White Group Research Articles

Sex and Race Differences in Obesity-Related Genetic Susceptibility and Risk of Cardiometabolic Disease in Older US Adults

The fat mass and obesity-associated gene (FTO) is associated with obesity phenotypes, but the association is inconsistent across populations. Within-population differences may explain some of the variability observed. To investigate sex differences in the association between FTO single-nucleotide variants (SNVs) and obesity traits among self-identified non-Hispanic Black and non-Hispanic White US adults, to examine whether the SNVs were associated with cardiometabolic diseases, and to evaluate whether obesity mediated the association between FTO SNVs and cardiometabolic diseases. This cross-sectional study used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a US population-based cohort study with available genetic data (assayed in 2018) and phenotypic data at baseline (enrolled 2003-2007). Participants were aged 45 to 98 years at baseline. Data were analyzed from October 2021 to October 2022. Eleven SNVs in the FTO gene present among both Black and White participants. Objectively measured obesity indicators (body mass index and waist-to-height ratio), objectively measured and/or self-reported cardiometabolic diseases (hypertension, stroke history, heart disease, and diabetes), and self-reported social-economic and psychosocial status. A total of 10 447 participants (mean [SD] age, 64.4 [9.7] years; 5276 [55.8%] women; 8743 [83.7%] Black and 1704 [16.3%] White) were included. In the White group, 11 FTO SNVs were significantly associated with obesity, hypertension, and diabetes using linear models (eg, body mass index: β = 0.536; 95% CI, 0.197-0.875), but none of the FTO SNVs were associated with obesity traits in the Black group. White males had a higher risk of obesity while White females had a higher risk of hypertension and diabetes. However, 1 FTO SNV (rs1121980) was associated with a direct increase in the risk of heart disease in Black participants not mediated by obesity (c' = 0.145 [SE, 0.0517]; P = .01). In this cross-sectional study of obesity phenotypes and their association with cardiometabolic diseases, the tested FTO SNVs reflected sex differences in White participants. Different patterns of associations were observed among self-identified Black participants. Therefore, these results could inform future work discovering risk alleles or risk scores unique to Black individuals or further investigating genetic risk in all US residents.

Exploring the Historical Consciousness in Selected Fiction of Nadine Gordimer

The novels of Nadine Gordimer run parallel with the era of apartheid. They are a record of the realities of the period during the apartheid and also the interregnum period in South Africa in a chronological manner. In South Africa, Gordimer belonged to a minority within the minority. But contained within that small white world is another group of whites who are opposed to the system of racial discrimination known as apartheid and stand with the country's majority. Nadine Gordimer examines the nature of apartheid which according to her, changes depending on who was looking at the issue. Different people react differently to what apartheid meant to them. As a writer she took her commitment to the community at large quite seriously and this is amply reflected in her work and the interviews that were recorded. Gordimer vociferously denounced the discrimination and violence that followed in her fiction as in real life. The research paper shall focus on the idea of the construction of identity in the selected novels whose plots are a reflection of events and situations that were taking place in South Africa as well as the historical consciousness of Gordimer.

Post Service Labor Market Performance of Immigrant Veterans

ABSTRACTMy research examines the labor market performance of prime-age (20-54) male immigrant veterans in the all-volunteer era, using the American Community Survey (2010-2019) and a linear regression model. I compare them with two reference groups: U.S.-born male veterans and non-veteran male immigrants. Immigrant veterans show higher labor force participation and employment rates compared to U.S.-born veterans. Conversely, when compared to non-veteran immigrants, the trend is reversed. Overall, no statistically significant disparities are found in labor income and wage analysis. However, heterogeneous effects emerge based on education level, race, and birthplace. Immigrant veterans earn less income compared to U.S.-born veterans in the non-Hispanic White group, while no significant differences are observed in other races. Furthermore, compared to non-veteran immigrants, Hispanic/Latino and non-Hispanic Black immigrant veterans have higher labor incomes or wages, especially for those with a high school education as their highest level of attainment. In contrast, non-Hispanic White immigrant veterans earn less, particularly among individuals with a college education. Additionally, immigrant veterans from developed countries have lower incomes and wages compared to their non-veteran counterparts, whereas no such disadvantage is observed for immigrants from developing countries. These findings suggest potential advantages associated with military service in minority groups.

Racial disparities in the selection of chief resident: A cross-sectional analysis of a national sample of senior residents in the United States

IntroductionPart of the difficulty in recruiting and retaining a diverse physician workforce, as well as within medical leadership, is due to racial disparities in medical education. We investigated whether self-identified race-ethnicity is associated with the likelihood of selection as chief resident (CR). Materials and methodsWe performed a cross sectional analysis using de-identified person-level data from the GME Track, a national resident database and tracking system, from 2015 through 2018. The exposure variable, self-identified race-ethnicity, was categorized as African American or Black, American Indian or Alaskan Native, Asian, Hispanic, Latino or of Spanish Origin, Native Hawaiian or Pacific Islander, White, and Multi-racial. The primary study outcome was CR selection among respondents in their final program year. Logistic regression was used to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI) of CR selection for each racial group, as compared to the White referent group. ResultsAmong the study population (N=121,247), Black, Asian and Hispanic race-ethnicity was associated with a significantly decreased odds of being selected as CR in unadjusted and adjusted analyses. Black, Asian and Hispanic residents had a 26% (aOR=0.74, 95% CI 0.66-0.83), 29% (aOR=0.71, 95% CI 0.66-0.76) and 28% (aOR=0.72, 95% CI 0.66-0.94) decreased likelihood of becoming CR, respectively. Multi-racial residents also had a decreased likelihood, but to a lesser degree (aOR=0.92, 95% CI 0.89-0.95). ConclusionsIn as much as CR is an honor that sets one up for future opportunity, our findings suggest that residents of color are disproportionately disadvantaged compared to their White peers.

Differential A/T/N Networks of Cerebrospinal Fluid and Neuroimaging Biomarkers and their Prediction of Cognition between Self‐reported Black/African American and Non‐Hispanic White Individuals

AbstractBackgroundDifferences in absolute levels of individual biomarkers from cerebrospinal fluid (CSF), amyloid PET, and MRI imaging between self‐reported Black and White individuals were reported. How the A/T/N network of AD biomarkers is biologically connected within a racialized group and whether it predicts cognition differentially between groups remain unknown.MethodThe Study of Race to Understand Alzheimer Biomarkers(SORTOUT‐AB) has centrally re‐processed the CSF samples and imaging scans collected at four AD Research Centers/studies: Washington University, University of Pennsylvania, Emory University, and the Harvard Aging Brain Study. A total of 286 Black and 2080 White participants had CSF biomarker data, 157 Black and 936 White participants provided PET amyloid biomarker data, 322 Black and 1530 White individuals had MRI structural data, and 67 Black and 492 White participants provided PET Tau biomarker data. Spearman correlations across biomarkers and cognition/memory were estimated within each race, then compared between groups, adjusting for age, sex, APOE e4 status, dementia status, and education.ResultThe absolute correlation between CSF Aß42 and the centiloid scale of PET amyloid mean cortical SUVR was significantly larger in White(r = ‐0.45) versus Black(r = ‐0.04) participants, similar to the absolute correlations between Aß42/40 ratio and each of below: PET amyloid centiloid(White r = ‐0.61, Black r = ‐0.12), CSF Tau(White r = ‐0.43, Black r = ‐0.25), and CSF pTau181(White r = ‐0.54, Black r = ‐0.33). Aß42 alone did not correlate with Tau or pTau181 in White individuals, but positively correlated with Tau(r = 0.15) and pTau181(r = 0.16) in Black participants. Significantly larger positive correlations were observed in Black versus White individuals between CSF Aß40 and pTau181(Black r = 0.68, White r = 0.55). PET amyloid centiloid, MRI hippocampal volume, and cortical thickness all predicted cognition, with no racial differences observed. However, cognition/memory was better predicted by Aß42/40 for White verses Black participants(Black r = 0.07, White r = 0.22), Tau(Black r = ‐0.06, White r = ‐0.20), and pTau181(Black r = ‐0.02, White r = ‐0.23).ConclusionBiological associations of CSF and imaging biomarkers differed between Black and White groups, suggesting that current A/T/N research framework of AD biomarkers may not apply across racialized groups. The prediction of CSF biomarkers to cognition also differed between groups. Use of biomarkers in studying AD and designing/analyzing AD clinical trials must appropriately address racial differences.

Differential A/T/N Networks of Cerebrospinal Fluid and Neuroimaging Biomarkers and their Prediction of Cognition between Self‐reported Black/African American and Non‐Hispanic White Individuals

AbstractBackgroundDifferences in absolute levels of individual biomarkers from cerebrospinal fluid (CSF), amyloid PET, and MRI imaging between self‐reported Black and White individuals were reported. How the A/T/N network of AD biomarkers is biologically connected within a racialized group and whether it predicts cognition differentially between groups remain unknown.MethodThe Study of Race to Understand Alzheimer Biomarkers(SORTOUT‐AB) has centrally re‐processed the CSF samples and imaging scans collected at four AD Research Centers/studies: Washington University, University of Pennsylvania, Emory University, and the Harvard Aging Brain Study. A total of 286 Black and 2080 White participants had CSF biomarker data, 157 Black and 936 White participants provided PET amyloid biomarker data, 322 Black and 1530 White individuals had MRI structural data, and 67 Black and 492 White participants provided PET Tau biomarker data. Spearman correlations across biomarkers and cognition/memory were estimated within each race, then compared between groups, adjusting for age, sex, APOE ε4 status, dementia status, and education.ResultsThe absolute correlation between CSF Aβ42 and the centiloid scale of PET amyloid mean cortical SUVR was significantly larger in White(r = ‐0.45) versus Black(r = ‐0.04) participants, similar to the absolute correlations between Aβ42/40 ratio and each of below: PET amyloid centiloid(White r = ‐0.61, Black r = ‐0.12), CSF Tau(White r = ‐0.43, Black r = ‐0.25), and CSF pTau181(White r = ‐0.54, Black r = ‐0.33). Aβ42 alone did not correlate with Tau or pTau181 in White individuals, but positively correlated with Tau(r = 0.15) and pTau181(r = 0.16) in Black participants. Significantly larger positive correlations were observed in Black versus White individuals between CSF Aβ40 and pTau181(Black r = 0.68, White r = 0.55). PET amyloid centiloid, MRI hippocampal volume, and cortical thickness all predicted cognition, with no racial differences observed. However, cognition/memory was better predicted by Aβ42/40 for White verses Black participants(Black r = 0.07, White r = 0.22), Tau(Black r = ‐0.06, White r = ‐0.20), and pTau181(Black r = ‐0.02, White r = ‐0.23).ConclusionBiological associations of CSF and imaging biomarkers differed between Black and White groups, suggesting that current A/T/N research framework of AD biomarkers may not apply across racialized groups. The prediction of CSF biomarkers to cognition also differed between groups. Use of biomarkers in studying AD and designing/analyzing AD clinical trials must appropriately address racial differences.

Sick individuals, sick populations revisited: a test of the Rose hypothesis for type 2 diabetes disparities

IntroductionThe Rose hypothesis predicts that since genetic variation is greater within than between populations, genetic risk factors will be associated with individuals’ risk of disease but not population disparities, and...

Demographic and travel characteristics and self-reported predeparture SARS-CoV-2 testing behavior in air passengers entering the United States from foreign destinations from July to September 2021.

From January 2021 to June 2022, the United States Centers for Disease Control and Prevention required predeparture SARS-CoV-2 testing for all air passengers arriving into the United States from a foreign country. Using data collected during a surveillance project, we described predeparture testing behavior among a convenience sample of international air passengers entering the United States from July to September 2021 at six US ports of entry. We analyzed pairwise relationships between self-reported test type, test timing, demographic and travel characteristics, and COVID-19 vaccination status using chi-square and Fisher's exact tests. Participants were more likely to get a NAAT versus antigen test if they identified as non-Hispanic Asian or Pacific Islander (68.2%, n = 173), non-Hispanic Black (62.6%, n = 147), or if they preferred not to report race and ethnicity (60.8%, n = 209) when compared to those who identified as non-Hispanic White (47.1%, n = 1086, all p < 0.05). Those who identified as Hispanic or Latino (n = 671) were less likely to get a NAAT than the non-Hispanic White group (39.5% vs. 47.1%, p < 0.05). Participants arriving in the US from the Americas were less likely to get a NAAT (38.5%, n = 871) compared to those arriving from Europe (45.5%, n = 1165, p < 0.05). Participants who reported receiving their predeparture test 2 days or 3 or more days before departure were more likely to report receiving a NAAT (52.2%, n = 879, and 60.2%, n = 410, respectively) than those who reported testing within 1 day (41.4%, n = 1040, all p < 0.001) of departure. Test type was significantly associated with race and ethnicity, departure region, and test timing. Differences likely reflected regional disparities in the availability of tests at the time of the activity. Discrepancies in predeparture test timing and type worldwide may have consequences for the effectiveness and equity of travel requirements in future pandemics.

Abstract B138: Examining factors that contribute to racial and ethnic disparities in liver cancer within an EHR-based epidemiologic cohort linked to cancer registries

Abstract Background: Racial and ethnic disparities in HCC risk have been documented, but disparities across detailed racial and ethnic groups and the relative contribution of these factors to HCC risk across those groups has not been assessed. We assembled a pooled, EHR-based cohort linked to cancer registry data to study disparities in HCC risk among detailed racial and ethnic groups and to examine the relative contribution of known and putative HCC risk factors to disparities in risk. Methods: Adults with at least one in-person encounter in 2000-2017 within three healthcare systems, San Francisco Health Network, Sutter Health Northern California, and Kaiser Permanente Hawai’i, were linked to their respective population-based state cancer registries for data on incident HCC. We used EHR data to define 17 detailed racial and ethnic groups and other sociodemographic and clinical factors. We used Cox proportional hazards regression with age as the timescale to examine racial/ethnic disparities in HCC risk with sex-specific models adjusted for length of active follow-up and with underlying stratification by site, birth cohort, baseline year and number of encounters. We calculated sex-specific hazards and population attributable fractions (PAFs) of HCC risk factors among racial/ethnic groups (e.g., smoking, hepatitis infections, metabolic syndrome). Results: The pooled cohort contained data on 4,249,671 adults followed a median of 6.8 years; 55% were female, and 2,916 had incident HCC. Compared to non-Hispanic White males, Vietnamese American males had greater risk of HCC (HR: 7.42; 95% CI: 4.25, 12.96) as did American Indian/Alaska Native, Black, Chinese American, Hispanic, Native Hawaiian, and Pacific Islander males, and those of multiple races or ethnicities. Among females, every group except for American Indian/Alaska Native, Asian Indian American, and Pacific Islander females had greater risk of HCC compared to the non-Hispanic White group; HRs ranged from 1.68 (1.01, 2.78) among Filipino to 6.38 (2.79, 14.55) among Vietnamese American females. Risk of HCC according to clinical risk factors was similar for males and females; however, the PAF of HCC for alcohol disorders was much higher for females (43%) than males (2%). Analyses by racial/ethnic group are ongoing, but variation in factor-specific risk of HCC was observed in preliminary analyses; for example, only non-Hispanic White and Asian American males had greater risk of HCC with metabolic-associated fatty liver disease and ever-smoking. Conclusions: Analysis of a large EHR-based cohort linked with cancer registry data yields additional information on cancer disparities across detailed racial and ethnic groups and may benefit efforts to identify targets for intervention. Our results indicate disparities in HCC risk across detailed racial and ethnic groups traditionally aggregated into larger groups (e.g., Asian American/Pacific Islander). Variation in the PAF of HCC for known risk factors suggest that the most impactful prevention efforts may require tailoring to the target populations. Citation Format: Mindy C. DeRouen, Alison J. Canchola, Janet Chu, Aly Cortella, Pushkar Inamdar, Sixiang Nie, Mai Vu, Ma Somsouk, Michele Tana, Caroline A. Thompson, Scarlett L. Gomez, Hashem El-Serag, Mi-Ok Kim, Mark Segal, Chanda Ho, Yihe G. Daida, Su-Ying Liang, Salma Shariff-Marco. Examining factors that contribute to racial and ethnic disparities in liver cancer within an EHR-based epidemiologic cohort linked to cancer registries [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B138.

The Role of Regional General Election Commission to Prevent Null Vote: Challenges and Opportunities

Every five years the Indonesian state holds General Elections, one of which is the Presidential Election or General Election for the President and Vice President which adheres to the LUBER JURDIL principle. The holding of General Elections is not far from the actions of the people who practice Abstentions. The percentage of Abstentions in Sidoarjo Regency in the 2019 Presidential Election was 18.12%. One of the causes of Abstentions is because people adhere to a typology of pragmatism, that is, if they are going to vote, they do not look at the vision and mission but from what they get from the candidate pair. Abstentions are regulated in articles 442 and 443 of Law Number 7 of 2017 Concerning General Elections. KPU Sidoarjo Regency has a very important role to play in minimizing the number of Abstentions by conducting outreach to all levels of society about the importance of General Elections.The focus of the research in this study are: 1.) What caused the White Group to occur in the 2019 General Election for President and Vice President in Sidoarjo Regency? 2.) What is the role or strategy of the Sidoarjo Regency KPU in minimizing or reducing the number of Whites in the 2019 General Election for President and Vice President. The research method uses a type of empirical juridical research with data collection techniques namely observation, interviews, and documentation. This study uses descriptive data analysis. The validity of the data in this thesis uses source triangulation which explores data from different points of view.The results of this study are 1.) The causes of abstaining from the people of Sidoarjo Regency are dominated by a typology of pragmatic society where if they vote they do not see their vision and mission but what they get when they are about to vote. The absence of sanctions in Law Number 7 of 2017 Concerning General Elections results in people easily committing Abstentions, 2.) The Sidoarjo Regency KPU's role in minimizing the Abstentions figure is guided by KPU Regulation Number 10 of 2018 Concerning Socialization, Voter Education and Participation Society in the Implementation of General Elections. Suggestions from research for the public to be aware of the importance of elections and not to vote for Abstentions and for the KPU so that the TPS locations are not too far away so that people can easily reach them when they want to vote.&#x0D;

“We Can Draw and Think About It Ourselves”: Putting Culture and Race in Phonics Reading Research

ABSTRACTYoung children of Color from minoritized communities can co‐author decodable stories using phonics skills they have been taught, their lived experiences, and home languages, including nondominant English languages, to develop decoding skills using student‐generated decodable readers. While traditional and curricular decodable readers are used during phonics instruction to support children's decoding development, they are written in White Mainstream English and may include diverse characters with experiences more familiar to the White dominant group of American society. Because there is a population of readers experiencing a gap between their identities and phonics instruction, there is an urgent need for their experiences to be improved. Building on my experiences as a primary grades teacher and researcher, I discuss a quantitative and qualitative study conducted in an urban second grade classroom where children of Color and I put culture and race into phonics instruction. Culturally relevant education and the language experience approach were used to advance children's decoding development using their funds of knowledge and existing language experiences which are often a part of their racial identities. By combining these approaches with co‐authorship, children of Color from minoritized communities were placed at the center of phonics instruction to receive more equitable educational opportunities while advancing their decoding skills as co‐authors of their decodable stories.

Assessment of Risk Factors for Developing Iron Overload in Patients with Pediatric Cancer and Bone Marrow Transplant Survivors: A Single Center Retrospective Chart Review

Background: Pediatric cancer survivors and those with chronic hematologic disorders are at risk for iron overload secondary to frequent transfusion therapy. As this patient population increases in number due to improvement of therapies, it is essential to identify risk factors associated with the development of iron overload. Classifying these risk factors will help improve screening methods and assist in decreasing side effects from iron overload, such as iron deposition resulting in organ damage. Objective: Assessment of risk factors associated with the development of iron overload in pediatric cancer survivors and those who underwent bone marrow transplant. Methods: Retrospective chart review of patients who completed therapy for pediatric malignancy or underwent bone marrow transplant and were screened for iron overload utilizing magnetic resonance imaging (MRI). Iron overload was defined as T2* liver MRI with iron levels of &amp;gt;5mg/g dry weight. Individuals determined to screen positive for iron overload were evaluated for additional demographic and treatment variables, such as race, age at diagnosis, and total transfused blood volume, to assess for risk factors associated with the development of iron overload. Statistical analyses were performed via univariate and multivariate regression models of the variables collected. Results: We report a large cohort of patients with a mean age of 10.6 years who underwent screening T2* liver MRIs. Of 71 patients who underwent liver MRI screening, 89% met criteria for moderately severe iron overload. Blood volume administered (ml) and Non-White Race were found to be statistically significant in association with higher iron content. Mean iron content was 12.9 mg/g in the Non-White group versus 8.8 mg/g in the White group (p=0.0185). For every 100ml/kg increase in the cumulative blood volume transfused, the predicted iron content increased approximately 1 mg/g (p=0.0227); mean transfused blood volume was 340ml/kg among those who met criteria for iron overload versus 224ml/kg among those who did not (p=0.1858). We did not find any correlation between iron content and age at diagnosis, primary diagnosis, BMI at diagnosis, or gender. Conclusions: Iron overload continues to be a risk for pediatric cancer survivors and those who receive chronic transfusions. Our study revealed a statistically significant correlation between increased amount of blood transfusions and development of iron overload; however, no specific quantity of cumulative transfused blood volume was determined to be the threshold for risk. Our study also revealed a statistically significant correlation between Non-White race and the development of iron overload independent of cumulative transfused blood volume. It is possible there are race-based differences in iron metabolism that result in this increased risk. Further studies regarding specific quantities of blood transfusions, assessing physiologic characteristics of the Non-White patient population, and development of iron overload are needed. These findings indicate the importance of continuing to research the development of iron overload in the pediatric cancer and bone marrow transplant population, as well as provide guidance for understanding the risk each unique patient has for developing this complication.

Association between Race and Social Deprivation in Patients with Hematologic Malignancies

Background: Recent therapeutic advances including biologics, immunomodulators, and cellular therapies have transformed management paradigms for hematologic malignancies. Nevertheless, disparities exist in terms of access to care, and non-White individuals are historically underrepresented in clinical trials. As it remains unknown whether there are inequalities in care related to adverse events of these therapeutic approaches, in this study we explored whether racial and social differences are related to outcomes of patients with hematologic malignancies. Methods: This was a retrospective chart review from January 2011 to December 2021 that included adult patients across our cancer center network with diagnostic codes for malignant neoplasms of lymphoid, myeloid, and hematopoietic origin who were receiving an immunologic therapy at the time of an emergency department visit. Data were compared according to White and non-White individuals. The non-White group comprised of Black or African American, Asian Indian, Chinese, Asian, or unspecified/other. Differences in continuous variables between groups were assessed using the Wilcoxon rank-sum test, and Chi-square or Fisher's exact test was used to compare categorical variables. Outcomes included time to admission, length of stay within the hospital, ICU admissions, and differences in social deprivation index (SDI). SDI is a composite measure of a geographic region's socioeconomic variation in health outcomes based on demographic characteristics collected by the U.S Census Bureau (www.census.gov/programs-surveys/acs). Higher SDI scores indicate more severe social deprivation. Results: 180 patients were identified with 142 patients meeting inclusion criteria. Among these, 43% were non-White patients. The median age for the White group was 71.6 and for the non-White group 65.8 (P=.001). The most common immunotherapies were lenalidomide (50%), pomalidomide (19.7%), daratumumab (12.7%), methotrexate (9.9%), and rituximab (8.5%). The main chief complaint that was statistically different between the two groups was musculoskeletal complaints; the incidence among the White group was 8.6% and 29.5% among the non-White group (P=0.001). Other reasons for presentation included neurological complaints (21)%, infection/sepsis (16%), respiratory issues (12%), and abnormal laboratory values (3.5%). There were no differences in time to hospitalization for White versus non-White patients (5 versus 6 hours, P=0.12). Differences in ICU admissions, 30 day-readmissions, and length of stay were also not statistically significant between the two groups. However, the median SDI for the White group was statically greater among the non-White group (p&amp;lt;0.001). Discussion: In this retrospective study, non-White patients with hematologic malignancies were found to have greater social deprivation than White patients, however this did not impact inpatient metrics. We found that non-White patients with hematologic malignancies were more likely to originate from socially disadvantaged backgrounds, although there were no differences in hospitalization outcomes among the two groups. Results suggest that social determinants may impact factors unrelated to access to acute care in patients with hematologic therapies receiving immunologic therapies.

Assessment of ethnic inequalities in diagnostic coding of familial hypercholesterolaemia (FH): A cross-sectional database study in Lambeth, South London

Background and aimsDifferences in the perceived prevalence of familial hypercholesterolemia (FH) by ethnicity are unclear. In this study, we aimed to assess the prevalence, determinants and management of diagnostically-coded FH in an ethnically diverse population in South London. MethodsA cross-sectional analysis of 40 practices in 332,357 adult patients in Lambeth was undertaken. Factors affecting a (clinically coded) diagnosis of FH were investigated by multi-level logistic regression adjusted for socio-demographic and lifestyle factors, co-morbidities, and medications. ResultsThe age-adjusted FH % prevalence rate (OR, 95%CI) ranged from 0.10 to 1.11, 0.00–1.31. Lower rates of FH coding were associated with age (0.96, 0.96–0.97) and male gender (0.75, 0.65–0.87), p < 0.001. Compared to a White British reference group, a higher likelihood of coded FH was noted in Other Asians (1.33, 1.01–1.76), p = 0.05, with lower rates in Black Africans (0.50, 0.37–0.68), p < 0.001, Indians (0.55, 0.34–0.89) p = 0.02, and in Black Caribbeans (0.60, 0.44–0.81), p = 0.001. The overall prevalence using Simon Broome criteria was 0.1%; we were unable to provide ethnic specific estimates due to low numbers.Lower likelihoods of FH coding (OR, 95%CI) were seen in non-native English speakers (0.66, 0.53–0.81), most deprived income quintile (0.68, 0.52–0.88), smokers (0.68,0.55–0.85), hypertension (0.62, 0.52–0.74), chronic kidney disease (0.64, 0.41–0.99), obesity (0.80, 0.67–0.95), diabetes (0.31, 0.25–0.39) and CVD (0.47, 0.36–0.63). 20% of FH coded patients were not prescribed lipid-lowering medications, p < 0.001. ConclusionsInequalities in diagnostic coding of FH patients exist. Lower likelihoods of diagnosed FH were seen in Black African, Black Caribbean and Indian ethnic groups, in contrast to higher diagnoses in White and Other Asian ethnic groups. Hypercholesterolaemia requiring statin therapy was associated with FH diagnosis, however, the presence of cardiovascular disease (CVD) risk factors lowered the diagnosis rate for FH.

Educational Intervention and Melanoma Prognosis in Black People.

A systematic search was conducted on the PubMed database using the keywords "education," "melanoma," and "African Americans." The results were filtered to include studies published within the last decade that focused on melanoma diagnosis, risk, or outcomes. These selected studies included African Americans, non-Hispanic Black individuals, or those with darker skin tones and compared them with educational interventions or non-Hispanic White groups. The studies showedan overall positive impact of targeted educational initiatives on using sun-protective behaviors, health education, and self-efficacy related to melanoma. Notably, interventions proven to be effective for non-Hispanic White populations also demonstrated efficacy in other racial groups, including non-Hispanic Blacks. It was observed that non-Hispanic Blacks exhibited an overall reduced level of concern regarding melanoma, partly due to its lower incidence within this demographic.Furthermore, these studies focussed on the disparities in melanoma incidence and survival rates among different racial groups. Non-Hispanic Black individuals were found to have a higher incidence of melanoma and lower survival rates compared to non-Hispanic White individuals. Collectively, the studies evaluating melanoma educational interventions for darker skin tones yield promising results for improving melanoma prognosis in Black communities. They underscore the importance of addressing racial disparities in melanoma awareness, diagnosis, and treatments. These studies also highlighted the barriers to sun protection behaviors, such as cost, limited awareness, and misconceptions, particularly prevalent among ethnic communities and youth. The use of melanoma photographs specifically tailored to darker skin tones in outreach efforts to enhance identification, self-examination, and early detection should be considered to improve melanoma prognosis similar to the non-White population.

Effects of light spectra on the ovarian maturation and maternal immunity in the little yellow croaker (Larimichthys polyactis)

Before spawning, fish ovaries undergo multiple events to prepare for embryogenesis. Although light plays a vital role in ovarian development and neuroendocrine activities, it is unclear how it affects ovarian maturation in the little yellow croaker (Larimichthys polyactis). This study aimed to investigate the influence of different light spectra [i.e., red, blue, dark, green, white, and ambient] on the gonadosomatic index (GSI) and hepatosomatic index (HSI); histology of the ovary; vitellogenin (VTG) levels in hepatic cells; plasma 17β-estradiol and growth hormone (GH) levels; total length; body weight; and innate/adaptive immune factors in captive-bred L. polyactis. The plasma 17β-estradiol levels gradually decreased from Jan 8 to Apr 9, and were higher in the red, green, and blue groups than in the white, dark, and control groups. By the end of the experiment, the VTG levels were significantly higher in the red group than in the control, white, and dark groups, while those in the blue group were the lowest among the treatments. The HSI fluctuated among the groups and was higher in the control, white, and green groups on Apr 9. The proportion of oocytes at stage IV was highest in the red group, which also exhibited the best synchronization of oocyte maturation. Maternal immunoglobulin M levels were significantly higher in the red and green groups than in the control, blue, dark, and white groups at the end of the experiment, while there was no significant difference in the complement component 3 (C3) levels. Collectively, these findings demonstrate that different light spectra affect 17β-estradiol secretion, VTG production, follicle synchronization and maternal immunity during ovarian maturation in L. polyactis.

The cost of primary care consultations associated with long COVID in non-hospitalised adults: a retrospective cohort study using UK primary care data

BackgroundThe economic impact of managing long COVID in primary care is unknown. We estimated the costs of primary care consultations associated with long COVID and explored the relationship between risk factors and costs.MethodsData were obtained on non-hospitalised adults from the Clinical Practice Research Datalink Aurum primary care database. We used propensity score matching with an incremental cost method to estimate additional primary care consultation costs associated with long COVID (12 weeks after COVID-19) at an individual and UK national level. We applied multivariable regression models to estimate the association between risk factors and consultations costs beyond 12 weeks from acute COVID-19.ResultsBased on an analysis of 472,173 patients with COVID-19 and 472,173 unexposed individuals, the annual incremental cost of primary care consultations associated with long COVID was £2.44 per patient and £23,382,452 at the national level. Among patients with COVID-19, a long COVID diagnosis and reporting of longer-term symptoms were associated with a 43% and 44% increase in primary care consultation costs respectively, compared to patients without long COVID symptoms. Older age, female sex, obesity, being from a white ethnic group, comorbidities and prior consultation frequency were all associated with increased primary care consultation costs.ConclusionsThe costs of primary care consultations associated with long COVID in non-hospitalised adults are substantial. Costs are significantly higher among those diagnosed with long COVID, those with long COVID symptoms, older adults, females, and those with obesity and comorbidities.

The effects of massage and white noise on physiological parameters of preterm infants: A randomized controlled research

PurposeThe present research was conducted to find out the effects of massage and white noise on physiological parameters in preterm infants. Material-methodWhile each preterm infant in the massage group was given massage by the researcher in the morning and evening for three days, the infants in the white noise group listened to white noise in the morning and evening for three days. Standard nursing care was provided for three days in the control group. Physiological parameters of the preterm infants in all of the groups on the first, second and third days were recorded by the researcher before the procedure. Following the interventions to preterm infants by the researcher, peak heart rate, respiratory rate and oxygen saturation data were recorded. ResultsSignificant difference was found between the first, second and third day peak heart rate, respiratory rate and oxygen saturation values of the preterm infants in the massage and white noise group when compared with the control group. No significant difference was found between the white noise and massage group. In the temporal analysis of the massage and white noise group, a decrease was found in peak heart rate and respiratory rate, while an increase was found in oxygen saturation values. ConclusionMassage and white noise were found to be effective on physiological parameters of preterm infants. It was found that in the neonatal intensive care unit, nurses can prefer massage or white noise methods in healing physiological parameters of preterm infants.

Cognitive Distortions in Men Who Have Exited White Supremacist Groups

ABSTRACT Despite reports of longterm cognitive and emotional difficulties after exiting right-wing extremist groups, the latter stages of the extremist group member’s trajectory have been given little attention. 1 This paper argues that clinical psychological theory has been underutilised in terrorism and extremism research in general, and, more specifically, that it can make a significant contribution to the understanding of the development and maintenance of unhelpful thinking that can hamper and prolong the reintegration process. The empirical data presented consists of sixteen life-history interviews and one group interview with three men who were former members of white supremacist groups. By applying codebook thematic analysis, five automatic cognitive distortions that developed during group membership and persisted after leaving were identified. These distortions offer a clinical explanation for the unwanted negative and automatic group-related cognitions and concomitant emotions that continue long after leaving. It is argued that CVE interventions should be informed by a recognition of the ways in which cognitive distortions can negatively affect the exit process.

Demographic and socioeconomic determinants of access to care: A subgroup disparity analysis using new equity-focused measurements.

Disparities in healthcare access and utilization associated with demographic and socioeconomic status hinder advancement of health equity. Thus, we designed a novel equity-focused approach to quantify variations of healthcare access/utilization from the expectation in national target populations. We additionally applied survey-weighted logistic regression models, to identify factors associated with usage of a particular type of health care. To facilitate generation of analysis datasets, we built an National Health and Nutrition Examination Survey (NHANES) knowledge graph to help automate source-level dynamic analyses across different survey years and subjects' characteristics. We performed a cross-sectional subgroup disparity analysis of 2013-2018 NHANES on U.S. adults for receipt of diabetes treatments and vaccines against Hepatitis A (HAV), Hepatitis B (HBV), and Human Papilloma (HPV). Results show that in populations with hemoglobin A1c level ≥6%, patients with non-private insurance were less likely to receive newer and more beneficial antidiabetic medications; being Asian further exacerbated these disparities. For widely used drugs such as insulin, Asians experienced insignificant disparities in odds of prescription compared to White patients but received highly inadequate treatments with regard to their distribution in U.S. diabetic population. Vaccination rates were associated with some demographic/socioeconomic factors but not the others at different degrees for different diseases. For instance, while equity scores increase with rising education levels for HBV, they decrease with rising wealth levels for HPV. Among women vaccinated against HPV, minorities and poor communities usually received Cervarix while non-Hispanic White and higher-income groups received the more comprehensive Gardasil vaccine. Our study identified and quantified the impact of determinants of healthcare utilization for antidiabetic medications and vaccinations. Our new methods for semantics-aware disparity analysis of NHANES data could be readily generalized to other public health goals to support more rapid identification of disparities and development of policies, thus advancing health equity.