Multiethnic Setting Research Articles

Adapting a Parental Support App to Promote Healthy Diet and Physical Activity Behaviors (MINISTOP) for a Multi-Ethnic Setting: A Qualitative Study on the Needs and Preferences of Parents and Nurses within Swedish Child Health Care.

Early efforts for prevention of childhood overweight and obesity are needed. In order to adapt an app promoting healthy diet and physical activity behaviors in children (MINISTOP 1.0) for multi-ethnic communities, we explored: (1) needs and concerns among Somali-, Arabic-, and Swedish-speaking parents in terms of supporting healthy diet and activity behaviors in their children; (2) nurses’ perceptions of parental needs and concerns in relation to diet and physical activity behaviors; and (3) how the features and content of the MINISTOP 1.0 app could be refined to better support health behaviors in children, among both parents and nurses. Focus groups with Somali-, Arabic-, and Swedish-speaking parents (n = 15), and individual interviews with nurses (n = 15) were conducted. Parents expressed several challenges in supporting children’s health behaviors, the need for a tailored app, and alternative ways of accessing the content (audio/video). Nurses emphasized the need of supporting parents early, and the value of a shared platform in different languages, to facilitate communication. This study contributes valuable insights about parental needs and relevant adaptations to a parental support app, such as addition of audio/video files for increased accessibility. This adapted app version—MINISTOP 2.0, can be useful for childhood obesity prevention in multi-ethnic communities.

Operationalising ethnicity in accountability: insights from an ethnic group within the Salvation Army

PurposeThis paper explores how ethnicity is implicated in an etic–emic understanding through day-to-day practices and how such practices meet external accountability demands. Addressing the broader question of how ethnicity presents in an accounting situation, it examines the mundane level responses to those accountability demands manifesting an operationalisation of the ethnicity of the people who make those responses.Design/methodology/approachThe study followed ethnomethodology principles whereby one of the researchers acted both as an active member and as a researcher within a Salvation Army congregation in Manchester (UK), while the others acted as post-fieldwork reflectors.FindingsThe conceivers and guardians of an accountability system relating to the Zimbabwean-Mancunian Salvationist congregation see account giving practices as they appear (etic), not as they are thought and interiorised (emic). An etic–emic misunderstanding on both sides occurs in the situation of a practice variation in a formal accountability system. This is due to the collision of one ethnic group's emics with the emics of conceivers. Such day-to-day practices are thus shaped by ethnic orientations of the participants who operationalise the meeting of accountability demands. Hence, while ethnicity is operationalised in emic terms, accounting is seen as an etic construct. Possible variations between etic requirements and emic practices can realise this operationalisation.Research limitations/implicationsThe authors’ findings were based on one ethnic group's emic construction of accountability. Further research may extend this to multi-ethnic settings with multiple etic/emic combinations.Originality/valueThis study contributed to the debate on both epistemological and methodological issues in accountability. As it is ill-defined or neglected in the literature, the authors offer a working conceptualisation of ethnicity – an operating cultural unit being implicated in both accounting and accountability.

Integrating marginalised students in Ghanaian schools: insights from teachers and principals

ABSTRACT This article focuses on deepening the understanding of the factors affecting migrant students’ integration in Ghana’s educational system. Research on migrant education has primarily centred on northern destination countries. Using the case of West African migrant children in a multiethnic and multilingual Ghanaian setting, the article examines the complex and interplaying factors affecting migrant students’ integration into Ghanaian schools. Analysis from 40 semi-structured interviews with teachers and principals drawn from 30 schools offers insights into the challenges faced by schools in trying to help migrant students succeed. The study offers practical insights into the advantages of having teachers with a migrant background, especially the extent to which they use their intercultural competencies in helping migrant students overcome school-related challenges. While the fieldwork was carried out in Ghana, the implications are also of interest to other jurisdictions where schools are faced with migration-related diversity.

Social dominance orientation and ethnocentric bias: ingroup identification and group status differentials

ABSTRACT In this study, social dominance orientation (SDO) was examined in relation to ethnocentric bias while ingroup identification and group status were tested as moderator variables. With a survey research design, data were collected via standardised psychological scales from a sample of 1050 participants drawn from majority and minority ethnic groups using a multistage sampling procedure. Findings showed that SDO was a significant positive predictor of ethnocentric bias. In addition, the predictive strength of SDO on ethnocentric bias was stronger for majority ethnic group. Also a preference for social hierarchy was associated with less devotion to one’s ingroup. Results further showed ingroup identification to be a moderator of the relationship between SDO and ethnocentric bias such that it reduces the strength of the relationship between the two variables. Likewise, ingroup identification was directly related to higher pro-ingroup and lower anti-outgroup attitudes. Going by the findings of this study, SDO proves to be a significant variable that consistently influences social/political attitudes. Equally, ingroup identification shows potential as a useful tool in brokering peaceful relations within a multi-ethnic setting in which interacting groups are competitive but interdependent. Findings were discussed within the tenets of extant literature and the social context of the study.

Restructuring Marriage and Family in Industrial Kazakhstan: Axes of Inequality and Conjugality in a Former Soviet Steel Plant

Abstract This paper addresses how changing patterns of conjugality, family and labour play out in a gender-mixed, multi-ethnic industrial setting built in Soviet times and nowadays owned by foreign corporate capital. Matrimonial relationships among Kazakhstani steel workers have come under sustained pressure as a consequence of privatization and labour restructuring. As a result, workers must accommodate their family lives and partnership prospects to their own precarious situation in an increasingly adverse world of industrial labour. Kazakh, Russian, male, female, precarious and regular workers are differently affected and adopt different strategies. Mirroring workplace related inequalities, marriage and family patterns rooted in distinctive traditions in multi-ethnic Kazakhstan are currently being reshaped. At the same time, marriage and family have become more important in determining workers’ wellbeing at work and beyond.

Development and Relative Validity of a Semiquantitative Food Frequency Questionnaire to Estimate Dietary Intake among a Multi-Ethnic Population in the Malaysian Cohort Project.

Measuring dietary intakes in a multi-ethnic and multicultural setting, such as Malaysia, remains a challenge due to its diversity. This study aims to develop and evaluate the relative validity of an interviewer-administered food frequency questionnaire (FFQ) in assessing the habitual dietary exposure of The Malaysian Cohort (TMC) participants. We developed a nutrient database (with 203 items) based on various food consumption tables, and 803 participants were involved in this study. The output of the FFQ was then validated against three-day 24-h dietary recalls (n = 64). We assessed the relative validity and its agreement using various methods, such as Spearman’s correlation, weighed Kappa, intraclass correlation coefficient (ICC), and Bland–Altman analysis. Spearman’s correlation coefficient ranged from 0.24 (vitamin C) to 0.46 (carbohydrate), and almost all nutrients had correlation coefficients above 0.3, except for vitamin C and sodium. Intraclass correlation coefficients ranged from −0.01 (calcium) to 0.59 (carbohydrates), and weighted Kappa exceeded 0.4 for 50% of nutrients. In short, TMC’s FFQ appears to have good relative validity for the assessment of nutrient intake among its participants, as compared to the three-day 24-h dietary recalls. However, estimates for iron, vitamin A, and vitamin C should be interpreted with caution.

'Focus on diet quality': a qualitative study of clinicians' perspectives of use of the Mediterranean dietary pattern for non-alcoholic fatty liver disease.

Practice guidelines for non-alcoholic fatty liver disease (NAFLD) recommend promoting the Mediterranean dietary pattern (MDP) which is cardioprotective and may improve hepatic steatosis. This study aimed to explore multidisciplinary clinicians' perspectives on whether the MDP is recommended in routine management of NAFLD and barriers and facilitators to its implementation in a multi-ethnic setting. Semi-structured individual interviews were conducted with fourteen clinicians (seven doctors, three nurses, three dietitians and one exercise physiologist) routinely managing patients with NAFLD in metropolitan hospital outpatient clinics in Australia. Interviews were audio-recorded, transcribed and analysed using thematic content analysis. Clinicians described that lifestyle modification was their primary treatment for NAFLD and promoting diet was recognised as everyone's role, whereby doctors and nurses raise awareness and dietitians provide individualisation. The MDP was regarded as the most evidence-based diet choice currently and was frequently recommended in routine care. Facilitators to MDP implementation in practice were: improvement in diet quality as a parallel goal to weight loss; in-depth knowledge of the dietary pattern; access to patient education and monitoring resources and; service culture, including an interdisciplinary clinic goal, and knowledge sharing from expert dietitians. Barriers included perceived challenges for patients from diverse cultural and socio-economic backgrounds and limited clinician training, time and resourcing to support behaviour change. Integration of MDP in routine management of NAFLD in specialist clinics was facilitated by a focus on diet quality, knowledge sharing, belief in evidence and an interdisciplinary team. Innovations to service delivery could better support and empower patients to change dietary behaviour long-term.

Abstract P272: Management of Acute Stroke Patients in the Extended Window in a Large Community Cohort

Background: Published data suggest that treating qualified acute strokes within the extended window (EW) or 6-24 hours of last seen normal with endovascular therapy (EST) is associated with better 90-day outcome. In a real-world multi-ethnic practice setting, we assessed our experience in triaging and treating patients in the EW. Methods: In 2016, our system of care launched a telestroke program for 19 primary and 2 comprehensive stroke centers to include immediate video evaluation by a stroke neurologist. In 2018, screening in the EW began. If the patient met clinical criteria (baseline independence and initial NIHSS ≥ 6), neuroimaging was performed to assess for a large vessel occlusion (LVO). Referral for EST was made for patients with an LVO and appropriate CT perfusion criteria. Our study included all health plan members presenting within the EW in 2019. Assessment included demographics, NIHSS, neuroimaging data, LVO, discharge outcomes, 90-day mRS and mortality with 95% confidence interval. Results: In 2019, there were 5349 suspected strokes (1255 EW) evaluated by teleneurologists; 2130 (39.8%) patients were appropriate for acute stroke imaging workup. Of 2130, final study cohort included 388 (18.2%) EW patients who met clinical criteria and underwent neuroimaging workup, and 117 of these patients (30.2%) had an LVO. There were 57 (14.7%) meeting CT perfusion criteria and referred for EST. Compared to 331 who were not referred for EST, the 57 patients were older and more likely to have atrial fibrillation, higher NIHSS, and to be discharged to a short-term facility than home. The 51 patients who went for EST within our system had 90-day good (mRS 0-2), bad (mRS 5-6), and mortality rates comparable to those from DAWN and DEFUSE-3 trials [Table]. Conclusions: In our system, only a small proportion of suspected strokes met criteria for EST during the EW. It was possible in a community setting to achieve 90-day outcomes that were comparable to those from clinical trials.

PESANTRENTS AND MULTICULTURAL VALUE IN A MULTI-ETHNIC SOCIETY

This is a study of endeavor in planting of multicultural values carried out by Pesantren Kauman of Lasem in a multi-ethnic community setting. The study of the importance of understanding multiculturalism in a society with religious backgrounds like Indonesia is very crucial. This study contributes to the aspect of teaching multicultural values by one of the representatives of the oldest Islamic education institution, pesantren. It focuses particularly to understand the Pesantren’s motivation and ways of implementation of planting of multicultural values as an effort to maintaining harmony with the surrounding community, which is dominated by ethnic Chinese. This research seeks to answer what are the urgency, the ways of implementation, as well as the responses in terms of educating multicultural values carried out by Pesantren Kauman of Lasem. This pesantren has its own uniqueness because it stands in the midst of a non-Muslim community. This can strengthen the opinion that religion can be social cohesion. This is a qualitative study which employed field observations, in-depth interviews, and documentation study as data collection tools. The main research site is located in Lasem, which is also known as Little China. It found out that the Pesantren grows the motivation to implement multicultural values from theological and sociological perspective. Furthermore, in terms of implementation, the pesantren utilizes the formal-pedagogical as well as nonformal-sociological aspects. This study also concludes that the implementation reaped both pro and contra responses. However, in general the Kauman Pesantren from Lasem succeeded in teaching multicultural values and using them to maintain harmony. This study shows that multicultural values can be taught formally-pedagogically or non-formally-sociologically. The theological aspect can be the point of departure, but the sociological aspects are also essential to consider in planting multicultural values which are then implemented in society. The Pesantren Kauman of Lasem has finally showed successful efforts in teaching multicultural values and using them to maintain harmony in a multicultural society. The results of this study are an evidence that multicultural values are able to be taught formally-pedagogically or non-formally-sociologically. The theological aspect can be the point of departure, but the sociological aspect is also essential to be considered in planting multicultural values which are then implemented in society.

Iodine status of pregnant women with obesity from inner city populations in the United Kingdom.

Iodine is essential for foetal neurodevelopment and growth. Requirements increase in pregnancy to support increased thyroid hormone synthesis for maternal and foetal requirements, and for foetal transfer. Iodine deficiency in pregnancy is widely reported, and obesity has been associated with sub-optimal thyroid function. We evaluated iodine status and its relation with birthweight in a secondary analysis of pregnant women with obesity from multi-ethnic inner-city settings who participated in the UK Pregnancies Better Eating and Activity trial (UPBEAT). Iodine and creatinine concentrations were evaluated in spot urine samples in the second (15+0-18+6 weeks, n = 954) trimester of pregnancy. We assessed iodine status as urinary iodine concentration (UIC) and urinary iodine-to-creatinine ratio (UI/Cr) and applied WHO/UNICEF/IGN population threshold of median UIC > 150 µg/L for iodine sufficiency. Relationships between iodine status and birthweight were determined using linear and logistic regression with appropriate adjustment, including for maternal BMI and gestational age. Median (IQR) UIC and UI/Cr in the second trimester of pregnancy were 147 µg/L (99-257) and 97 µg/g (59-165), respectively. An UI/Cr <150 μg/g was observed in 70% of women. Compared to women with UI/Cr >150 µg/g, there was a trend for women with UI/Cr <150 µg/g to deliver infants with a lower birthweight (β = -60.0 g; 95% CI -120.9 to -1.01, P = 0.05). Iodine status of pregnant women with obesity from this cohort of UK women was suboptimal. Lower iodine status was associated with lower birthweight.

Breaking News of Cancer Diagnosis: A Qualitative Study on the Experiences and Emotional Needs of Patients With Cancer in a Multiethnic Asian Setting.

The breaking of news of a cancer diagnosis is an important milestone in a patient's cancer journey. We explored the emotional experiences of patients with cancer during the breaking of news of a cancer diagnosis and the arising needs in a multiethnic Asian setting with limited supportive cancer care services. Twenty focus group discussions were conducted with 102 Asian patients with cancer from diverse sociodemographic backgrounds. Thematic analysis was performed. While most participants, especially younger patients with young children, experienced intense emotional distress upon receiving a cancer diagnosis, those with a family history of cancer were relatively calm and resigned. Nonetheless, the prior negative experience with cancer in the family made affected participants with a family history less eager to seek cancer treatment and less hopeful for a cure. Although a majority viewed the presence of family members during the breaking of bad news as important, a minority opted to face it alone to lessen the emotional impact on their family members. Difficulties disclosing the news of a cancer diagnosis to loved ones also emerged as an important need. Sensitive and empathetic patient-physician communication during the breaking of news of a cancer diagnosis was stressed as paramount. A patient-centered communication approach needs to be developed to reduce the emotional distress to patients and their families after the breaking of bad news of a cancer diagnosis. This is expected to positively affect the patients' subsequent coping skills and attitudes toward cancer, which may improve adherence to cancer therapy.

Withholding/Withdrawing Life-Sustaining Treatment in a Multiethnic Critical Care Setting: An Ethnographic Study.

Background: Critical care physicians often have to make challenging decisions to withhold/withdraw life-sustaining treatments. As a result of society's increasingly cultural diversity such decision making often involves patients from ethnic minority groups, which might pose extra challenges. Objective: To investigate withholding/withdrawing life-sustaining treatments with patients from ethnic minority groups and their families during critical care. Design: Ethnographic fieldwork (observations, in-depth interviews and reading patients' medical files). Setting/Subjects: Eighteen patients from ethnic minority groups, their relatives, physicians and nurses were studied in one intensive care unit of a multi-ethnic urban hospital (Belgium). Results: During decision making physicians had a very central role. The contribution of patients and nurses was limited, while families' input was more noticeable. Decision making was hampered by communication difficulties between: (1) staff and relative(s), (2) relatives, and (3) patient and relative(s). Different approaches were used by physicians to overcome difficulties, which often reflected their tendency to control decision making, for example, stressing their central role. At times their approaches reflected their inability to align families' wishes with their own, for example, when making decisions without explicitly informing relatives. Conclusions: Withholding/withdrawing life-sustaining treatments in a multi-ethnic critic care context has a number of alarming difficulties, such as how to take families' input correctly into account. It is important that decision making happens in a cultural sensitive way and with involvement tailored to patients' and relatives' needs and in close consultation with interprofessional health care workers/other services.

Can interethnic contact between majority (Han) and minority (Uyghur) people in China influence sense of Chinese national Community? The role of positive and negative direct, extended and vicarious intergroup contact

ObjectivesIn multiethnic countries, enhancing the sense of community and preventing ethnic segregation represents a major challenge. In this study we aimed to test the effects of different forms of intergroup contact in fostering sense of community among majority and minority ethnic groups in China, by focusing on the sense of the community at the national level. MethodsParticipants were Han (N = 355, ethnic majority group) and Uyghur (N = 546, ethnic minority group) people at a multiethnic university in the Xinjiang province in China. ResultsResults from path analysis revealed that positive direct contact for the minority, and positive extended and vicarious contact for both majority and minority group were indirectly associated with higher sense of Chinese national community via greater focus on positive characteristics of the outgroup. In addition, negative contact (extended contact for the majority; direct contact for the minority) were indirectly associated with lower sense of Chinese national community via reduced focus on positive outgroup characteristics. No evidence was found for negative focus (focus on negative outgroup characteristics) and intergroup threat as mediators. Theoretical and practical implications of the findings for improving intergroup relations in multiethnic and conflictual settings by using multiple forms of intergroup contact are discussed.

Negative affect moderates the link between body image dissatisfaction and disordered eating among psychiatric outpatients in a multi-ethnic Asian setting.

Few studies have investigated the factors that affect the relationship between body image dissatisfaction and disordered eating locally. Our study aimed to investigate the moderating effects of depression and anxiety levels on the body dissatisfaction-disordered eating link in Singapore. A total of 329 participants completed a set of questionnaires that included various scales pertaining to eating behaviours, body image, psychological distress and quality of life. Participants were diagnosed with schizophrenia (47.4%), depression (46.8%) and substance use disorders (5.8%). Moderation analyses revealed that depression (F [9, 251] = 18.50, p < 0.001, R2 change = 0.021) and anxiety levels (F [9, 268] = 19.54, p < 0.001, R2 change = 0.014) were significant moderators of the relationship between body dissatisfaction and disordered eating scores. Subsequent multivariate linear logistic regression analyses showed that high disordered eating scores were significantly associated with lower physical (F [8, 273] = 9.59, R2 = 0.22, p < 0.001, β = -0.27, p < 0.001), psychological (F [8, 273] = 10.51, R2 = 0.49, p < 0.001, β = -0.27, p < 0.001), social (F [8, 256] = 6.78, R2 = 0.18, p < 0.001, β = -0.18, p = 0.004) and environment (F [8, 273] = 5.29, R2 = 0.13, p < 0.001, β = -0.19, p = 0.001) quality of life scores after controlling for sociodemographic covariates. Greater effort should be dedicated to the screening of disordered eating behaviours in psychiatric outpatients presenting with greater psychological distress.

Metabolic Surgery Diabetes Remission (MDR) Score: a New Preoperative Scoring System for Predicting Type 2 Diabetes Remission at 1Year After Metabolic Surgery in the Singapore Multi-ethnic Asian Setting.

The utility of available scoring systems for type 2 diabetes (T2D) remission prediction after metabolic surgery has not been defined in a multi-ethnic Asian population like Singapore. We sought to assess the predictive performance of the Asia-developed ABCD scoring system for T2D remission after metabolic surgery, and develop a new algorithm to improve prediction. We conducted a retrospective analysis of adults with T2D who underwent either Roux-en-Y gastric bypass or sleeve gastrectomy between 2007 and 2018, and followed for 1year postoperatively (n = 114, mean age 46 ± 9years, 48.2% men, body mass index 40.1 ± 6.6kg/m2). The primary outcome was complete T2D remission defined as HbA1c < 6% without the use of anti-diabetic medication at 1year after surgery. Complete T2D remission was observed in 47.4% of subjects at 1year post-surgery. Stepwise logistic regression identified preoperative age, T2D duration, HbA1c, and β-cell function (estimated by the homeostasis model) as predictors of complete T2D remission. Based on these four variables, we constructed a new 10-point scoring system named Metabolic surgery Diabetes Remission (MDR) score. Compared with ABCD, MDR produced fewer misclassifications at the mid-high scores, achieving a predictive accuracy of 71-100% at 6 points and above. In addition, MDR achieved a higher area under the receiver operating characteristic curve than ABCD for the primary outcome (0.79 versus 0.67, P = 0.007). MDR may serve as a useful clinical scoring system for predicting short-term T2D remission after metabolic surgery in Singapore's multi-ethnic Asian cohort.

Effects of Self-Care for Older PErsons (SCOPE) on Functional and Physiological Measures: A Cluster Randomized Controlled Trial.

Background: Population aging poses unprecedented demands on the healthcare system. There is also a scarcity of evidence on self-care intervention to improve objective measures of morbidity and aging-associated functional and physiological measures in a low-income multi-ethnic population setting. Methods: We conducted a cluster randomized controlled trial (ClinicalTrials.gov Identifier: NCT01672177) to examine the effects of the Self-Care for Older PErsons (SCOPE) program. We randomized 14 Senior Activity Centers and randomly selected older adults within these centers. Functional and physiological measurements were performed at baseline, 10-month, and 18-month periods. The primary outcome was a composite of three morbidity-specific measures, which include hemoglobin A1c (HbA1C), peak expiratory flow, and systolic blood pressure. Aging-associated functional and physiological measures were examined as secondary outcomes. Repeated-measure mixed models were employed to examine the effects of SCOPE on these measures. Results: 378 community-dwelling older adults participated in either the treatment (n= 164) or the control arm (n = 214). The primary outcome was not significantly improved. For the secondary outcomes, SCOPE participants demonstrated slower oxygen desaturation at an 18-month period (p = 0.001), improved time to complete the chair-stand test (p < 0.001) at a 10-month period with the effect persisting at the 18-month period (p < 0.001). SCOPE participants also had significantly improved vitamin B12 levels at the 18-month period (p < 0.001), increased hemoglobin concentration (p < 0.001), decreased mean corpuscular volume (p = 0.001), and decreased creatinine (p = 0.002) at the 10-month period. Conclusions: SCOPE did not improve morbidity-specific measures. However, it improved several aging-associated measures implicated in geriatric syndromes. This study highlights the potential of a self-care program in the prevention of geriatric syndromes in community-dwelling older adults, while emphasizing self-management to manage existing morbidities.

Does Poverty Undermine Cooperation in Multiethnic Settings? Evidence from a Cooperative Investment Experiment – ERRATUM

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Therapeutic Plasma Exchange in Neuromyelitis Optica Spectrum Disorders and Related Disorders in Resource-Limited Settings: Outcomes in a Multiethnic Single-Center Population.

We evaluated therapeutic plasma exchange (TPE) efficiency in treatment of a single relapse in steroid-refractory patients with neuromyelitis optica spectrum disorders (NMOSD) in a multi-ethnic resource-limited setting. This was a historical cohort study on the clinical outcomes post-TPE in a multiethnic cohort of 53 steroid-refractory NMOSD patients at a single Malaysian tertiary center. Primary outcomes, assessed both pre- and post-TPE, were Medical Research Council scale of muscle power, Modified Rankin Scale, Expanded Disability Status Scale (EDSS), and visual acuity. Secondary outcomes were ambulatory status and target neurological deficit (TND)-based TPE response. Significant improvements in Medical Research Council, Modified Rankin Scale, EDSS, and visual acuity (P < 0.001) were observed at 1-month post-TPE with further improvement of EDSS at 6 months (EDSSΔ6) post-TPE (P < 0.001). At 6 months post-TPE, 87% of patients has successful TND-based TPE response and 69.8% were ambulating without support. Patients with anti-aquaporin 4 seronegativity (P = 0.004), myelitis and brainstem features at first relapse (P = 0.004), longer cord lesions (P = 0.030), higher pre-TPE EDSS of ≥8 (P = 0.018) and delayed TPE initiation of >14 days (P = 0.047) were significantly associated with improved EDSSΔ6. TND-based TPE response was significant in absence of cord atrophy (P = 0.030). TPE is an effective treatment for steroid-refractory acute relapses of NMOSD in a multiethnic Malaysian population despite its resource-limited setting. The predictive factors of EDSSΔ6 improvement were anti-aquaporin 4 seronegativity, longer cord lesions, and higher pre-TPE EDSS. Absence of cord atrophy was predictive of better TND-based TPE response. Unexpectedly, our study showed that delayed TPE initiation of more than 14 days and up to 60 days may also be beneficial.

Kiezdeutsch, Kurzdeutsch, Migrantendeutsch: una nuova varietà linguistica?

This contribution deals with Kiezdeutsch, a form of youth slang spoken in multilingual and multi-ethnic urban settings in Germany. Based on three works by German scholars published in the past few years the linguistic features of Kiezdeutsch are described and the issues of its sociolinguistic status and of its origin are discussed. Then, the role played by Kiezdeutsch in present day German society is scrutinized relying on the dichotomy ‘community vs. migrancy’.

A phenotypic and genomics approach in a multi-ethnic cohort to subtype systemic lupus erythematosus

Systemic lupus erythematous (SLE) is a heterogeneous autoimmune disease in which outcomes vary among different racial groups. Here, we aim to identify SLE subgroups within a multiethnic cohort using an unsupervised clustering approach based on the American College of Rheumatology (ACR) classification criteria. We identify three patient clusters that vary according to disease severity. Methylation association analysis identifies a set of 256 differentially methylated CpGs across clusters, including 101 CpGs in genes in the Type I Interferon pathway, and we validate these associations in an external cohort. A cis-methylation quantitative trait loci analysis identifies 744 significant CpG-SNP pairs. The methylation signature is enriched for ethnic-associated CpGs suggesting that genetic and non-genetic factors may drive outcomes and ethnic-associated methylation differences. Our computational approach highlights molecular differences associated with clusters rather than single outcome measures. This work demonstrates the utility of applying integrative methods to address clinical heterogeneity in multifactorial multi-ethnic disease settings.