Hispanic Subjects Research Articles

Prevalence of Aflatoxin-Associated TP53R249S Mutation in Hepatocellular Carcinoma in Hispanics in South Texas.

We aimed to determine whether aflatoxin dietary exposure plays a role in the high incidence of hepatocellular carcinoma (HCC) observed among Hispanics in South Texas. We measured TP53R249S somatic mutation, hallmark of aflatoxin etiology in HCC, using droplet digital PCR and RFLP. TP53R249S mutation was detected in 3 of 41 HCC tumors from Hispanics in South Texas (7.3%). We also measured TP53R249S mutation in plasma cell-free DNA (cfDNA) from 218 HCC patients and 96 Hispanic subjects with advanced fibrosis or cirrhosis, from South Texas. The mutation was detected only in Hispanic and Asian HCC patients, and patients harboring TP53R249S mutation were significantly younger and had a shorter overall survival. The mutation was not detected in any Hispanic subject with advanced fibrosis or cirrhosis. Genes involved in cell-cycle control of chromosomal replication and in BRCA1-dependent DNA damage response were enriched in HCCs with TP53R249S mutation. The E2F1 family members, E2F1 and E2F4, were identified as upstream regulators. TP53R249S mutation was detected in 5.7% to 7.3% of Hispanics with HCC in South Texas. This mutation was associated with a younger age and worse prognosis. TP53R249S was however not detected in Hispanics in South Texas with cirrhosis or advanced fibrosis. Aflatoxin exposure may contribute to a small number of HCCs in Hispanics in South Texas, but the detection of TP53R249S mutation in plasma cfDNA is not a promising biomarker of risk assessment for HCC in subjects with cirrhosis or advanced fibrosis in this population. Cancer Prev Res; 11(2); 103-12. ©2017 AACR.

Variability in Affect and Willingness to Take Medication.

To determine if 1) patients have distinct affective reaction patterns to medication information, and 2) whether there is an association between affective reaction patterns and willingness to take medication. We measured affect in real time as subjects listened to a description of benefits and side effects for a hypothetical new medication. Subjects moved a dial on a handheld response system to indicate how they were feeling from "Very Good" to "Very Bad". Patterns of reactions were identified using a cluster-analytic statistical approach for multiple time series. Subjects subsequently rated their willingness to take the medication on a 7-point Likert scale. Associations between subjects' willingness ratings and affect patterns were analyzed. Additional analyses were performed to explore the role of race/ethnicity regarding these associations. Clusters of affective reactions emerged that could be classified into 4 patterns: "Moderate" positive reactions to benefits and negative reactions to side effects ( n = 186), "Pronounced" positive reactions to benefits and negative reactions to side effects ( n = 110), feeling consistently "Good" ( n = 58), and feeling consistently close to "Neutral" ( n = 33). Mean (standard error) willingness to take the medication was greater among subjects feeling consistently Good 4.72 (0.20) compared with those in the Moderate 3.76 (0.11), Pronounced 3.68 (0.14), and Neutral 3.62 (0.26) groups. Black subjects with a Pronounced pattern were less willing to take the medication compared with both Hispanic ( P = 0.0270) and White subjects ( P = 0.0001) with a Pronounced pattern. Patients' affective reactions to information were clustered into specific patterns. Reactions varied by race/ethnicity and were associated with treatment willingness. Ultimately, a better understanding of how patients react to information may help providers develop improved methods of communication.

Abstract 4927: Presence of genotoxic and/or pro-inflammatory bacterial genes in stool is associated with colorectal neoplasia

Abstract Despite increasing adherence to routine screening and advances in therapeutic strategies, CRC is the 1st and 3rd leading cause of cancer-related death in Puerto Rico and the United States (US), respectively. Currently, CRC screening is the primary means for prevention; however, 60% of CRC patients are diagnosed at more advanced, less treatable stages, which emphasize the need for novel CRC prevention and risk stratification strategies. The etiology of CRC is complex and still incompletely understood. However, environmental factors including diet, the gut microbiota, and inflammation are accepted as major contributors to colorectal carcinogenesis. It has been shown that individuals with CRC have a distinct gut microbiota, but the mechanisms by which gut bacteria exert their CRC-promoting effects remains elusive. Certain pathogenic bacterial strains carry genes encoding toxins that promote DNA damage and perpetuate inflammation, yet the association of these toxins to CRC remains poorly understood. The aim of this study was to gain insight into the association and possible mechanisms by which a subset of the gut microbiota contribute to colorectal carcinogenesis by profiling six genes encoding genotoxic and/or pro-inflammatory bacterial toxins in stool from individuals with and without colorectal neoplasia (adenoma and CRC). The association between the genes encoding toxins and CRC was examined by characterizing the toxic colonic bacterial gene profile in stool samples from healthy individuals (controls) and individuals with colorectal neoplasia (cases). Stool samples from individuals in the mainland US (n= 20) and Caribbean Hispanics (n=33) living in Puerto Rico were provided by the NCI Early Detection Research Network and the Puerto Rico Familial Colorectal Cancer Registry, respectively. Detection pks, TcPC, GelE, cnf-1, murB, and usp in stool was performed by qPCR using gene-specific primers. Associations were assessed using odds ratios. Four of the six toxic genes were detected more frequently in stool samples from individuals from the US with colorectal neoplasia (controls=10; adenoma=10). Results show borderline statistical significant associations (p=0.07) with the presence of usp and >2 genes and a higher odds of colorectal neoplasia (OR=5.44 and OR=9.33, respectively). In the cohort from our Caribbean Hispanic subjects (controls=13; adenomas=12; CRC=8), individuals with the presence GelE weres 8.6-times ore likely to have adenomas (p=.07) and individuals with ≥ 2 of the genes were 11.3-times more likely to have CRC than individuals without these genes (p=0.04). Analysis with a larger number of samples will be necessary to determine a more definite association between the presence of the toxic genes in this panel in stool and colorectal neoplasia. Additional mechanistic analysis will be required to fully understand how these bacterial toxins contribute to colorectal carcinogenesis. Citation Format: María González-Pons, Michelle Cruz-Badia, Ramon Gomez-Moreno, Abel Baerga-Ortiz, Marcia Cruz-Correa. Presence of genotoxic and/or pro-inflammatory bacterial genes in stool is associated with colorectal neoplasia [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4927. doi:10.1158/1538-7445.AM2017-4927

MYOPIC CHOROIDAL NEOVASCULAR MEMBRANES TREATED WITH RANIBIZUMAB IN COLOMBIAN POPULATION

Purpose : the aim of this study was to describe the characteristics of myopic choroidal neovascular membranes of hispanic subjects treated with a loading dose of Ranibizumab (Lucentis®) Methods : This is a non-randomized prospective observational case study. Five eyes of 5 patients with naive CNV secondary to pathological myopia were recruited for the study. Demographic features, basal best-corrected visual acuity, grade of myopia, angiographic and tomographic features were obtained at baseline. A loading dose of three monthly Ranibizumab (Lucentis®) inections were given to the recruited subjects. After completion of the loading dose, a complete ophthalmological evaluation, angiography and spectral domain optical coherence tomography (SD-OCT) were obtained subsequently at six and twelve months of follow-up. Results : The mean age of patients was 45 years. The mean spherical equivalent refractive error was -13.85. At baseline, the mean number of letters was 61.4 and at follow-up to 12 months the mean number of letters was 73.2. The central foveal thickness and subfoveal choroidal thickness decreased in all cases. After loading dose there was no persistent nor recurrent leakage from treated CNV on fluorescein angiography. FAF evidenced an increase in the area of atrophy, with an special circle pattern around the CNV. Conclusions : This study showed a functional and morphologic improvement at 12 months in five Colombian subjects treated with a loading dose of 3 Ranibizumab monthly injection.

Genome-wide Association For Exercise Tolerance In The TIGER Study

PURPOSE: The genetic basis of physical activity has been firmly established through both animal and human studies. The purpose of this study was to examine genetic variation across the genome for association to quantitative measures of exercise dose, intensity, duration, and adherence. METHODS: Young adults (18-35 y) underwent 15 weeks of aerobic exercise training while wearing computerized heart rate monitors. Exercise intensity was defined as age- and gender-specific percent heart rate reserve, and exercise dose was calculated as session duration adjusted for exercise intensity, summed over all exercise sessions. A total of 1,012 non-Hispanic white, 700 African American, and 332 Hispanic subjects were genotyped for ~200K genetic markers using the Illumina Metabochip, and genome-wide association analysis was performed using PLINK. Principal component analysis was used to control for racial/ethnic background and population substructure. RESULTS: SNPs in 10 genes exceeded a genome-wide significance of p<10-4.5, including FN3KRP, FAM148A, CUX2, RIPK2, ABCB11, B3GNTL1, BRE, BDNF, ZHX3, IDE, and TBCD. Pathways contributing to lipid metabolism, neural signaling, muscle contraction, and adiposity were significantly represented by SNPs with a nominal p<0.0001. The brain-derived neurotropic factor (BDNF) signaling pathway emerged as a central factor linking multiple other pathways, highlighting neural signaling as a target for exercise tolerance. Two SNPs in the CEP112 gene were significantly associated with exercise adherence (p<10-6); this gene has previously been implicated in smoking cessation, suggesting a common genetic pathway for persistent behavior. CONCLUSIONS: This study represents the first genome-wide analysis of exercise tolerance and adherence in a multi-racial sample of young adults; neural signaling pathways appear to be important in both outcomes.

Racial and sex differences in timing of the cervical vertebrae maturation stages

Our objective was to investigate skeletal maturation of female and male subjects from different racial groups by comparing the cervical vertebrae maturation (CVM) stages. The study included 3 racial groups: white, African American, and Hispanic subjects. Each group was subdivided into female and male. The age range of the subjects was between 7 and 18years. The sample included 60 lateral cephalographs for each subgroup. Skeletal maturation of the cervical vertebrae was assessed according to a method that described 6 CVM stages. Racial differences were evident in the mean ages of CVM stages 2, 3, 4, and 5 (P=0.002; P=0.003; P=0.001; and P=0.001, respectively) among females; among males, only stage 3 was different (P=0.001). Sex differences in the mean ages of stages 1, 2, and 3 in Hispanic subjects (P<0.001), and in stages 2 and 3 in African American subjects (P=0.019 and P<0.001) and white subjects (P=0.004 and P<0.001) were detected. In both sexes, racial differences were not apparent between whites and African Americans, but differences were evident between Hispanics vs both whites and African Americans. Sex differences were apparent between the sexes in each of the 3 ethnic groups in CVM stages 2 and 3. No sex differences were detected in stages 4, 5, or 6 in any of the 3 racial groups. It is recommended to consider racial and sex differences when using the CVM stage as a skeletal maturation indicator.

Tu1974 - Molecular Disparities and Kras Mutational Spectrum of Colorectal Tumors from Puerto Rican Hispanic Subjects

Tu1974 - Molecular Disparities and Kras Mutational Spectrum of Colorectal Tumors from Puerto Rican Hispanic Subjects

Differentially expressed haptoglobin as a potential biomarker for type 2 diabetic mellitus in Hispanic population

Glycosylated hemoglobin (HbA1c) measurement is currently a primary tool for diagnosis of type 2 diabetes mellitus (T2DM), especially for the assessment of chronic hyperglycemia. However, many studies reported the limitation of using HbA1c for T2DM diagnosis/prognosis, such as poor sensitivities, difficult standardization, and variable cut points across ethnic groups. Therefore, the aim of this study was to discover novel biomarkers associated with elevated HbA1c levels as complementary T2DM diagnostic tools. Two-dimensional difference gel electrophoresis combined with mass spectrometry were applied for protein profile analyses of two pooled serum samples collected from Hispanic T2DM subjects (n=74) with HbA1c ≥7 and HbA1c< 7, respectively. Isoforms of haptoglobin (Hp) α1/α2 chains were significantly altered in pooled serum samples from T2DM subjects with HbA1c ≥7 compared to those with HbA1c< 7. Hp genotypes of 262 Hispanic subjects, including 109 T2DM and 153 nondiabetic controls, were further determined by PCRs and western blotting analysis. Meanwhile, a new droplet digital PCR method for Hp genotyping was also established. The distribution of Hp2 allele was higher in T2DM subjects compared to nondiabetic controls and the HbA1c levels of T2DM subjects carrying at least one Hp2 allele tended to be higher than T2DM subjects with Hp 1-1. In summary, our results indicate that differentially expressed serum Hp protein isoforms could be associated with HbA1c levels and subjects with Hp2 allele have a higher risk for the occurrence of T2DM in Hispanic population. © 2016 BioFactors, 43(3):424-433, 2017.

Abstract A09: Association of genotoxic and/or pro-inflammatory bacterial genes to colorectal neoplasia

Abstract Background: Although colorectal cancer (CRC) is a potentially preventable disease, it is still one of the most common and deadliest malignancies worldwide. Despite increasing adherence to routine screening and advances in therapeutic strategies, CRC is the 1st and 3rd leading cause of cancer-related death in Puerto Rico and the United States (US), respectively. Currently, CRC screening is the primary means for prevention; however, only 40% of CRC patients are diagnosed with localized-stage disease. The fact that in 60% of CRC patients are diagnosed at more advanced, less treatable stages emphasizes the need for CRC prevention and risk stratification strategies, that other than routine screening, are still unavailable. The etiology of CRC is complex and still incompletely understood. However, environmental factors including diet, the gut microbiota, and inflammation are accepted as major contributors to colorectal carcinogenesis. It has been shown that individuals with CRC have a distinct gut microbiota, but the mechanisms by which gut bacteria exert their CRC-promoting effects remains elusive. Certain pathogenic bacterial strains carry genes encoding toxins that promote DNA damage and perpetuate inflammation, yet the association of these toxins to CRC remains poorly understood. The aim of this study was to gain insight into the mechanisms by which a subset of the gut microbiota contribute to colorectal carcinogenesis by profiling six genes encoding genotoxic and/or proinflammatory bacterial toxins in stool from individuals with and without colorectal neoplasia (adenoma and CRC). Methods: The association between the genotoxic and/or pro-inflammatory bacterial genes and CRC was examined by characterizing the toxic colonic bacterial gene profile in stool samples from healthy individuals (controls) and individuals with colorectal neoplasia (cases). Stool samples from individuals in the mainland US (n= 20) and Caribbean Hispanics (n=33) living in Puerto Rico were provided by the NCI Early Detection Research Network (http://edrn.nci.nih.gov/) and the Puerto Rico Familial Colorectal Cancer Registry (http://purificar.rcm.upr.edu/index_eng.html), respectively. Detection pks, TcPC, GelE, cnf-1, murB, and usp in stool was performed by qPCR using gene-specific primers. Associations were assessed using odds ratios. Results: Four of the six toxic genes were detected more frequently in stool samples from individuals from the US with colorectal neoplasia (controls=10; adenoma=10). Results show borderline statistical significant associations (p=0.07) with the presence of usp and &amp;gt;2 genes and a higher odds of colorectal neoplasia (OR=5.44 and OR=9.33, respectively). In the cohort from our Caribbean Hispanic subjects (controls=13; adenomas=12; CRC=8), individuals with the presence GelE were 8.6-times more likely to have adenomas (p=.07) and individuals with ≥ 2 of the genes were 11.3-times more likely to have CRC than individuals without these genes (p=0.04). Conclusions: Analysis with a larger number of samples will be necessary to determine a more definite association between the presence of the toxic genes in this panel in stool and colorectal neoplasia. Additional mechanistic analysis will be required to fully understand how these bacterial toxins contribute to colorectal carcinogenesis. Citation Format: Maria Gonzalez-Pons, Ramon Gómez-Moreno, Abel Baerga-Ortiz, Marcia Cruz-Correa. Association of genotoxic and/or pro-inflammatory bacterial genes to colorectal neoplasia. [abstract]. In: Proceedings of the AACR Special Conference on Colorectal Cancer: From Initiation to Outcomes; 2016 Sep 17-20; Tampa, FL. Philadelphia (PA): AACR; Cancer Res 2017;77(3 Suppl):Abstract nr A09.

The Confounding Effect of Assessor Ethnicity on Subjective Pain Reporting in Women

The current study examines how subjective pain reporting is influenced by the concordant and discordant nature of the ethnic identities of pain expressers (participants) and pain assessors (experimenters). Three discomfort conditions that varied in stimuli intensity (Study 1: mild pain; Study 2: severe pain), and distraction components (Study 3) were used to assess whether pain intensity and tolerance reporting differ with the ethnic identification of the participant and the experimenter. Specifically, 87 Hispanic and 74 Non-Hispanic White (NHW) women (18–51 yrs., Mage = 20.0, SD = 4.3) underwent a cold pressor pain task (CPT) after engaging in minimal procedural interactions with one of the 22 research experimenters (47% Hispanic, 42% females). The procedural interactions with the experimenters included only consenting and instructions, with no interaction between experimenter and participant during the actual CPT. Random-effects models showed that between the 0% and 18% of the variance in pain sensitivity (intensity and tolerance scores) was attributable to characteristics of the experimenters. Controlling for self-esteem, baseline pain levels, and the gender of the experimenter, Hispanic subjects showed higher pain sensitivity (as marked by lower pain tolerance and higher pain intensity scores) following interactions with an NHW rather than a Hispanic experimenter in response to the most severe pain intensity stimuli. These results question the validity of common findings of ethnic differences in pain sensitivity from studies that have not accounted for the ethnic identity of the pain assessor (and the general communicative nature of pain reporting).

Hispanic Ethnicity Is Associated with Younger Age at Presentation and Worse Survival in AML

Introduction: Previous studies have suggested differences in presentation, prognostic factors and treatment outcomes between blacks and whites with acute myeloid leukemia (AML). Such differences, however, are not well described in Hispanics, who are otherwise known to have higher rates of B-ALL and APL compared to whites. This study aimed to examine the relationship of the hispanic ethnicity with non-APL AML baseline characteristics and treatment outcomes in comparison to non-Hispanic whites.Methods: All patients diagnosed with AML between the years 2000-2010 were identified within the Montefiore Medical System in the Bronx, NY. Descriptive statistics were used to compare differences in baseline patient and disease characteristics between white and hispanic subjects. Kaplan Meier survival function was utilized to compare the survival experience of patients, stratified by key prognostic factors. Cox PH multivariable models were constructed to look at ethnic differences in overall survival (OS), adjusted for clinically important and statistically significant prognostic variables.Results: 248 evaluable subjects with newly diagnosed AML were identified, among which 153 were whites (n=80) and Hispanics (n=73). Hispanics were significantly younger at presentation compared to whites [median age 59 (45-71) vs 70yrs (57-82), p<0.001]. The cytogenetic profile of AML in Hispanics (favorable 8.8%, intermediate 49.1%, high-risk 42.1%) was not significantly different when compared to Caucasians (favorable 3.8%, intermediate 58.5%, high-risk 37.7%, p=0.51) A subset of patients (n=81) had mutational testing done, that revealed a higher frequency of p53 mutations in hispanic (7/33, 21%) compared to white patients (1/25, 4%). Other mutations were not significantly different between the groups. 66% of Hispanics were treated with "7+3" induction chemotherapy, compared to only 50% of whites, due to the higher proportion of elderly AML patients in the latter group (p=0.09). Only 68% of those Hispanic AML patients induced, however, achieved complete remission compared to 76% of whites (p=0.45). The rates of allogeneic transplantation were similar in both ethnic groups (H: 12.7%, W: 11.3%, p=0.27). In multivariable Cox PH analysis, adjusted for age, cytogenetic risk group and initial treatment modality, Hispanics were noted to have significantly lower OS compared to whites (HR 1.72, 95%CI 1.02 - 2.88, p=0.04).Conclusion: In this multiethnic, multiracial, single-center, inner-city adult AML cohort, we report for the first time that even though AML in Hispanics presents at an earlier age, it is associated with worse OS. The higher frequency of deleterious p53 mutations in hispanic AML patients could explain their poorer outcomes. Ongoing mutational studies are testing larger cohorts of patients and will be reported at ASH. DisclosuresNo relevant conflicts of interest to declare.

Differentiation of self-rated oral health between American non-citizens and citizens

Oral health disparities exist in the USA. However, little is known of the relationship between oral health disparity and citizenship. The aims of this study were: (i) to describe the differences in self-rated oral health (SROH) between adult American citizens and non-citizens (>20 years of age); and (ii) to test whether factors such as frequency of dentist visits and socio-economic status (SES) are differently associated with SROH in these two groups. The data used in this study were drawn from the National Health and Nutrition Examination Survey conducted in 2011-2012. Weighted logistic regression models were used to detect the strengths of the association between a series of predictors and SROH. More non-citizens (59.54%) than their citizen peers (26.24%) rated their oral health as fair/bad. All factors analysed in this study were differently associated with SROH based on citizenship. More specifically, natural characteristics, such as ethnicity and age, were significantly associated with SROH among non-citizens, and SES was significantly associated with American citizens. Among non-citizens, Hispanic, Non-Hispanic Black and Asian subjects were more likely than Non-Hispanic White subjects to report their oral health as being 'good'. Family poverty level, education and the frequency of dentist visits were significantly associated with SROH among citizens. The findings of this study indicate that American immigrants report their oral health across most dimensions as being worse than do American citizens. Each explanatory factor may have a different strength of association with SROH in immigrants and citizens, which implies that different steps should be taken within these groups to reduce disparities in oral health.

LPA Gene, Ethnicity, and Cardiovascular Events.

The relationship of LPA single nucleotide polymorphisms (SNPs), apolipoprotein(a) isoforms, and lipoprotein(a) [Lp(a)] levels with major adverse cardiovascular events (MACE) in different ethnic groups is not well known. LPA SNPs, apolipoprotein(a) isoforms, Lp(a), and oxidized phospholipids on apolipoprotein B-100 (OxPL-apoB) levels were measured in 1792 black, 1030 white, and 597 Hispanic subjects enrolled in the Dallas Heart Study. Their interdependent relationships and prospective association with MACE after median 9.5-year follow-up were determined. LPA SNP rs3798220 was most prevalent in Hispanics (42.38%), rs10455872 in whites (14.27%), and rs9457951 in blacks (32.92%). The correlation of each of these SNPs with the major apolipoprotein(a) isoform size was highly variable and in different directions among ethnic groups. In the entire cohort, Cox regression analysis with multivariable adjustment revealed that quartiles 4 of Lp(a) and OxPL-apoB were associated with hazard ratios (95% confidence interval) for time to MACE of 2.35 (1.50-3.69, P<0.001) and 1.89 (1.26-2.84, P=0.003), respectively, versus quartile 1. Addition of the major apolipoprotein(a) isoform and the 3 LPA SNPs to these models attenuated the risk, but significance was maintained for both Lp(a) and OxPL-apoB. Evaluating time to MACE in specific ethnic groups, Lp(a) was a positive predictor and the size of the major apolipoprotein(a) isoform was an inverse predictor in blacks, the size of the major apolipoprotein(a) isoform was an inverse predictor in whites, and OxPL-apoB was a positive predictor in Hispanics. The prevalence and association of LPA SNPs with size of apolipoprotein(a) isoforms, Lp(a), and OxPL-apoB levels are highly variable and ethnicity-specific. The relationship to MACE is best explained by elevated plasma Lp(a) or OxPL-apoB levels, despite significant ethnic differences in LPA genetic markers.

Achieving High Adolescent HPV Vaccination Coverage.

Despite national recommendations for adolescent human papillomavirus (HPV) vaccination, rates have lagged behind those of other adolescent vaccines. We implemented interventions and examined rates of vaccination coverage in a large, urban, safety net health care system to understand whether our tactics for achieving high rates of adolescent vaccination were successful. Denver Health is an integrated urban safety net health system serving >17 000 adolescents annually. The process for achieving high vaccination rates in our health system includes "bundling" of vaccines, offering vaccines at every visit, and standard orders. Data from vaccine registry and utilization statistics were used to determine vaccination rates in adolescents aged 13 to 17 years from 2004 to 2014, and these findings were compared with state and national rates for 2013. Regression analysis was used to identify characteristics associated with vaccination. In 2013 (N = 11 463), HPV coverage of ≥1 dose was 89.8% (female subjects) and 89.3% (male subjects), compared with national rates of 57.3% and 34.6%. Rates of HPV coverage (≥3 doses) were 66.0% for female subjects and 52.5% for male subjects, versus 37.6% and 13.9% nationally. For both sexes, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed, vaccine coverage was 95.9% (86.0% nationally), and meningococcal conjugate vaccine coverage was 93.5% (77.8% nationally). Female subjects, Hispanic subjects, non-English speakers, and teenagers <200% below the federal poverty level were more likely to have received 3 doses of HPV. Through low-cost, system-wide standard procedures, Denver Health achieved adolescent vaccination rates well above national coverage rates. Avoiding missed opportunities for vaccination and normalizing the HPV vaccine were key procedures that contributed to high coverage rates.

Ethnic Differences in Autoantibody Diversity and Hierarchy: More Clues from a US Cohort of Patients with Systemic Sclerosis.

To determine the autoantibody repertoire and clinical associations in a multiethnic cohort of American patients with systemic sclerosis (SSc). There were 1000 patients with SSc (196 Hispanic, 228 African American, 555 white, and 21 other) who were screened for antinuclear antibodies (ANA), including anticentromere antibodies (ACA) by indirect immunofluorescence assay, antitopoisomerase-1 (topo-1/Scl-70) by immunodiffusion, and anti-RNA polymerase III (RNAP III) by ELISA. Sera from 160 patients with mainly nucleolar and/or speckled ANA pattern, but negative for ACA, Scl-70, and RNAP III, were further characterized by immunoprecipitation for SSc-specific antibodies. The prevalence of antibodies against RNAP III, Th/To, and PM/Scl did not differ significantly among the ethnic groups. The frequency of anti-Scl-70 was lowest in whites (18.0%) compared with 24.0% and 26.8% in Hispanics and African Americans (p = 0.01), respectively. Compared with African American patients, Hispanic and white subjects had a higher frequency of ACA (p < 0.0001) and lower frequency of U3-RNP (p < 0.0001). U3-RNP antibodies were uniquely higher in African American patients, independent of clinical subset, while Th/To autoantibodies were associated with limited cutaneous SSc in white subjects. Overall, Hispanic and African American patients had an earlier age of onset and a predominance of diffuse cutaneous SSc compared with their white counterparts. SSc-specific antibodies may predict disease subset; however, the hierarchy of their prevalence differs across ethnic groups. This study provides the most extensive analysis to date on the relevance of autoantibodies in the diagnosis and clinical manifestations of SSc in Hispanic American patients.

Birth Rates Among Hispanics and Non-Hispanics and their Representation in Contemporary Obstetric Clinical Trials.

Objective Our study aims were to establish whether subjects enrolled in current obstetric clinical trials proportionately reflects the contemporary representation of Hispanic ethnicities and their birth rates in the United States. Methods Using comprehensive source data over a defined interval (January 2011-September 2015) on birth rates by ethnicity from the Centers for Disease Control and Prevention (CDC), we evaluated the proportional rate by ethnicity, then analyzed the observed to expected relative ratio of enrolled subjects. Results Hispanic women comprise a significant contribution to births in the United States (23% of all births). Systematic analysis of 90 published obstetric clinical trials showed a correlation between inclusion of Hispanic gravidae and the corresponding state's birth rates (r = 0.501, p < 0.001). While the mean was strongly correlated, individual clinical trials may have relatively over-enrolled (n = 31, or 34%) or under-enrolled (n = 33, or 37%) relative to their regional population. In 48% of obstetric clinical trials the Hispanic proportion of the study population was not reported. Conclusion Hispanic gravidae represent a significant number of contemporary U.S. births, and are generally adequately represented as obstetric subjects in clinical trials. However, this is trial-dependent, with significant trial-specific under- and over-enrollment of Hispanic subjects relative to the regional birth population.

Differences in Health-Related Quality of Life Between New Mexican Hispanic and Non-Hispanic White Smokers

Smoking is associated with impaired health-related quality of life (HRQL) across all populations. Because decline in lung function and risk for COPD are lower in New Mexican Hispanic smokers compared with their non-Hispanic white (NHW) counterparts, the goal of this study was to ascertain whether HRQL differs between these two racial/ethnic groups and determine the factors that contribute to this difference. We compared the score results of the Medical Outcomes Short-Form 36 Health Survey (SF-36) and St. George's Respiratory Questionnaire (SGRQ) in 378 Hispanic subjects and 1,597 NHW subjects enrolled in the Lovelace Smokers' Cohort (LSC) from New Mexico. The associations of race/ethnicity with SGRQ and SF-36 were assessed by using multivariable regression. Physical functioning (difference, -4.5; P= .0008) but not mental health or role emotional domains of the SF-36 was worse in Hispanic smokers than in their NWH counterparts in multivariable analysis. SGRQ total score and its activity and impact subscores were worse in Hispanic (vs NHW) smokers after adjustment for education level, current smoking, pack-years smoked, BMI, number of comorbidities, and FEV1 %predicted (differencerange, 2.9-5.0; all comparisons, P≤ .001). Although the difference in the SGRQ activity domain was above the clinically important difference of four units, the total score wasnot. New Mexican Hispanic smokers have clinically relevant, lower HRQL than their NHW counterparts. A perception of diminished physical functioning and impairment in daily life activities contribute to the poorer HRQL among Hispanic subjects.

A multicultural study of biometric privacy concerns in a fire ground accountability crisis response system

Biometric technology is rapidly gaining popularity as an access control mechanism in the workplace. In some instances, systems relying on biometric technology for access control have not been well received by employees. One potential reason for resistance may be perceived privacy issues associated with organizational collection and use of biometric data. This research draws on previous organizational information handling and procedural fairness literature to frame and examine these underlying privacy issues. Perceived accountability, perceived vulnerability, and distrust were distilled from the previous literature as the primary dimensions of employee privacy concerns related to biometric technology. This study assesses the effects of these privacy concerns, how they vary based on the cultural influences of Anglos and Hispanics.Fire ground accountability is a critical management objective in the firefighting domain. In multi-unit or multi-agency crisis response scenarios, the on-scene incident commander tracks and accounts for each first responder. This research designed and deployed a new fire ground accountability system that tracked firefighters through finger pattern-based biometric logins to their assigned positions on the firefighting apparatus. An instrument measuring level of privacy concern on three underlying dimensions and demographic data was developed, validated and administered in a quasi-experimental field study. A pre-test–post-test survey methodology was employed to detect potential differences in privacy concerns as familiarity with the system increased. The study shows that Anglo and Hispanic subjects frame privacy issues differently associated with use of biometric technology in a fire ground accountability system. Finally, the study showed that some privacy concerns such as distrust and perceived vulnerability can be alleviated through system use with changes in post-use privacy concerns moderated by ethnic affiliation.

Identification of an Association of TNFAIP3 Polymorphisms With Matrix Metalloproteinase Expression in Fibroblasts in an Integrative Study of Systemic Sclerosis-Associated Genetic and Environmental Factors.

Systemic sclerosis (SSc) is a fibrotic disease attributed to both genetic susceptibility and environmental factors. This study was undertaken to investigate the associations between SSc-associated genetic variants and the expression of extracellular matrix (ECM) genes in human fibroblasts stimulated with silica particles in time-course and dose-response experiments. A total of 200 fibroblast strains were examined for ECM gene expression after stimulation with silica particles. The fibroblasts were genetically profiled using Immunochip assays and then subjected to whole-genome genotype imputation. Associations of genotypes and gene expression were first analyzed in a Caucasian cohort and then validated in a meta-analysis combining the results from Caucasian, African American, and Hispanic subjects. A linear mixed model for longitudinal data analysis was used to identify genetic variants associated with the expression of ECM genes, and the associations were validated by using a haplotype-based longitudinal association test on regions that included the loci identified. The single-nucleotide polymorphism rs58905141 in TNFAIP3 was consistently associated with time-course and/or dose-response expression of MMP3 and MMP1 in the fibroblasts stimulated with silica particles in both the analysis of Caucasian subjects only and the meta-analysis. Results of the haplotype-based analysis validated the association signals. Our findings indicate that a genetic variant of TNFAIP3 is strongly associated with the silica-induced profibrotic response of fibroblasts. In silico functional analysis based on the ENCODE database revealed that rs58905141 might affect the binding activities of the transcription factors for TNFAIP3. This is the first genome-wide study of interactions between genetic and environmental factors in a complex SSc fibroblast model.

Data on coronary artery calcium score performance and cardiovascular risk reclassification across gender and ethnicities

The current guidelines recommend the new risk score, Atherosclerotic Cardiovascular Disease score (ASCVD), to assess an individual׳s risk of future cardiovascular disease (CVD) events. No data exist on the predictive utility of ASCVD score with the incremental value of coronary artery calcium scoring (CACS) across ethnicities and gender. Multi-Ethnic Study of Atherosclerosis (MESA) is a population based study (n=6814) of White (38%), Black (28%), Chinese (22%) and Hispanic (12%) subjects, aged 45–84 years, free from clinical cardiovascular disease. We performed a post-hoc analysis of 6742 participants (mean age 62, 53% female) from the MESA cohort. We evaluated the predictive accuracy for the ASCVD score for each participant in accord with the American College of Cardiology/American Heart Association guidelines using pooled cohort equations. Similar to the publication by Fudim et al. “The Metabolic Syndrome, Coronary Artery Calcium Score and Cardiovascular Risk Reclassification” [1] the analytic properties of models incorporating the ASCVD score with and without CACS were compared for cardiovascular disease CVD prediction. Here the analysis focused on ASCVD score (with and without CACS) performance across gender and ethnicities.