White Group Research Articles

Abstract 13354: Higher Severe Maternal Morbidity Rates at Delivery Hospitalization Among Racial and Ethnic Groups Related to Chronic Hypertension and Hypertensive Disorders of Pregnancy

Severe maternal morbidity (SMM) affects 0.5-3% of pregnancies in the United States, with risk varying for racial and ethnic groups. Studies have rarely evaluated how chronic hypertension (cHTN) and hypertensive disorders of pregnancy (HDP) affect differences in SMM risk. This study sought to evaluate cHTN and HDP as contributors to racial disparities in SMM rates. Retrospective cohort study of 263,518 patients aged 18-46 years who received prenatal care ≤14 weeks' gestation and delivered a stillborn or live singleton birth ≥20 weeks’ gestation at a Kaiser Permanente Northern California hospital (2009-2019). We evaluated the relation of cHTN and HDP [preeclampsia (PE), gestational hypertension (GH) and superimposed preeclampsia (s_PE)] to SMM at delivery hospitalization, defined as the presence of at least 1 of 21 conditions meeting CDC criteria. Modified Poisson regression models estimated the adjusted relative risk (aRR) of SMM associated with cHTN and HDP among self-reported racial and ethnic groups [Asian, Black, Hispanic, Native Hawaiian Pacific Islander (NHPI), White] adjusted for covariables. There were 13,626 women (5.2%) with cHTN, in whom 4297 (31.5%) developed s_PE. For patients with no cHTN, 11,744 (4.7%) developed PE and 11,514 (4.6%) developed GH. The overall SMM rate (number of cases/10,000 births) was 219.7. SMM rates were higher for patients with cHTN vs no cHTN (417.6 vs. 208.9, p<.0001), and for PE (934.3) and s_PE (898.3) vs no cHTN + no HDP (165.9), p<0.001. SMM rates differed for racial and ethnic groups. Compared to White patients with No cHTN or HDP, aRRs of SMM associated with PE and s_PE increased in order for White, Asian, Hispanic, Black, and NHPI groups (Table 1). Preeclampsia was 6 times more prevalent among those with cHTN than no cHTN. Preeclampsia was strongly associated with higher SMM rates in both women with cHTN and without cHTN, especially among NHPI and Black groups. Preeclampsia may contribute substantially to racial disparities in SMM.

Ancestry-attenuated effects of socioeconomic deprivation on type 2 diabetes disparities in the All of Us cohort

BackgroundDiabetes is a common disease with a major burden on morbidity, mortality, and productivity. Type 2 diabetes (T2D) accounts for roughly 90% of all diabetes cases in the USA and has a greater observed prevalence among those who identify as Black or Hispanic.MethodsThis study aimed to assess T2D racial and ethnic disparities using the All of Us Research Program data and to measure associations between genetic ancestry (GA), socioeconomic deprivation, and T2D. We used the All of Us Researcher Workbench to analyze T2D prevalence and model its associations with GA, individual-level (iSDI), and zip code-based (zSDI) socioeconomic deprivation indices among participant self-identified race and ethnicity (SIRE) groups.ResultsThe study cohort of 86,488 participants from the four largest SIRE groups in All of Us: Asian (n = 2311), Black (n = 16,282), Hispanic (n = 16,966), and White (n = 50,292). SIRE groups show characteristic genetic ancestry patterns, consistent with their diverse origins, together with a continuum of ancestry fractions within and between groups. The Black and Hispanic groups show the highest levels of socioeconomic deprivation, followed by the Asian and White groups. Black participants show the highest age- and sex-adjusted T2D prevalence (21.9%), followed by the Hispanic (19.9%), Asian (15.1%), and White (14.8%) groups. Minority SIRE groups and socioeconomic deprivation, both iSDI and zSDI, are positively associated with T2D, when the entire cohort is analyzed together. However, SIRE and GA both show negative interaction effects with iSDI and zSDI on T2D. Higher levels of iSDI and zSDI are negatively associated with T2D in the Black and Hispanic groups, and higher levels of iSDI and zSDI are negatively associated with T2D at high levels of African and Native American ancestry.ConclusionsSocioeconomic deprivation is associated with a higher prevalence of T2D in Black and Hispanic minority groups, compared to the majority White group. Nonetheless, socioeconomic deprivation is associated with reduced T2D risk within the Black and Hispanic groups. These results are paradoxical and have not been reported elsewhere, with possible explanations related to the nature of the All of Us data along with SIRE group differences in access to healthcare, diet, and lifestyle.

Fecal Microbiome Analysis Distinguishes Bacterial Taxa Biomarkers Associated with Red Fillet Color in Rainbow Trout.

The characteristic reddish-pink fillet color of rainbow trout is an important marketing trait. The gastrointestinal microbiome is vital for host health, immunity, and nutrient balance. Host genetics play a crucial role in determining the gut microbiome, and the host-microbiome interaction impacts the host's phenotypic expression. We hypothesized that fecal microbiota could be used to predict fillet color in rainbow trout. Fish were fed Astaxanthin-supplemented feed for six months, after which 16s rDNA sequencing was used to investigate the fecal microbiome composition in rainbow trout families with reddish-pink fillet coloration (red fillet group, average saturation index = 26.50 ± 2.86) compared to families with pale white fillet color (white fillet group, average saturation index = 21.21 ± 3.53). The linear discriminant analysis effect size (LEFse) tool was used to identify bacterial biomarkers associated with fillet color. The alpha diversity measure shows no difference in the red and white fillet groups. Beta diversity principal component analysis showed clustering of the samples along the white versus red fillet group. The red fillet group has enrichment (LDA score > 1.5) of taxa Leuconostoc lactis, Corynebacterium variabile, Jeotgalicoccus halotolerans, and Leucobacter chromiireducens. In contrast, the white fillet group has an enriched presence of mycoplasma, Lachnoclostridium, and Oceanobacillus indicireducens. The enriched bacterial taxa in the red fillet group have probiotic functions and can generate carotenoid pigments. Bacteria taxa enriched in the white fillet group are either commensal, parasitic, or capable of reducing indigo dye. The study identified specific bacterial biomarkers differentially abundant in fish families of divergent fillet color that could be used in genetic selection to improve feed carotenoid retention and reddish-pink fillet color. This work extends our understanding of carotenoid metabolism in rainbow trout through the interaction between gut microbiota and fillet color.

Vaccine hesitancy and related factors among South African adults in 2021: unpacking uncertainty versus unwillingness.

Amidst widespread public health recommendations and availability of COVID-19 vaccinations, half of South African adults are vaccinated against COVID-19. This study investigated the socio-behavioral determinants of vaccine hesitancy in South Africa, where vaccine hesitancy was separated into unwilling ness and uncertainty to take a COVID-19 vaccine. Data was collected from a large-scale public survey during June-October 2021 that included online and telephonic surveys. Vaccination hesitancy was based on the question "When available, would you take the COVID 19 vaccine?," with responses categorized into those who were willing, unwilling, and uncertain about taking a COVID-19 vaccine. Multinomial regression examined the association between socio-behavioral variables and vaccine hesitancy. Overall, 73.8% reported they would definitely or probably take the vaccine, 16.4% were uncertain and 9.9% reported they probably or definitely would not (n = 16,988). Younger age, White and Colored population groups, no influenza vaccination history, previous vaccination refusal, knowing someone who experienced a serious vaccination side-effect, misperceptions about vaccine benefits, cultural or religious discouragement from taking a COVID-19 vaccination, lack of governmental confidence, concerns about side-effects, perceived lack of safety information, and lack of trust in the pharmaceutical industry and in the information from health care providers were all associated with higher odds of being uncertain and unwilling to take a COVID-19 vaccination. Strengths of association for unwillingness and uncertainty varied by the explanatory variables. Concern about effectiveness due to fast development was associated with uncertainty to take the vaccine but not with unwillingness. Concerns about side-effects had stronger associations with uncertainty than with unwillingness, while previous vaccine refusal, misperceptions of the protective benefits of vaccines, White population group, religious/cultural discouragement, and lack of trust in the pharmaceutical industry and health care providers' information had stronger associations with unwillingness than uncertainty. The determinants of COVID-19 vaccine hesitancy should be addressed in interventions to improve vaccine uptake. Public health interventions and health communication can be prioritized and tailored to the different forms of vaccination hesitancy.

Association between oxidative balance score and kidney stone in United States adults: analysis from NHANES 2007-2018.

Purpose: To investigate the relationship between the Oxidative Balance Score (OBS) and kidney stone risk using NHANES 2007-2018 data, and to explore potential mechanisms and population-specific effects. Materials and methods: Data from the NHANES 2007-2018 were analyzed. OBS was calculated based on 16 dietary components and 4 lifestyle components. Multivariate logistic regression was employed to investigate the relationship between OBS and kidney stone. Further stratified analyses were conducted to examine the associations across different subgroups. Results: A total of 19,799 participants were included in the study. There was a consistent inverse association between OBS and the risk of kidney stones (OR = 0.97; 95% CI: 0.96-0.99). After dividing the participants into quartiles based on OBS, compared to the lowest quartile of OBS, the risk of kidney stones in the highest quartile of OBS was reduced by 33% (95% CI 0.50-0.89; p = 0.002). This association was consistent across both dietary and lifestyle OBS scores. The protective effect of OBS was notably pronounced among Non-Hispanic white and Other race groups, and among individuals with a higher level of education. However, the association was not significant among individuals with diabetes. Conclusion: A higher OBS, indicating a balance skewed towards antioxidants, is associated with a reduced risk of kidney stones, especially among specific population subgroups. These findings underscore the potential role of oxidative balance in kidney stone pathogenesis and highlight the importance of considering individual and population-specific factors in future research and preventive strategies.

12 Purpose in Life, Loneliness, and Subjective Cognitive Decline in an Ethnically Diverse US Sample

Objective:Subjective cognitive decline (SCD), the self-reported experience of worsening cognitive abilities (Jessen et al., 2014), is associated with increased risk of developing Alzheimer’s disease and Mild Cognitive Impairment. Modifiable factors such as purpose in life (PiL), the experience of living a meaningful life where one’s life goals are attainable or being achieved (Boyle et al., 2009), and loneliness, an individual’s perceived social isolation (Luhmann & Hawkley, 2016), are known to be associated with SCD. These relationships are understudied among ethnically diverse groups. Using an online survey, we examined associations between PiL, loneliness and SCD in older ethnically diverse individuals living in the US.Participants and Methods:870 older adults (126 Latino, 74 Black, 33 Asian, and 637 White; average age=67.0 [7.6]) completed an online survey including the Life Purpose Questionnaire, the Gierveld Loneliness Scale, and the Everyday Cognition scale (ECog), which measures subjective cognitive concerns in memory, language, executive function, and divided attention. Chi-square tests and analyses of variance were conducted to assess group differences in SCD and demographic/lifestyle predictors. Multiple regressions and correlations were conducted to assess the relationships between ethnicity and PiL with SCD, and the moderating effect of race/ethnicity. Multiple regressions and correlations were conducted to identify sociodemographic and lifestyle predictors of SCD in each study group.Results:White participants were older (p<.001), and White and Asian groups had higher levels of education (p=.009) compared to Latinos. The White group had a higher proportion of female (p=.016) and middle-income (p=.019) respondents. Black participants had higher PiL (p=.035) and lower loneliness (p=.047) compared to White participants; there were no group differences in ECog ratings (p=.143). Regression results indicated that higher PiL associated with lower SCD in the whole sample (β=-.435, p<.001). The interaction between PiL and ethnic group was significant (β=.078, p=.025), suggesting the relationship between PiL and SCD was strongest in White participants, followed by Asian, then Latino, and finally Black participants. In Latinos, female sex (β=-.281, p=.004) and higher PiL (β=-.240, p=.034) predicted lower SCD ratings. In White participants, higher PiL (β = -.394, p < .001), and lower loneliness (β = .128, p = .003) predicted lower SCD ratings. Correlation analyses revealed no significant associations with SCD in the Black group, although the correlation between loneliness and SCD was trending (r=.222, p=.063). In the Asian group, greater PiL was associated with lower SCD ratings (r=-.439, p=.011).Conclusions:Our findings suggest that PiL may be protective against SCD, particularly in Latino, Asian, and White adults. Differential predictive factors of SCD were also identified for our study groups, suggesting certain groups may benefit from specific targeted interventions. Overall, findings suggest that interventions geared toward increasing PiL and/or mitigating loneliness may help reduce SCD and the risk of cognitive decline in older adults in the US. As the current study was cross-sectional and faced sample size limitations in Asian and Black groups, future studies should include longitudinal assessment of these associations with larger and more representative samples to confirm our findings.

NCCN survivorship assessment of cancer survivors at an academic cancer center in the midwest and Great Plains region.

497 Background: Previous research has shown the patient reported outcome measures (PROM) have been instrumental in screening patient for physical and psychological morbidities, maximizing cancer care services, improving overall survival in cancer care, and provide tailored self-management advice to individual patients. This project is designed to describe the characteristics of our cancer survivorship population at the Buffett Cancer Center and to identify areas where both further research is needed in cancer survivorship for this unique population and where patient reported outcome measures may be helpful in providing individual personalized care. Methods: This needs assessment study is a retrospective review of demographic and patient reported outcome data collected on cancer survivors as part of routine clinical care at the UNMC Buffett Cancer Center. The study population focused on adult cancer patients with a unique encounter at the Cancer Survivorship clinic from 1/1/20-6/22/21. The NCCN Survivorship Assessment Survey was collected from all survivorship patients who had at least one unique encounter in the survivorship clinic at the Buffett Cancer Center in Omaha Nebraska. Data was stored in REDCap for patient safety and analyzed descriptively using SAS software. Results: There were a total of 473 patients seen in the Cancer Survivorship Clinic between 1/1/20 through 6/22/21. Mean age of all patients was 56 y/o with the youngest patient being 19 and the oldest patient at 87 y/o. Sixty-five percent of patients were female. Twenty-nine percent of patients lived in rural locations. There was a statistically significant difference in flu shot maintenance and vaccine maintenance between the different insurance groups. Those with private insurance had the highest proportion of individuals who perceived themselves to be up-to-date with both flu shots and all other vaccines as compared to Medicare, Medicaid and self-pay. There was also a statistically significant difference in vitamin usage among race. The white group had the highest proportion of individuals taking vitamins in survivorship care. In addition, life interference from stress was the lowest in the non-white and rural populations. Conclusions: This project showed that a third of the patient population utilizing cancer survivorship resources at this midwest cancer center were from rural communities. This underlines the need for further survivorship research at UNMC focusing on streamlining efficient and effective delivery of cancer survivorship care to rural populations. In addition, further research is needed concerning the impact of race and insurance on survivorship care.

39 The role of Subjective Cognitive Decline and Aging Perceptions in Help Seeking across White and Non-White older adults

Objective:Research has indicated that racial and ethnic minoritized groups in the United States are disproportionately affected by dementia (e.g., Alzheimer’s disease), and seek help (HS) later in the disease course, if at all. It has also been posited that individuals from different ethno-racial groups have divergent perceptions of the aging process, which may influence HS. These disparities warrant tailored preventive efforts to encourage identification of factors which contribute to HS to enable earlier psychoeducation and enhanced access to resources. The factors which influence HS may differ across ethnoracial groups. Here we examine the relative influence of subjective cognitive decline (SCD), a risk factor for AD, and aging perceptions to HS in these groups.Participants and Methods:The current sample consisted of 161 healthy older adults (51 Male, 110 Female), aged 51 to 92 (M=73.43, SD=6.85) with a mean education of 16 years (SD=2.3 years) who performed > -1.5 SD on clinical neuropsychological testing. 26.7% of the sample self-reported as race/ethnic minorities (e.g., Hispanic or Non-Hispanic African American, Asian, Other.) Participants completed a 20-item SCD questionnaire assessing perceived cognitive difficulties in comparison to same aged peers, in addition to measures assessing HS behavior, (e.g., Have you gone to the doctor specifically for memory concerns?), and aging perceptions (e.g., older adulthood group identification, explicit stereotypes, essentialism). Point biserial correlations examined relationships between SCD, HS and aging perceptions, and multinomial logistic regressions examined the contribution of SCD and aging perceptions to HS across majority (White) and minoritized groups (Non-White participants).Results:In bivariate analyses of the White participant group, HS was associated with SCD (r=0.43, p<0.001) and age group identification (r=0.27, p<0.01), and the latter were also associated (r=-0.19, p<0.05). The logistic regression model correctly classified 86% of participants (same as null), explaining a relatively small proportion of variance in HS, Snell R2 = 0.09, Nagelkerke’s R2 = 0.16. Age group identification was not associated with HS (b=-0.02, SE=0.26, p=0.94, 95% CI [0.59, 1.63] but SCD was (p=0.04). In the non-White group (n=42), bivariate analyses showed that HS was associated with essentialism (r=-0.41, p<0.01; belief aging as a fixed and inevitable process)) and explicit stereotypes (r=-0.42, p<0.01) but not with SCD (r=0.21, p=0.19). SCD was also associated with essentialism (p=-0.32, p<0.05), stereotypes (p=0.32, p<0.05), and age group identification (r=0.38, p<0.01). The regression model correctly classified 88.9% of participants (same as null); neither SCD (p=0.39), explicit stereotypes (p=0.43), essentialism (p=0.72), nor age group identification (p=0.62) contributed to HS when all were considered.Conclusions:When both SCD and age perceptions are examined together as predictors of HS, SCD alone predicts HS in the majority group. Neither construct predicts HS in the minoritized group—despite significant bivariate associations between HS, aging perceptions and SCD that varied across ethno-racial groups. Findings illustrate that SCD and aging perceptions may contribute differently to HS across ethno-racial groups in the US, and as such may indicate different priorities when implementing HS tools (e.g., screeners for detection of cognitive impairment). Ongoing work is addressing illness perceptions, another key barrier in HS in these groups to further inform on tailoring of services.

Intuitive pathways into racist beliefs

In this article, we present empirical evidence on the cognitive processes underlying racist beliefs and judgement. We draw on 47 life history interviews with former members of White supremacist groups to better understand how social interactions and stimuli from the wider environment inform cognitive pathways or how people think. While we examine both deliberate and intuitive pathways to racist belief, we focus on the intuitive ways that extreme racist beliefs are cognitively processed before, during and after an individual is involved in the White supremacist movement. In doing so, we fill a critical gap in the literature by providing an empirical analysis of intuition. We illustrate the analytic contributions of our approach, and we conclude by drawing on our evidence to elucidate three puzzles, including: (1) why racist beliefs persist; (2) how people draw on implicit beliefs to make explicit judgements; and (3) how explicit beliefs become encoded in intuitive pathways.

15 Examining Unmet Needs in a Brain Injury Sample, Consisting of Various Races/Ethnicities, Referred to Resource Facilitation

Objective:To investigate differences of the perceived unmet needs in a post-acute brain injury sample when referred to Resource Facilitation (RF) among various race/ethnic groups.Participants and Methods:The methodology utilizied within this study consisted of a retrospective chart review, which was sourced from a clinical database serving chronic outpatients in the Midwest region. The main outcome measure was the Service of Unmet Needs & Service Use (SUNSU). The sample consisted of N = 455 subjects, which included a small sample size of Hispanics (N=7). Therefore, African American and Hispanic groups were combined for a total minority sample (N=84). Clinical disorders included within the study was an ABI from either stroke, anoxic injury, ruptured aneurysm, or tumor resection surgery. Eligibility criteria included participants’ admission into a RF program, a vocational goal, and a diagnosis of a moderate to severe TBI or other ABI. Lastly, key sociodemographic features included age, race, ethnicity, education, and sex.Results:Significant differences were found between ethnic groups (white non-Hispanics and minority group) in terms of years of education (p=<.01). White non-Hispanics had higher education (M=13.39, SD=2.23), reported significantly more rural addresses (40.2%, p=<.01), and had private insurance coverage more frequently than the minority group (33.7%, p=<.01). The full model was statistically significant, R2=.077 = F(4,450) = 9.387, p<.0001; adjusted R2 = .069. The addition of ethnicity led to a statistically significant increase in R2 of .019, F(1,450) =9.025, p<.0005.Conclusions:Ethnicity was found to be a predictive factor for greater unmet needs even after controlling for insurance, employment status, and urbanicity. It is currently unknown RF’s success rate in providing culturally competent services to different racial/ethnic groups, which consider factors such as primary language spoken, immigration status, and additional ethnocultural factors that could deter accurate reporting of unmet needs by minoritized groups. Future studies should investigate barriers in referring and meeting eligibility for this program and analyze post-treatment data to determine if the impact of racial, geographic, and insurance disparities is mitigated with RF treatment.

Progressive Vertical and Horizontal Phytocompound Changes during Agarwood Formation in Aquilaria sinensis after Geotrichum candidum Injection.

(1) Background: Agarwood is an aromatic resin produced by the host tree through an immunological response against biotic and abiotic stress. The aim was, first, to use the fungus Geotrichum candidum to stimulate compound changes in Aquilaria sinensis horizontally (color formation) and vertically (cutting layers) after injection with it. (2) Methods: Horizontal and vertical sections were collected and separated five months after injection with the fungal broth. Two grams of dry powder was mixed with 20 mL methanol for 3 h at room temperature, and the solution was vibrated in an ultrasonic cleaner bath at 40 °C for 1 h. After vacuum drying, a concentration of 10 mg/mL of the tested samples in methanol was prepared for reversed-phase high-performance liquid chromatography (RP-HPLC), gas chromatography/mass spectrometry (GC/MS), and thin-layer chromatography (TLC) analysis. (3) Results: The horizontal changes in the compounds and their concentrations were associated with color. Compared to the normal (N) group, G. candidum injection stimulated more compounds at RT 27-42 in the white (W) group, brown (BR) group, and black (B) group. Furthermore, a significant increase in fatty acids was observed in the W group, implying an early plant response after G. candidum injection. In the BR group, the compounds were more similar to commercial agarwood (Out group). In the B group, alkaloids were the main compounds. Vertical changes in the main compounds were not observed, although the compound level varied. A TLC analysis determined the main compounds in the BR group at 254 nm and in the B group at 365 nm. Higher fatty acid levels were found in L6 and L5 and were correlated with higher terpenoid and sesquiterpene levels, suggesting that these compounds were possibly the first stage of agarwood formation. A GC/MS analysis demonstrated that the main compound groups were almost identical to the BR parts. (4) Conclusions: The injection of G. candidum led A. sinensis to synthesize different phytochemicals horizontally, not vertically, in the BR group.

Ensayo clínico aleatorizado: utilización de la luz IMAGE1S (SPIES) vs. luz blanca durante la resección transuretral de tumores vesicales para la prevención de recurrencias, análisis a los 12 meses de seguimiento

IntroductionThe improved image resolution of IMAGE1 S technology will increase tumor detection, achieve a greater number of complete resections, and would probably have an impact on the reduction of recurrences. AimThe primary objective was to compare the recurrence rates of IMAGE1 S vs. white light during transurethral resection of the bladder; the secondary objective was to compare the complication rates according to Clavien-Dindo at 12 months of follow-up. MethodolgyProspective, randomized 1:1, blinded clinical trial. Recurrence and complication rates according to Clavien-Dindo were analyzed using chi-square/U Mann-Whitney tests, and recurrence-free survival using Kaplan-Meier curves. The European Association of Urology 2021 scoring model was used. ResultsThe analysis included 103 participants; 49 were assigned to the IMAGE1 S group and 54 to the white light group. Recurrence rates were 12.2% and 25.9%, respectively (P=.080). The low and intermediate risk group had a lower recurrence rate with IMAGE1 S (7.7% vs. 30.8%, P=.003) and a higher recurrence-free survival with IMAGE1 S (85.2% vs. 62.8% Log Rank: 0.021), with a Hazard Ratio of 0.215 (95% CI: 0.046-0.925). No differences were observed in the high and very high-risk groups. Complications were mostly grade I and rates were similar between both groups (IMAGE1 S 20.4% vs. white light 7.4% P=.083). ConclusionsThere were no differences in the recurrence rates between groups. However, the low and intermediate risk group had a lower recurrence rate with IMAGE1 S. In addition, perioperative complication rates were not higher.

Ethnic differences in early onset multimorbidity and associations with health service use, long-term prescribing, years of life lost, and mortality: A cross-sectional study using clustering in the UK Clinical Practice Research Datalink.

The population prevalence of multimorbidity (the existence of at least 2 or more long-term conditions [LTCs] in an individual) is increasing among young adults, particularly in minority ethnic groups and individuals living in socioeconomically deprived areas. In this study, we applied a data-driven approach to identify clusters of individuals who had an early onset multimorbidity in an ethnically and socioeconomically diverse population. We identified associations between clusters and a range of health outcomes. Using linked primary and secondary care data from the Clinical Practice Research Datalink GOLD (CPRD GOLD), we conducted a cross-sectional study of 837,869 individuals with early onset multimorbidity (aged between 16 and 39 years old when the second LTC was recorded) registered with an English general practice between 2010 and 2020. The study population included 777,906 people of White ethnicity (93%), 33,915 people of South Asian ethnicity (4%), and 26,048 people of Black African/Caribbean ethnicity (3%). A total of 204 LTCs were considered. Latent class analysis stratified by ethnicity identified 4 clusters of multimorbidity in White groups and 3 clusters in South Asian and Black groups. We found that early onset multimorbidity was more common among South Asian (59%, 33,915) and Black (56% 26,048) groups compared to the White population (42%, 777,906). Latent class analysis revealed physical and mental health conditions that were common across all ethnic groups (i.e., hypertension, depression, and painful conditions). However, each ethnic group also presented exclusive LTCs and different sociodemographic profiles: In White groups, the cluster with the highest rates/odds of the outcomes was predominantly male (54%, 44,150) and more socioeconomically deprived than the cluster with the lowest rates/odds of the outcomes. On the other hand, South Asian and Black groups were more socioeconomically deprived than White groups, with a consistent deprivation gradient across all multimorbidity clusters. At the end of the study, 4% (34,922) of the White early onset multimorbidity population had died compared to 2% of the South Asian and Black early onset multimorbidity populations (535 and 570, respectively); however, the latter groups died younger and lost more years of life. The 3 ethnic groups each displayed a cluster of individuals with increased rates of primary care consultations, hospitalisations, long-term prescribing, and odds of mortality. Study limitations include the exclusion of individuals with missing ethnicity information, the age of diagnosis not reflecting the actual age of onset, and the exclusion of people from Mixed, Chinese, and other ethnic groups due to insufficient power to investigate associations between multimorbidity and health-related outcomes in these groups. These findings emphasise the need to identify, prevent, and manage multimorbidity early in the life course. Our work provides additional insights into the excess burden of early onset multimorbidity in those from socioeconomically deprived and diverse groups who are disproportionately and more severely affected by multimorbidity and highlights the need to ensure healthcare improvements are equitable.

Ethnic inequities in routine childhood vaccinations in England 2006–2021: an observational cohort study using electronic health records

Population groups that are underserved by England's childhood vaccination programme must be identified to address the country's declining vaccination coverage. We examined routine childhood vaccination coverage in England by maternal ethnicity between 2006 and2021. We created first, second and fifth birthday cohorts using mother-child linked electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum. After validation against the UK Health Security Agency (UKHSA) and National Health Service England (NHSE) annual statistical reports, we described vaccination coverage for each vaccine by ethnicity and year. We used modified Poisson regression to analyse the effect of ethnicity on receiving the primary and full course of each vaccine. Up to 1,170,804 children born after 1 April 2006 were included in the first birthday cohort, reducing to 645,492 by the fifth birthday. Children were followed up until 31 March 2021at the latest. Children born to mothers in 9 minority ethnic groups and those of unknown ethnicity had lower vaccination coverage (61.3-97.5%) than the White British group (79.9-97.8%) for all vaccines. Indian, Pakistani, Bangladeshi, Chinese, Any other Asian background, and White and Asian ethnic groups had similar vaccination coverage to the White British group (above 90% for most vaccines in most years). Inequities particularly affected the Caribbean group (e.g. 61% coverage for the 6/5/4-in-1 full course in 2020-21 by children's fifth birthday; RR 0.66, 95% CI 0.6-0.74 compared with the White British group) and Any other Black, African and Caribbean background (e.g. coverage 68% for the MMR primary course in 2020-21; RR 0.71, 95% CI 0.64-0.78). These inequities widened over the study period. For example, the absolute difference in coverage between the Caribbean and White British groups for the full course of MMR increased from 12% in 2011-12 to 22% in 2019-20. These inequities remained even after accounting for sociodemographic, maternal and birth related factors, and also widened from primary course to full course. Our findings suggest that urgent policy action is needed to address the ethnic inequities throughout England's routine childhood vaccination programme, which have been worsening over time. University of Oxford Clarendon Fund, St Cross College and Nuffield Department of Population Health.

Power of inclusion: Enhancing polygenic prediction with admixed individuals

Admixed individuals offer unique opportunities for addressing limited transferability in polygenic scores (PGSs), given the substantial trans-ancestry genetic correlation in many complex traits. However, they are rarely considered in PGS training, given the challenges in representing ancestry-matched linkage-disequilibrium reference panels for admixed individuals. Here we present inclusive PGS (iPGS), which captures ancestry-shared genetic effects by finding the exact solution for penalized regression on individual-level data and is thus naturally applicable to admixed individuals. We validate our approach in a simulation study across 33 configurations with varying heritability, polygenicity, and ancestry composition in the training set. When iPGS is applied to n= 237,055 ancestry-diverse individuals in the UK Biobank, it shows the greatest improvements in Africans by 48.9% on average across 60 quantitative traits and up to 50-fold improvements for some traits (neutrophil count, R2= 0.058) over the baseline model trained on the same number of European individuals. When we allowed iPGS to use n= 284,661 individuals, we observed an average improvement of 60.8% for African, 11.6% for South Asian, 7.3% for non-British White, 4.8% for White British, and 17.8% for the other individuals. We further developed iPGS+refit to jointly model the ancestry-shared and -dependent genetic effects when heterogeneous genetic associations were present. For neutrophil count, for example, iPGS+refit showed the highest predictive performance in the African group (R2= 0.115), which exceeds the best predictive performance for the White British group (R2= 0.090 in the iPGS model), even though only 1.49% of individuals used in the iPGS training are of African ancestry. Our results indicate the power of including diverse individuals for developing more equitable PGS models.

Prediksi Ancaman Keamanan dan Antisipasinya Pada Pemilu Serentak 2024

ABSTRACT: The aim of the article is to provide a prediction of the threat of simultaneous elections in 2024 by highlighting the threat of absenteeism or white groups, the threat of delays in election logistics, the threat of identity politics, the threat of successful team conflict, and the threat of security disturbances. The method used is a literature review from secondary sources related to threat prediction and anticipation. The findings in this article show that the readiness and cooperation of election organizers, the police and political parties is very important to reduce and manage threats from the beginning to the end of the 2024 simultaneous elections.

Breastfeeding Disparities Among Rural Breastfeeding Dyads in High-Income Countries: A Scoping Study.

Background/Objective: Low breastfeeding initiation and duration of exclusivity put rural mothers and infants at risk for morbidity and mortality and significant economic costs. This scoping study aimed to identify determinants of breastfeeding disparities among rural dyads in high-income countries and their modifiable factors. Methods: The Arksey and O'Malley methodological framework was used. A literature review was conducted using PubMed, CINAHL Complete, Embase, and APA PsycInfo databases to identify studies related to rural breastfeeding that met criteria published between 2012 and 2022. Results: Twenty-five studies were included. Rural mothers from high-income countries are more likely to be younger, be unmarried, have lower educational attainment, have lower socioeconomic status, smoke, and have a higher prepregnancy body mass index than their urban counterparts. Rural mothers across White, Black, and Hispanic racial and ethnic groups have significantly lower breastfeeding rates compared to urban mothers. Maternal physiological preparedness, breastfeeding problems, lifestyle choices, support from family, evidence-based practice, workplace support, and policy development and implementation for breastfeeding promotion were identified as modifiable factors. Interventions using technology are an emerging field to overcome rurality. Conclusions: Although breastfeeding disparities are prevalent in rural dyads, the basic challenges mothers face when breastfeeding are universal, despite geographical locations in high-income countries. More specific support needs to be provided for breastfeeding dyads to continue breastfeeding. Resource allocation needs to be improved to increase access to care. Patient-centered technology interventions may decrease breastfeeding barriers in rural areas.

Whole Genome Resequencing Reveals Selection Signals Related to Wool Color in Sheep.

Wool color is controlled by a variety of genes. Although the gene regulation of some wool colors has been studied in relative depth, there may still be unknown genetic variants and control genes for some colors or different breeds of wool that need to be identified and recognized by whole genome resequencing. Therefore, we used whole genome resequencing data to compare and analyze sheep populations of different breeds by population differentiation index and nucleotide diversity ratios (Fst and θπ ratio) as well as extended haplotype purity between populations (XP-EHH) to reveal selection signals related to wool coloration in sheep. Screening in the non-white wool color group (G1 vs. G2) yielded 365 candidate genes, among which PDE4B, GMDS, GATA1, RCOR1, MAPK4, SLC36A1, and PPP3CA were associated with the formation of non-white wool; an enrichment analysis of the candidate genes yielded 21 significant GO terms and 49 significant KEGG pathways (p < 0.05), among which 17 GO terms and 21 KEGG pathways were associated with the formation of non-white wool. Screening in the white wool color group (G2 vs. G1) yielded 214 candidate genes, including ABCD4, VSX2, ITCH, NNT, POLA1, IGF1R, HOXA10, and DAO, which were associated with the formation of white wool; an enrichment analysis of the candidate genes revealed 9 significant GO-enriched pathways and 19 significant KEGG pathways (p < 0.05), including 5 GO terms and 12 KEGG pathways associated with the formation of white wool. In addition to furthering our understanding of wool color genetics, this research is important for breeding purposes.

Quality of ethnicity data within Scottish health records and implications of misclassification for ethnic inequalities in severe COVID-19: a national linked data study.

We compared the quality of ethnicity coding within the Public Health Scotland Ethnicity Look-up (PHS-EL) dataset, and other National Health Service datasets, with the 2011 Scottish Census. Measures of quality included the level of missingness and misclassification. We examined the impact of misclassification using Cox proportional hazards to compare the risk of severe coronavirus disease (COVID-19) (hospitalization & death) by ethnic group. Misclassification within PHS-EL was higher for all minority ethnic groups [12.5 to 69.1%] compared with the White Scottish majority [5.1%] and highest in the White Gypsy/Traveller group [69.1%]. Missingness in PHS-EL was highest among the White Other British group [39%] and lowest among the Pakistani group [17%]. PHS-EL data often underestimated severe COVID-19 risk compared with Census data. e.g. in the White Gypsy/Traveller group the Hazard Ratio (HR) was 1.68 [95% Confidence Intervals (CI): 1.03, 2.74] compared with the White Scottish majority using Census ethnicity data and 0.73 [95% CI: 0.10, 5.15] using PHS-EL data; and HR was 2.03 [95% CI: 1.20, 3.44] in the Census for the Bangladeshi group versus 1.45 [95% CI: 0.75, 2.78] in PHS-EL. Poor quality ethnicity coding in health records can bias estimates, thereby threatening monitoring and understanding ethnic inequalities in health.

Waterlogged wood remains found in a Late Bronze Age settlement (İnönü Cave) on the Western Black Sea coast of Türkiye

The remains of wooden structures belonging to the Late Bronze Age were unearthed during the excavations carried out in the İnönü Cave, which is located approximately 25 km inside the Ereğli district of Zonguldak, on the western Black Sea coast of Türkiye. Thanks to the special conditions of the cave, the woods that makes up the structures that have survived until today has been examined within the scope of this study. All wood flooring elements examined in this study consist of water-filled wood, except for one example (NNDK-1), which has semi-water-filled properties. In the construction of the wooden floor, one oak species from the white oak group (probably Quercus petraea (Matt.) Liebl.) and one pine species from the Sylvestris group (probably Pinus nigra Arnold), Alnus glutinosa (L.) Gaertner and Acer L. sp. were used. In addition, the most used genus in its construction was oak (Quercus L., section Quercus). The inhabitants of İnönü cave in the Late Bronze Age must have met their wood needs from nearby local resources. Wood anatomical analysis pointed out the occurrence of riverine forests formed by Black alder along the streams and temperate broadleaf and mixed forests formed by Sessile oak, maple, and Black pine in İnönü cave and its vicinity. These, together with others like Fagus orientalis Lipsky, Carpinus betulus L., Carpinus orientalis Mill., Salix alba L., and Populus nigra L., are the genera/species present in the region today.