Non-white Ethnicity Research Articles

P0787 A large-scale comparison of clinical response to IBD therapies in white and non-white ethnicities

Abstract Background IBD phenotypes differ between non-White (NW) and White (WH) populations. Ethnic differences can influence the effectiveness of non-IBD medications, and IBD therapies differ by IBD phenotype. An unanswered question is whether IBD therapies are equally efficacious, with a similar side effect profile, for all ethnic groups. This multi-centre cohort study sought to compare the effectiveness and adverse events (AEs) of IBD therapies in WH and NW patients. Methods Phenotypic and outcome data were extracted from the UK IBD BioResource, a large-scale IBD database enrolling patients across the UK. Response and AEs to 5-ASAs, thiopurines, anti-TNFs and anti-integrins were assessed. Treatment effectiveness was defined as treatment persistence free of discontinuation or failure, and evaluated using Kaplan-Meier survival and Cox regression analysis. The risk of experiencing any AE (and individual AEs with a given treatment) was assessed using Cox regression analysis. Models were adjusted for sex, smoking status, IBD subtype, disease duration, disease location/extent, disease behaviour (CD), perianal disease (CD), co-morbidities, presence of extra-intestinal manifestations, age at commencing therapy, steroid and concomitant immunomodulator use, and the occurrence of an AE (in treatment response models). Results In total 27,433 patients were included [51.1% females; median age at diagnosis 30 years (IQR 21-43); 94.7% WH, 5.3% NW (71.3% South Asian)]. NW were diagnosed at a younger age, exhibited different disease phenotypes, and were younger at treatment initiation therapy than WH. However, no differences in treatment persistence between WH and NW were identified for all therapies analysed, in either CD or UC (Table 1). NW were at significantly increased risk of AEs when treated with thiopurines [HR 1.16 (95% CI 1.00-1.35), p=0.046] and a similar trend was observed for anti-TNFs [HR 1.25 (95% CI 0.99-1.56), p=0.057]; Table 2]. Specifically, NW were at increased risk of developing leucopenia [HR 1.66 (95% CI 1.10-2.42), p=0.01] and pancreatitis [ p=0.009] with thiopurines, and renal dysfunction with anti-TNFs [HR 2.33 (95% CI 1.11-4.38), p=0.02]. Conclusion This is the first large-scale study focussing on ethnic differences in IBD treatment response. No differences were observed in treatment response, but we have shown that thiopurines are associated with increased risks of leucopenia and pancreatitis, whilst anti-TNFs are associated with a higher risk of renal dysfunction in NW patients. These findings underscore the importance of thorough pre-treatment risk assessment and patient counselling by clinicians, and the need for more diverse patient representation in research.

How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour

ABSTRACT Background: Cervical cancer is a common cancer among young women aged 25–29 in England, and the NHS cervical screening leaflet is the first point of contact for those being invited for their first screening. This study aimed to explore how young women (18–24) understand and engage with the leaflet, as well as the barriers and facilitators associated with its interpretation, engagement, and screening intentions. Methods: The study used a mixed-methods approach, including a survey (n = 120) to identify interpretation difficulties and how they were affected by different characteristics, and a follow-up interview (n = 10) to assess the utility of the leaflet, identify issues with its practicality, and determine the factors that influence screening intentions. Results: The survey results showed that interpretation difficulties were common, particularly regarding HPV assessment, screening results, additional tests/treatment, and screening risks. Lower interpretation accuracy was associated with lower numeracy scores and non-white ethnicity. Despite these difficulties, participants had high confidence and motivation to engage with the leaflet. The interviews revealed knowledge gaps, issues with the leaflet's practicality, and a preference for digital information. Factors that were identified as barriers and facilitators of leaflet interpretation, engagement, and screening intentions included knowledge, social influence, beliefs about consequences, environmental context and resources, social role and identity, emotions and intentions. Conclusion: The current leaflet does not provide enough information for young women to make an informed decision about screening attendance. Implementing a digital invitation featuring simplified gist representation, targeted behaviour change techniques (BCTs), videos, and interactive tools can enhance education and promote screening behaviour. Future research should consider using digital tools and strategies to address existing barriers related to interpretation and engagement.

Comparative Demography of Biliary Atresia and Choledochal Malformation in London.

Choledochal malformation (CM) and biliary atresia (BA) are the two most important bile duct pathologies arising in infancy and childhood. The aim was to investigate for evidence of shared demographic features in a common temporo-spatial area. Patients identified prospectively and defined as being born within metropolitan London in the period 1999-2022. Index of Multiple Deprivation (IMD) Rank Index (based on maternal post-code - England 2019) and live-birth data taken from the Office of National Statistics to assess incidence and differences assessed using the Poisson distribution and Chi2 tests. P≤0.05 was regarded as significant. 280 patients (BA n=202; CM n=78). The incidence of BA and CM in London was 7.45/100,000 (1 in 13,430) and 2.9/100,000 (i.e. 1 in 34,480) with no change over the period. The incidence of BA in Inner London was significantly higher at 9.42/100,000 (1 in 10,650) (P=0.006). Marked female predominance evident in the CM group (77% vs. 54.4%; P=0.0006) with more patients of non-white ethnicity in both groups (BA=52.4%; CM=55%, P=0.32). No difference in IMDR between BA and CM (11,557 vs. 11,594; P=0.26), with a marked difference between Inner and Outer boroughs for CM (8976 vs. 16,717; P<0.001), but less so in BA (10,384 vs. 12,891; P=0.039). IMDR was higher in those of white ethnicity for BA (11,979 vs. 10,660; P=0.03). Inner London has the highest incidence of BA than anywhere in Europe or North America. The calculated incidence of CM is higher than anticipated and the first to be based on actual observation.

Survival Outcomes Following Chemotherapy for High-Grade Central Nervous System Tumors in Adolescents and Young Adults: An Exploration of Variations According to Ethnicity and Deprivation.

Introduction: Adolescents and young adults (AYA) are a unique subgroup of patients who experience cancer at the interface between pediatric and adult oncology services. Central nervous system (CNS) tumors are the leading cause of cancer-related morbidity and mortality in this group. Socioeconomic status and ethnicity are known to impact CNS tumor survival in patients of all ages. Studies reporting AYA CNS survival outcomes by ethnicity and area-based deprivation, however, are lacking in the United Kingdom (UK). Methods: Using cancer registration data for 351 patients (12-29 years) who received systemic chemotherapy for a high-grade malignant CNS tumor in England between April 2014 and December 2018, we quantified differences in survival at 1, 2, and 3 years post-diagnosis by ethnicity and area-based socioeconomic status. Results: Lower survival estimates were seen for non-White ethnicity and lower socioeconomic groups. Three-year survival was 64.4% (95% CI 58.3-69.9) for White patients but 46.6% (95% CI 29.9-61.7) for non-Whites and 64.0% (95% confidence interval [CI]49.0-75.7) and 62.9% (95% CI 50.7-72.8) in those from the two least deprived fifths compared to 50.2% (95% CI 36.1-62.7) and 56.1% (95% CI 42.4-67.7) in the two most deprived groups. Conclusion: Our study is the first to show the existence of health disparities in AYA treated with chemotherapy for a primary CNS tumor in England, where patients from ethnic minorities and deprived areas had worse survival rates than their White and socioeconomically advantaged counterparts. These findings call for further research into the underlying reasons behind survival differences between sociodemographic groups to improve survivorship outcomes.

Implementation and Evaluation of Automated, Online Study Recruitment from Computerised Medical Records in a Primary Care Sentinel Surveillance Network.

Infectious intestinal disease (IID) is a syndrome consisting of diarrhoea and vomiting symptoms linked to a causative pathogen. The Third Study of IID (IID3) will report its incidence in the community within the UK and assess how it has changed since the second IID study (IID2) in 2012. We implemented an automated, online patient recruitment process within a national sentinel surveillance network and compared its performance versus IID2 in terms of: Patient recruitment rates and demographic characteristics of recruited participants. We utilised a text messaging system (TMS) running off a computerised medical record systems (CMR) application programme interface (API). Demographic analysis showed that the majority of those recruited to IID3/IID2 studies were >65 years and female. However, the recruitment of participants of non-white ethnicity was statistically significantly different between IID3/IID2. Further work is required to improve recruitment in the younger patient demographic and in ethnic minority populations.

Dolutegravir with enteral feeds in intensive care: nutrition vs viral suppression

Abstract Introduction People living with HIV requiring admission to intensive care often receive enteral nutrition via feeding tubes. Enteral feeds contain cations which may interfere with dolutegravir (DTG) absorption due to chelation1. For this reason, temporal spacing (six hours before/ two hours after DTG administration2) is recommended, possibly leading to suboptimal caloric intake3. The clinical significance of the interaction between enteral feeds and DTG when co-administered is not fully understood and public data are sparse. Aim We aim to evaluate the impact and outcomes of co-administering DTG and enteral feeds. Methods Review of prospectively collected data on therapeutic drug monitoring (TDM) and electronic patient records of patients on DTG and enteral feeds, whilst in intensive care unit (ITU) between 2022 and 2023. Maximum (Cmax) and trough (Ctrough) DTG concentrations were measured and compared to reference ranges (DTG 50 mg once daily: Cmax 3340 ng/mL; Ctrough 830 ng/mL). All data were anonymised and collected as part of routine care for analysis. According to the National Research Ethics Service guidelines, further patient consent and ethical approval were not required. Results Six cases were identified with eight incidences of TDM sampling: 2 (33%) female; median age 34 (IQR 33-42); 3 (50%) non-white ethnicity; mean number of days on ITU 46 days; mean number of days into feeds 28 days; all (100%) suffered from hypoalbuminaemia (18-26 g/L). All patients were taking tenofovir-based regimens as their backbone antiretroviral therapy and once daily DTG, unless when co-administered with rifampicin where twice daily DTG is required to overcome enzyme induction effects of rifampicin. In three of the eight samples, temporal spacing with enteral feeds occurred as per SPC guidance2. The highest Cmax with once daily DTG seen in this cohort was 2201 ng/mL which was achieved without temporal spacing, whilst the lowest Ctrough (44 ng/mL) was observed in a different individual with sufficient temporal spacing. The viral loads measured while patients were receiving feeds varied, with 3 (50%) remaining suppressed. All (100%) patients had a fully suppressed viral load after enteral feeds ceased, including one patient who was naïve to treatment prior to admission with a high viral load. Discussion/Conclusion DTG Cmax were lower than those observed in literature regardless of temporal spacing from enteral feeds. Ctrough concentrations were also lower than expected in all cases. Six of eight Ctrough were lower than the DTG minimum effective concentration (MEC) of 300 ng/mL, however, only one was below IC90 for wildtype virus (64 ng/mL). Virological failure or onset of resistance was not observed in any of the patients. Multiple factors are likely to be contributing to low DTG concentrations, of which the most significant is likely impaired drug absorption, whilst nutritional feed co-administration seems to not be relevant.

Evolving HIV service delivery: scalability of pharmacist-led care

Abstract Introduction With declining healthcare budgets and numbers of HIV medical trainees1, workforce innovation is crucial to sustain delivery of HIV care. Since local introduction of an advanced pharmacist practitioner (APP) role, we have demonstrated the ability of pharmacists to provide holistic care to people living with HIV, including those with complex medical needs. Scaling up pharmacist-led care may be a potential solution to sustain service delivery2 whilst addressing the needs of an ageing cohort3. Further APP clinics were introduced with consultant support and supervision. Aim We aim to evaluate the impact and outcomes of these APP clinics. Method Prospective data collection of consultations conducted by four pharmacist practitioners (PP) across four HIV clinics between January to December 2023. Surveys were distributed after the appointment to capture service users’ opinions on the pharmacists’ role and care provided. Ethical approval was not required as this does not constitute as research. This was registered as a service evaluation with the research and innovation team at Chelsea and Westminster NHS Foundation Trust. All patient information is anonymised. Results A total of 634 consultations (513 individuals) within 170 clinical sessions were conducted during the 12 month period: 585 (92%) in person; 176 (34%) female; median age 52 (IQR 43-58); 233 (45%) non-white ethnicity; mean number of co-morbidities 2 (0-8); 87 (17%) had more than 5 co-medications (0-21); 87% virologically suppressed [viral load (VL) &amp;lt;50cp/mL]. Of 55 individuals seen with detectable VL, 32 (58%) resuppressed within 6 months. PPs have made 522 interventions and investigations in total, for example 147 referrals to other specialities such as dietitians and mental health services, 112 imaging requested (e.g DEXA and liver ultrasounds) and 99 initiation or switching of antiretroviral therapy (ART). Following investigations, 44 new medical conditions were identified and managed by the PPs which included namely 18 cases of micronutrient deficiencies, 8 cases of skin conditions and 6 cases of metabolic disorders. From the survey, 55% (30/55) of service users were aware that pharmacists could review their overall health. All (100%) respondents felt that the quality of care received met or exceeded expectations and 54 (98%) would attend a pharmacist-led appointment in future. Discussion/Conclusion We have previously successfully demonstrated implementation of pharmacist practitioner clinics as a novel way of utilising and developing the pharmacist workforce. We demonstrate scalability of this service delivery model in our large, urban multi-site centre by successfully increasing the number of pharmacist practitioner clinics from three clinics to six clinics week. The positive feedback from service users indicates high acceptability of this model. HIV services may consider investment into mobilising senior pharmacists to facilitate expansion of this advanced practitioner role in order to address increasing levels of co-morbidities, polypharmacy and complex medical needs observed in our ageing population. The knowledge base of HIV pharmacists means they are ideally placed to facilitate communication across sectors, specialties and disciplines. Future development plans include expanding to other specialist areas such as HIV pre-exposure prophylaxis, contraception, gender health and research delivery and enhanced skills such as phlebotomy, injectable ART administration.

Food insecurity, food behaviours, mental wellbeing and diet quality: a nationally representative cross-sectional investigation during the UK cost of living crisis

In the 12-month period leading up to March 2023, inflation in the UK increased by 8.9%(1). Notably, the annual inflation rate for food and non-alcoholic beverages reached a peak of 19.2% in March 2023, marking a 45-year high(1). Concurrently, research conducted between October 2022 and January 2023, revealed that 25% of adult respondents were classified as food insecure(2). Food insecurity disproportionately affects young families, ethnic minorities, and individuals with disabilities, and correlates with poorer mental health, higher rates of obesity, and lower dietary quality. However, improving skills in cooking, meal planning, and budget shopping may alleviate some of the adverse health consequences associated with food insecurity. This primary research aimed to investigate the relationships between food insecurity, mental wellbeing, dietary quality, and food behaviours among a nationally representative sample of UK adults and was pre-registered (https://doi.org/10.17605/OSF.IO/ZFMHD).A nationally representative cross-sectional survey was conducted in April 2023. Participants were recruited using a market research company (Dynata, UK) and quota-controlled sampling ( ± 5%) for age, gender, region and socioeconomic status. Data on food insecurity, mental wellbeing, diet quality and food behaviours, were collected, using validated measures where available. Ethical approval was received from King’s College London (Ref: LRS/DP-22/23-35412). Data analysis consisted of chi-square tests of homogeneity, Kruskal-Wallis H tests and hierarchical multiple regression modelling with adjustment of relevant covariates, using SPSS Statistics v29.0.2. The significance threshold was set at p&lt;0.05.1493 UK adults participated. Within the sample, 49.9% were male, mean age was 44.7 years (SD 16.3), 35.9% were classified into groups of either low (22.2%) or very low (13.7%) food security(3). Analyses revealed significantly higher proportions of females, individuals with lower income, and those of non-white ethnicity in the low or very low food security groups compared to groups with higher levels of food security (p&lt;0.05). Participants in the low or very low food security groups exhibited lower mental wellbeing scores and consumed fewer fruits and vegetables per day compared to those with higher food security (p&lt;0.05). Hierarchical regression models explained 28.5% of the variance in mental wellbeing scores and 16.4% in daily fruit and vegetable intake. Notably, variables related to food behaviour, such as food engagement and cooking skills confidence, significantly added to the variance explained by the models (p&lt;0.001), even after controlling for factors such as food insecurity score and income, respectively.This study reveals the substantial prevalence of food insecurity among UK adults, whilst also highlighting its associations with mental wellbeing and dietary quality, particularly among higher risk groups. The findings emphasise the urgent need for targeted interventions. Implementing programs focused on enhancing cooking skills and wider food behaviours could serve to mitigate some of the adverse health consequences associated with food insecurity, leading to improvements in overall wellbeing.

How can HIV self-testing facilitate increased access to HIV testing among multiply marginalised populations? Perspectives from GBMSM and trans women in England and Wales

Background HIV self-testing (HIVST) may facilitate marginalised populations’ uptake of HIV testing, but whether the extent of marginalisation challenges individual uptake of HIVST remains under-researched. We aim to explore the perspectives of multiply marginalised cis-gender gay, bisexual and other men who have sex with men (GBMSM) and trans women on whether HIVST might increase their uptake of HIV testing. Methods We reanalysed qualitative interview data from SELPHI (the UK’s largest HIVST randomised trial) collected between 2017 and 2020 from marginalised populations, defined as people self-identifying as non-heterosexual, transgender, non-White ethnicity and/or with low educational attainment. Thirty-eight interviews with multiply marginalised individuals were thematically examined using the framework method. We specifically focussed on kit usability (a function of the interaction between blood-based HIVST kits and users), perspectives on how HIVST can improve access to HIV testing and suggestions on need-based scale-up of HIVST. Results HIVST kits were considered usable and acceptable by multiply marginalised GBMSM and trans women. The majority of interviewees highlighted multi-levelled barriers to accessing HIV testing services due to structural and social marginalisation. Their multiply marginalised identities did not impede HIVST uptake but often form motivation to self-test. Three potential roles of HIVST in the HIV testing landscape were identified: (1) alternation of HIVST and facility-based testing, (2) integration of HIVST into sexual health services and (3) substituting facility-based testing with HIVST in the future. Perceived beneficiaries of HIVST included trans communities, individuals with undisclosed sexuality and people with physical disabilities. Discussion HIVST can facilitate marginalised populations’ access and uptake of HIV testing by alternating with, integrating into and substituting for facility-based services in the UK. Marginalised identities did not present challenges but rather opportunities for person-centred scale-up of HIVST. Future implementation programmes should ensure equitable access to HIVST among trans people, men unable to disclose their sexuality, and perhaps people with physical disabilities.

Development of an air quality communication strategy with underserved groups

Abstract Air quality is the greatest environmental health threat. Effective communication can support individuals to take actions to protect themselves, however, we know some groups are less likely to engage with exposure reducing behaviours than others. We aimed to explore what information individuals want to receive about raised air pollution levels, when, where and how they would like to receive it. In this qualitative study individuals participated in either semi-structured interviews (n = 6) or focus groups (n = 8) in North East England between Oct23-Feb24. We used purposive sampling underpinned by extensive community-based engagement to ensure inclusion of those who were underserved and/ or at risk of digital exclusion. The Capability Opportunity Motivation-Behaviour model was used to help guide discussions and the data thematically analysed using an inductive approach. Fifty individuals participated, many of whom were of non-white ethnicity (n = 23, 46%), spoke English as an additional language (n = 12, 24%), and had lower educational attainment levels (i.e., no-qualifications n = 7, 14%). Participants discussed four aspects that they deemed important to include in air quality communication: (1) the risk and harms of air pollution should be stated, and be tailored because “what’s a dangerous level for one person isn’t a dangerous level for another”(P41) (2) Participants felt detail about the pollutants should be included such as: “what is causing the air pollution?”(P15) to “avoid the exposure to this source”(P21). (3) Messages should also include actionable recommendations about how to protect oneself and, (4) various ways to communicate these messages (text-message-based approaches being the most popular) were suggested. Our findings indicated using a combined communication strategy including text messages and community-based approaches. This work can inform the development of inclusive future air quality information communication Key messages • Effective communication can support individuals to take actions to protect themselves from air pollution. • A combined communication strategy including text messages and community-based approaches were suggested as being effective communication strategies.

Association of Fusobacterium nucleatum Levels by ddPCR in Oral Rinse Samples With Periodontal Disease in Oral Squamous Cell Carcinoma Patients and in Controls.

The role of microbiome, particularly Fusobacterium nucleatum (Fn), in periodontal disease and oral squamous cell carcinoma (OSCC) has been recently explored. This study aimed to evaluate the Fn presence and its levels in oral rinse samples from Brazilian OSCC patients and healthy individuals and its association with sociodemographic, clinical, and oral health features. In this case-control study, 80 participants were included, 31 OSCC patients and 49 individuals without a cancer history. Clinical data were collected, and an oral exam was done on a subset of the cohort. Fn levels were evaluated by droplet digital PCR (ddPCR) in oral rinse samples and were categorized as Fn-high or Fn-low based on the median number of copies per reaction. OSCC patients showed higher levels of Fn (68%, p = 0.03) than controls, and all OSCC cases were diagnosed with periodontal disease (100%, p = 1.0). In the univariate analysis, Fn-high level was more frequently present in OSCC cases compared to controls (p = 0.01). It was also observed that Fn-high level OSCC cases were significantly associated with self-reported non-white ethnicity (71.4%, p = 0.01) and had more infiltrative lesions (57.1%, p = 0.02) than Fn-low OSCC cases. Fn-high levels in oral rinse samples, were significantly more prevalent among OSCC than in controls. In OSCC patients, Fn-high levels were associated with non-white ethnicity and lesions with infiltrative clinical aspects. Among OSCC cases, all had periodontal disease.

Factors affecting prostate cancer detection through asymptomatic PSA testing in primary care in England: Evidence from the 2018 National Cancer Diagnosis Audit.

Background Prostate-Specific Antigen (PSA) is used in primary care for prostate cancer detection, either for symptomatic assessment or asymptomatic testing following an informed decision. Aim To estimate the proportion of prostate cancer cases diagnosed following asymptomatic PSA testing, and patient and practice factors influencing this route. Design and setting 2018 English National Cancer Diagnosis Audit (NCDA) data were analysed, with linkage to the national cancer registry, practice-level Quality Outcomes Framework (QOF), and General Practice Patient Survey (GPPS) data. All 2018 NCDA patients with a diagnosis of prostate cancer were included (n = 9,837). Method Patients with recorded biomarker testing and no recorded symptoms prior to diagnosis were classified as asymptomatic PSA detected prostate cancer. Patient (age, ethnicity, deprivation, co-morbidities) and GP practice (geographical location, area deprivation, list size, urgent suspected cancer referral rate, QOF outcomes, GPPS results) factors were analysed for association with asymptomatic PSA testing using mixed effects logistic regression models. Results 1,884 out of 9,837 (19%) prostate cancer cases were detected following asymptomatic PSA testing, 982 (52.1%) of whom were patients aged 50-69 years. Younger age, non-White ethnicity, lower deprivation, and lower co-morbidity count were associated with an increased likelihood of diagnosis following asymptomatic PSA testing. There was a 13-fold variation between practices in the odds of asymptomatic PSA-detected cases, without clear explanatory GP practice-level factors. Conclusion One in five patients with prostate cancer in England are diagnosed after asymptomatic PSA testing in primary care, with large variation in asymptomatic PSA detection between GP practices.

Suicide in prison in the North of Italy (1993-2022): a case-control study examining differences between suicides inside and outside prison.

Prisoners constitute a group at suicide risk, showing higher relative rates of suicides than the general population. However, there is limited knowledge about the characteristics of those who die by suicide in Italian prisons. Based on the total sample of suicides of the Institute of Forensic Medicine of Milan (1993-2022), suicides in prison (N = 120) were matched by age and gender with cases that occurred outside prison (N = 300) and compared with them. The considered variables were sociodemographic, clinical, and suicide-related. Univariate analyses and logistic regression model were performed. In univariate analyses, suicides in prison showed higher rates of ethnicity different from white Caucasian, lower rates of depression, higher rates of alcoholism, addiction, respiratory system diseases, hepatitis, and amyotrophic lateral sclerosis, lower use of any medication, and in particular psychotropic medications, and a higher percentage of violent suicide method versus nonviolent compared to suicides outside prison. In the logistic regression model, ethnicity, depression, and addiction were the only features differentiating suicides in prison from ones outside prison. Particular attention should be paid to inmates with non-white ethnicity and those with addiction. Ensuring adequate access to psychiatric care and implementing comprehensive suicide prevention strategies within Italian prisons is crucial.

Beyond the stereotypes: Artificial Intelligence image generation and diversity in anesthesiology.

Artificial Intelligence (AI) is increasingly being integrated into anesthesiology to enhance patient safety, improve efficiency, and streamline various aspects of practice. This study aims to evaluate whether AI-generated images accurately depict the demographic racial and ethnic diversity observed in the Anesthesia workforce and to identify inherent social biases in these images. This cross-sectional analysis was conducted from January to February 2024. Demographic data were collected from the American Society of Anesthesiologists (ASA) and the European Society of Anesthesiology and Intensive Care (ESAIC). Two AI text-to-image models, ChatGPT DALL-E 2 and Midjourney, generated images of anesthesiologists across various subspecialties. Three independent reviewers assessed and categorized each image based on sex, race/ethnicity, age, and emotional traits. A total of 1,200 images were analyzed. We found significant discrepancies between AI-generated images and actual demographic data. The models predominantly portrayed anesthesiologists as White, with ChatGPT DALL-E2 at 64.2% and Midjourney at 83.0%. Moreover, male gender was highly associated with White ethnicity by ChatGPT DALL-E2 (79.1%) and with non-White ethnicity by Midjourney (87%). Age distribution also varied significantly, with younger anesthesiologists underrepresented. The analysis also revealed predominant traits such as "masculine, ""attractive, "and "trustworthy" across various subspecialties. AI models exhibited notable biases in gender, race/ethnicity, and age representation, failing to reflect the actual diversity within the anesthesiologist workforce. These biases highlight the need for more diverse training datasets and strategies to mitigate bias in AI-generated images to ensure accurate and inclusive representations in the medical field.

The OBS UK Dashboard: an interactive tool for representative trial site selection to facilitate equality and diversity in maternity research

BackgroundObstetric Bleeding Study UK (OBS UK) (award ID: 152057) is a National Institute for Health and Care Research (NIHR)-funded stepped wedge cluster randomised controlled trial of a complex intervention for postpartum haemorrhage. This was developed in Wales and evaluated in a feasibility study, with improvements in maternal outcomes observed. Generalisability of the findings is limited by lack of control data and limited ethnic diversity in the Welsh obstetric patient population compared to the United Kingdom (UK): 94% of the Welsh population identifies as White, versus 82% in the UK. Non-White ethnicity and socioeconomic deprivation are linked to increased risk of adverse maternal outcomes. Traditionally, decisions regarding site selection are based on desire to complete trials on target in ‘tried and tested’ research active institutions. To ensure widespread applicability of the results and investigate the impact of ethnicity and social deprivation on trial outcomes, maternity units were recruited that represent the ethnic diversity and social deprivation profiles of the UK.MethodUsing routinely collected, publicly available data, an interactive dashboard was developed that demonstrates the demographics of the population served by each maternity unit in the UK, to inform site recruitment. Data on births per year, ethnic and socioeconomic group of the population for each maternity unit, across the UK, were integrated into the dashboard.ResultsThe dashboard demonstrates that OBS UK trial sites reflect the ethnic and socioeconomic diversity of the UK (study vs UK population ethnicity: White 79.2% vs 81.7%, Asian 10.5% vs 9.3%, Black 4.7% vs 4.0%, Mixed 2.5% vs 2.9%, Other 3.0% vs 2.1%) with variation in site demography, size and location. Missing data varied across sites and nations and is presented.ConclusionThe NIHR equality, diversity and inclusion strategy states studies must widen participation, facilitating individuals from all backgrounds to engage. The development of this novel interactive dashboard demonstrates an innovative way of achieving this. National Health Service (NHS) maternity researchers should consider using this tool to enhance diversity in research, address health disparities and improve generalisability of findings. This approach could be applied to healthcare settings beyond maternity care and across different global populations.Trial registrationISRCTN 17679951. Registered on August 30, 2023.

Steroid-Resistant Nephrotic Syndrome Is Associated With a Unique Genetic Profile in a Highly Admixed Pediatric Population

The profile of genetic and nongenetic factors associated with progression to kidney failure (KF) in steroid-resistant nephrotic syndrome (SRNS) is largely unknown in admixed populations. A total of 101 pediatric patients with primary SRNS were genetically assessed targeting Mendelian causes and APOL1 status with a 62-NS-gene panel or whole exome sequencing, as well as genetic ancestry. Variant pathogenicity was evaluated using the American College Medical of Genetics and Genomics (ACMG) criteria. Focal segmental glomerulosclerosis (FSGS) was diagnosed in 54% of patients whereas familial disease was reported by 13%. The global genetic ancestry was 65% European, 22% African, 10.5% Native American, and 2% East-Asian, while 96% of cases presented with the first 3 components. APOL1 high-risk genotypes were identified in 8% of families and causative Mendelian variants in 12%: NPHS1= 3, NPHS2= 3, PLCE1= 2, WT1= 2, COQ2= 1, and CUBN= 1. Two novel causative variants arose in the Native American background. The percentage of African genetic ancestry did not associate with the number of APOL1 risk alleles. Forty-four percent of all patients progressed to KF. Mendelian forms and APOL1 high-risk genotypes were associated with faster progression to KF. Cox regression analyses revealed that higher non-European genetic ancestry, self-declared non-White ethnicity, age of onset<1 year or≥9 years, and non-minimal change disease (MCD) histology associated with higher risk of KF, independently of genetic findings. Mendelian variants and APOL1 high-risk genotype compose a unique causative genetic profile associated with pediatric SRNS in this highly admixed population, accounting for approximately 20% of families. This ancestry pattern is consistent with the identification of APOL1 high-risk genotypes in children with low proportion of African genetic ancestry. Self-declared ethnicity, age of manifestation and histology were independently associated with the risk of KF.

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.

Comparison of race- and ethnicity-specific BMI cutoffs for categorizing obesity severity: a multicountry prospective cohort study.

The objective of this study was to compare race- and ethnicity-specific BMI cutoffs for the three classes of obesity based on equivalent risk of type 2 diabetes (T2D). Participants without T2D were included from the UK Biobank, the China Health and Nutrition Survey, and the Singapore Chinese Health Study. Poisson regressions with restricted cubic splines were applied to determine BMI cutoffs for each non-White race and ethnicity for equivalent incidence rates of T2D at BMI values of 30.0, 35.0, and 40.0 kg/m2 in White adults. During a median follow-up of 13.8 years among 507,763 individuals, 5.2% developed T2D. In women, BMI cutoffs for an equivalent incidence rate of T2D as observed at 40.0 kg/m2 in White adults were 31.6 kg/m2 in Black, 29.2 kg/m2 in British Chinese, 27.3 kg/m2 in South Asian, 26.9 kg/m2 in Native Chinese, and 25.1 kg/m2 in Singapore Chinese adults. In men, the corresponding BMI cutoffs were 31.9 kg/m2 in Black, 30.6 kg/m2 in British Chinese, 29.0 kg/m2 in South Asian, 29.6 kg/m2 in Native Chinese, and 27.6 kg/m2 in Singapore Chinese adults. The race and ethnicity order was consistent when equivalent BMI cutoffs were estimated for class I and II obesity. Establishing a race- and ethnicity-tailored classification of the three classes of obesity is urgently needed.

Acceptance among the public of weight screening and interventions delivered by dental professionals: observational study.

The objective of this study was to explore the acceptability to the public of receiving weight screening and the offer of support to lose weight from dental teams. A cross-sectional survey was conducted with recruitment of adults from dental practices and community and hospital settings in England and the National Institute for Health and Care Research (NIHR) Be Part of Research initiative. A total of 3580 participants were recruited across 22 dental sites and the NIHR Be Part of Research initiative. Sixty percent (n = 2055/3430) of participants reported that they would be comfortable with their height and weight being measured at a dental appointment. Male participants and those of non-White race and ethnicity had significantly increased odds of accepting weight screening (odds ratio [OR]: 1.98, 95% CI: 1.66-2.36; OR: 2.07, 95% CI: 1.42-3.03). Fifty-seven percent (n = 1915/3375) of participants reported that it would be acceptable for their dental team to offer support to help with weight management. Male participants and those of non-White race and ethnicity had significantly increased odds of accepting support (OR: 1.79, 95% CI: 1.49-2.13; OR: 1.62, 95% CI: 1.11-2.37). The most accepted form of support was provision of information on local weight-management programs (n = 1989/2379, 83.6%). The public is largely receptive to receiving weight screening and the offer of weight interventions from dental teams. Feasibility studies to test the implementation of lifestyle weight interventions in dental settings are required.

Individual risk factors associated with SARS-CoV-2 infection during Alpha variant in high-income countries: a systematic review and meta-analysis.

This study aimed to systematically appraise risk factors associated with SARS-CoV-2 infection in high-income countries during the period of predominance of the Alpha variant (January 2020 to April 2021). Four electronic databases were used to search observational studies. Literature search, study screening, data extraction and quality assessment were conducted by two authors independently. Meta-analyses were conducted for each risk factor, when appropriate. From 12,094 studies, 27 were included. The larger sample size was 17,288,532 participants, more women were included, and the age range was 18-117 years old. Meta-analyses identified men [Odds Ratio (OR): 1.23, 95% Confidence Interval (CI): 1.97-1.42], non-white ethnicity (OR: 1.63, 95% CI: 1.39-1.91), household number (OR: 1.08, 95% CI: 1.06-1.10), diabetes (OR: 1.22, 95% CI: 1.08-1.37), cancer (OR: 0.82, 95% CI: 0.68-0.98), cardiovascular diseases (OR: 0.92, 95% CI: 0.84-1.00), asthma (OR: 0.83, 95% CI: 0.75-0.92) and ischemic heart disease (OR: 0.82, 95% CI: 0.74-0.91) as associated with SARS-CoV-2 infection. This study indicated several risk factors for SARS-CoV-2 infection. Due to the heterogeneity of the studies included, more studies are needed to understand the factors that increase the risk for SARS-CoV-2 infection. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244148, PROSPERO registration number, CRD42021244148.