women, and lower educational level. Within Denmark, we observed only minor regional differences in AF incidence and prevalence.

“I am not really into the government telling me what I need to eat”: exploring dietary beliefs, knowledge, and practices among ethnically diverse communities in England

BackgroundCommunities with diverse ethnicity in high-income countries are disproportionately affected by poor diet-related health outcomes. In England, the United Kingdom’s government’s healthy eating dietary resources are not well accepted and are underutilised among this population. Thus, this study explored perceptions, beliefs, knowledge, and practices around dietary intake among communities with African and South Asian ethnicity residing in Medway, England.MethodsThis qualitative study generated data from 18 adults aged 18 and above using a semi-structured interview guide. These participants were sampled using purposive and convenience sampling strategies. All the interviews were conducted in English over the telephone, and responses were thematically analysed.ResultsSix overarching themes were generated from the interview transcripts: eating patterns, social and cultural factors, food preferences and routines, accessibility and availability, health and healthy eating, and perceptions about the United Kingdom government’s healthy eating resources.ConclusionThe results of this study indicate that strategies to improve access to healthy foods are required to improve healthy dietary practices among the study population. Such strategies could help address this group’s structural and individual barriers to healthy dietary practices. In addition, developing a culturally responsive eating guide could also enhance the acceptability and utilisation of such resources among communities with ethnic diversity in England.

Different diabetes

Different diabetes

Cream skimming and discrimination in access to medical care: A field experiment.

This study measures the differences in access to healthcare for female patients in France in three medical specialties (dentistry, gynecology and psychiatry) according to two criteria: the African ethnicity of the patient and the benefit of having means-tested health insurance coverage. To this purpose, we conducted a nationally representative field experiment on more than 1500 physicians. We do not find substantial discrimination against the patient of African origin. However, the results indicate that patients with means-tested health insurance coverage are less likely to get an appointment. Differentiating between two types of coverage, we show that the lesser-known coverage (ACS) is more penalized than the other (CMU-C) as poor knowledge of the program increases the physician's expectation of additional administrative tasks and is an important element to explain cream-skimming. We also find that, for physicians who are free to set their fees, the opportunity cost of accepting a means-tested patient increases the penalty. Finally, the results suggest that enrollment in OPTAM, the controlled pricing practice option that incentivizes physicians to accept means-tested patients, reduces cream-skimming.

People With Type 1 Diabetes of African Caribbean Ethnicity Are at Increased Risk of Developing Sight-Threatening Diabetic Retinopathy.

There is limited information on the effect of ethnicity on the development of referable sight-threatening diabetic retinopathy (STDR) in people with type 1 diabetes. This study describes the risk factors for STDR in a diverse cohort of people with type 1 diabetes attending a regional diabetes eye screening service. Clinical and digital retinal imaging data from 1,876 people with type 1 diabetes (50% women, 72.1% Caucasian, 17.3% African Caribbean, 2.9% Asian, and 7.6% other) with no retinopathy at baseline, attending surveillance eye screening were reviewed. Referable STDR was defined as the presence of any moderate to severe nonproliferative or preproliferative diabetic retinopathy or proliferative diabetic retinopathy or maculopathy in either eye as per U.K. National Diabetic Eye Screening criteria. Median follow-up was 6 years. The median (interquartile range) age of the cohort was 29 (21, 41) years. Of the cohort of 1,876 people, 359 (19%) developed STDR. People who developed STDR had higher baseline HbA1c, raised systolic blood pressure (SBP), longer diabetes duration, and were more often of African Caribbean origin (24% vs. 15.6%; P < 0.05 for all). In multivariable Cox regression analyses, African Caribbean ethnicity (hazard ratio [HR] 1.39, 95% CI 1.09-1.78, P = 0.009), baseline SBP (HR 1.01, 95% CI 1.00-1.01, P = 0.033), and baseline HbA1c (HR 1.01, 95% CI 1.00-1.01, P = 0.0001) emerged as independent risk factors for STDR. We observed that people with type 1 diabetes of African Caribbean ethnicity are at significantly greater risk of STDR. Further research is required to understand the mechanisms that explain this novel observation.

Revolutionizing Literacy: The Life of Omar ibn Said, Written by Himself

The Library of Congress has acquired the Omar ibn Said Collection, including an exceptional artifact, the autobiography of Omar ibn Said, written in ancient Arabic by an African enslaved man. In this article, I analytically examine the role of literacy in Omar ibn Said's life as informed by African cultures, ethnicities, histories, languages, and literacies in the Senegambia region, and the history of Black literacy access in the United States. In Arabic, Omar ibn Said stealthily applied sophisticated literacy skills to contest living under anti-Black racism and chattel enslavement through his rhetorical and strategic use of Qur’anic surahs and verses. Early translations and interpretations of his autobiography, filtered through Eurocentrism and White supremacy, failed to discern Omar ibn Said's proclamation of his humanity and bold condemnation of chattel enslavement. Africanist, Islamist, and Muslim scholars valorize his resilience as an African Muslim man who remained faithful to Islam under anti-Black racism, the horrors of chattel enslavement, and attempts at Christian conversion. They also provide knowledge about centuries of literacy among people of African descent; expose the pervasiveness of White supremacy; and unveil the roots of deliberate anti-Black literacy laws, policies, and practices, historically and contemporaneously. Omar ibn Said's autobiography dismantles prevailing assumptions about people of African descent as sub-human, without culture, history, intellect, language, or literacy. To create an equitable and ethical approach to literacy: We must transcend the past and present, respect humanity, acknowledge literacy as a global construct, understand literacy as a human right, cultivate a critical consciousness, and require authenticated knowledge.

Gestational diabetes in women living with HIV in the UK and Ireland: insights from population-based surveillance data.

The prevalence of gestational diabetes (GD) is increasing globally. While universal risk factors for GD are reasonably well understood, questions remain regarding risks for women living with HIV (WLWH). We aimed to describe GD prevalence, evaluate associated maternal risk factors and assess specific birth outcomes in WLWH in the UK and Ireland. We analysed all pregnancies (≥24 weeks' gestation) in women diagnosed with HIV before delivery, reported to the UK-based Integrated Screening Outcomes Surveillance Service between 2010 and 2020. Every report of GD was considered as a case. A multivariable logistic regression model, adjusted for women with more than one pregnancy fitted with generalized estimating equations (GEE) assessed the effect of independent risk factors. There were 10,553 pregnancies in 7916 women, of which 460 (4.72%) pregnancies had reported GD. Overall, the median maternal age was 33 years (Q1:29-Q3:37), and 73% of pregnancies were in Black African women. WLWH with GD (WLWH-GD) were older (61% vs. 41% aged ≥35 years, p < 0.001) and more likely to be on treatment at conception (74% vs. 64%, p < 0.001) than women without GD. WLWH-GD were more likely to have a stillbirth (odds ratio [OR]: 5.38, 95% CI: 2.14-13.5), preterm delivery (OR: 2.54, 95% CI: 1.95-3.32) and fetal macrosomia (OR: 1.14, 95% CI: 1.04-1.24). Independent risk factors for GD included estimated year of delivery (GEE-adjusted odds ratio [GEE-aOR]: 1.14, 95% CI: 1.10-1.18), advanced maternal age (≥35 years) (GEE-aOR: 2.87, 95% CI: 1.54-5.34), Asian (GEE-aOR: 2.63, 95% CI: 1.40-4.63) and Black African (GEE-aOR: 1.55, 95% CI: 1.13-2.12) ethnicity. Timing and type of antiretroviral therapy showed no evidence of a relationship with GD in multivariable analyses; however, women with a CD4 count ≤350 cells/μl were 27% less likely to have GD than women with CD4 counts >350 cells/μl (GEE-aOR: 0.73, 95% CI: 0.50-0.96). GD prevalence increased over time among WLWH but was not significantly different from the general population. Maternal age, ethnicity and CD4 count were risk factors based on available data. Stillbirth and preterm delivery were more common in WLWH-GD than other WLWH over the study period. Further studies are required to build upon these results.

"Fitting in whilst standing out": Identity flexing strategies of professional British women of African, Asian, and Caribbean ethnicities.

Professional British women of African, Asian, and Caribbean (AAC) ethnicities contend with unique challenges and experiences in the workplace. These challenges are often due to experiences that occur at the intersection of gender and ethnic identity, thus many professional white British women (of Anglo-Saxon decent), do not face the same challenges. AAC women are more often discriminated against, excluded from informal networks, and their contributions credited to someone else. We take an intersectional theoretical approach to better understand both the disadvantaged experiences and the possible advantaged experiences that British AAC women face, based on their experiences as AAC individuals, as women and as AAC women. The study seeks to 'give voice' to the experiences of AAC professional women, due to the limited amount of scholarship that adequately considers their workplace experiences. We consider the ways that their identity produces qualitatively different experiences determined by the context, by the nature of interpersonal encounters or by both the context and interpersonal encounters. We conduct real-time online written interviews and utilize thematic template analysis to understand whether AAC women strategically flex identity at work. We present four major themes. These are (1) the benefits of identity flexing, (2) the role of specific stereotypes, (3) context specific opportunities, and (4) the costs of identity flexing. We draw on literature that suggests that AAC women's identity experiences are not exclusively oppressive. We find that unique experiences, occurring at the intersection of facets of identity may also yield forms of relative advantage, wherein individuals are able to adaptively leverage opportunities. Our results demonstrate that where the facets of one's identity are more varied, there might be more chance that the particular identity will be valued in a given social context. As a result, the individual may try to assimilate with certain identity groups (through flexing), as the context directs. Nevertheless, engaging in identity flexing strategies has costs for women's well-being, such as needing to perform increased amounts of emotional labor and heightened feelings of frustration. Overall, these costs (as well as benefits), evidence the complex nature of identity flexing and the likely negative well-being implications that could ensue for the individual.

Resting-state fMRI functional connectivity and clinical correlates in Afro-descendants with schizophrenia and bipolar disorder

Schizophrenia (SCZ) and bipolar disorder (BD) exhibited altered activation in several brain areas, including the prefrontal and temporal cortex; however, a less explored topic is how brain connectivity and functional disturbances occur in non-Caucasian samples of SCZ and BD. Individuals with SCZ (n=20), BD (n=21), and healthy controls (HC, n=21) from indigenous and African ethnicity were submitted to clinical screening and functional assessments. Mood, compulsive and psychotic symptoms were also correlated to network dysfunction in each group. Two distinct networks' subcomponents demonstrated significant lower global efficiency (GE) in SCZ versus HC, corresponding to left posterior dorsal attention and medial left ventral attention (VA) networks. Lower GE was found in BD versus controls in four subcomponents, including the left medial and right VA. Higher compulsion scores correlated in BD with lower GE in the left VA, whereas increased report of alcohol abuse was associated with higher GE in left default mode network. Although preliminary, differences in the activation of specific networks, notably the left hemisphere, in SCZ versus controls, and lower activation in VA areas, in BD versus controls. Results highlight default mode and salient network as relevant for the emotional processing of SCZ and BD of indigenous and black ethnicity.Abstract: schizophrenia, bipolar disorder, functional neuroimaging, ethnicity, default network

Targeted Next-Generation Sequencing in Children With Bilateral Sensorineural Hearing Loss: Diagnostic Yield and Predictors of a Genetic Cause.

To investigate the diagnostic yield of targeted next-generation sequencing using hearing loss panels and to identify patient-related factors that are associated with a definite genetic cause. Retrospective chart review. Tertiary referral center. Children with congenital or late-onset, bilateral sensorineural hearing loss. Diagnostic. The number of patients with a definite genetic diagnosis. We report on 238 patients with hearing loss: 130 were male and 108 were female. About 55% had congenital hearing loss. A genetic cause was identified in 94 of the patients (39.5%), with 72.3% of these showing nonsyndromic and 27.6% showing syndromic hearing loss. The diagnostic yield was highest among North African patients (66.7%). A multiple linear regression model shows that profound hearing loss, family history of hearing loss, congenital hearing loss, and North African ethnicity are significantly related to identifying a genetic cause. Targeted next-generation sequencing using a panel of hearing loss genes identified a genetic diagnosis in almost 40% of children with bilateral sensorineural hearing loss. We describe the predictors of a genetic diagnosis, and this information may be used during genetic counseling.

Exploring the Cross-cultural Acceptability of Digital Tools for Pain Self-reporting: Qualitative Study.

Culture and ethnicity influence how people communicate about their pain. This makes it challenging to develop pain self-report tools that are acceptable across ethnic groups. We aimed to inform the development of cross-culturally acceptable digital pain self-report tools by better understanding the similarities and differences between ethnic groups in pain experiences and self-reporting needs. Three web-based workshops consisting of a focus group and a user requirement exercise with people who self-identified as being of Black African (n=6), South Asian (n=10), or White British (n=7) ethnicity were conducted. Across ethnic groups, participants shared similar lived experiences and challenges in communicating their pain to health care professionals. However, there were differences in beliefs about the causes of pain, attitudes toward pain medication, and experiences of how stigma and gender norms influenced pain-reporting behavior. Despite these differences, they agreed on important aspects for pain self-report, but participants from non-White backgrounds had additional language requirements such as culturally appropriate pain terminologies to reduce self-reporting barriers. To improve the cross-cultural acceptability and equity of digital pain self-report tools, future developments should address the differences among ethnic groups on pain perceptions and beliefs, factors influencing pain reporting behavior, and language requirements.

Ethnic differences in complement system biomarkers and their association with metabolic health in men of Black African and White European ethnicity.

Inflammation plays a fundamental role in the development of several metabolic diseases, including obesity and type 2 diabetes (T2D); the complement system has been implicated in their development. People of Black African (BA) ethnicity are disproportionately affected by T2D and other metabolic diseases but the impact of ethnicity on the complement system has not been explored. We investigated ethnic differences in complement biomarkers and activation status between men of BA and White European (WE) ethnicity and explored their association with parameters of metabolic health. We measured a panel of 15 complement components, regulators, and activation products in fasting plasma from 89 BA and 96 WE men. Ethnic differences were statistically validated. Association of complement biomarkers with metabolic health indices (BMI, waist circumference, insulin resistance, and HbA1c) were assessed in the groups. Plasma levels of the key complement components C3 and C4, the regulators clusterin and properdin and the activation marker iC3b were significantly higher in BA compared to WE men after age adjustment, while FD levels were significantly lower. C3 and C4 levels positively correlated with some or all markers of metabolic dysfunction in both ethnic groups while FD was inversely associated with HbA1c in both groups, and clusterin and properdin were inversely associated with some markers of metabolic dysfunction only in the WE group. Our findings of increased levels of complement components and activation products in BA compared to WE men suggest differences in complement regulation that may impact susceptibility to poor metabolic health.

Peritoneal dialysis outcomes in a tertiary-level state hospital in Johannesburg, South Africa: Ethnicity and HIV co-infection do not increase risk of peritonitis or discontinuation.

Peritoneal dialysis (PD) is a valuable means to increase access to kidney replacement therapy in South Africa (SA). An increased rate of modality discontinuation related to an increased risk of peritonitis in patients of black African ethnicity, in those with diabetes and in those living with HIV has previously been suggested, which may lead to hesitancy in adoption of 'PD first' programmes. To analyse the safety of a PD-first programme in terms of 5-year peritonitis risk and patient and modality survival at the outpatient PD unit at Helen Joseph Hospital, Johannesburg. After exclusions, clinical data from 120 patients were extracted for analysis. The effects of patient age at PD initiation, ethnicity, gender, diabetes mellitus and HIV infection on patient and modality survival and peritonitis risk were analysed using Cox proportional hazards modelling and logistic regression analysis. Five-year technique and patient Kaplan-Meier survival curves for peritonitis and comorbidity groups were compared using the Cox-Mantel test. The Mann-Whitney U-test and Fisher's exact test were used to compare continuous and categorical variables where appropriate. Five-year patient survival was 49.9%. Black African ethnicity was associated with reduced mortality hazard (hazard ratio (HR) 0.33; 95% confidence interval (CI) 0.15 - 0.71; p=0.004), and patients with diabetes had poorer 5-year survival (19.1%; p=0.097). Modality survival at 5 years was 48.1%. Neither Black African ethnicity nor HIV infection increased the risk of PD discontinuation. Peritonitis was associated with increased modality failure (HR 2.99; 95% CI 1.31 - 6.87; p=0.009). Black African ethnicity did not increase the risk of peritonitis. HIV was not independently associated with an increased risk of peritonitis. Patient and PD survival were generally similar to other contemporaneous cohorts, and the peritonitis rate in this study was within the International Society for Peritoneal Dialysis acceptable range. PD is a safe and appropriate therapy in a low socioeconomic setting with a high prevalence of HIV infection. Consideration of home circumstances and training in sterile technique reduce peritonitis risk and improve PD modality survival. Patients with diabetes may be at risk of poorer outcomes on PD.