Ethnic Backgrounds Research Articles

Hospital employees’ perceived racism, ethnically offensive behavior, and patient violence

Abstract Background Hospitals are sensitive environments with complex interactions between employees and patients. Israeli society is ethnically diverse, and Israeli hospitals reflect this diversity and may create opportunities for rapprochement between different ethnic groups or might raise conflicts between them. In radical situations, such encounters might lead to violence. The phenomenon of physical or verbal violence towards caregivers and hospital employees exists. However, the uniqueness of this study is in examining whether the origin of the violence stems from racist reactions and how offensive behavior on an ethnic background could develop into actual violence. Methods Data were collected through an online close-ended survey among 370 hospital employees. 83% were Jewish, 68% were female, and 38 years old on average, with a mean hospital tenure of 6.5 years. The survey explored respondents’ perceived racism toward them, their exposure to offensive patient behavior based on ethnicity, and their exposure to general violence. Data were analyzed by SPSS 28. Results Preliminary results suggest positive correlations between study variables (r=.42-.52, p< .001). Regression analysis revealed that perceived racism contributed to general violence (β=.43, p< .001; R²=.19). Next, ethnic-based offensive behavior was added to the model (β=.36, p< .001). The analysis shows that general violence can be explained by these variables [F(2, 359)= 70.42, p< .001; R²=.28]. The R² of the general model increased significantly by 9.6%. The weight of perceived racism dropped yet is still significant (β=.24, p< .001). These results indicate that patients’ ethnic-based offensive behavior partially mediates the relationship between employees’ perceived racism and general violence. Conclusions The results suggest that employees who suffer from racism experience patients’ offensive behaviors based on ethnicity, which finally results in higher exposure to general violence in the workplace. Key messages • Understanding the phenomenon of violence in hospitals and examining the relationship between it and racism may amend policy and improve the quality of care and working conditions in the health sector. • The hospital environment involves diverse groups of society. Hence, the awareness of offensive behavior on an ethnic background is a condition to reduce racism and violence proactively.

Right-sided exercise-induced cardiac remodelling is more pronounced in white than in black elite football players

Abstract Background Most echocardiography studies investigating exercise-induced cardiac remodelling (EICR) in athletes have predominantly focused on left ventricular end-diastolic volume (LVEDV) and wall thickness. Moreover, studies investigating right-sided EICR in individuals with different ethnic backgrounds are scarce, but are needed to assist clinicians in the differentiation between EICR and pathology. Purpose To investigate differences in right-sided EICR between Caucasian (white) and Sub-Saharan (black) male elite football players. Methods We included all male elite football players with echocardiography data from the Evaluation of Lifetime participation in Intensive Top-level sports and Exercise (ELITE) cohort. ELITE collects data from standardised cardiovascular screenings of elite level athletes in the Netherlands, including (but not limited to) standardised resting transthoracic echocardiograms (TTE). Athletes with known cardiovascular disease were excluded. Our primary metrics of interest were right ventricular end-diastolic diameter (RVEDD), maximal dimension of the inferior vena cava (IVC) and right atrial (RA) reservoir, conduit and contractile strain (measured using 2D-Speckle tracking). Secondary metrics of interest included LV ejection fraction (LVEF), LV mass index (LVMi) and left atrial reservoir strain. All metrics of interest were stratified by ethnicity, and indexed for body surface area (BSA) if appropriate. Results A total of 74 elite football players were included (black n = 37; white n = 37), with similar age (18 [2.0] vs 19 [3.0], p = 0.013) and BSA (2 [0.1] vs 2 [0.2] m2, p = 0.268) across ethnicities. There were no differences in indexed LA (35 [10.0] vs 33 [10.0] ml/m2, p = 0.417) and RA volumes (27 [7.4] vs 27 [6.6] ml/m2,p = 0.953). However, black athletes demonstrated smaller max IVC (18 [5.0] vs 25 [5.0] cm, p = <0.001) and RVEDD (40 [2.0] vs 43 [6.0] mm,p = 0.001). Moreover, black athletes demonstrated less RA deformation in the reservoir (31 [8.0] vs 36 [8.0] %, p = 0.003) and contractile phases (9 [4.0] vs 11 [4.0] %, p = 0.017) than white athletes. There were no ethnic-specific differences in RA conduit strain (23 [7.0] vs 25 [6.0] %, p = 0.076). We found no statistically significant differences in LVEF (55 [6.0] vs 55 [6.0] %, p = 0.914), LVMi (92 [15.0] vs 88 [26.8] g/m2, p = 0.236) or LA reservoir strain (32 [7.0] vs 33 [7.0] %, p = 0.157) in black vs white athletes. Conclusion Male elite football players with a Sub-Saharan ethnic background demonstrate less pronounced right-sided EICR than athletes with a Caucasian ethnic background. Our findings emphasize the need for ethnic-specific reference ranges for right-sided EICR to aid in the differentiation between EICR and pathology.

Ethnic minorities who complete cardiac rehabilitation achieve equivalent functional capacity outcomes after cardiac rehabilitation but only half complete

Abstract Background Cardiac rehabilitation (CR) reduces the risk of death and repeat cardiac events and improves multiple patient outcomes. Ethnic minority backgrounds experience significant health disparities, often due to lack of fluency in dominant language and higher rates of cardiovascular disease risk factors. Despite these issues, outcomes for ethnic minorities from CR are rarely differentiated and participation in CR programs infrequently reported. Purpose To compare participation in and exercise outcomes from CR programs for patients from ethnic minorities versus the majority. Methods A secondary analysis from a national CR audit including 2335 CR participants. Ethnic minority was defined as having poor English language fluency requiring an interpreter for CR assessment. Functional capacity was assessed using 6-minute walk test (6MWT) or metabolic equivalent of tasks (METs). Binary logistic regression model was created to identify independent predictors of completion, accounting for baseline variables. Multiple linear regression models were used to determine if ethnic minority status was an independent predictor of change in 6MWT and METs after adjusting for baseline characteristics. Results Of the 2335 participants, 326 (14%) were from ethnic minorities. The mean age was 66.3±12.4 years and 70% males. There were no differences between minority and majority groups in relation to baseline characteristics. The most common referral diagnosis was myocardial infarction (27%), angina (25%), other – arrhythmias, cardiac devices, valve diseases/procedures (24%), and cardiac surgery (24%). Ethnic minorities were half as likely to complete CR (OR 0.49, 95% CI 0.38, 0.65) adjusted for age, sex, diagnosis, minority status, smoking, referral site and wait time (Table 1). Other factors that increase completion likelihood included all other cardiac diagnoses (compared to myocardial infarction as reference) and non-smokers, whereas major referral centre and female sex negatively impacted completion. Patients from ethnic minority backgrounds had less functional capacity at CR entry compared to the majority (379.9±118 versus 430.7±103 metres, p<0.001), though METs were comparable (6.69±2.73 versus 6.46±2.28 mg/kg/min, p=0.69). However, improvements were equivalent for 6MWT: minority 71.03±58.57 versus majority 71.37±61.16 (p=0.96), and for METs: minority 3.01±1.66 versus majority 3.13±1.74 mg/kg/min (p=0.77). Ethnic minority status was not an independent predictor of change in 6MWT and METs after accounting for age, sex, diagnosis, smoking, referral site, and wait time. Conclusion For patients from ethnic minority groups who completed CR, exercise/functional capacity outcomes were equivalent to majority participants, however less than one-in-two completed. CR programs should consider the needs of ethnic minority groups, particularly in relation to language and tailor content and delivery to promote participation and ensure more equitable access.

Gestational diabetes and pregnancy outcome in Kurdish, Somali and general population in Finland

Abstract Gestational diabetes (GDM) increases the risk of type II diabetes and cardiovascular morbidity later in life but GDM incidence in women from different cultural backgrounds varies. This study aims to examine treatment of GDM and pregnancy outcomes in Somali, Kurdish and general population women. Patient data of 312 Kurdish, 254 Somali and 508 general population women was collected from Turku University Hospital records from 2008 to 2019. The general population was selected by randomization with matching year, BMI, age, and parity. Singleton deliveries after 34th gestational week with no prior diabetes mellitus were included. Descriptive and comparison analyses (SPSS, version 29.0) were used to identify associations between ethnic background and pregnancy outcomes in women with GDM. The incidence of GDM was 22 % (CI 95 % 17-27) in Somali, 36 % (CI 95 % 31-42) in Kurdish, and 16 % (CI 95 % 13-19) in the general population women. Kurdish women had medication for GDM more often (43 % CI 95 % 34-53) than the Somali (22 % CI 95 % 11-33) and general population women (18 % CI 95 % 9-26). Metformin was more commonly used among Kurdish (30 % CI 95 % 22-39) compared to the general population (12 % CI 95 % 4-18) and Somali women (13 % CI 95 % 4-22). There was no difference in insulin or combined metformin and insulin treatment between the groups. In GDM group, vaginal deliveries were more common in general population (89 % CI % 81-95) than in Somali women (67 % CI % 64-81). Induction of labour (indication GDM or other) and instrumental vaginal delivery rates were similar between the groups. Newborns of all Somali women had a lower weight (SD -0.3 CI 95 % -0.7 - -0.2) compared to the general population (SD 0 CI 95 % -0.1 - 0.3). The prevalence of GDM was increased and dietary treatment decreased in Kurdish women compared to the general population in Finland. In the future, the treatment of GDM should be adjusted to better optimize the care for different cultural background women. Key messages • Kurdish women have increased incidence of GDM and less dietary treatment compared to the general population with similar risk factors. The pregnancy outcomes remain good in all groups. • With Somali women, the birth weight of the child is lower despite GDM status. This might direct clinicians to underestimate the effect of GDM when considering individual treatment.

Validity of the Multigroup Ethnic Identity Measure for Māori, Pacific, Asian & European adolescents

Abstract Background Ethnic identity is important for positive health and wellbeing outcomes, especially for Indigenous youth and adolescents from minoritised ethnic groups. The Multigroup Ethnic Identity Measure (MEIM) is widely used to examine ethnic identity as a general phenomenon across ethnic groups. However, evidence regarding its validity for adolescents from different ethnic backgrounds is mainly limited to the US context. This study investigated psychometric properties of the MEIM, for the first time, within a large ethnically diverse population-based sample in New Zealand. Methods We used data from the Growing Up in New Zealand study. Participants were 4500 12-year-olds and included 22.4% Māori (the Indigenous people of New Zealand), 16.7% Pacific, 14.8% Asian and 51.9% European young people. 45.7% were cisgender boy, 37.4% were cisgender girl, and 16.4% were non-binary, trans or unsure. We conducted factor analysis for the 12-item MEIM. Results Confirmatory factor analysis model fit tended to be best for a solution with two factors representing two ethnic identity subcomponents of Exploration and Affirmation/Belonging. A single ‘ethnic identity’ factor showed a slightly weaker model fit. Exploratory factor analysis revealed a 2-factor structure with a slightly different item composition as compared to the original MEIM subscales. The findings were largely comparable across ethnic groups. Conclusions The MEIM appears to be a valid measure for Māori, Pacific, Asian and European young people. However, nuances may exist due to unique contexts including structural factors, societal norms and challenges, opportunities and access to cultural engagement. Ethnic identity is strongly linked to health and wellbeing including quality of life, self-esteem and life satisfaction. Therefore, we recommend acknowledging nuances of ethnic identity during an important time of development within diverse cultural contexts, by applying subscales and subgroup analyses where possible. Key messages • The Multigroup Ethnic Identity Measure is valid and appropriate to use at age 12-years among diverse ethnic groups including Māori, Pacific, Asian and European. • Nuances of ethnic identity should be acknowledged as an important factor for health and wellbeing, especially during critical times of transition for adolescents within diverse cultural contexts.

Self-reported mistreatment of Danish medical students

Abstract Background Evidence suggests that mistreatment of medical students (MS) exists and that it is associated with stress, anxiety, burnout, substance abuse etc. Mistreatment encompasses discrimination and sexual harassment and impacts MS’ ability to partake their education with increased risk of dropout. The aim of the study is therefore to explore whether Danish MS and junior physicians enrolled in the Clinical basic education (CBE) have experienced mistreatment during their studies. Methods An online survey was conducted by email and sent to 5234 MS enrolled in one of four medical Master programs in Denmark or in the CBE. Reminders were distributed by email, shared in Facebook groups, and presented during lectures, accompanied by cards with QR codes for the survey. Data collection took place during spring 2023 and 645 completed the questionnaire giving a response rate of 12 %. The questions were based on the Everyday Discrimination Scale. Descriptive statistics and multivariate logistic regression were used for data analysis. Results MS most often encounter mistreatment from physicians, other health professionals and patients during their clinical internships. They also encounter mistreatment from lecturers and peers. MS who self-identify with another ethnicity than Danish/European were 3.2 times more likely than MS identifying with Danish/European ethnicity to report mistreatment from other students (95% CI 1.76 -5.95). Men were also less likely than women to report mistreatment. The mistreatment reported by MS is predominantly based on gender, ethnicity, religion, and age. The most frequent experiences are stereotypical statements (71,8%), lack of respect (65,1%) and being ignored (54,1%). Conclusions Our results indicate that Danish MS experience mistreatment, which can potentially impact their mental health. These results underscore the need for targeted interventions to create an inclusive educational environment that fosters the well-being and success of MS. Key messages • Danish medical students often face mistreatment from peers and health professionals, and more often reported by woman and students identifying with ethnic backgrounds other than Danish/European. • Action by University management is needed to implement targeted interventions such as diversity training, as mistreatment can negatively impact students’ mental health and educational outcomes.

The impact of ethnicity on clinical outcomes in patients with heart failure and atrial fibrillation

Abstract Introduction Heart failure (HF) and atrial fibrillation (AF) are increasingly prevalent and associated with substantial morbidity (1,2). When HF and AF co-exist, the outcome profile is significantly worse than for either condition in isolation (3). Ethnic background is known to influence disease outcomes and treatment efficacy (4), but there is limited knowledge about how HF, AF and ethnicity interact on mortality and hospital admission. Purpose This study aims to address the null hypothesis of no difference in death and cardiovascular events comparing non-white and white patients with HF and concomitant AF, and assess the differential impact of ethnicity in patients with these conditions. Methods Individual patient data were obtained from 12 randomized controlled trials (RCTs) in patients with HF. RCT data were harmonised and meta-analysed to investigate the interaction of baseline heart rhythm (sinus rhythm versus atrial fibrillation) and ethnicity (non-white versus white). The primary outcome of all-cause mortality and secondary outcome of cardiovascular (CV)-related mortality were analysed using adjusted Cox regression models and propensity-score matching. Results 16,713 HF patients were included of which 1,899 (11%) were non-white, median age 66 (interquartile range [IQR] 57-73) and 4,703 (28%) women. During median follow-up of 1.4 years (IQR 0.8-2.3), death occurred in 394 (21%) non-white patients and 2,142 (15%) white patients; adjusted hazard ratio (HR) 1.36, 95% CI 1.20-1.54; p<0.001. The impact of ethnicity was greater in patients with coexisting HF and AF (non-white versus white HR 2.05; 95% CI 1.55-2.70; p<0.001), than in those with HF in sinus rhythm (non-white versus white HR 1.24; 95% CI 1.08-1.41; p=0.002). A significant interaction was evident between ethnicity and rhythm status for all-cause mortality (p=0.003), with similar findings using propensity-score matching (Figure 1). An exploratory analysis of beta-blockers versus placebo demonstrated divergent efficacy with respect to mortality for non-white (HR 1.00, 95% CI 0.79-1.27; p=0.99) and white patients (HR 0.70, 95% CI 0.63-0.78; p<0.001); p-interaction=0.008 (Figure 2). For cardiovascular hospitalisation, the non-white cohort also had higher rates, with greatest disparity in patients with combined HF and AF (non-white versus white HR 1.80, 95% CI 1.63-2.37; p<0.001) compared to HF in sinus rhythm (non-white versus white HR 1.23, 95% CI 1.11-1.36; p<0.001); p-interaction=0.012 in propensity-matching. Conclusion Non-white patients with HF suffer from substantially higher rates of death and hospitalisation than corresponding white patients, with the presence of comorbid AF significantly worsening this ethnicity-related disparity. In those with HF in sinus rhythm, beta blockers were found to be significantly less effective at reducing mortality in non-white patients.Figure 1 Figure 2

Hospital policies as a tool to reduce gaps between ethnic groups of employees and patients

Abstract Background As diverse organizations, hospitals require an inclusive culture that respects and promotes ethnic diversity. Violence, a threat to this diversity, hampers effective organizational functioning. Our study delves into the positive influence of cultural diversity policies and communication about violence on the perception of the hospital’s atmosphere regarding ethnic differences among health employees. It enhances hospital labor relations and mitigates the risk of workplace violence. Methods 372 hospital employees with an average tenure of 6.5 and an average age of 38 filled out an online close-ended questionnaire (83% are Israeli Jews, 68% are female). 91% report working closely with people from different ethnic origins. Respondents ranked the atmosphere in the hospital regarding ethnic differences between employees and patients, the hospital’s cultural diversity policy, and organizational communication about violence. Data were analyzed by SPSS 28. Results Positive correlations were found between variables. A positive atmosphere was significantly related to the hospital’s cultural diversity policy (r=.14, p=.002) and to organizational communication about violence (r=.22, p< .001). However, the regression analysis (with control variables age, sex, and managerial role) revealed that despite employees acknowledging the hospital’s efforts to address diversity and violence, these factors only predict 10% of the variance of the hospital atmosphere [F(5, 366) = 8.346, p < .001; R²=.10]. Conclusions The hospital should increase actions that will improve the ethnic atmosphere in the hospital. Understanding how the encounter, where employees and patients from diverse ethnic backgrounds interact, influences the hospital’s atmosphere is crucial. These interactions can lead to tensions and offensive behaviors toward employees if not managed well. Hospitals can create an inclusive and harmonious work environment by addressing these tensions. Key messages • A cultural diversity policy and communication are necessary to maintain harmonious working relationships. It is essential, particularly in health organizations characterized by ethnic diversity. • Reducing the perception of ethnic differences may increase well-being and decrease violence. While hospitals often don’t prioritize these issues, this study forefront their influence and importance.

Fairer Training in public health, the UK FPH example

Abstract Background Public Health (PH) advocates for health equity and social justice. The UK Faculty of Public Health (FPH) is committed to tackling inequalities across the public health career pathway. The Fair Training project is a multi-phased programme which focuses on fair recruitment into PH, reducing differential attainment during PH training and postgraduate examinations. Objectives • Analyse available data from various sources; • Identify gaps in fair training culture and any biases; • Identify where support or interventions may best be focussed to minimise disadvantages; • Identify improvements in data that could be used to monitor actions; • Identify areas of good practice. Variables explored were demographic characteristics e,g, age, sex, ethnicity, disability status, professional background, candidate status (UK or overseas), place of primary qualification. Results Results show that candidates from ethnic minority backgrounds, those who are older, from international medical graduate backgrounds and backgrounds other than medicine are under-represented at the end of recruitment. Multivariable analysis of the diplomate exam shows that an attainment gap exists across increase with age, and those from black, Asian or white other ethnicity, professional background other than medicine, and overseas candidates. For the membership exam, multivariable analysis shows the attainment gap persists across those of increasing age and black ethnicity. Conclusions Recognising differential attainment as a structural problem requires organisational and individual leadership. Recommendations include an action plan to ensure: • Equality of opportunity for learning and career progression; • Collaborative working to eliminate discrimination in the design of education; • Ensure that training and the working environment are inclusive and diverse; • Inform future PH workforce planning; • Share good practice. FPH will implement the recommendations and share with other organisations and countries. Key messages • Structural causes of differential attainment during recruitment and training in public health do exist and should be mitigated. • FPH aims to promote Fair Training and excellence in public health practice.

Co-producing COVID-19 health education resources with ethnic minority communities in the UK

Abstract Background Effective communication of relevant health information is challenging in elderly minority ethnic groups due to language barriers and cultural differences. During the COVID-19 pandemic, much of the public health guidance around COVID-19 was in dominant languages, lacking cultural nuance. This study aimed to co-produce culturally, linguistically, and age-appropriate health education resources in COVID-19, tailored to the needs of older adults from ethnic minority backgrounds. Methods This study involved three stages: 1) Semi-structured interviews with Indian and Nepalese older adults (≥65 years), their families (≥18 years) and healthcare professionals (HCPs) (≥18 years) engaging with these communities; 2) Co-production of COVID-19 information resource, and c) Implementation of co-produced resources among the communities. Results 24 participants took part in the study. There was wide variation in participants’ knowledge of COVID-19; some were knowledgeable, while others had limited information. Participants highlighted the need for information in multiple formats and languages and discussed the importance of culturally avenues for information dissemination. Drawing on these findings and two co-production workshops held with the stakeholders, culturally sensitive information leaflets (electronic and paper) were co-prodcued in Hindi and Nepalese using age-appropriate images and infographics. The leaflets were distributed widely to the Nepalese and Indian communities, healthcare trusts and local authorities using the networks of community members, HCPs, and religious leaders. Conclusions The project highlights the significance of participatory methods in the development of culturally relevant public health interventions applicable to the cultural practices of ethnic minority groups. The co-production approach in this study could influence information provision for future public health campaigns for other marginalised groups. Key messages • Health information should be co-produced with a representative sample of the community members and relevant stakeholders. • There is a need on an ongoing basis to identify and fill the information gaps, address misinformation and develop targeted messages.

Preferences of parents from diverse backgrounds on genomic screening of apparently healthy newborns.

Genomic sequencing has been proposed as a strategy to expand newborn screening. Perspectives on genomic newborn screening from parents of diverse racial, ethnic, and socioeconomic backgrounds are needed to shape equitable implementation of this modality. We conducted 20 semi-structured interviews (15 English, 5 Spanish) and seven focus groups (4 English, 3 Spanish) with parents from diverse backgrounds to assess their perspectives regarding which disorders and variants might be screened, data privacy, and barriers to pursuing specialized care. Parents felt that genomic newborn screening would provide them with improved understanding of their children's health and had the potential to yield health and personal benefits. Themes that became evident included: interest in childhood and family health risks, the value of emotional preparation and personal planning, understanding of uncertain and low-risk results, concerns regarding data privacy, and concerns about support following the receipt of a positive newborn screening result. The expected benefits and concerns expressed by parents of diverse backgrounds regarding genomic newborn screening should guide future policy decisions. Their preferences should be considered prior to the implementation of large-scale genomic newborn screening programs.

Inter-ethnic heterogeneity in valvular morphology and aortopathy of a worldwide bicuspid aortic valve cohort referred for TAVR

Abstract Background Bicuspid aortic valve (BAV) represents one of the most common congenital heart disease. BAV stenosis tipycally occurs in younger, low-surgical risk patients compared to tricuspid aortic valves (TAV). With the predicted expansion of trans-catheter aortic valve replacement (TAVR) into lower-risk patients, the proportion of BAV is expected to rise. Although some observational studies have investigated the characteristics of Asian versus European patients with BAV undergoing TAVR, little is known about the inter-ethnic differences within the large and diverse Asian, African, Russian, and Caucasian population. Purpose To evaluate the inter-ethnic differences of aortic valve morphology, annular size and associated aortopathy, in a worldwide population of patients with severe aortic stenosis referred for TAVR. Methods Cardiovascular multislice computed tomography data of patients with severe aortic valve stenosis referred for TAVR worldwide were obtained from the database of the Meril Life Core Lab. Inter-ethnic and epidemiological differences in terms of valvular phenotype, annular size and aortic morphology were evaluated with particular focus on patients with BAV. Results Among 12,712 patients (59% male), n=3,203 subjects (25%) exhibited a BAV morphology. According to the Siever’s BAV classification, type 1 (71%, n=2,284) was the most prevalent BAV morphology and particularly Type 1a was the most common in almost all population, with 26% exhibiting a type 0 BAV, while only 3% of the patients (n= 92) had a type 2 (Table 1). A significantly higher prevalence of severe calcium score (>1000 mm3) was found in patients with BAV compared with patients exhibiting a TAV morphology (51% vs. 32, p<0.01). Additionally, larger ascending aorta (AA) diameter (AA >40 mm) (BAV: 31% vs TAV 7%, p = 0.04), along with a higher prevalence of horizontal aorta (HA) (BAV: 20% vs TAV: 9%, p<0.01) was found in patients with BAV compared with TAV. As for inter-ethnic characteristics, there was a higher prevalence of BAV in Indian and Asian Pacific populations (respectively 43% and 28%), with the African population exhibiting the lowest prevalence (7%, n= 28, p=0.02) (Table 2). In Indian patients a higher prevalence of BAV was found in an earlier age (61-70 years old) compared to Western countries (p=0.05). Finally, smaller annular size (456±98 mm2 vs 584±99 mm2, p<0.01) and lower coronary ostia height (Asia and India: RCA 14.5±3 mm, LCA 14±2.9mm vs Caucasian and Russian: RCA 16±3.2 mm, LCA 16.9±3.3mm; p<0.01) were found in the Asian and Indian population when compared with Russian, African and Caucasian subjects. Conclusions BAV morphology, aortopathy and annular size resulted widely heterogenous according to the ethnicity and geographical origin of patients referred for TAVR worldwide. These features may lead different therapeutical decision making and outcomes following TAVR in patients with BAV.Table 1Table 2

Genotype‒phenotype correlation in recessive DNAJB4 myopathy

AbstractProtein aggregate myopathies can result from pathogenic variants in genes encoding protein chaperones. DNAJB4 is a cochaperone belonging to the heat shock protein-40 (HSP40) family and plays a vital role in cellular proteostasis. Recessive loss-of-function variants in DNAJB4 cause myopathy with early respiratory failure and spinal rigidity, presenting from infancy to adulthood. This study investigated the broader clinical and genetic spectrum of DNAJB4 myopathy. In this study, we performed whole-exome sequencing on seven patients with early respiratory failure of unknown genetic etiology. We identified five distinct pathogenic variants in DNAJB4 in five unrelated families of diverse ethnic backgrounds: three loss-of-function variants (c.547 C > T, p.R183*; c.775 C > T, p.R259*; an exon 2 deletion) and two missense variants (c.105G > C, p.K35N; c.181 A > G, p.R61G). All patients were homozygous. Most affected individuals exhibited early respiratory failure, and patients from three families had rigid spine syndrome with axial weakness in proportion to appendicular weakness. Additional symptoms included dysphagia, ankle contractures, scoliosis, neck stiffness, and cardiac dysfunction. Notably, J-domain missense variants were associated with a more severe phenotype, including an earlier age of onset and a higher mortality rate, suggesting a strong genotype‒phenotype correlation. Consistent with a loss of function, the nonsense variants presented decreased stability. In contrast, the missense variants exhibited normal or increased stability but behaved as loss-of-function variants in yeast complementation and TDP-43 disaggregation assays. Our findings suggest that DNAJB4 is an emerging cause of myopathy with rigid spine syndrome of variable age of onset and severity. This diagnosis should be considered in individuals presenting with suggestive symptoms, particularly if they exhibit neck stiffness during infancy or experience respiratory failure in adults without significant limb muscle weakness. Missense variants in the J domain may predict a more severe phenotype.

Adding ethnicity to cardiovascular risk prediction: external validation and model updating of SCORE2 using data from the multiethnic HELIUS population cohort

Abstract Background Current prediction models for mainland Europe do not include ethnicity, despite ethnic disparities in cardiovascular disease (CVD) risk. Purpose We evaluated the performance of SCORE2 across the largest ethnic groups in the Netherlands with and without the factor of ethnicity. Methods We linked data from 11,614 participants enrolled between 2011 and 2015 in the prospective, multi-ethnic HELIUS cohort study, the Netherlands, aged between 40 and 70 years without CVD with hospital data. Variables (age, sex, smoking status, blood pressure, cholesterol) and outcome first CVD event (myocardial infarction, stroke, CVD death) were consistent with SCORE2. We used Fine and Gray models to calculate sub-distribution hazard ratios (SHR) for South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin groups, relative to the Dutch origin group, on top of individual SCORE2 risk predictions. Model performance was evaluated by discrimination, calibration and net reclassification index (NRI). Results Overall, 274 fatal and non-fatal CVD events, and 146 non-cardiovascular deaths were observed during a median of 7.8 years follow-up (IQR 6.8–8.8). SHRs for CVD events were 1.86 (95% CI 1.31-2.65, p=0.0005) for the South-Asian Surinamese, 1.09 (95% CI 0.76-1.56) for the African-Surinamese, 1.48 (95% CI 0.94-2.31) for the Ghanaian, 1.63 (95% CI 1.09-2.44, p=0.018) for the Turkish, and 0.67 (95% CI 0.39-1.18) for the Moroccan origin groups. Adding ethnicity to SCORE2 led to comparable calibration and discrimination [0.76 (0.74-0.79) vs. 0.77 (95% CI 0.74-0.78)]. The NRI for adding ethnicity to SCORE2 was 0.24 (95% CI 0.18-0.31) for events and -0.12 (95% CI -0.13--0.12) for non-events. Conclusion Adding ethnic backgrounds improves risk classification of the SCORE2 risk prediction model in a middle-aged, multi-ethnic Dutch population, which may help to address disparities in CVDs through timely treatment.

Exploring economic assimilation of immigrants and their descendants in France: recent insights

ABSTRACT This paper examines the labour market performances of immigrants and their descendants in France by applying a series of empirical Tobit II models on a recent TeO2 database. Our work questions the labour market participation and wage disparities of these groups compared to native-born individuals by controlling different individual attributes, such as gender and educational level, and job characteristics, such as the firm size or the type of job. It also introduces information on ethnic origins and location. Our study provides crucial insights into the labour market performances of immigrants and their descendants in France. It reveals that disparities manifest primarily in labour market participation rather than wages. It also underscores that high-skilled workers’ wages do not converge as immigrants consistently yield lower returns on education than natives. Our findings underscore the heterogeneity within the immigrant group based on origins criteria. The performances of immigrants with African and Northern-African origins are lower than those of other groups of immigrants.

The prevalence of adolescent problem gambling: examining sociodemographic risk factors in New Mexico

ABSTRACT Problem gambling in adolescence can lead to significant negative consequences, yet few studies have examined the prevalence and risk factors among diverse youth populations. This study investigated gambling and related non-gambling activities and sociodemographic correlates of problem gambling in 2,533 high-school students in New Mexico aged 12–18 years (mean age 15.6), with an approximately equal gender distribution (49.3% male, 49.3% female, 1.4% unspecified). Overall, 3% screened positive for problem gambling, with higher rates among males (3.9%) than females (2.1%), Native American (4.5%), and Hispanic (3.3%) versus white (1.5%) students. In-person activities were more common than online activities for both gambling and non-gambling activities. Substance use behaviors, including binge drinking, e-cigarette, marijuana, and prescription painkiller use, were more prevalent among people with gambling problems. Controlling for demographics, the interaction between Hispanic ethnicity and past 30-day binge drinking was positively associated with problem gambling. A risk score combining substance use and housing instability also positively predicted problem gambling. These findings demonstrate sociodemographic and substance use risk factors for problem gambling among New Mexico adolescents. The study highlights the importance of considering diverse ethnic backgrounds and co-occurring risk behaviors in developing targeted prevention and intervention strategies for adolescent problem gambling across various cultural contexts.

“You really shouldn’t be here”: using social identity theory to explore under-represented ethnic minority (UREM) students experiences of belonging in a UK dental school

There is tacit acknowledgment that the psycho-social and educational challenges experienced by under-represented ethnic minorities in medical school are likely to be similar to those experienced by ethnic minorities in dental school. However, dental scholarship is not as expansive or comprehensive by comparison to confirm if this is the case. This paper addresses this research gap by presenting the findings of a small-scale exploratory study into the experiences of nine dental undergraduates from a variety of ethnic backgrounds studying at one UK dental school. A social identity theoretical framework was applied to the analysis of semi-structured interview data. The study reveals that dental school is a racialised educational space, where whiteness and white privilege are the norm and students from ethnic minority backgrounds occupy ‘out-group’ status through a process of depersonalisation and stereotyping. Their experiences reveal the existence of a climate of everyday racism perpetuated by students and faculty alike. This research calls on dental schools, and the dental profession more generally to address the lack of inclusivity as a pressing concern requiring immediate action.

Ethnic origin of Israeli Jews and psychological responses to the extreme stress of the ongoing war with Hamas in Gaza

IntroductionDiscrimination constitutes a source of stress for minority groups, leading to heightened levels of depression. Discrimination can also elicit positive responses aimed at reducing detrimental impacts. The stress experienced by minority groups may impact their mindset and influence their negative emotional responses. Israeli Jewish society comprised for many years two large communities: the dominant Ashkenazi people, who emigrated from East Europe, and the Mizrahi discriminated minority whose members came from Muslim countries. The Mizrahi minority has become a mainstream community over time, and its size equals the Ashkenazi group. This change raises an interesting issue that has not been investigated empirically: What characterizes the psychological responses to the stress of a formerly discriminated minority?MethodsTwo representative samples responded to a similar questionnaire measuring inhibiting and bolstering coping strategies. The first sample of 930 people participated in this structured survey between October 12 and 19, 2022. No external adversity threatened Israel at that time. The second sample of 1,608 Israeli Jews participated between October 11 and 17, 2023, a few days after Hamas attacked the southern region of Israel, killed more than a 1,000 people, and kidnapped 100. We examine the impact of moderate and extreme stress of war on the maladaptive levels of anxiety and depression. Furthermore, we investigated the shielding psychological coping measures of this former minority, as compared to Ashkenazi group’s response.ResultsResults show that the formerly minority Mizrahi group expresses higher levels of depression, anxiety, and sense of danger under extreme stress compared to the Ashkenazi group. Mizrahi individuals compensated concurrently for these negative emotions by fostering enhanced hope and societal resilience compared to the other group.DiscussionThe main contributions of the present study are (a) Demonstration that psychological responses of descendants of a minority group to highly stressful conditions do not necessarily agree with their current status as a mainstream community. (b) Indicating that the phenomenon of concurrently enhanced negative and positive responses in face of extreme stress is associated with ethnic origin and history. (c) Associating the effects of different socio-demographic variables with the psychological response of the investigated groups to extreme and moderate stress.

Towards equitable reporting of Indigenous status, ethnicity, language and country of birth in Australian paediatric clinical studies: A scoping review.

This scoping review aims to expansively review the reporting of Indigenous status, ethnicity, culture, language and country of birth in Australian paediatric clinical studies. Scoping review of Australian clinical studies, including randomised controlled trials, non-randomised controlled trials, cluster randomised controlled trials and quasi-experimental studies, with paediatric participants (<18 years) or mixed adult and paediatric participants. PubMed, Cumulated Index to Nursing and Allied Health Literature and Embase databases were searched for clinical studies published 1 January 2018 to 28 November 2022. Of the 2717 studies identified in the search, 209 clinical studies were included. Overall, 131 (62.7%) clinical studies captured in this review did not report any of the variables of interest. When reported, terms used by study authors varied extensively and subsequently five study-defined categories emerged 'Indigenous status', 'race', 'race and ethnicity', 'ethnicity', or 'natural skin colour'. 'Indigenous status' was most reported (n = 37, 17.7%), followed by 'ethnicity and/or cultural background' (n = 15, 7.2%), 'race and ethnicity' (n = 4, 1.9%), race (n = 1, 0.5%) and 'natural skin colour' (n = 1, 0.5%). Furthermore, language used at home was reported in 27 studies (12.9%) and country of birth in 23 studies (11.0%). This review demonstrated very low reporting of Indigenous status, ethnicity, culture, language and country of birth in Australian paediatric clinical studies. Poor reporting has raised concerns surrounding generalisability of findings from these trials in addition to equity. The recent international shift encompassing improved clinical trial reporting requirements, for ethnicity and race, require prompt establishment in the Australian clinical trial domain.

The Chilean COVID-19 Genomics Network Biorepository: A Resource for Multi-Omics Studies of COVID-19 and Long COVID in a Latin American Population

Although a lack of diversity in genetic studies is an acknowledged obstacle for personalized medicine and precision public health, Latin American populations remain particularly understudied despite their heterogeneity and mixed ancestry. This gap extends to COVID-19 despite its variability in susceptibility and clinical course, where ethnic background appears to influence disease severity, with non-Europeans facing higher hospitalization rates. In addition, access to high-quality samples and data is a critical issue for personalized and precision medicine, and it has become clear that the solution lies in biobanks. The creation of the Chilean COVID-19 Biorepository reported here addresses these gaps, representing the first nationwide multicentric Chilean initiative. It operates under rigorous biobanking standards and serves as one of South America’s largest COVID cohorts. A centralized harmonization strategy was chosen and included unified standard operating procedures, a sampling coding system, and biobanking staff training. Adults with confirmed SARS-CoV-2 infection provided broad informed consent. Samples were collected to preserve blood, plasma, buffy coat, and DNA. Quality controls included adherence to the standard preanalytical code, incident reporting, and DNA concentration and absorbance ratio 260/280 assessments. Detailed sociodemographic, health, medication, and preexisting condition data were gathered. In five months, 2262 participants were enrolled, pseudonymized, and sorted by disease severity. The average Amerindian ancestry considering all participant was 44.0% [SD 15.5%], and this value increased to 61.2% [SD 19.5%] among those who self-identified as Native South Americans. Notably, 279 participants self-identified with one of 12 ethnic groups. High compliance (&gt;90%) in all assessed quality controls was achieved. Looking ahead, our team founded the COVID-19 Genomics Network (C19-GenoNet) focused on identifying genetic factors influencing SARS-CoV-2 outcomes. In conclusion, this bottom-up collaborative effort aims to promote the integration of Latin American populations into global genetic research and welcomes collaborations supporting this endeavor. Interested parties are invited to explore collaboration opportunities through our catalog, accessible online.