Ethnic Representation Research Articles

The Missing Voices, an exploration of what healthcare-related research would matter to Global Ethnic Majority Women in Aberdeenshire, Scotland

Abstract Introduction In multicultural communities, such as the UK, published evidence has indicated that patients from marginalised backgrounds experience healthcare inequality and inequity with regards to accessibility and safety.1 The lack of appropriate ethnic representation in healthcare-related research, has been identified as a potential causation of some of these disparities and poorer health outcomes.2,3 The focus of this project was the marginalised communities identified by the NIHR to have poorer health outcomes, such as Global Ethnic Majority (GEM) women. Aim To explore what healthcare research matters to marginalised communities with a focus on lived and perceived experiences on access to healthcare for GEM women in Aberdeen city and Aberdeenshire, Scotland. Methods This pilot project captured real world data through an inclusive community engagement approach of reaching within rather than reaching out. A framework of 5Cs (Connect, Collaborate, Consult, Co-create and Circulate) was used to establish a diverse panel of ten GEM women. All panel members had a passion for equality and wellbeing as well as diverse lived experiences. The method used to establish the panel is presented elsewhere. Based on a review of literature, open-ended, flexible, thought-provoking questions for the discussions were developed and circulated to all panel members for approval. These questions were used to guide both in-person and virtual open discussions with aforementioned stakeholders to capture narratives and perspectives around barriers and facilitators to equitable healthcare access in the area. As the public members were research partners and not participants, no ethical approval was required as advised by a professor of pharmacy research and the school’s ethics convenor. The project had three main objectives. This submission will only report on objective three that aimed to Identify and prioritise research questions relating to equitable access to healthcare and the needs of marginalised minority ethnic communities. Results The objective was met. A list of emergent themes from the pre-panel questions and a list of panel-approved research questions were devised with a focus on access to healthcare. The emergent themes were around accessibility and equity of maternal/reproductive healthcare, lack of early screening for high-risk GEM groups and culturally appropriate approaches to mental healthcare. Solution focused recommendations included the design of an inclusive healthcare curriculum, compulsory EDI and cultural competency training for healthcare professionals who practice in diverse communities, additional screening programmes tailored to specific GEM groups based on prevalence and risk factors and the development of localised culturally appropriate and inclusive community programmes, especially for those who support new immigrants. Mistrust and lack of inclusive language were mentioned as potential barriers to participating in research. Discussion / Conclusion This pilot offered the historically under-represented and usually silent communities an equal voice within a trusting and collaborative environment. Over ten years after the enaction of the UK Equality Act (2010) inequity in healthcare access and poor outcomes are still evident. The outcomes of this small pilot study highlight that GEM-specific projects should be driven by that community.

A cross sectional analysis of residents by race/ethnicity and specialty from 2020-2023

BackgroundMinorities are underrepresented in all areas of medical education relative to the United States general population, and minority physicians are more likely to practice in disadvantaged areas and in primary care settings. Many individual and structural factors contribute to this discrepancy. We aimed to demonstrate how resident race/ethnicity representation differs across the various resident specialties. MethodsWe used publically available data from the Association of American Medical College's Report on Residents data series and averaged the four academic years from 2019 to 2020 through 2022-2023. We then calculated the odds ratio (OR) of self-reported race/ethnicity (alone and in combination) in thirty-four specialties. ResultsAcross the four-year study period, there were, on average, 147026 unduplicated resident trainees. The average number of duplicated residents by self-identified ethnic category (alone and in combination) include: American Indian or Alaska Native (839, 0.6%), Asian (31627, 21.5%), Black or African American (7935, 5.4%), Hispanic, Latino, or of Spanish Origin (10900, 7.4%), Native Hawaiian or Other Pacific Islander (296, 0.2%), White (76289, 51.9%), Other (4879, 3.3%), Unknown (522, 0.4%), and Non-US Citizens (23914, 16.3%). Across race/ethnicity, there are differences in ORs of representation in different specialties. Key findings include high representation in Public Health and Preventative Medicine by Black and African American (OR=3.7) and Native Hawaiian (OR=2.6) residents, and Family Medicine in Native Americans (OR=1.9), Native Hawaiian (OR=1.7), Black (OR=1.5), and Hispanic (OR=1.3) residents. Psychiatry also had high ORs of representation in minority residents. ConclusionThis study illustrates relative resident ethnic representation across training specialties. Minorities ethnicities were more likely to be represented in primary care and public health domains. This has implications for creating a physician workforce suitable to serve the United States Population.

The diabetes cardiovascular outcomes trials and racial and ethnic minority enrollment: impact, barriers, and potential solutions

Type 2 diabetes (T2D) affects millions of individuals worldwide and is a well-documented risk factor for cardiovascular (CV) disease and chronic kidney disease, both of which are leading causes of mortality. Racial and ethnic minority groups in the US, including but not limited to Hispanic/Latino, non-Hispanic Black, and Southeast Asian individuals, are disproportionately burdened by both T2D and its adverse outcomes. In recent years, there have been numerous cardiovascular outcomes trials (CVOTs) on novel antidiabetic therapies, including the dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists (RAs), and sodium-glucose cotransporter-2 (SGLT2) inhibitors. CVOTs’s initial aim was to demonstrate the cardiovascular safety of these drugs. Unexpected CV and kidney protective effects were found, specifically among the GLP-1 RAs and the SGLT2 inhibitors. These benefits informed the new paradigm of the management of patients with T2D. However, some experts argued that the lack of racial and ethnic minority group representation in these trials represented a challenge. While the downstream effects of this lack of representation must be further elucidated, it is clear and recognized that efforts need to be made to include a more representative sample in future CVOTs, specifically including individuals from those groups most burdened by T2D and its complications, if clinicians are to have an accurate picture of the benefits and potential pitfalls of utilizing these drugs in a real-world setting. In this comprehensive review, we briefly summarize the significant findings from the CVOTs, report the lack of representation of Hispanic/Latino, non-Hispanic Black, and Southeast Asian individuals in the CVOTs, investigate the barriers to recruiting racial and ethnic minority groups into clinical trials, and suggest potential solutions to overcome these obstacles at the patient-, provider-, and sponsor/system-level in future trials.

The Prevalence of Specific Learning Difficulties in Higher Education: A Study of UK Universities Across 12 Academic Years.

Specific learning and attention difficulties are often first identified in childhood, but they can cause lifelong academic and occupational challenges. We explored the prevalence of these difficulties and the representation of sex and ethnicity amongst all first-year students in UK higher education across 12 years-almost 5.7 million students-and compared course preferences and University destinations of those with and without difficulties. Students declaring learning/attention difficulties were more likely to be White or of Mixed ethnicity and least likely to be Asian. They were more likely to attend specialist HE institutions or newer universities, and more likely to study courses in creative arts and design, agriculture and architecture than law, languages, computer science, and mathematical sciences. The number of students declaring difficulties has increased year on year, in actual terms and as a proportion of the student body, suggesting that efforts to increase diversity and inclusion have been successful. However, differences remain between students with and without learning/attention difficulties in terms of ethnicity, subjects studied, and HE institutions attended, so more needs to be done to identify and address reasons for this. While this paper reports data from UK students, it addresses an international question and invites similar explorations of other national datasets.

Who gets to be an ELT course book author? Native speakerism in English for specific purposes and business English course books

IntroductionNative speakerism has a profound influence on many aspects of ELT, for example negatively affecting job opportunities of those perceived as ‘non-native speakers’. Nevertheless, little is known about the effect of native speakerism on the recruitment of course book authors (CBAs).MethodsTherefore, this study analysed the linguistic and ethnic representation of 161 CBAs of 77 business English business English and English for specific purposes English for Specific Purposes course books (CBs) published globally by Pearson, OUP, CUP, Macmillan and NGL.ResultsThe data clearly show that publishers tend to hire white ‘native speakers’ from the UK as CBAs. More specifically, 90% of all CBA slots were taken by ‘native speakers’, 95% by white CBAs, and 78% by CBAs from the UK.DiscussionThis indicates a profound native speakerist bias among publishers against not only ‘non-native speakers’, but also those ‘native speakers’ who are not white or do not come from the UK. It is thus suggested that business English and English for Specific Purposes publishers pay greater attention to the diversity of the author teams they hire.

Race and ethnicity representation in phase 2/3 oncology clinical trial publications in the United States: A systematic review.

20 Background: The five 1997 Office of Management and Budget (OMB) races in the US include American Indian or Alaskan Native (AI/AN), Asian, Black or African American, Native Hawaiian or Other Pacific Islander (NHPI), and White, with Hispanic ethnicity. Despite the Affordable Care Act (ACA) mandating OMB-based collecting/reporting standards, race and ethnicity publishing in medical journals is inconsistent, despite being necessary to achieve health equity. We aimed to quantify race and ethnicity reporting rates and calculate representation quotients (RQs) in published oncology clinical trials. Methods: In this systematic review, PubMed/Embase were queried for phase 2/3 clinical trials of the 6 most common noncutaneous solid malignancies, published between 2012-2022, in 4 high-impact journals. Trial characteristics were recorded. The RQs for each race and ethnicity were calculated by dividing the percent of representation in clinical trial publications by the percent of year-matched, site-specific incident cancers in the US, compared with Kruskal-Wallis tests with Bonferroni Correction (BC). Reporting was compared between journal publications and ClinicalTrials.gov. Results: Among 1,202 publications evaluated, 364 met inclusion criteria: 16 JAMA , 241 JCO , 19 Lancet , and 88 NEJM . Publications included 268,209 patients (171,132 women [64%]), with a median of 356 (IQR, 131-800) patients per publication. Reported race and ethnicity included AI/AN in 52 (14%) publications, Asian in 196 (54%), Black or African American in 215 (59%), Hispanic in 67 (18%), NHPI in 28 (8%), and White in 254 (70%). Median RQ varied across race (P < .001 BC) with 1.04 (IQR, 0.09-4.77) for Asian, 0.98 (IQR, 0.86-1.06) for White, 0.42 (IQR, 0.12-0.75) for Black or African American, and 0.00 (IQR, 0.00-0.00) for both AI/AN and NHPI patients. Sensitivity analyses showed similar findings upon subset analysis for US-only clinical trials. There was significantly less race and ethnicity reporting in the clinical trial publications compared with ClinicalTrials.gov documentation for AI/AN (14% vs 45%, P < .001 per McNemar χ 2 with continuity correction [MC]) and NHPI (7.7% vs 43%; P < .001 MC). Conclusions: While most phase 2/3 oncology clinical trials published in high-impact journals report race and ethnicity, most did not report AI/AN and NHPI racial categories. Our findings support a call to action for consistent journal policies and transparent race and ethnicity reporting, in alignment with ACA-concordant race and ethnicity federal reporting requirements.

S1251 Clinical Trial Characteristics of Inflammatory Bowel Disease Trials Influencing Reporting and Representation of Race and Ethnicity on ClinicalTrials.gov

S1251 Clinical Trial Characteristics of Inflammatory Bowel Disease Trials Influencing Reporting and Representation of Race and Ethnicity on ClinicalTrials.gov

Evaluating the Performance and Bias of Natural Language Processing Tools in Labeling Chest Radiograph Reports.

Background Natural language processing (NLP) is commonly used to annotate radiology datasets for training deep learning (DL) models. However, the accuracy and potential biases of these NLP methods have not been thoroughly investigated, particularly across different demographic groups. Purpose To evaluate the accuracy and demographic bias of four NLP radiology report labeling tools on two chest radiograph datasets. Materials and Methods This retrospective study, performed between April 2022 and April 2024, evaluated chest radiograph report labeling using four NLP tools (CheXpert [rule-based], RadReportAnnotator [RRA; DL-based], OpenAI's GPT-4 [DL-based], cTAKES [hybrid]) on a subset of the Medical Information Mart for Intensive Care (MIMIC) chest radiograph dataset balanced for representation of age, sex, and race and ethnicity (n = 692) and the entire Indiana University (IU) chest radiograph dataset (n = 3665). Three board-certified radiologists annotated the chest radiograph reports for 14 thoracic disease labels. NLP tool performance was evaluated using several metrics, including accuracy and error rate. Bias was evaluated by comparing performance between demographic subgroups using the Pearson χ2 test. Results The IU dataset included 3665 patients (mean age, 49.7 years ± 17 [SD]; 1963 female), while the MIMIC dataset included 692 patients (mean age, 54.1 years ± 23.1; 357 female). All four NLP tools demonstrated high accuracy across findings in the IU and MIMIC datasets, as follows: CheXpert (92.6% [47 516 of 51 310], 90.2% [8742 of 9688]), RRA (82.9% [19 746 of 23 829], 92.2% [2870 of 3114]), GPT-4 (94.3% [45 586 of 48 342], 91.6% [6721 of 7336]), and cTAKES (84.7% [43 436 of 51 310], 88.7% [8597 of 9688]). RRA and cTAKES had higher accuracy (P < .001) on the MIMIC dataset, while CheXpert and GPT-4 had higher accuracy on the IU dataset. Differences (P < .001) in error rates were observed across age groups for all NLP tools except RRA on the MIMIC dataset, with the highest error rates for CheXpert, RRA, and cTAKES in patients older than 80 years (mean, 15.8% ± 5.0) and the highest error rate for GPT-4 in patients 60-80 years of age (8.3%). Conclusion Although commonly used NLP tools for chest radiograph report annotation are accurate when evaluating reports in aggregate, demographic subanalyses showed significant bias, with poorer performance in older patients. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Cai in this issue.

Race, Ethnicity, and Gender Representation Among US Academic Spine Surgeons.

Although diversity has improved across certain orthopaedic subspecialties, enhancing diversity within spine surgery has remained a challenge. We aimed to investigate the current state of sex, racial, and ethnic diversity among academic orthopaedic spine surgeons in the United States. In January 2024, a cross-sectional analysis of orthopaedic spine surgery faculty in the United States was conducted using the Doximity database to identify eligible surgeons. Fellowship-trained orthopaedic spine surgeons (professor, associate professor, and assistant professor) who graduated residency between 1990 and 2022 were included. Race, sex, academic rank, residency year of graduation, and H-Index scores were recorded using publicly available information from faculty profile pages and the Doximity database. Four hundred fifty-two spine faculty were included in the analysis: 95.1% men and 4.84% women. Across race and ethnicity, 315 surgeons (69.7%) were White, 111 (24.6%) Asian, 15 (3.32%) Black or African American, and 11 (2.43%) Hispanic or Latino or of Spanish origin. Of the 101 professor-level surgeons, 3 (2.97%) were Black men. Among female professors, none were Black, Asian, or Hispanic/Latino. No Hispanic or Latino female professors, associate professors, or assistant professors were identified. The sex and race/ethnicity demographics that have increased in percentage over time include White women (0.92% to 6.08%), Asian men (11.0% to 26.5%), Asian women (0% to 1.66%), and Hispanic/Latino men (1.83% to 3.87%). The surgeon demographic groups that demonstrated minimal fluctuations over time included Black men, Black women, and Hispanic/Latino women. Our findings demonstrate that underrepresentation among academic spine surgeons remains an ongoing challenge that warrants increased attention. Enhancing the representation of Black and Hispanic men, as well as Black, Asian, and Hispanic women, in spine surgery requires a deliberate effort at every level of orthopaedic training.

Racial and ethnic representation of youth in type 1 diabetes interventional trials

BackgroundUnderrepresentation of racial and ethnic groups in clinical trials can limit generalizability of research findings and equitable access to treatment. This study evaluates racial and ethnic representation of youth in US-based interventional trials on childhood type 1 diabetes (T1D). MethodsThis cross-sectional study examined interventional trials of T1D conducted in the US and registered on ClinicalTrials.gov. Trials were included if completed as of June 6, 2023, began between years 2010 and 2022, and exclusively enrolled youth ≤19 years old. We assessed representation of racial and ethnic groups in T1D trials, estimated using the enrollment-prevalence difference (EPD). ResultsA total of 106 trials were eligible for inclusion. Of those eligible, 62 (58 %) trials reported participant race or ethnicity and were included in the analyses. Significant disparities in enrollment were observed for American Indian/Alaska Native, Asian/Pacific Islander, Black, and Hispanic youth compared to their respective contribution to disease burden among youth in the US. Disparities in trial enrollment were greatest for Black (EPD, −10.2; 95 % confidence interval [CI], −14.4 to −7.9) and Hispanic (EPD, −7.7; 95 % CI, −12.6 to −4.8) youth. EPDs of trials conducted prior to year 2017 did not differ significantly from those conducted as of year 2017. ConclusionsHistorically marginalized racial and ethnic youth were underrepresented in T1D trials. Strategies to improve recruitment of these populations are needed to reduce inequities in diabetes treatment and outcomes.

Disparities in the Representation of Sex, Race and Ethnicity in Tension-Type Headache Clinical Trials.

While tension-type headache (TTH) is the most common primary headache disorder, its effect according to sex, race and ethnicity remains unclear. We investigated disparities in sex, racial and ethnic representation in TTH clinical trials with comparison to global disease burdens. In this cross-sectional analysis, TTH clinical trials had female overrepresentation and racial and ethnic minority underrepresentation, which may affect understanding of the impact of TTH on different populations and personalized treatment development. Trial enrollment that is diverse and reflective of global disease burdens is crucial for improving study generalizability, understanding of diverse clinical presentations, and ensuring healthcare equity.

Racial and ethnic minority representation in dementia risk factor research: a scoping review of cohort studies

BackgroundDespite a potentially greater burden of dementia, racial and ethnic minority populations around the world may be more likely to be excluded from research examining risk factors for incident dementia....

Ethnicity in neuro-oncology research: How are we doing and how can we do better?

This study systematically reviews and meta-analyses the extent of ethnic minority representation in neuro-oncology Phase III and IV clinical trials, explores the effect of ethnicity on outcomes, and identifies predictors for the inclusion of ethnicity data in publications. Adhering to PRISMA guidelines, we conducted a comprehensive literature search across multiple databases, on Phase III and IV trials in neuro-oncology that reported on adult and/or paediatric subjects. Through meta-analysis, we synthesized information on overall survival, event-free survival, and the incidence of adverse outcomes across ethnicities. From 448 identified articles, a fraction reported ethnicity data, with an even smaller number providing outcome data stratified by ethnicity. Most study participants were identified as White, underscoring a significant underrepresentation of minorities. Our meta-analysis did not reveal significant outcome differences by ethnicity, which may be attributed to the limited and inadequate reporting of data. Predictors for including ethnicity data were identified, including trials in North America(OR2.39, 95%CI 1.18-5.12, p < 0.02),trials of drugs or biologic agents(OR 5.28, 95%CI 1.43-3.42, p < 0.05),and trials funded by charities(OR 2.28, 95% CI 1.04-5.27, p < 0.05) or pharmaceutical companies(OR 3.98, 95% CI 1.60-10.0, p < 0.005). The underrepresentation of minorities in neuro-oncology clinical trials and the inadequately characterized impact of ethnicity on treatment outcomes highlight a critical need for more inclusive recruitment strategies and improved reporting standards. Change is necessary to ensure trials reflect the diversity of the patient population, which is essential for developing tailored strategies and improving outcomes. Future research should prioritize understanding the role of ethnicity in neuro-oncology to facilitate personalized treatment approaches.

Этническое мифотворчество в киберпространстве как фактор репрезентации этничности чувашей

The article is devoted to the study of Chuvash ethnic myth-making in cyberspace. The aim of the work is to determine its role as one of the factors of ethnicity representation. The study is based on the analysis of the relevant content presented on popular web platforms and social networks YouTube, Rutube, Zen, VKontakte, Odnoklassniki. The study identifies a certain section of content offered by search algorithms as the most viewed and included in thematic collections and playlists. The author examines the myth-making components of the Internet space, characterizes formats and plots, identifies their authors, and studies the audience's reaction to the content. Data analysis showed that ethnic myth-making has a positive effect on the representation of the Chuvash culture. Despite some inaccuracies in the information, such material generally evokes positive emotions in users. Information in video and text format is published on popular Russian platforms, making ethno-myth-creating content accessible to a wide audience. The myths created by the authors reflect their desire to show the antiquity and significance of the Chuvash people, which helps the Chuvash people to understand their identity, place and role in the world. Ethno-myth-creating content on the Internet increases interest in the Chuvash culture, promoting its popularization and representation.

Exploring Smokers Perspectives on Health Status and Health Seeking Behavior: A Qualitative Exploration

Objective: Smokers might tend to ignore when communicating about smoking health risks. We used Bourdieu’s conceptual tool to guide and explore their perception of being healthy despite their smoking behavior and their health seeking practice. Material and Methods: A qualitative method, using a semi-structured interview as the main method of collecting the data, was used. This method was implemented because of its flexibility in the exploration, based on participant responses. Results: The findings are reported as per the thematic analysis of 15 purposively selected participants. The ages of the 15 participants varied from 20 to 55 years old, and they were selected from the quantitative study to participate voluntarily in this qualitative exploration. Among them, 14 were males and one was female. The ethnic representation in this qualitative part were Malays (n=14) and Chinese (n=1). The duration of smoking varied in the sample, with the majority smoking for more than five years. Conclusion: This study better understands smokers’ health perception and their health-seeking behavior. Firstly, the perception of the less harmful effects of smoking on the health of smokers was understood within the views of Bourdieu’s Theory of Cultural Health Capital, which, in turn poses challenges to smoking cessation programs and campaigns. This study reported that smokers perceived themselves as healthy, and thus continued their smoking habit despite knowing its side effects.

A - 128 Informant Characteristics Impact Clinical Dementia Rating Scale Sum of Boxes in Mild Cognitive Impairment

Abstract Objective The Clinical Dementia Rating (CDR) Scale is an informant-based instrument widely used in clinical and research settings to stage dementia severity. Informant-based reports of functioning have been shown to be influenced by informant characteristics, indicating a potential source of bias. The current study adds to this growing area of research by exploring the differential impact of informant characteristics on CDR Sum of Boxes (CDR-SB) among non-Hispanic White (NHW), non-Hispanic Black (NHB) and Hispanic older adults with mild cognitive impairment (MCI). Method Participants included 2775 older adults diagnosed with MCI from the National Alzheimer’s Coordinating Center Uniform Data Set. Multiple linear regression models with forward selection evaluated the extent to which various informant characteristics predicted CDR-SB scores in the whole sample and NHW (n = 2170), NHB (n = 495), and Hispanic (n = 110) groups, covarying for participant demographics and cognition (MoCA). Results Informant sex, education, age, relationship type, and cohabitation status significantly predicted CDR-SB scores in this sample (R2 = 0.096, p &amp;lt; 0.001). Models stratified by race and ethnicity accounted for 20.2%, 10.3%, and 6.9% of the variance in CDR-SB scores in Hispanic, NHB, and NHW groups, respectively (ps &amp;lt; 0.001). Variability in model predictors was observed across groups, with informant characteristics accounting for more model variance than participant demographics in Hispanic and NHB groups. Results remained significant after adjusting for multiple comparisons. Conclusions Informant characteristics and relational factors may influence perceptions of participant functioning on the CDR-SB and may particularly affect scores among Hispanic older adults with MCI, though further validation in community-based cohorts with adequate racial and ethnic representation is warranted.

Representation in the UK MS Register: A Comparison of Nationwide Ethnicity and Register Data

BackgroundThe United Kingdom MS Register (UKMSR) collects longitudinal data on people with Multiple Sclerosis (pwMS) from clinical sources and as Patient Reported Outcomes (PROs) via a web portal. People from non-white ethnicities are often poorly represented in research and clinical trials; the UKMSR aims to be representative of people with MS (pwMS) across the UK. AimTo compare ethnic representation in the UKMSR to data from the Office for National Statistics (ONS). MethodEthnicity data was taken from the UKMSR as a ‘snapshot’ in 2024. Comparative data from ONS in England and Wales was gathered. Due to low numbers in the UKMSR of some ethnicities and areas, participants were grouped into ‘White’ and ‘All Other Ethnicities’. Using Chi-Sq tests, we compared ethnicities across ten regions of ONS 2021 Census data. ResultsTen regions were compared (nine in England, Wales as one). Analysis of both web-reported (n = 18648) and clinical (n = 5456) ethnicity found UKMSR diversity to be significantly lower than national statistics (p &lt; .05), with the exception of the clinical Register in Wales (numbers were insufficient to test) and clinical Register in the English West Midlands. The clinical Register was more representative in 7/10 regions than the web Register. DiscussionThe clinical Register, via NHS hospital sites reaches a more diverse audience than the patient-reported web Register; further work is needed in reaching a broader audience of pwMS, as well as harmonising discrepancies between the clinical and web Register populations.

Racial and Ethnic Representation in Food Allergen Immunotherapy Trial Participants

The lack of inclusion of diverse population samples in food allergy immunotherapy clinical trials not only leads to decreased applicability to the general population in terms of results and treatments but can also be seen as a broader social injustice contributing to inequity within the health care system. To investigate the racial and ethnic distribution of participants included in food allergy immunotherapy clinical trials, and determine whether the racial and ethnic representation in trials accurately reflects the patients who experience food allergy. Data were collected from articles found on PubMed and ClinicalTrials.gov using key terms of food hypersensitivity, food allergy, and immunotherapy, while also incorporating specific criteria such as clinical trials conducted within the last 5 years with children aged from birth to 18 years old. Articles were selected based on their relevance to the research question. Main outcomes were totals and percentages of trial participants by race and ethnicity, stratified by pediatric trials, site of study, and National Institutes of Health funding. Thirty-five articles were initially identified, of which 34 were classified as human clinical trials. Of these trials, 26 met criteria of an original randomized clinical trial and included racial and ethnic demographics for analysis in the study. Among trials included, the majority of the 3689 participants identified as White (2640 participants [72.0%]), followed by Black or African American (293 participants [8.0%]), Asian (239 participants [6.0%]), multiple races or other (210 participants [6.0%]), Hispanic or Latino (96 participants [3.0%]), American Indian (3 participants [<1.0%]), and Native American or Pacific Islander (3 participants [<1.0%]). We observed differences in racial and ethnic inclusion by study site (US vs external to US) and funding support (National Institutes of Health vs industry or other non-National Institutes of Health sources). In this systematic review of racial and ethnic diversity in food allergy immunotherapy trials, there was a lack of diversity relative to the overall food allergy burden among Black and Hispanic patients, indicating important gaps in the conduct of pediatric clinical trials, especially for treatments that are meant for use in broad populations where significant race- and ethnicity-related disparities exist. Working to correct this disparity will not only increase the usefulness of future clinical trial data but can further assist in alleviating public health inequities.

Understanding practices and support needs of family caregivers of people with dementia in Africa: a scoping review

Caregiving for people with dementia is a growing challenge, particularly in low- and middle-income countries, where 60 per cent of people with dementia globally reside. Yet the experiences and needs of caregivers supporting this population in African regions have not received adequate policy and practice attention. As a first step toward addressing this issue, we aimed to describe key challenges and solutions, and attend to knowledge gaps related to the needs and experiences of caregivers of persons with dementia across Africa. Informed by Arskey and O’Malley’s five-stage framework, we conducted a scoping review of empirical literatures, without year restriction. We included studies focusing on family caregivers supporting people with dementia in Africa. We reviewed five databases and screened titles and abstracts using Rayyan before extracting full texts. Our initial search yielded 3,982 articles, of which 29 met the inclusion criteria. Most of the selected dementia caregiving studies were conducted in South Africa, did not attend to the diverse ethnic beliefs and practices of the region in question and drew their samples from hospitals. While many studies explored caregiver support types, only a few focused on local support systems, like traditional and spiritual healing centres. Some studies addressed stigma and positive aspects of caregiving, offering insights for policy and practice. Future research should broaden regional and ethnic representation, investigate various support networks, such as community elders and healing centres, and examine the impact of local beliefs on stigma and caregiving positivity.

Association of candidate gene (INSR & THADA) polymorphism with polycystic ovary syndrome: meta-analysis and statistical power analysis.

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder that impacts women before reaching menopause. In addition to notable features (irregular ovulation, elevated androgen levels, and the existence of numerous ovarian cysts), individuals with PCOS frequently encounter diverse metabolic, cardiovascular, and psychological conditions. The onset of PCOS is influenced by a combination of factors, and various genetic variations are believed to play a significant role in its progression. The objective of the current study was to explore the link between genetic variations in the candidate genes thyroid-adenoma-associated (THADA) gene and insulin receptor (INSR) and susceptibility to developing PCOS. We conducted an extensive search across various databases, including Google Scholar, PubMed, Science Direct, Scopus, and EMBASE, to compile relevant case-control studies and literature reviews for subsequent statistical analysis. In the present study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, a guideline for Systematic Reviews and Meta-Analysis. While a previous meta-analysis explored the correlation between INSR rs1799817 and THADA rs13429458 and their association with susceptibility to PCOS, our current study did not integrate any findings from these prior investigations. Our research encompassed articles published between 2017 and 2023, and we employed MetaGenyo software to assess the collected data. Statistical power analysis was performed using G*Power 3.1 software. Odds ratios and their corresponding 95% confidence intervals were calculated for each genetic model. Fifteen studies that met the criteria were analyzed. Out of these, ten studies, involving 1,189 cases and 1,005 controls, examined the INSR rs1799817 gene polymorphism, while five studies, including 783 cases and 553 controls, investigated the THADA rs13429458 gene polymorphism. The meta-analysis results indicated that there was no statistically significant association between the INSR rs1799817 gene polymorphism and the risk of PCOS (p>0.05). In contrast, the THADA rs13429458 gene polymorphism showed a significant association with PCOS risk under the over-dominant model (p<0.05). The present meta-analysis demonstrated a notable association between the THADA rs13429458 gene polymorphism and the likelihood of developing PCOS. Further rigorous studies with expanded sample sizes and diverse ethnic representation will be important to comprehensively evaluate and validate these findings.