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Wei Y, Zhang T, Wang B, Pan J, Jin S, Fang B, Gu W, Qin X, Dai B, Lin G, Gan H, Wu J, Ye D, Zhu Y. Prospective clinical sequencing of 1016 Chinese prostate cancer patients: uncovering genomic characterization and race disparity. Mol Oncol 2023; 17:2183-2199. [PMID: 37584393 PMCID: PMC10552897 DOI: 10.1002/1878-0261.13511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Abstract
Although there is a well-known disparity in prostate cancer (PC) incidence and mortality between Chinese and Western patients, the underlying genomic differences have been investigated only sparsely. This clinicogenomic study was conducted to reveal the genomic mutations contributing to the PC disparity across ethnicities and investigate the mutational profile of Chinese PC patients. A total of 1016 Chinese PC patients were prospectively enrolled and subjected to targeted sequencing, resulting in usable sequencing data for 41 genes from 859 patients. Genomic data retrieved from The Cancer Genome Atlas (TCGA; locoregional PC), Memorial Sloan Kettering Cancer Center [MSKCC; metastatic castration-sensitive PC (mCSPC)], and Stand Up To Cancer [SU2C; metastatic castration-resistant PC (mCRPC)] cohorts were used as comparators representing Western men. Genomic mutations were analyzed using an integrated bioinformatic strategy. A comparison of the disease stages revealed that mutations in tumor protein 53 (TP53), androgen receptor (AR), forkhead box A1 (FOXA1), and genes involved in the cell cycle pathway were enriched in mCRPC. Mutations in adenomatous polyposis coli (APC) gene were found to be more prevalent in patients with visceral metastasis. Genomic differences between Western and Chinese men were mainly observed in castration-sensitive PC, with tumors from Chinese men having more FOXA1 (11.4% vs. 4.2%) but fewer TP53 (4.8% vs. 13%) mutations in locoregional PC and harboring fewer TP53 (11% vs. 29.2%), phosphatase and tensin homolog (PTEN; 2.5% vs. 10.3%), and APC (1.7% vs. 7.4%) mutations in the mCSPC stage than those of Western men. Patients of both ethnicities with mCRPC had similar mutational spectra. Furthermore, FOXA1 class-2 was less common than FOXA1 class-1 and showed no enrichment in metastasis, contrary to the findings in the Western cohort. Our study provides a valuable resource for a better understanding of PC in China and reveals the genomic alterations associated with PC disparity across races.
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Affiliation(s)
- Yu Wei
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Tingwei Zhang
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Beihe Wang
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Jian Pan
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Shengming Jin
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Bangwei Fang
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Weijie Gu
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Xiaojian Qin
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Bo Dai
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Guowen Lin
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Hualei Gan
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Department of PathologyFudan University Shanghai Cancer CenterChina
| | - Junlong Wu
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Dingwei Ye
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
| | - Yao Zhu
- Department of UrologyFudan University Shanghai Cancer CenterChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
- Shanghai Genitourinary Cancer InstituteChina
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Mercado KE, Badiner NM, Wang C, Denham L, Unternaehrer JJ, Hong LJ, Ioffe YJ. Racial and Ethnic Disparities in Gynecologic Carcinosarcoma: A Single-Institution Experience. Cancers (Basel) 2023; 15:4690. [PMID: 37835384 PMCID: PMC10571738 DOI: 10.3390/cancers15194690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
We aimed to determine the incidence, treatment regimen, and treatment outcomes (including progression-free survival and overall survival) of gynecologic carcinosarcoma, a rare, aggressive, and understudied gynecologic malignancy. This retrospective review included all patients with gynecologic cancers diagnosed and treated at a single tertiary care comprehensive cancer center between January 2012 and May 2021. A total of 2116 patients were eligible for review, of which 84 cases were identified as carcinosarcoma: 66 were uterine (5.2% of uterine cancers), 17 were ovarian (3.6% of ovarian cancers), 1 was cervical (0.28% of cervical cancers), and 1 was untyped. Of the patients, 76.2% presented advanced-stage disease (stage III/IV) at the time of diagnosis. Minority patients were more likely to present with stage III/IV (p < 0.0001). The majority of patients underwent surgical resection followed by systemic chemotherapy with carboplatin and paclitaxel. The median PFS was 7.5 months. Of the patients, 55% were alive 1 year after diagnosis, and 45% were alive at 5 years. In the studied population, minorities were more likely to present with more advanced disease. The rate of gynecologic carcinosarcomas was consistent with historical reports.
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Affiliation(s)
- Kristina E. Mercado
- Department of Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Nora M. Badiner
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Canty Wang
- Department of Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Laura Denham
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Juli J. Unternaehrer
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
- Division of Biochemistry, Department of Basic Sciences, Loma Linda University, Loma Linda, CA 92354, USA
| | - Linda J. Hong
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Yevgeniya J. Ioffe
- Division of Gynecologic Oncology, Department of Gynecology and Obstetrics, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
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Babiker S, Ogunmwonyi I, Georgi MW, Tan L, Haque S, Mullins W, Singh P, Ang N, Fu H, Patel K, Khera J, Fricker M, Fleming S, Giwa-Brown L, A Brennan P, Irune E, Vig S, Nathan A. Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN): Protocol for a Cross-Sectional Study. JMIR Res Protoc 2023; 12:e40545. [PMID: 37327055 DOI: 10.2196/40545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The unequal distribution of academic and professional outcomes between different minority groups is a pervasive issue in many fields, including surgery. The implications of differential attainment remain significant, not only for the individuals affected but also for the wider health care system. An inclusive health care system is crucial in meeting the needs of an increasingly diverse patient population, thereby leading to better outcomes. One barrier to diversifying the workforce is the differential attainment in educational outcomes between Black and Minority Ethnic (BME) and White medical students and doctors in the United Kingdom. BME trainees are known to have lower performance rates in medical examinations, including undergraduate and postgraduate exams, Annual Review of Competence Progression, as well as training and consultant job applications. Studies have shown that BME candidates have a higher likelihood of failing both parts of the Membership of the Royal Colleges of Surgeons exams and are 10% less likely to be considered suitable for core surgical training. Several contributing factors have been identified; however, there has been limited evidence investigating surgical training experiences and their relationship to differential attainment. To understand the nature of differential attainment in surgery and to develop effective strategies to address it, it is essential to examine the underlying causes and contributing factors. The Variation in Experiences and Attainment in Surgery Between Ethnicities of UK Medical Students and Doctors (ATTAIN) study aims to describe and compare the factors and outcomes of attainment between different ethnicities of doctors and medical students. OBJECTIVE The primary aim will be to compare the effect of experiences and perceptions of surgical education of students and doctors of different ethnicities. METHODS This protocol describes a nationwide cross-sectional study of medical students and nonconsultant grade doctors in the United Kingdom. Participants will complete a web-based questionnaire collecting data on experiences and perceptions of surgical placements as well as self-reported academic attainment data. A comprehensive data collection strategy will be used to collect a representative sample of the population. A set of surrogate markers relevant to surgical training will be used to establish a primary outcome to determine variations in attainment. Regression analyses will be used to identify potential causes for the variation in attainment. RESULTS Data collected between February 2022 and September 2022 yielded 1603 respondents. Data analysis is yet to be competed. The protocol was approved by the University College London Research Ethics Committee on September 16, 2021 (ethics approval reference 19071/004). The findings will be disseminated through peer-reviewed publications and conference presentations. CONCLUSIONS Drawing upon the conclusions of this study, we aim to make recommendations on educational policy reforms. Additionally, the creation of a large, comprehensive data set can be used for further research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40545.
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Affiliation(s)
| | | | - Maria W Georgi
- University College London Medical School, London, United Kingdom
| | | | - Sharmi Haque
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - William Mullins
- St Georges University Hospital National Health Service Trust, London, United Kingdom
| | - Prisca Singh
- University of Birmingham Medical School, Birmingham, United Kingdom
| | - Nadya Ang
- Barts and The London School of Medicine and Dentistry, London, United Kingdom
| | - Howell Fu
- South West London Elective Orthopaedic Centre, London, United Kingdom
| | - Krunal Patel
- University College London Medical School, London, United Kingdom
| | - Jevan Khera
- University Hospital Coventry & Warwickshire, Coventry, United Kingdom
| | | | - Simon Fleming
- Institute of Health Sciences Education, Queen Mary University of London, London, United Kingdom
| | - Lolade Giwa-Brown
- Barts Health National Health Service Trust, Royal London Hospital, London, United Kingdom
| | - Peter A Brennan
- Maxillofacial Unit, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Ekpemi Irune
- Department of Otolaryngology, Head and Neck Surgery, Cambridge University Hospitals National Health Service Foundation, Cambridge, United Kingdom
| | - Stella Vig
- Department of Vascular and General Surgery, Croydon University Hospital, London, United Kingdom
| | - Arjun Nathan
- Division of Surgery and Interventional Sciences, University College London, London, United Kingdom
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Oh SS, Kang B, Park J, Kim S, Park EC, Lee SH, Kawachi I. Racial/ Ethnic Disparity in Association Between Fetal Alcohol Syndrome and Alcohol Intake During Pregnancy: Multisite Retrospective Cohort Study. JMIR Public Health Surveill 2023; 9:e45358. [PMID: 37083819 PMCID: PMC10147559 DOI: 10.2196/45358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Alcohol consumption during pregnancy is associated with a range of adverse birth-related outcomes, including stillbirth, low birth weight, preterm birth, and fetal alcohol syndrome (FAS). With more than 10% of women consuming alcohol during pregnancy worldwide, it is increasingly important to understand how racial/ethnic variations affect FAS onset. However, whether race and ethnicity inform FAS risk assessment when daily ethanol intake is controlled for remains unknown. OBJECTIVE This study aimed to assess racial/ethnic disparities in FAS risk associated with alcohol consumption during pregnancy. METHODS We used data from a longitudinal cohort study (the Collaborative Initiative on Fetal Alcohol Spectrum Disorders) at 5 hospital sites around the United States of 595 women who consumed alcohol during pregnancy from 2007 to 2017. Questionnaires, in-person interviews, and reviews of medical, legal, and social service records were used to gather data on average alcoholic content (AAC) during pregnancy. Self-reports of maternal race (American Indian/Alaska Native [AI/AN], Asian, Native Hawaiian or other Pacific Islander, Black or African American, White, more than one race, and other) and ethnicity (Hispanic/Latino or not Hispanic/Latino), as well as FAS diagnoses based on standardized dysmorphological criteria, were used for analysis. Log-binomial regression was used to examine the risk of FAS associated with each 1-gram increase in ethanol consumption during pregnancy, stratified by race/ethnicity. RESULTS A total of 3.4% (20/595) of women who reported consuming alcohol during pregnancy gave birth to a baby with FAS. Women who gave birth to a baby with FAS had a mean AAC of 32.06 (SD 9.09) grams, which was higher than that of women who did not give birth to a baby with FAS (mean 12.07, SD 15.87 grams). AI/AN mothers with FAS babies had the highest AAC (mean 42.62, SD 8.35 grams), followed by White (mean 30.13, SD 4.88 grams) and Black mothers (mean 27.05, SD 12.78 grams). White (prevalence ratio [PR] 1.10, 95% CI 1.03-1.19), Black (PR 1.13, 95% CI 1.04-1.23), and AI/AN (PR 1.10, 95% CI 1.00-1.21) mothers had 10% to 13% increased odds of giving birth to a baby with FAS given the same exposure to alcohol during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in a 4% increase (PR 1.04, 95% CI 1.02-1.07) in the chance of giving birth to a baby with ≥2 facial anomalies (ie, short palpebral fissures, thin vermilion border of the upper lip, and smooth philtrum) and a 4% increase (PR 1.04, 95% CI 1.01-1.07) in the chance of deficient brain growth. CONCLUSIONS The risk of delivering a baby with FAS was comparable among White, Black, and AI/AN women at similar levels of drinking during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in increased odds of giving birth to a baby with facial anomalies or deficient brain growth.
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Affiliation(s)
- Sarah Soyeon Oh
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bada Kang
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Jewel Park
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - SangMin Kim
- Harvard Medical School, Boston, MA, United States
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Preventive Medicine and Public Health, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hee Lee
- College of Nursing and Brain Korea 21 Four Project, Yonsei University, Seoul, Republic of Korea
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States
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Abu Baker F, Ben Ari Z, Green I, Israel A, Kopelman Y, Abu Mouch S, Davidov Y, Khoury T, Mari A. The impact of ethnicity on chronic hepatitis B infection course and outcome: big data analysis from Israel. Ethn Health 2023; 28:458-467. [PMID: 35179096 DOI: 10.1080/13557858.2022.2040957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The effect of ethnicity on chronic hepatitis B virus (CHB) infection's course and outcome has attracted little research. We aimed to compare different aspects of ethnic disparities in CHB patients, including prevalence, phenotypes, management, and outcome between two major ethnic groups in Israel. DESIGN We conducted a large retrospective cohort study utilizing the Leumit-Health-Service database. Electronic reports of almost 700,000 members from different ethnicities and districts throughout Israel from 2000 to 2019 were reviewed. Patients' ethnicity was categorized based on the classification of the Israeli Central Bureau of Statistics into two main groups, Arabs and Jews. CHB diagnosis was based on ICD-9-CM codes and supportive serology results. Prevalence, clinical backgrounds, disease course, and patients' outcomes were compared between both groups. RESULTS The prevalence of CHB in the Arab minority group was almost twice and a half-higher when compared to their Jewish counterparts (4.3% vs. 1.8%), but they had a lower rate of referral for HBsAg testing (7% vs. 7.9%). The Arab CHB patients were significantly younger at the time of diagnosis (37.6± 13.5 vs. 45.3± 15; P < 0.001). Male predominance was noted in both groups. The Arab patients had a higher rate of active hepatitis (HBeAg-positive and/or negative hepatitis) phase (36.4% vs. 29.8%; P = 0.01), as well as a significantly higher rate of HBeAg seroconversion (45.2% vs. 35.4%; P = 0.033). Nucleos/tide analogue treatment figures were similar, with most patients in both groups receiving a high barrier to resistance treatment. Patients' outcome was similar in both groups as the rate of hepatocellular carcinoma, cirrhosis, and advanced fibrosis (after stratification analysis) were comparable between both groups. CONCLUSION Marked by a prominently higher prevalence of HBV infection, patients in the Arab ethnic group had a lower rate of referral for HBsAg testing but received comparable management and had a similar outcome compared to their Jewish counterparts.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Ziv Ben Ari
- Liver Diseases Center, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ilan Green
- Research Institute, Leumit Health Services, Tel Aviv, Israel
| | - Areil Israel
- Research Institute, Leumit Health Services, Tel Aviv, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Saif Abu Mouch
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Hadera, Israel
- Technion Faculty of Medicine, Haifa, Israel
| | - Yana Davidov
- Liver Diseases Center, Sheba Medical Center and Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Tawfik Khoury
- Department of Gastroenterology, Galilee Medical Center, Nahariya, Israel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital, Shillong, Meghalaya, India
- Faculty of Medicine, Bar-Illan University, Safed, Israel
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Ali M, Bariani MV, Vafaei S, Omran MM, Yang Q, Madueke-Laveaux OS, Al-Hendy A. Prevention of Uterine Fibroids: molecular mechanisms and potential clinical application. J Endometr Uterine Disord 2023; 1:100018. [PMID: 37637856 PMCID: PMC10451784 DOI: 10.1016/j.jeud.2023.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Uterine fibroids (UFs; leiomyoma) are the most common benign neoplastic threat to women worldwide, exacting an immense personal burden on female health and a monetary expense to the healthcare system estimated in the hundreds of billions of dollars every year globally. With no long-term non-invasive treatment option currently available to treat UFs, deeper insights regarding tumor etiology are the key for developing newer therapies. Accordingly, in this review, we discuss new mechanistic paradigm to explain UF tumor development through an exquisite model involving developmental reprogramming of myometrial stem cells due to early life endocrine disruptors exposure, inflammation, fibrosis, DNA damage, and eventually tissue stiffness. Further, we propose to utilize shear wave elastography as a potential screening tool for the early identification of women at risk for developing UFs who can benefit from several simple preventive strategies, including the consumption of natural compounds such as vitamin D and green tea as a safe fertility friendly non-hormonal modality to delay or even arrest or reverse UF progression.
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Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Maria Victoria Bariani
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Somayeh Vafaei
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Mervat M. Omran
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
- Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Obianuju Sandra Madueke-Laveaux
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, 5841 S. Maryland Ave, Chicago, IL 60637, USA Chicago, IL 60637, USA
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Alldredge J, Kumar V, Nguyen J, Sanders BE, Gomez K, Jayachandran K, Zhang J, Schwarz J, Rahmatpanah F. Endogenous Retrovirus RNA Expression Differences between Race, Stage and HPV Status Offer Improved Prognostication among Women with Cervical Cancer. Int J Mol Sci 2023; 24:1492. [PMID: 36675007 PMCID: PMC9864224 DOI: 10.3390/ijms24021492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/15/2023] Open
Abstract
Endogenous human retroviruses (ERVs) are remnants of exogenous retroviruses that have integrated into the human genome. Using publicly available RNA-seq data from 63 cervical cancer patients, we investigated the expression of ERVs in cervical cancers. Four aspects of cervical cancer were investigated: patient ancestral background, tumor HPV type, tumor stage and patient survival. Between the racial subgroups, 74 ERVs were significantly differentially expressed, with Black Americans having 30 upregulated and 44 downregulated (including MER21C, HERV9-int, and HERVH-int) ERVs when compared to White Americans. We found that 3313 ERVs were differentially expressed between HPV subgroups, including MER41A, HERVH-int and HERVK9. There were 28 downregulated (including MLT1D and HERVH-int) and 61 upregulated (including MER41A) ERVs in locally advanced-stage compared to early-stage samples. Tissue microarrays of cervical cancer patients were used to investigate the protein expression of ERVs with protein coding potential (i.e., HERVK and ERV3). Significant differences in protein expression of ERV3 (p = 0.000905) were observed between early-stage and locally advanced-stage tumors. No significant differential expression at the protein level was found for HERVK7 (p = 0.243). We also investigated a prognostic model, supplementing a baseline prediction model using FIGO stage, age and HPV positivity with ERVs data. The expression levels of all ERVs in the HERVd were input into a Lasso-Cox proportional hazards model, developing a predictive 67-ERV panel. When ERVs expression levels were supplemented with the clinical data, a significant increase in prognostic power (p = 9.433 × 10-15) relative to that obtained with the clinical parameters alone (p = 0.06027) was observed. In summary, ERV RNA expression in cervical cancer tumors is significantly different among racial cohorts, HPV subgroups and disease stages. The combination of the expression of certain ERVs in cervical cancers with clinical factors significantly improved prognostication compared to clinical factors alone; therefore, ERVs may serve as future prognostic biomarkers and therapeutic targets. Novelty and Impact: When endogenous retroviral (ERV) expression signatures were combined with currently employed clinical prognosticators of relapse of cervical cancer, the combination outperformed prediction models based on clinical prognosticators alone. ERV expression signatures in tumor biopsies may therefore be useful to help identify patients at greater risk of recurrence. The novel ERV expression signatures or adjacent genes possibly impacted by ERV expression described here may also be targets for the development of future therapeutic interventions.
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Affiliation(s)
- Jill Alldredge
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO 80045, USA
| | - Vinay Kumar
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA 92697, USA
| | - James Nguyen
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA 92697, USA
| | - Brooke E. Sanders
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO 80045, USA
| | - Karina Gomez
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO 80045, USA
| | - Kay Jayachandran
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Jin Zhang
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63108, USA
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Julie Schwarz
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO 63108, USA
- Institute for Informatics, Washington University School of Medicine, St. Louis, MO 63108, USA
- Department of Cell Biology and Physiology, Washington University School of Medicine, St. Louis, MO 63108, USA
| | - Farah Rahmatpanah
- Department of Pathology and Laboratory Medicine, University of California, Irvine, CA 92697, USA
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Huttler A, Hong C, Shah DK. Racial and ethnic disparities in the surgical management of tubal ectopic pregnancy. F S Rep 2022; 3:311-316. [PMID: 36568938 PMCID: PMC9783145 DOI: 10.1016/j.xfre.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 12/27/2022] Open
Abstract
Objective To evaluate racial and ethnic disparities in the surgical management of ectopic pregnancy over time. Design Retrospective cohort study. Setting None. Patients Surgically-managed cases of patients with tubal ectopic pregnancy within the American College of Surgeons National Surgical Quality Improvement Program database between 2010 and 2019. Interventions None. Main outcome measures Surgical approach (laparoscopic compared with open) and procedure (salpingectomy compared with salpingostomy/other). Results Of 7791 patients undergoing surgical management of tubal ectopic pregnancy, 21.8% identified as Hispanic, 24.5% as Black, 9.4% as Asian/other, and 44.3% as White. Use of laparoscopy increased 1.3% per year from 81.4% in 2010 to 91.0% in 2019 (95% confidence interval [CI], 0.010-0.016). Odds of undergoing laparoscopic surgery were lower in Black (adjusted odds ratio [aOR] 0.52; 95% CI, 0.45-0.61) and Hispanic patients (aOR 0.52; 95% CI, 0.44-0.61) compared with White patients and remained similar over time. The use of salpingectomy increased by 1.1% per year from 80.6% in 2010 to 94.7% in 2019 (95% CI, 0.009-0.014). Odds of undergoing salpingectomy were higher among Black (aOR 1.78, 95% CI 1.43-2.23) and Hispanic patients (aOR 1.54; 95% CI, 1.24-1.93) and lower among Asian patients (aOR 0.73, 95% CI, 0.56-0.95) compared with White patients. These ratios remained similar for Black and Asian patients over time. Conclusions Despite the increased use of laparoscopy and salpingectomy in the surgical management of ectopic pregnancy over time, Black and Hispanic patients remain less likely to undergo minimally invasive surgery and more likely to undergo salpingectomy compared with White patients.
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Affiliation(s)
- Alexandra Huttler
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania,Reprint requests: Alexandra Huttler, M.D., Department of Obstetrics and Gynecology, Pennsylvania Hospital, 2 Pine East 800 Spruce Street, Philadelphia, Pennsylvania 19107
| | - Christopher Hong
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, Philadelphia, Pennsylvania,Division of Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Divya Kelath Shah
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania, Philadelphia, Pennsylvania
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9
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Boehme KW, Kennedy JL, Snowden J, Owens SM, Kouassi M, Mann RL, Paredes A, Putt C, James L, Jin J, Du R, Kirkpatrick C, Modi Z, Caid K, Young S, Zohoori N, Kothari A, Boyanton BL, Craig Forrest J. Pediatric SARS-CoV-2 Seroprevalence in Arkansas Over the First Year of the COVID-19 Pandemic. J Pediatric Infect Dis Soc 2022; 11:248-256. [PMID: 35294550 PMCID: PMC8992271 DOI: 10.1093/jpids/piac010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) seroprevalence studies largely focus on adults, but little is known about spread in children. We determined SARS-CoV-2 seroprevalence in children and adolescents from Arkansas over the first year of the coronavirus disease of 2019 (COVID-19) pandemic. METHODS We tested remnant serum samples from children ages 1-18 years who visited Arkansas hospitals or clinics for non-COVID-19-related reasons from April 2020 through April 2021 for SARS-CoV-2 antibodies. We used univariable and multivariable regression models to determine the association between seropositivity and participant characteristics. RESULTS Among 2357 participants, seroprevalence rose from 7.9% in April/May 2020 (95% CI, 4.9-10.9) to 25.0% in April 2021 (95% CI, 21.5-28.5). Hispanic and black children had a higher association with antibody positivity than non-Hispanic and white children, respectively, in multiple sampling periods. CONCLUSIONS By spring 2021, most children in Arkansas were not infected with SARS-CoV-2. With the emergence of SARS-CoV-2 variants, recognition of long-term effects of COVID-19, and the lack of an authorized pediatric SARS-CoV-2 vaccine at the time, these results highlight the importance of including children in SARS-CoV-2 public health, clinical care, and research strategies.
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Affiliation(s)
- Karl W Boehme
- Department of Microbiology & Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Center for Microbial Pathogenesis and Host Inflammatory Responses, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joshua L Kennedy
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Children’s Research Institute, Little Rock, Arkansas, USA
| | - Jessica Snowden
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Shana M Owens
- Department of Microbiology & Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marianne Kouassi
- Department of Microbiology & Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ryan L Mann
- Department of Microbiology & Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amairani Paredes
- Department of Microbiology & Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Claire Putt
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Laura James
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jing Jin
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ruofei Du
- Department of Environmental and Occupational Health, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | | | - Zeel Modi
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Katherine Caid
- Arkansas Children’s Research Institute, Little Rock, Arkansas, USA
| | - Sean Young
- Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Namvar Zohoori
- Department of Epidemiology, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Department of Health, Little Rock, Arkansas, USA
| | - Atul Kothari
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Department of Health, Little Rock, Arkansas, USA
- Department of Bioinformatics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Bobby L Boyanton
- Department of Pathology, Arkansas Children’s Hospital and University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - J Craig Forrest
- Department of Microbiology & Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Center for Microbial Pathogenesis and Host Inflammatory Responses, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Guo H, Chen N, Yang Y, Zhou X, Li X, Jiang Y, Huang J, Du Q. Ethnic Disparity in the Incidence of Scoliosis Among Adolescents in Tianzhu Tibetan Autonomous County, China. Front Public Health 2022; 10:791550. [PMID: 35570980 PMCID: PMC9092046 DOI: 10.3389/fpubh.2022.791550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives To determine the influence of ethnic disparities, socioeconomic status (SES) and hukou on the incidence of scoliosis. Methods We enrolled 2,445 junior high school students (Han: 1,153; ethnic minorities: 1,292) aged 12–16 years from two schools in Tianzhu Tibetan Autonomous County, Gansu Province from November 2020 to February 2021. We measured the angle of trunk rotation (ATR) using a scoliometer. Two-factor analysis of variance was used to comparatively analyze differences in the ATR according to ethnicity, age, sex, body mass index (BMI), and SES between the groups. Associations between risk factors and scoliosis were estimated using odds ratios and 95% confidence intervals with an unconditional multivariate logistic regression model for the two groups. Results Adolescents with Han ethnicity were more likely to have scoliosis than their ethnic minority counterparts (10.8% vs. 7.1%, P < 0.05). The ATR value in the Han group decreased with age whereas the minority group showed an upward trend (P < 0.05). The difference between ethnic groups was not significant, only at level 3. In particular, the ATR values among Han girls were significantly higher than those of ethnic minority girls (P < 0.05). Compared with Han adolescents, the BMI of ethnic minorities had a greater impact on the ATR. A statistically significant difference in SES was found between the two ethnic groups (P < 0.05). Hukou and parents' occupation had an important influence on the onset of scoliosis. Conclusions Han adolescents had higher ATR values and were more likely to have scoliosis than ethnic minority adolescents in our study. Growth and development indicators (height and BMI) and differences in SES between the two groups played an important role.
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Affiliation(s)
- Haibin Guo
- Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuqi Yang
- College of Global Public Health, New York University, New York, NY, United States
| | - Xuan Zhou
- Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Li
- Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Jiang
- Department of Rehabilitation Medicine, Third People's Hospital of Gansu Province, Lanzhou, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Du
- Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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11
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Zhang R, Sun J, Wang C, Wang X, Zhao P, Yuan Y, Ai H, Zhou Q. The Racial Disparities in the Epidemic of Metabolic Syndrome With Increased Age: A Study From 28,049 Chinese and American Adults. Front Public Health 2022; 9:797183. [PMID: 35178373 PMCID: PMC8843927 DOI: 10.3389/fpubh.2021.797183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies have revealed ethnic disparities in the prevalence of metabolic syndrome (MetS); however, the literature regarding aging-related patterns of disparities in MetS and its components remains limited. METHODS This cross-sectional study recruited 28,049 subjects, consisting of one Chinese race and three American races, 18-85 years of age, from the National Health and Nutrition Examination Survey (NHANES, 1999-2018) of the United States, and the Guangdong Gut Microbiome Project (GGMP, 2018) of China. MetS was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III. A modified sliding-window-based algorithm was used to depict the trajectories of the prevalence of MetS with increased age. Logistic regression analysis was performed to investigate associations between MetS and its components. RESULTS The prevalence of MetS increased non-linearly with age, with growth speed reaching its maximum at approximately 40-50 years. Chinese subjects exhibited a lower prevalence of MetS than non-Hispanic whites, non-Hispanic blacks, and Mexican Americans in all age groups. The two most prevalent components in Chinese subjects were reduced high-density lipoprotein cholesterol levels (42.0%) and elevated blood pressure (49.5%), and elevated triglyceride levels (36.3-49.5%) and abdominal obesity (55.8-55.9%) in Americans. Before 40 years of age, the top two MetS-associated components were abdominal obesity and elevated triglyceride levels in all races, while after 40 years, the prominent associations between MetS and its components varied among the different races and age groups. CONCLUSIONS Although racial disparities in the epidemic of MetS varied with increased age, abdominal obesity and elevated triglyceride levels were the top two MetS-associated components in all younger adults of different races.
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Affiliation(s)
- Ruiying Zhang
- Department of Nephrology, Harrison International Peace Hospital, The People's Hospital of Hengshui City, Hengshui, China
| | - Jie Sun
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaofan Wang
- School of Public Health, Capital Medical University, Beijing, China
| | - Xiangtuo Wang
- Department of Nephrology, Harrison International Peace Hospital, The People's Hospital of Hengshui City, Hengshui, China
| | - Pei Zhao
- Department of Nephrology, Harrison International Peace Hospital, The People's Hospital of Hengshui City, Hengshui, China
| | - Yucong Yuan
- Department of Nephrology, Harrison International Peace Hospital, The People's Hospital of Hengshui City, Hengshui, China
| | - Hu Ai
- Department of Cardiology, National Center of Gerontology, Institute of Geriatric Medicine, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Zhou
- The Key Laboratory of Geriatrics, National Center of Gerontology of National Health Commission, Beijing Institute of Geriatrics, Institute of Geriatrics, Beijing Hospital, Chinese Academy of Medical Sciences, Beijing, China
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12
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Baker FA, Taher R, Ganayem M, Mari A, Kopelman Y. Ethnic disparities in colorectal cancer outcomes : a population study from Israel. Ethn Health 2022; 27:554-564. [PMID: 32692255 DOI: 10.1080/13557858.2020.1795630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
Objectives: Colorectal cancer (CRC) is an important cause of morbidity and mortality worldwide. Clear ethnic disparities in the incidence of CRC and its outcomes have been observed globally, but only few research efforts have been invested so far in the unique ethnic scene of Israeli population. This study aims to compare the clinico-pathologic features, tumor's characteristics and prognosis between Arab and Jewish CRC patients as well as among Jewish subgroups living within the same central coastal region in Israel.Methods: In this retrospective, single center study, a total of 401 patients with pathologically confirmed CRCs diagnosed during the years 2008-2015 were included. These were divided into Jewish (n = 334) and Arab (n = 67) groups. Data collected included demographics, country of birth, clinical presentation and family history. Tumor stage, location, histologic grade and mortality rate were compared retrospectively between both groups and within Jewish sub-populations.Results: Arabs were significantly younger at diagnosis (62.7 ± 12.9 vs. 69.3 ± 13.01; P < 0.01), presented more frequently with rectal bleeding, and were less likely to be diagnosed due to positive fecal occult blood test (9% vs. 22.6%; P = 0.012). Tumor distribution through the colon was comparable between both groups and characterized by a distal predominance. Arabs had a significantly higher rate of advanced stage at diagnosis (58% vs. 50.5%, OR = 2.454, 95%CI = 1.201-5.013; P = 0.02) when compared to Jews. Mortality rates were comparable between both groups. In the Jewish subpopulation analysis, we found that immigrants, especially those born in the former USSR, presented with significantly advanced tumor stages when compared to native Israelis (55% vs. 37.5%; P = 0.02).Conclusion: CRC in two major ethnic populations in Israel, Arabs and Jews, varied in terms of age at diagnosis, clinical presentation and stage at diagnosis. Similar findings were documented within a non-native Jewish subpopulation, raising the possibility of a low utilization of screening programs in these groups.
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Affiliation(s)
- Fadi Abu Baker
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
| | - Randa Taher
- Department of Internal Medicine, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
| | - Mohanad Ganayem
- Department of Internal Medicine, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
| | - Amir Mari
- Department of Gastroenterology, Nazareth EMMS Hospital (Affiliated with the Faculty of Medicine, Bar Illan University), Nazareth, Israel
| | - Yael Kopelman
- Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center (Affiliated to the Technion Faculty of Medicine, Haifa, Israel), Hadera, Israel
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13
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Mathlouthi A, Zarrintan S, Khan MA, Malas M, Barleben A. Contemporary Outcomes of Limb-Salvage Procedures Using Vascular Quality Initiative-Medicare Linked Data: Racial and Ethnic Disparities Persist. J Vasc Surg 2022; 75:2013-2018. [PMID: 35149160 DOI: 10.1016/j.jvs.2022.01.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 01/21/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Several reports have shown that ethnic and racial minorities with chronic limb-threatening ischemia (CLTI) are more likely to undergo major amputation. Whether this disparity is driven by limited access to care, statistical discrimination or biological factors remains a matter of debate. We sought to study the effect of race/ethnicity on short and long-term outcomes of limb-salvage procedures among patients with new onset CLTI. METHODS We identified all patients who underwent first time (open or endovascular) revascularization for CLTI between January 2010 and December 2016 in the Vascular Quality Initiative-Medicare linked database. These patients were divided into non-Hispanic whites (NHW) and racial/ethnic minority (REM) groups. Early end points included length of stay and operative mortality, while 2-year outcomes included major amputation, freedom from subsequent revascularization, number of limb salvage reinterventions and all-cause mortality. A sub-analysis comparing NHWs to Hispanics and NHWs to blacks was also performed. RESULTS Of 16,249 presenting with CLTI, 73.9% were non-Hispanic whites. Racial/ethnic minority patients were younger (mean age, 69.9 ± 11.3 years vs 74.2 ± 10.5 years; P < .001) and more likely to be female (45.9% vs 37.7%; P < .001). Other baseline differences included a higher rate of smoking history, coronary artery disease, chronic obstructive pulmonary disease and chronic kidney disease among non-Hispanic whites, whereas racial/ethnic minority patients were more likely to have diabetes and hypertension and more likely to present with tissue loss (78% vs 76.6%; P =.04). Preoperative ankle-brachial index and procedure type (endovascular vs open) were similar between the groups. On multivariable analysis, NHW's had a 13% increase in length of stay and a 25% decrease in operative mortality. In regard to 2-year outcomes, limb salvage estimates were 86% for the NHW group versus 77.1% for the REM group; P < .001. Comparison between the two groups showed similar rates of freedom from subsequent revascularization (67.9% vs 67.1%; P =.2). REM patients achieved higher rates of overall survival (70.3% vs 68.4%; P =.01) when compared to their white counterparts. Patients in the REM group were more likely to undergo more than two limb salvage reinterventions during follow-up (14.2% vs 8.6%; P < .001). After adjusting for potential confounders, REM patients had significantly higher odds of major amputation at 2 years (adjusted hazard ratio, 1.49; 95% confidence interval, 1.36-1.63; P < .001) CONCLUSIONS: In this Vascular Quality Initiative-Medicare matched study, racial and ethnic minority patients continue to face a higher major amputation risk despite having equivalent attempts at limb salvage. Further studies identifying risk factors and evaluating intervention strategies that may be more effective in preventing amputation in this particular population are warranted.
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Affiliation(s)
- Asma Mathlouthi
- Division of Vascular and Endovascular Surgery, University of California, San Diego, La Jolla, Calif
| | - Sina Zarrintan
- Division of Vascular and Endovascular Surgery, University of California, San Diego, La Jolla, Calif
| | - Maryam-Ali Khan
- Division of Vascular and Endovascular Surgery, University of California, San Diego, La Jolla, Calif
| | - Mahmoud Malas
- Division of Vascular and Endovascular Surgery, University of California, San Diego, La Jolla, Calif
| | - Andrew Barleben
- Division of Vascular and Endovascular Surgery, University of California, San Diego, La Jolla, Calif.
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Xiao X, Qin Z, Lv X, Dai Y, Ciren Z, Yangla Y, Zeng P, Ma Y, Li X, Wang L, Hu Y, Yang F, Fan C, Tang D, Dai S, Zhang N, Xie X, Yin J, Zhao X. Dietary patterns and cardiometabolic risks in diverse less-developed ethnic minority regions: results from the China Multi-Ethnic Cohort (CMEC) Study. Lancet Reg Health West Pac 2021; 15:100252. [PMID: 34528018 PMCID: PMC8383007 DOI: 10.1016/j.lanwpc.2021.100252] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/09/2023]
Abstract
Background In Western developed countries, food-based dietary patterns have been associated with the risk of cardiometabolic diseases, but little is known about such associations in less developed ethnic minority regions (LEMRs), where the cardiometabolic disease burden is growing rapidly and food patterns differ substantially. Methods Between May 2018 and September 2019, we recruited 99556 participants aged 30-79 years from the China Multi-Ethnic Cohort (CMEC) Study. We measured habitual dietary intake with validated food frequency questionnaire (FFQ) and then calculated dietary pattern scores for two of the most studied a priori dietary patterns, i.e., Dietary Approaches to Stop Hypertension (DASH) and alternative Mediterranean (aMED) style diets, and three a posteriori dietary patterns. Four cardiometabolic risks, including hypertension, diabetes, dyslipidaemia and metabolic syndrome (MetS), were newly diagnosed by medical examination and blood tests. We estimated adjusted odds ratios (OR) relating various dietary pattern scores to cardiometabolic risks using marginal structural models under the guidance of directed acyclic graphs. For the above associations, we further calculated the proportion mediated by overweight (PM) using regression-based mediation analysis for better public health implications. Findings The final study sample consisted of 68834 participants. Among them, we newly diagnosed 12803 hypertension, 3527 diabetes, 16342 hyperlipidaemia, and 8198 MetS cases. Overall, all 5 dietary patterns showed considerable associations with risks of hypertension and MetS. Comparing the highest with the lowest quintiles, the DASH score showed the strongest inverse associations with risks of hypertension (OR=0.74, 95% CI:0.70-0.79; PM=10%) and MetS (OR=0.79, 95% CI:0.74-0.85; PM=35%); conversely, scores of the localized a posteriori Yunnan-Guizhou plateau dietary pattern in LEMRs showed the strongest positive associations with risks of hypertension (OR=1.44, 95% CI:1.35-1.52; PM=10%) and MetS (OR=1.35, 95% CI:1.26-1.46; PM=33%), with all P values for trend <0.001. These associations were consistent in various subgroups defined by sex, age, smoking and physical activity, but with magnitudes that differed substantially across different ethnic regions and urbanicity. By investigating the single-component effects of dietary patterns, the dairy intake component contributed a major proportion to the beneficial effects of DASH (41.9% for hypertension and 100.5% for MetS). Interpretation Substantial socioeconomic status and ethnic disparities in diet quality and related cardiometabolic risks were seen in LEMRs, with hypertension being the top diet-related cardiometabolic risk. Our findings support that DASH provides superior dietary guidance compared to aMED for reducing cardiometabolic risks in LEMRs. In particular, the dairy intake encouraged by DASH may produce considerable beneficial effects. Funding This study was funded by the National Key R&D Program of China; full funding sources listed in the acknowledgements.
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Affiliation(s)
- Xiong Xiao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zixiu Qin
- the key Laboratory of Environmental Pollution Monitoring and Disease Control, School of Public Health, Guizhou Medical University, Guiyang, China
| | - Xiaoyan Lv
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Yingxue Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Zhuoga Ciren
- Tibet Center for Disease Control and Prevention, Lhasa, China
| | | | | | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiang Li
- Institute of Surveying and Mapping, Information Engineering University, Zhengzhou, China
| | - Lina Wang
- School of Computer and Communication Engineering, Zhengzhou University of Light Industry, Zhengzhou, China
| | - Yifan Hu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fan Yang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chaonan Fan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Dan Tang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Suyao Dai
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ning Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xiaofen Xie
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jianzhong Yin
- School of Public Health, Kunming Medical University; Baoshan College of Traditional Chinese Medicine, Kunming, China
- Prof Jianzhong Yin, School of Public Health, Kunming Medical University; Baoshan College of Traditional Chinese Medicine, Kunming, China
| | - Xing Zhao
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Correspondence to: Prof Xing Zhao, Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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Lokken EM, Taylor GG, Huebner EM, Vanderhoeven J, Hendrickson S, Coler B, Sheng JS, Walker CL, McCartney SA, Kretzer NM, Resnick R, Kachikis A, Barnhart N, Schulte V, Bergam B, Ma KK, Albright C, Larios V, Kelley L, Larios V, Emhoff S, Rah J, Retzlaff K, Thomas C, Paek BW, Hsu RJ, Erickson A, Chang A, Mitchell T, Hwang JK, Gourley R, Erickson S, Delaney S, Kline CR, Archabald K, Blain M, LaCourse SM, Adams Waldorf KM. Higher severe acute respiratory syndrome coronavirus 2 infection rate in pregnant patients. Am J Obstet Gynecol 2021; 225:75.e1-75.e16. [PMID: 33607103 PMCID: PMC7884918 DOI: 10.1016/j.ajog.2021.02.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 10/31/2022]
Abstract
BACKGROUND During the early months of the coronavirus disease 2019 pandemic, risks associated with severe acute respiratory syndrome coronavirus 2 in pregnancy were uncertain. Pregnant patients can serve as a model for the success of clinical and public health responses during public health emergencies as they are typically in frequent contact with the medical system. Population-based estimates of severe acute respiratory syndrome coronavirus 2 infections in pregnancy are unknown because of incomplete ascertainment of pregnancy status or inclusion of only single centers or hospitalized cases. Whether pregnant women were protected by the public health response or through their interactions with obstetrical providers in the early months of pandemic is not clearly understood. OBJECTIVE This study aimed to estimate the severe acute respiratory syndrome coronavirus 2 infection rate in pregnancy and to examine the disparities by race and ethnicity and English language proficiency in Washington State. STUDY DESIGN Pregnant patients with a polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection diagnosed between March 1, 2020, and June 30, 2020 were identified within 35 hospitals and clinics, capturing 61% of annual deliveries in Washington State. Infection rates in pregnancy were estimated overall and by Washington State Accountable Community of Health region and cross-sectionally compared with severe acute respiratory syndrome coronavirus 2 infection rates in similarly aged adults in Washington State. Race and ethnicity and language used for medical care of pregnant patients were compared with recent data from Washington State. RESULTS A total of 240 pregnant patients with severe acute respiratory syndrome coronavirus 2 infections were identified during the study period with 70.7% from minority racial and ethnic groups. The principal findings in our study were as follows: (1) the severe acute respiratory syndrome coronavirus 2 infection rate was 13.9 per 1000 deliveries in pregnant patients (95% confidence interval, 8.3-23.2) compared with 7.3 per 1000 (95% confidence interval, 7.2-7.4) in adults aged 20 to 39 years in Washington State (rate ratio, 1.7; 95% confidence interval, 1.3-2.3); (2) the severe acute respiratory syndrome coronavirus 2 infection rate reduced to 11.3 per 1000 deliveries (95% confidence interval, 6.3-20.3) when excluding 45 cases of severe acute respiratory syndrome coronavirus disease 2 detected through asymptomatic screening (rate ratio, 1.3; 95% confidence interval, 0.96-1.9); (3) the proportion of pregnant patients in non-White racial and ethnic groups with severe acute respiratory syndrome coronavirus disease 2 infection was 2- to 4-fold higher than the race and ethnicity distribution of women in Washington State who delivered live births in 2018; and (4) the proportion of pregnant patients with severe acute respiratory syndrome coronavirus 2 infection receiving medical care in a non-English language was higher than estimates of pregnant patients receiving care with limited English proficiency in Washington State (30.4% vs 7.6%). CONCLUSION The severe acute respiratory syndrome coronavirus 2 infection rate in pregnant people was 70% higher than similarly aged adults in Washington State, which could not be completely explained by universal screening at delivery. Pregnant patients from nearly all racial and ethnic minority groups and patients receiving medical care in a non-English language were overrepresented. Pregnant women were not protected from severe acute respiratory syndrome coronavirus 2 infection in the early months of the pandemic. Moreover, the greatest burden of infections occurred in nearly all racial and ethnic minority groups. These data coupled with a broader recognition that pregnancy is a risk factor for severe illness and maternal mortality strongly suggested that pregnant people should be broadly prioritized for coronavirus disease 2019 vaccine allocation in the United States similar to some states.
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Varghese C, Liu VY, Immanuel T, Chien N, Green T, Chan G, Theakston E, Kalev-Zylinska M. Ethnic differences in acute promyelocytic leukaemia between New Zealand Polynesian and European patients. ACTA ACUST UNITED AC 2021; 26:215-224. [PMID: 33594940 DOI: 10.1080/16078454.2021.1882146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Ethnic differences in haematologic malignancies remain poorly elucidated, hence research in this area is important. This was a retrospective study into potential ethnic disparity in the presentation and outcomes of acute promyelocytic leukaemia (APL) between New Zealand (NZ) Polynesian and European patients. Data were analysed for patients treated at Auckland City Hospital (ACH; n = 55) and recorded in the New Zealand Cancer Registry (NZCR; n = 173), both for the period 2000-2017. We found that Polynesian patients treated at ACH presented at a younger age than European (P = 0.005), showed higher blast counts (P = 0.033), and a marginally higher prothrombin ratio (P = 0.02). Treatment with all-trans retinoic acid (ATRA) was started faster in Polynesian patients than European (P = 0.021), suggesting Polynesians were sicker at presentation but were managed accordingly. There were no differences in bleeding events, transfusion requirements and early deaths during the first month of treatment. Long-term survival was also similar. Data extracted from the NZCR confirmed NZ Polynesian patients with APL were younger than European (P < 0.001), but long-term survival was similar (P = 0.920). In summary, this study indicates a discrepancy in the presentation and severity of APL between NZ Polynesian and European patients but treatment initiation was rapid with no difference in outcomes. The distinctive features of APL in NZ Polynesians raise the possibility of a predisposing genetic factor or a different risk factor profile, elucidation of which is important for all patients with APL.
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Affiliation(s)
- Chris Varghese
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | | | - Tracey Immanuel
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - Nicole Chien
- Department of Haematology, Auckland City Hospital, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Taryn Green
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand
| | - George Chan
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Department of Haematology, Auckland City Hospital, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
| | - Maggie Kalev-Zylinska
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, University of Auckland, Auckland, New Zealand.,Department of Pathology and Laboratory Medicine, LabPlus Haematology, Auckland City Hospital, Auckland, New Zealand
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Varghese C, Immanuel T, Ruskova A, Theakston E, Kalev-Zylinska ML. The Epidemiology of Myeloproliferative Neoplasms in New Zealand between 2010 and 2017: Insights from the New Zealand Cancer Registry. ACTA ACUST UNITED AC 2021; 28:1544-1557. [PMID: 33919650 PMCID: PMC8167767 DOI: 10.3390/curroncol28020146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a paucity of data on ethnic disparities in patients with the classical Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs): polycythaemia vera (PV), essential thrombocythaemia (ET) and primary myelofibrosis (PMF). METHODS This study analysed the demographic data for PV, ET and PMF collected by the New Zealand Cancer Registry (NZCR) between 2010 and 2017. RESULTS We found that the NZCR capture rates were lower than average international incidence rates for PV and ET, but higher for PMF (0.76, 0.99 and 0.82 per 100,000, respectively). PV patients were older and had worse outcomes than expected, which suggests these patients were reported to the registry at an advanced stage of their disease. Polynesian patients with all MPN subtypes, PV, ET and PMF, were younger than their European counterparts both at the time of diagnosis and death (p < 0.001). Male gender was an independent risk factor for mortality from PV and PMF (hazard ratios (HR) of 1.43 and 1.81, respectively; p < 0.05), and Māori ethnicity was an independent risk factor for mortality from PMF (HR: 2.94; p = 0.006). CONCLUSIONS New Zealand Polynesian patients may have increased genetic predisposition to MPN, thus we advocate for modern genetic testing in this ethnic group to identify the cause. Further work is also required to identify modifiable risk factors for mortality in MPN, in particular those associated with male gender and Māori ethnicity; the results may benefit all patients with MPN.
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Affiliation(s)
- Chris Varghese
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, The University of Auckland, Auckland 1023, New Zealand; (C.V.); (T.I.)
| | - Tracey Immanuel
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, The University of Auckland, Auckland 1023, New Zealand; (C.V.); (T.I.)
| | - Anna Ruskova
- Department of Pathology and Laboratory Medicine, Auckland City Hospital, Auckland 1023, New Zealand; (A.R.); (E.T.)
| | - Edward Theakston
- Department of Pathology and Laboratory Medicine, Auckland City Hospital, Auckland 1023, New Zealand; (A.R.); (E.T.)
| | - Maggie L. Kalev-Zylinska
- Blood and Cancer Biology Laboratory, Department of Molecular Medicine & Pathology, School of Medical Sciences, The University of Auckland, Auckland 1023, New Zealand; (C.V.); (T.I.)
- Department of Pathology and Laboratory Medicine, Auckland City Hospital, Auckland 1023, New Zealand; (A.R.); (E.T.)
- Correspondence:
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18
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Klemt C, Walker P, Padmanabha A, Tirumala V, Xiong L, Kwon YM. Minority Race and Ethnicity is Associated With Higher Complication Rates After Revision Surgery for Failed Total Hip and Knee Joint Arthroplasty. J Arthroplasty 2021; 36:1393-1400. [PMID: 33190994 DOI: 10.1016/j.arth.2020.10.043] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Racial and ethnic disparities in access to hip and knee total joint arthroplasty (TJA) and postoperative outcomes have wide-reaching implications for patients and the health care system. The aim of this study is to evaluate the effect of ethnicity on clinical outcomes and complications following revision hip and knee TJA. METHODS A single-institution, retrospective analysis of a consecutive series of 4424 revision hip and knee TJA patients was evaluated. Student's t-test and chi-squared analysis were used to identify significant differences in patient demographics and clinical outcomes between Caucasians and various ethnic minorities, including African Americans, Hispanics, and Asians. RESULTS When compared with white patients, African American patients demonstrated a significantly higher BMI (P = .04), ASA score (P = .04), length of hospital stay (P = .06), and postoperative infection rates (P = .04). Hispanics demonstrated a significantly higher BMI (P = .04), when compared with white patients, alongside a significantly higher risk for postoperative infection (P < .01). African American demonstrated a significantly higher ASA score (P = .02; P = .03), when compared with Hispanics and Asians, alongside a significantly increased length of stay (P = .01) and higher risk for postoperative infection (P = .02). CONCLUSION The study findings demonstrate an underutilization of revision TJA by ethnic minority groups, suggesting that disparities in access to orthopedic surgery increase from primary to revision surgery despite higher failure rates of minority ethnic groups reported after primary TJA surgery. In addition, inferior postoperative outcomes were associated with African Americans and Hispanics, when compared to white patients, with African Americans demonstrating the highest risk of postoperative complications.
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Affiliation(s)
- Christian Klemt
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Paul Walker
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Anand Padmanabha
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Venkatsaiakhil Tirumala
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Liang Xiong
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Young-Min Kwon
- Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Amano T, Gallegos CA, Waters WF, Freire WB. Ethnic Disparities in Nutritional Status among Older Adults: Evidence from the Survey of Health, Welfare and Aging (SABE) Ecuador. J Gerontol Soc Work 2021; 64:106-119. [PMID: 32967572 DOI: 10.1080/01634372.2020.1814476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 06/11/2023]
Abstract
This study aims to identify those populations that should be targeted by specific interventions. A cross-sectional design was utilized. Ordered logistic regression analysis was utilized to assess the association between ethnic identity and risk of malnutrition. Data were drawn from Ecuador's Survey of Health, Welfare and Aging (SABE). The final sample consisted of 4,572 people who were 60 years or older who were able to provide responses to the survey by themselves. Ethnic identity was categorized into four: indigenous, mestizo (Spanish and Indigenous mixed heritage), Afro-Ecuadorian/mulato, and other. Risk of malnutrition was measured using Mini Nutritional Assessment Short-Form (MNA-SF). A range of covariates were selected from three groups of factors: sociodemographic, health-related, and social network. Results revealed that the indigenous ethnicity was the only group who had significantly higher risk of malnutrition compared to mestizo even after controlling for a range of covariates including socio-economic status, health related factors, and social support. Findings suggest the existence of underlaying factors hindering the risk of malnutrition among indigenous older adults. Considering the information revealed by SABE, interventions and other strategies should be targeted and designed specifically accounting for the needs, preferences, and culture of the most vulnerable population.
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Affiliation(s)
- Takashi Amano
- Department of Social Work, School of Arts and Sciences, Rutgers University , Newark, NJ, USA
| | - Carlos Andres Gallegos
- Brown School, Washington University in St. Louis , St. Louis, MO, USA
- Institute for Research in Health and Nutrition, Universidad San Francisco de Quito (Ecuador) , San Francisco, CA, USA
| | - William F Waters
- Institute for Research in Health and Nutrition, Universidad San Francisco de Quito (Ecuador) , San Francisco, CA, USA
| | - Wilma B Freire
- Institute for Research in Health and Nutrition, Universidad San Francisco de Quito (Ecuador) , San Francisco, CA, USA
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Olivier MMG, Smith OU, Croteau-Chonka CC, VanderBeek BL, Maguire MG, Lum F, Fujino D, Kelly SP, Rich WL, Miller-Ellis EG. Demographic and Clinical Characteristics Associated with Minimally Invasive Glaucoma Surgery Use: An Intelligent Research in Sight (IRIS®) Registry Retrospective Cohort Analysis. Ophthalmology 2021; 128:1292-1299. [PMID: 33600867 DOI: 10.1016/j.ophtha.2021.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/13/2021] [Accepted: 02/05/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Minimally invasive glaucoma surgery (MIGS) is increasingly performed at the time of cataract extraction. Understanding the demographic and clinical characteristics of patients undergoing MIGS procedures may provide insight into patient selection. This study evaluates racial-ethnic and other differences in the use of MIGS in persons with cataract and open-angle glaucoma (OAG). DESIGN Retrospective cohort study using Intelligent Research in Sight (IRIS) Registry data. PARTICIPANTS Patients aged ≥ 40 years with a diagnosis of OAG and no history of MIGS or cataract surgery who were undergoing cataract extraction, with or without MIGS, during 2013 to 2017 in the United States. METHODS Multivariable logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). MAIN OUTCOME MEASURES Variables assessed include age, sex, race-ethnicity, disease severity, insurance type, census region, comorbidity, and cup-to-disc ratio (CDR). RESULTS The odds of MIGS use was greater among patients who were aged ≥ 60 years (OR, 1.10 [95% CI, 1.05-1.16]); Black (OR, 1.11 [CI, 1.07-1.15]) compared with White; a Medicare recipient (OR, 1.12 [CI, 1.10-1.15]) versus privately insured; or in the Midwest (OR, 1.32 [CI, 1.28-1.36]) or Northeast (OR, 1.26 [CI, 1.22-1.30]) compared with the South. Having moderate rather than mild glaucoma (OR, 1.07 [CI, 1.04-1.11]) and a higher CDR (OR for 0.5 to 0.8 vs. <0.5, 1.24 [CI, 1.21-1.26]; OR for >0.8 to 1.0 vs. <0.5, 1.27 [CI, 1.23-1.32]) were also each associated with increased odds of MIGS use. Use of MIGS was less likely in women (OR, 0.96 [CI, 0.94-0.98]); patients taking 5 to 7 glaucoma medications (OR, 0.94 [CI, 0.90-0.99]) compared with 1 to 2 medications; and patients with severe, compared with mild, glaucoma (OR, 0.64 [CI, 0.61-0.67]). CONCLUSIONS This analysis highlights the importance of capturing race-ethnicity data and other pertinent patient characteristics in electronic health records to provide insight into practice patterns. Such data can be used to assess the long-term performance of MIGS and other procedures in various patient populations.
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Affiliation(s)
- Mildred M G Olivier
- Rosalind Franklin University of Medicine and Science/The Chicago Medical School, North Chicago, Illinois.
| | | | | | - Brian L VanderBeek
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen G Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Danielle Fujino
- American Academy of Ophthalmology, San Francisco, California
| | - Scott P Kelly
- American Academy of Ophthalmology, San Francisco, California
| | - William L Rich
- American Academy of Ophthalmology, San Francisco, California
| | - Eydie G Miller-Ellis
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania
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Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry 2021; 20:124-130. [PMID: 33026219 PMCID: PMC7675495 DOI: 10.1002/wps.20806] [Citation(s) in RCA: 401] [Impact Index Per Article: 133.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Concerns have been expressed that persons with a pre-existing mental disorder may represent a population at increased risk for COVID-19 infec-tion and with a higher likelihood of adverse outcomes of the infection, but there is no systematic research evidence in this respect. This study assessed the impact of a recent (within past year) diagnosis of a mental disorder - including attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, depression and schizophrenia - on the risk for COVID-19 infection and related mortality and hospitalization rates. We analyzed a nation-wide database of electronic health records of 61 million adult patients from 360 hospitals and 317,000 providers, across 50 states in the US, up to July 29, 2020. Patients with a recent diagnosis of a mental disorder had a significantly increased risk for COVID-19 infection, an effect strongest for depression (adjusted odds ratio, AOR=7.64, 95% CI: 7.45-7.83, p<0.001) and schizophrenia (AOR=7.34, 95% CI: 6.65-8.10, p<0.001). Among patients with a recent diagnosis of a mental disorder, African Americans had higher odds of COVID-19 infection than Caucasians, with the strongest ethnic disparity for depression (AOR=3.78, 95% CI: 3.58-3.98, p<0.001). Women with mental disorders had higher odds of COVID-19 infection than males, with the strongest gender disparity for ADHD (AOR=2.03, 95% CI: 1.73-2.39, p<0.001). Patients with both a recent diagnosis of a mental disorder and COVID-19 infection had a death rate of 8.5% (vs. 4.7% among COVID-19 patients with no mental disorder, p<0.001) and a hospitalization rate of 27.4% (vs. 18.6% among COVID-19 patients with no mental disorder, p<0.001). These findings identify individuals with a recent diagnosis of a mental disorder as being at increased risk for COVID-19 infection, which is further exacerbated among African Americans and women, and as having a higher frequency of some adverse outcomes of the infection. This evidence highlights the need to identify and address modifiable vulnerability factors for COVID-19 infection and to prevent delays in health care provision in this population.
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Affiliation(s)
- QuanQiu Wang
- Center for Artificial Intelligence in Drug DiscoverySchool of Medicine, Case Western Reserve UniversityClevelandOHUSA
| | - Rong Xu
- Center for Artificial Intelligence in Drug DiscoverySchool of Medicine, Case Western Reserve UniversityClevelandOHUSA
| | - Nora D. Volkow
- National Institute on Drug AbuseNational Institutes of HealthBethesdaMDUSA
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Wong K, Owen-Smith A, Caskey F, MacNeill S, Tomson CRV, Dor FJMF, Ben-Shlomo Y, Bouacida S, Idowu D, Bailey P. Investigating Ethnic Disparity in Living-Donor Kidney Transplantation in the UK: Patient-Identified Reasons for Non-Donation among Family Members. J Clin Med 2020; 9:E3751. [PMID: 33233422 DOI: 10.3390/jcm9113751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
There is ethnic inequity in access to living-donor kidney transplants in the UK. This study asked kidney patients from Black, Asian and minority ethnic groups why members of their family were not able to be living kidney donors. Responses were compared with responses from White individuals. This questionnaire-based mixed-methods study included adults transplanted between 1/4/13–31/3/17 at 14 UK hospitals. Participants were asked to indicate why relatives could not donate, selecting all options applicable from: Age; Health; Weight; Location; Financial/Cost; Job; Blood group; No-one to care for them after donation. A box entitled ‘Other—please give details’ was provided for free-text entries. Multivariable logistic regression was used to analyse the association between the likelihood of selecting each reason for non-donation and the participant’s self-reported ethnicity. Qualitative responses were analysed using inductive thematic analysis. In total, 1240 questionnaires were returned (40% response). There was strong evidence that Black, Asian and minority ethnic group individuals were more likely than White people to indicate that family members lived too far away to donate (adjusted odds ratio (aOR) = 3.25, 95% Confidence Interval (CI) 2.30–4.58), were prevented from donating by financial concerns (aOR = 2.95, 95% CI 2.02–4.29), were unable to take time off work (aOR = 1.88, 95% CI 1.18–3.02), were “not the right blood group” (aOR = 1.65, 95% CI 1.35–2.01), or had no-one to care for them post-donation (aOR = 3.73, 95% CI 2.60–5.35). Four qualitative themes were identified from responses from Black, Asian and minority ethnic group participants: ‘Burden of disease within the family’; ‘Differing religious interpretations’; ‘Geographical concerns’; and ‘A culture of silence’. Patients perceive barriers to living kidney donation in the UK Black, Asian and minority ethnic population. If confirmed, these could be targeted by interventions to redress the observed ethnic inequity.
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Yan C, Tadadej C, Chamroonsawasdi K, Chansatitporn N, Sung JFC. Ethnic Disparities in Utilization of Maternal and Child Health Services in Rural Southwest China. Int J Environ Res Public Health 2020; 17:E8610. [PMID: 33228187 PMCID: PMC7699543 DOI: 10.3390/ijerph17228610] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies in China on ethnic disparities in access to health care in remote and rural population remain insufficient. This study aimed to assess the disparities in utilization of maternal and child health (MCH) services, including antenatal care (ANC), hospital birth, child growth monitoring, and immunization compliance between Han and ethnic minority women in Yunnan Province. METHODS A multi-stage sampling scheme was used to randomly recruit women from 40 townships in 14 remote prefectures of extremely remote areas in Yunnan. From birth records, we identified and recruited 303 Han women and 222 ethnic minority women who had given birth to a child within 3 years for an interview. RESULTS Overall, 96% of women used the ANC checkups and more than 95% had infants born in hospitals. However, the proportion of women compliant with early ANC visits (having antenatal care in the first trimester) was 22.5% lower in minority women than in Han women (61.3% vs. 83.8%, p < 0.001) with an adjusted odds ratio (aOR) of 2.04 (95% confidence interval (CI) of 1.13-3.66) for the minority group. The proportion of children under one year old with immunizations completed in a timely manner was also lower in minority families than in Han families (80.2% vs. 86.8%, p < 0.05) with an aOR of 1.99 (95% CI = 1.16-3.40). CONCLUSIONS Ethnic disparities remain in utilization of early ANC visits and timely immunization completion for newborns. Ethnic minority women tended to lag behind for both. Further intervention should focus on assisting minority women living in extremely rural areas to comply with the MCH policy. Culturally-sensitive policies and skills are needed, and priority should be given to improve utilization of early ANC and timely immunization completion.
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Affiliation(s)
- Chaofang Yan
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Charuwan Tadadej
- Department of Public Health Administration, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Kanittha Chamroonsawasdi
- Department of Family Health, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - Natkamol Chansatitporn
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok 10400, Thailand;
| | - John FC Sung
- Institute of Health and Development Studies, School of Public Health, Kunming Medical University, Kunming 650500, China;
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Cao J, Chen J, Zhang Q, Wu J, Wang W, Zhang X, Zhao D, Zhang Q, Yang W, Chen Z. Ethnic disparities in demographic, clinicopathologic and biological behaviours and prognosis of gastric cancer in northwest China. Cancer Med 2020; 9:9353-9364. [PMID: 33084161 PMCID: PMC7774720 DOI: 10.1002/cam4.3551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/11/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022] Open
Abstract
This retrospective study aimed to investigate ethnic disparities in demographic, clinicopathologic, and biological behaviours of gastric cancer (GC) in a high GC incidence area of China. There were 5022 GC patients, including 3987 Han (79.4%) and 987 Hui (14.4%) patients from Northwest China. All patient data were retrieved from 2009 to 2017. Median survival was estimated using the Kaplan‐Meier method and compared using the log‐rank test. A Cox proportional hazards model was used to assess the impact of covariates. Similarly, low 5‐year OS rates were observed in both the Hui and Han groups (23.8% and 24.2% respectively). Hui patients with stage T1 or N0 or with tumours <5 cm had 2.144‐fold, 1.426‐fold and 1.305‐fold increased risks of poor prognosis compared with Han patients with these characteristics respectively (all p < 0.05). Further, Hui patients had 1.265‐fold, 1.364‐fold and 1.401‐fold increased risks of poor prognosis compared with Han patients among those with high expression of Ki67, EGFR and VEGF respectively (all p < 0.05). There are ethnic disparities in the prognosis of GC patients in Northwest China. Understanding the effects of ethnicity on GC will guide reasonable evaluations of prognosis and future interventions to equalise access to high‐quality care for GC patients of different ethnicities in China.
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Affiliation(s)
- Juan Cao
- Medical Research Center, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China.,Key Laboratory of Fertility Preservation and Maintenance (Ministry of Education), Ningxia Medical University, Yinchuan, China
| | - Jing Chen
- Key Laboratory of Fertility Preservation and Maintenance (Ministry of Education), Ningxia Medical University, Yinchuan, China
| | - Qinghua Zhang
- Department of Neurosurgery, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China
| | - Jing Wu
- Key Laboratory of Fertility Preservation and Maintenance (Ministry of Education), Ningxia Medical University, Yinchuan, China
| | - Wenfan Wang
- Department of Gastroenterology, the General Hospital, Ningxia Medical University, Yinchuan, China
| | - Xiaoxu Zhang
- Department of Gastroenterology, the General Hospital, Ningxia Medical University, Yinchuan, China
| | - Dan Zhao
- Department of Gastroenterology, the General Hospital, Ningxia Medical University, Yinchuan, China
| | - Qian Zhang
- Key Laboratory of Fertility Preservation and Maintenance (Ministry of Education), Ningxia Medical University, Yinchuan, China
| | - Wenjun Yang
- Medical Research Center, Union Shenzhen Hospital, Huazhong University of Science and Technology, Shenzhen, China.,Key Laboratory of Fertility Preservation and Maintenance (Ministry of Education), Ningxia Medical University, Yinchuan, China
| | - Zhiqiang Chen
- Department of Radiology, the General Hospital, Ningxia Medical University, Yinchuan, China
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Abstract
In January 2020, the World Health Organisation (WHO) declared the outbreak of a new corona virus disease, COVID-19 to be public health Emergency of International concern and by March 2020 it had progressed rapidly across several continents to be a pandemic. After COVID-19 was declared a global pandemic the U.K. Government placed strict measures in mid-March 2020 to limit spread by enforcing social distancing, travel restrictions and complete lockdown. In U.K. by end of April 2020 official estimates of confirmed COVID-19 positive cases reached 161,000 and the number of deaths has exceeded 26,000 in hospitals and in care homes. COVID-19 continues to have an impact on all aspects of life in U.K. The Royal College of Psychiatrists (RCPsych), London, a leading professional body of U.K. and global mental health professionals was prompt to act in this public health emergency. RCPsych has issued guidance for clinicians, patients & carers, organised a series of webinars to support members and undertook a membership survey. It has played a crucial role in influencing national policy decisions. This article will focus on mental health impact of COVID-19 pandemic in U.K. and the initiatives taken by RCPsych.
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Affiliation(s)
- Wendy Burn
- Immediate Past President, The Royal College of Psychiatrists, 21 Prescot Street, London E1 8BB, Nottinghamshire DN22 0PD England, UK
| | - Santosh Mudholkar
- The Royal College of Psychiatrists, London and Nottinghamshire Healthcare NHS Foundation Trust, Rampton Hospital, Woodbeck, Nottinghamshire DN22 0PD England, UK
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Abstract
We newly apply the concept of self-affirmation typically used in the domain of health and education to the domain of parenting. Recruiting parents of children age 13 or younger (n = 1,044), we test how eliciting positive self-concept affects interest in receiving parenting materials and participating in a parenting program. We find that an adapted, pride-based written self-affirmation exercise increased parents' positive self-concept and their interest in parenting programs and resources, particularly among parents with a high baseline fear of judgment associated with seeking help. Implications for applying insights from psychology as a strategy to mitigate fear of judgment to optimize participation in an evidence-based parenting program at scale are discussed.
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Affiliation(s)
- Zoelene Hill
- The Institute of Human Development and Social Change, New York University, New York, NY, United States
| | - Michelle Spiegel
- School of Education, University of California, Irvine, Irvine, CA, United States
| | - Lisa A. Gennetian
- Sanford School of Public Policy, Duke University, Durham, NC, United States
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Hamm LM, Black J, Burn H, Grey C, Harwood M, Peiris-John R, Gordon I, Burton MJ, Evans JR, Ramke J. Interventions to promote access to eye care for non-Indigenous, non-dominant ethnic groups in high-income countries: a scoping review protocol. BMJ Open 2020; 10:e033775. [PMID: 32499258 PMCID: PMC7279662 DOI: 10.1136/bmjopen-2019-033775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION For many people, settling in a new country is associated with a new identity as an 'ethnic minority', one that can remain through future generations. People who are culturally distinct from the dominant population group may experience a variety of barriers to accessing healthcare, including linguistic and cultural barriers in communication, navigation of an unfamiliar health system and unconscious or overt discrimination. Here, we outline the protocol of a scoping review to identify, describe and summarise interventions aimed at improving access to eye care for non-Indigenous, non-dominant ethnic groups residing in high-income countries. METHODS AND ANALYSIS We will search MEDLINE, Embase and Global Health from their inception to July 2019. We will include studies of any design that describe an intervention to promote access to eye care for non-Indigenous, non-dominant ethnic groups. Two authors will independently review titles, abstracts and full-text articles for inclusion. Reference lists from all included articles will also be searched. In cases of disagreement between initial reviewers, a third author will help resolve the conflict. For each included article, we will extract data about the target population, details of the intervention delivered and the effectiveness of or feedback from the intervention. Overall findings will be summarised with descriptive statistics and thematic analysis. ETHICS AND DISSEMINATION This review will summarise existing literature and as such ethics approval is not required. We will publish the review in an open-access, peer-reviewed journal, and draft appropriate summaries for dissemination to the wider community. This wider community could include clinicians, policymakers, health service managers and organisations that work with non-dominant ethnic groups. Our findings will also feed into the ongoing Lancet Global Health Commission on Global Eye Health.
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Affiliation(s)
- Lisa Marie Hamm
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Joanna Black
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Helen Burn
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Corina Grey
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Roshini Peiris-John
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Iris Gordon
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- Moorfields Eye Hospital, London, UK
| | - Jennifer R Evans
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Jacqueline Ramke
- School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Feng Y, Jaratlerdsiri W, Patrick SM, Lyons RJ, Haynes A, Collins CC, Stricker PD, Bornman MR, Hayes VM. Metagenomic analysis reveals a rich bacterial content in high-risk prostate tumors from African men. Prostate 2019; 79:1731-1738. [PMID: 31454437 PMCID: PMC6790596 DOI: 10.1002/pros.23897] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 08/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Inflammation is a hallmark of prostate cancer (PCa), yet no pathogenic agent has been identified. Men from Africa are at increased risk for both aggressive prostate disease and infection. We hypothesize that pathogenic microbes may be contributing, at least in part, to high-risk PCa presentation within Africa and in turn the observed ethnic disparity. METHODS Here we reveal through metagenomic analysis of host-derived whole-genome sequencing data, the microbial content within prostate tumor tissue from 22 men. What is unique about this study is that patients were separated by ethnicity, African vs European, and environments, Africa vs Australia. RESULTS We identified 23 common bacterial genera between the African, Australian, and Chinese prostate tumor samples, while nonbacterial microbes were notably absent. While the most abundant genera across all samples included: Escherichia, Propionibacterium, and Pseudomonas, the core prostate tumor microbiota was enriched for Proteobacteria. We observed a significant increase in the richness of the bacterial communities within the African vs Australian samples (t = 4.6-5.5; P = .0004-.001), largely driven by eight predominant genera. Considering core human gut microbiota, African prostate tissue samples appear enriched for Escherichia and Acidovorax, with an abundance of Eubacterium associated with host tumor hypermutation. CONCLUSIONS Our study provides suggestive evidence for the presence of a core, bacteria-rich, prostate microbiome. While unable to exclude for fecal contamination, the observed increased bacterial content and richness within the African vs non-African samples, together with elevated tumor mutational burden, suggests the possibility that bacterially-driven oncogenic transformation within the prostate microenvironment may be contributing to aggressive disease presentation in Africa.
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Affiliation(s)
- Ye Feng
- Sir Run Run Shaw HospitalZhejiang University School of MedicineHangzhouChina
- Institute of Translational MedicineZhejiang University School of MedicineHangzhouChina
| | - Weerachai Jaratlerdsiri
- Laboratory for Human Comparative and Prostate Cancer Genomics, Garvan Institute of Medical ResearchThe Kinghorn Cancer CentreDarlinghurstNew South WalesAustralia
| | - Sean M. Patrick
- School of Health Systems and Public HealthUniversity of PretoriaPretoriaSouth Africa
| | - Ruth J. Lyons
- Laboratory for Human Comparative and Prostate Cancer Genomics, Garvan Institute of Medical ResearchThe Kinghorn Cancer CentreDarlinghurstNew South WalesAustralia
| | - Anne‐Maree Haynes
- Laboratory for Human Comparative and Prostate Cancer Genomics, Garvan Institute of Medical ResearchThe Kinghorn Cancer CentreDarlinghurstNew South WalesAustralia
| | - Colin C. Collins
- Vancouver Prostate CentreVancouverCanada
- Department of UrologyUniversity of British ColumbiaVancouverCanada
| | - Phillip D. Stricker
- Department of UrologySt Vincent's Hospital SydneyDarlinghurstNew South WalesAustralia
| | - M.S. Riana Bornman
- School of Health Systems and Public HealthUniversity of PretoriaPretoriaSouth Africa
| | - Vanessa M. Hayes
- Laboratory for Human Comparative and Prostate Cancer Genomics, Garvan Institute of Medical ResearchThe Kinghorn Cancer CentreDarlinghurstNew South WalesAustralia
- School of Health Systems and Public HealthUniversity of PretoriaPretoriaSouth Africa
- St Vincent's Clinical SchoolUniversity of New South Wales SydneySydneyNew South WalesAustralia
- Central Clinical School, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
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Cloete E, Sadler L, Bloomfield FH, Crengle S, Percival T, Gentles TL. Congenital left heart obstruction: ethnic variation in incidence and infant survival. Arch Dis Child 2019; 104:857-862. [PMID: 30824490 DOI: 10.1136/archdischild-2018-315887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the relationship between ethnicity and health outcomes among fetuses and infants with congenital left heart obstruction (LHO). DESIGN A retrospective population-based review was conducted of fetuses and infants with LHO including all terminations, stillbirths and live births from 20 weeks' gestation in New Zealand over a 9-year period. Disease incidence and mortality were analysed by ethnicity and by disease type: hypoplastic left heart syndrome (HLHS), aortic arch obstruction (AAO), and aortic valve and supravalvular anomalies (AVSA). RESULTS Critical LHO was diagnosed in 243 fetuses and newborns. There were 125 with HLHS, 112 with AAO and 6 with isolated AVSA. The incidence of LHO was significantly higher among Europeans (0.59 per 1000) compared with Māori (0.31 per 1000; p<0.001) and Pacific peoples (0.27 per 1000; p=0.002). Terminations were uncommon among Māori and Pacific peoples. Total case fatality was, however, lower in Europeans compared with other ethnicities (42% vs 63%; p=0.002) due to a higher surgical intervention rate and better infant survival. The perinatal and infant mortality rate was 82% for HLHS, 15% for AAO and 2% for AVSA. CONCLUSION HLHS carries a high perinatal and infant mortality risk. There are ethnic differences in the incidence of and mortality from congenital LHO with differences in mortality rate suggesting inequities may exist in the perinatal management pathway.
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Affiliation(s)
- Elza Cloete
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lynn Sadler
- Department of Obstetrics and Gynaecology, National Women's Hospital, Auckland, New Zealand
| | | | - Sue Crengle
- Department of Preventative and Social Medicine, University of Otago, Dunedin, New Zealand
| | | | - Thomas L Gentles
- Greenlane Paediatric and Congenital Cardiac Service, Starship Hospital, Auckland, New Zealand
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Ramke J, Jordan V, Vincent AL, Harwood M, Murphy R, Ameratunga S. Diabetic eye disease and screening attendance by ethnicity in New Zealand: A systematic review. Clin Exp Ophthalmol 2019; 47:937-947. [PMID: 31034719 DOI: 10.1111/ceo.13528] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/27/2019] [Accepted: 04/14/2019] [Indexed: 11/29/2022]
Abstract
To examine differences in incidence, prevalence and screening for diabetic retinopathy in New Zealand, we searched MEDLINE, EMBASE and CINAHL up to 6 December 2018 for observational studies reporting diabetic eye disease or attendance at retinal screening, disaggregated by ethnicity. Two authors separately screened and selected studies, and extracted data. None of the 11 included studies reported data on visual impairment from diabetic retinopathy. All nine studies reporting diabetic eye disease by ethnicity found Pacific people and Māori had higher rates of sight-threatening disease and lower rates of screening attendance compared to Europeans. Data for Asian people were infrequently reported, but when they were, they also fared worse than Europeans. This review highlights that equity-focused strategies are needed to address ethnic disparities in eye health among New Zealanders with diabetes. The review also identifies how research methods can be strengthened to enable future calculation of robust disease prevalence estimates.
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Affiliation(s)
- Jacqueline Ramke
- Section of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,International Centre for Eye Health, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Andrea L Vincent
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Te Kupenga Hauora Māori, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Shanthi Ameratunga
- Section of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
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Yu Q, Medeiros KL, Wu X, Jensen RE. Nonlinear Predictive Models for Multiple Mediation Analysis: With an Application to Explore Ethnic Disparities in Anxiety and Depression Among Cancer Survivors. Psychometrika 2018; 83:991-1006. [PMID: 29611093 PMCID: PMC6168435 DOI: 10.1007/s11336-018-9612-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 02/23/2018] [Indexed: 06/08/2023]
Abstract
Mediation analysis allows the examination of effects of a third variable (mediator/confounder) in the causal pathway between an exposure and an outcome. The general multiple mediation analysis method (MMA), proposed by Yu et al., improves traditional methods (e.g., estimation of natural and controlled direct effects) to enable consideration of multiple mediators/confounders simultaneously and the use of linear and nonlinear predictive models for estimating mediation/confounding effects. Previous studies find that compared with non-Hispanic cancer survivors, Hispanic survivors are more likely to endure anxiety and depression after cancer diagnoses. In this paper, we applied MMA on MY-Health study to identify mediators/confounders and quantify the indirect effect of each identified mediator/confounder in explaining ethnic disparities in anxiety and depression among cancer survivors who enrolled in the study. We considered a number of socio-demographic variables, tumor characteristics, and treatment factors as potential mediators/confounders and found that most of the ethnic differences in anxiety or depression between Hispanic and non-Hispanic white cancer survivors were explained by younger diagnosis age, lower education level, lower proportions of employment, less likely of being born in the USA, less insurance, and less social support among Hispanic patients.
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Affiliation(s)
- Qingzhao Yu
- Biostatistics Program, School of Public Health, Louisiana State University Health Sciences Center, 3rd Floor, 2020 Gravier Street, New Orleans, LA, 70112, USA.
| | | | - Xiaocheng Wu
- Louisiana Tumor Registry, 2020 Gravier Street, New Orleans, LA, 70112, USA
| | - Roxanne E Jensen
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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Leng S, Picchi MA, Tesfaigzi Y, Wu G, Gauderman WJ, Xu F, Gilliland FD, Belinsky SA. Dietary nutrients associated with preservation of lung function in Hispanic and non-Hispanic white smokers from New Mexico. Int J Chron Obstruct Pulmon Dis 2017; 12:3171-3181. [PMID: 29133979 PMCID: PMC5669789 DOI: 10.2147/copd.s142237] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background COPD is the third leading cause of death in the United States. Cigarette smoking accelerates the age-related forced expiratory volume in 1 s (FEV1) decline, an important determinant for the genesis of COPD. Hispanic smokers have lower COPD prevalence and FEV1 decline than non-Hispanic whites (NHWs). Patients and methods A nutritional epidemiological study was conducted in the Lovelace Smokers cohort (LSC; n=1,829) and the Veterans Smokers cohort (n=508) to identify dietary nutrients (n=139) associated with average FEV1 and its decline and to assess whether nutrient intakes could explain ethnic disparity in FEV1 decline between Hispanics and NHW smokers. Results Nutrients discovered and replicated to be significantly associated with better average FEV1 included magnesium, folate, niacin, vitamins A and D, eicosenoic fatty acid (20:1n9), eicosapentaenoic acid (20:5n3), docosapentaenoic acid (DPA; 22:5n3), docosahexaenoic acid (22:6n3), and fiber. In addition, greater intakes of eicosenoic fatty acid and DPA were associated with slower FEV1 decline in the LSC. Among omega 3 polyunsaturated fatty acids, DPA is the most potent nutrient associated with better average FEV1 and slower FEV1 decline. Adverse effect of continuous current smoking on FEV1 decline was completely negated in LSC members with high DPA intake (>20 mg/day). Slower FEV1 decline in Hispanics compared to NHWs may be due to the greater protection of eicosenoic fatty acid and DPA for FEV1 decline rather than greater intake of protective nutrients in this ethnic group. Conclusion The protective nutrients for the preservation of FEV1 in ever smokers could lay foundation for designing individualized nutritional intervention targeting “optimal physiological levels” in human to improve lung function in ever smokers. Ethnic disparity in FEV1 decline may be explained by difference in magnitude of protection of dietary intakes of eicosenoic fatty acid and DPA between Hispanics and NHWs.
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Affiliation(s)
- Shuguang Leng
- The Lung Cancer Program, Lovelace Respiratory Research Institute.,Cancer Control Research Program, University of New Mexico Comprehensive Cancer Center
| | - Maria A Picchi
- The Lung Cancer Program, Lovelace Respiratory Research Institute
| | | | - Guodong Wu
- The Lung Cancer Program, Lovelace Respiratory Research Institute
| | - W James Gauderman
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Fadi Xu
- Pathophysiology Program, Lovelace Respiratory Research Institute
| | - Frank D Gilliland
- Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Steven A Belinsky
- The Lung Cancer Program, Lovelace Respiratory Research Institute.,Cancer Control Research Program, University of New Mexico Comprehensive Cancer Center.,Cancer Genetics and Epigenetics Program, University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
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Hobbs MR, Morton SM, Atatoa-Carr P, Ritchie SR, Thomas MG, Saraf R, Chelimo C, Harnden A, Camargo CA, Grant CC. Ethnic disparities in infectious disease hospitalisations in the first year of life in New Zealand. J Paediatr Child Health 2017; 53:223-231. [PMID: 27714893 DOI: 10.1111/jpc.13377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 08/10/2016] [Accepted: 08/28/2016] [Indexed: 11/29/2022]
Abstract
AIM Infectious disease (ID) hospitalisation rates are increasing in New Zealand (NZ), especially in pre-school children, and Māori and Pacific people. We aimed to identify risk factors for ID hospitalisation in infancy within a birth cohort of NZ children, and to identify differences in risk factors between ethnic groups. METHODS We investigated an established cohort of 6846 NZ children, born in 2009-2010, with linkage to a national data set of hospitalisations. We used multivariable logistic regression to obtain odds ratios (OR) for factors associated with ID hospitalisation in the first year of life, firstly for all children, and then separately for Māori or Pacific children. RESULTS In the whole cohort, factors associated with ID hospitalisation were Māori (OR: 1.49, 95% CI: 1.17-1.89) or Pacific (2.51; 2.00-3.15) versus European maternal ethnicity, male gender (1.32; 1.13-1.55), low birthweight (1.94, 1.39-2.66), exclusive breastfeeding for <4 months (1.22, 1.04-1.43), maternal experience of health-care racism (1.60, 1.19-2.12), household deprivation (most vs. least deprived quintile of households (1.50, 1.12-2.02)), day-care attendance (1.43, 1.12-1.81) and maternal smoking (1.55, 1.26-1.91). Factors associated with ID hospitalisation for Māori infants were high household deprivation (2.16, 1.06-5.02) and maternal smoking (1.48, 1.02-2.14); and for Pacific infants were delayed immunisation (1.72, 1.23-2.38), maternal experience of health-care racism (2.20, 1.29-3.70) and maternal smoking (1.59, 1.10-2.29). CONCLUSIONS Māori and Pacific children in NZ experience a high burden of ID hospitalisation. Some risk factors, for example maternal smoking, are shared, while others are ethnic-specific. Interventions aimed at preventing ID hospitalisations should address both shared and ethnic-specific factors.
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Affiliation(s)
- Mark R Hobbs
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Susan Mb Morton
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Polly Atatoa-Carr
- Faculty of Arts and Social Sciences, University of Waikato, Hamilton, New Zealand
| | - Stephen R Ritchie
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Mark G Thomas
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Rajneeta Saraf
- Centre for Longitudinal Research, University of Auckland, Auckland, New Zealand
| | - Carol Chelimo
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Anthony Harnden
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Cameron C Grant
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
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Loh PT, Toh MPHS, Molina JA, Vathsala A. Ethnic disparity in prevalence of diabetic kidney disease in an Asian primary healthcare cluster. Nephrology (Carlton) 2015; 20:216-23. [PMID: 25495003 DOI: 10.1111/nep.12379] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2014] [Indexed: 11/30/2022]
Abstract
AIMS Diabetic kidney disease (DKD) incidence is rising in Singapore. While measures to prevent onset and early detection of diabetes as well as optimal diabetes and blood pressure control are important, early detection and treatment of DKD at primary care are crucial to ameliorate its course. This study aimed to evaluate the prevalence of DKD in a primary care cluster in Singapore and identify its risk factors in a multi-ethnic Asian population. METHODS A total of 57,594 patients with type 2 diabetes mellitus (T2DM) followed-up at the National Healthcare Group Polyclinics with estimated glomerular filtration rate and at least two urine albumin/creatinine ratio (UACR) were stratified into DKD stages: normoalbuminuria (UACR <30 mg/g), microalbuminuria (MI, UACR 30-299 mg/g), macroalbuminuria (MA, ≥300 mg/g) and renal impairment (RI, estimated glomerular filtration rate eGFR <60 mL/min per 1.73 m(2)). Factors associated with DKD stages were evaluated. RESULTS Overall DKD prevalence (T2DM with MI, MA or RI) was high at 52.5%; 32.1% had MI, 5.3% had MA and 15.1% had RI. DKD prevalence within ethnic subpopulations was different: 52.2% of Chinese, 60.4% of Malays and 45.3% of Indians had DKD, respectively. Malays had a 1.42-fold higher DKD prevalence, while Indians had a 0.86-fold lower. Other independent risk factors were age, female gender, duration of diabetes and hypertension, HbA1c and body mass index. CONCLUSION The high prevalence of DKD and its interethnic differences suggest need for additional measures to optimize the care of T2DM at primary care to mitigate its progression.
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Affiliation(s)
- Ping Tyug Loh
- Division of Nephrology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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36
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Zuckerman KE, Mattox KM, Sinche BK, Blaschke GS, Bethell C. Racial, ethnic, and language disparities in early childhood developmental/behavioral evaluations: a narrative review. Clin Pediatr (Phila) 2014; 53:619-31. [PMID: 24027231 PMCID: PMC3955219 DOI: 10.1177/0009922813501378] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Katharine E. Zuckerman
- Oregon Health & Science University Division of General Pediatrics, Portland, OR,Child and Adolescent Health Measurement Initiative, Portland, OR
| | - Kimber M. Mattox
- Oregon Health & Science University Division of General Pediatrics, Portland, OR,Child and Adolescent Health Measurement Initiative, Portland, OR
| | | | - Gregory S. Blaschke
- Oregon Health & Science University Division of General Pediatrics, Portland, OR
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Abstract
BACKGROUND Uterine leiomyomata (also known as fibroids) are benign tumors of uterine smooth muscle that are characterized by overproduction of extracellular matrix. Fibroids are the leading indication for hysterectomy in the United States. The active metabolite of vitamin D has been shown to inhibit cell proliferation and extracellular matrix production in fibroid tissue culture and to reduce fibroid volume in the Eker rat. No previous study has examined whether vitamin D is related to fibroid status in women. METHODS The National Institute of Environmental Health Sciences Uterine Fibroid Study enrolled randomly selected 35- to 49-year-old women who were members of an urban health plan during 1996-1999. Fibroid status was determined by ultrasound screening of premenopausal women (620 blacks, 416 whites). Vitamin D status was assessed in stored plasma by radioimmunoassay of 25-hydroxyvitamin D (25(OH)D) and questionnaire data on sun exposure. Associations were evaluated with logistic regression, controlling for potential confounders. RESULTS Only 10% of blacks and 50% of whites had levels of 25(OH)D regarded as sufficient (>20 ng/ml). Women with sufficient vitamin D had an estimated 32% lower odds of fibroids compared with those with vitamin D insufficiency (adjusted odds ratio [aOR] = 0.68, 95% confidence interval [CI] = 0.48-0.96). The association was similar for blacks and whites. Self-reported sun exposure ≥ 1 hour per day (weather permitting) was also associated with reduced odds of fibroids (aOR = 06. [0.4-0.9]), with no evidence of heterogeneity by ethnicity. CONCLUSIONS The consistency of findings for questionnaire and biomarker data, the similar patterns seen in blacks and whites, and the biological plausibility provide evidence that sufficient vitamin D is associated with a reduced risk of uterine fibroids.
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Affiliation(s)
- Donna Day Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, USA.
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Fisher H, Trotter CL, Audrey S, MacDonald-Wallis K, Hickman M. Inequalities in the uptake of human papillomavirus vaccination: a systematic review and meta-analysis. Int J Epidemiol 2013; 42:896-908. [PMID: 23620381 PMCID: PMC3733698 DOI: 10.1093/ije/dyt049] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The human papillomavirus (HPV) vaccine offers an opportunity to reduce health inequalities associated with cervical cancer provided the vaccine is delivered equitably at population level. Method We reviewed evidence of inequalities in HPV vaccine uptake in young women after undertaking a comprehensive search of databases from inception to March 2012. Studies that compared HPV vaccination initiation and/or completion by at least one ethnicity or socioeconomic-related variable in adolescent young women were included. There were no language restrictions. Data were extracted by two reviewers and pooled in a meta-analysis using a random-effects model; sub-analyses and meta-regression were undertaken to investigate sources of heterogeneity. Results In all, 29 publications related to 27 studies were included in the review. Black young women were less likely to initiate HPV vaccination compared with White young women (combined OR: 0.89, 95% CI: 0.82–0.97). In the USA, young women without healthcare insurance were less likely to initiate (combined OR: 0.56, 95% CI: 0.40–0.78). There was no strong evidence that lower family income (combined OR: 1.16, 95% CI: 1.00–1.34) or lower parental education (combined OR 1.06, 95% CI: 0.92–1.22) influenced HPV vaccination initiation. Conclusions We found strong evidence for differences in HPV vaccination initiation by ethnicity and healthcare coverage, but did not find a strong association with parental education or family income variables. The majority of studies originated from the USA. Population-based studies reporting both initiation and completion of the HPV vaccination programme are required to establish patterns of uptake in different healthcare contexts.
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Affiliation(s)
- Harriet Fisher
- School of Social and Community Medicine, University of Bristol, Bristol, UK.
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Salz T, Woo H, Starr TD, Jandorf LH, DuHamel KN. Ethnic disparities in colonoscopy use among colorectal cancer survivors: a systematic review. J Cancer Surviv 2012; 6:372-8. [PMID: 23054847 PMCID: PMC3827777 DOI: 10.1007/s11764-012-0231-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/31/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE After curative treatment for colorectal cancer (CRC), routine colonoscopies are recommended. We aimed to identify all studies of ethnic disparities in CRC surveillance and examine any association between race/ethnicity and colonoscopy use. METHODS We conducted a systematic literature review to address the association between race/ethnicity and colonoscopy use among CRC survivors. We searched Medline for relevant articles. Two authors reviewed titles, abstracts, and articles based on pre-determined inclusion/exclusion criteria. RESULTS Of the 1,544 titles reviewed, eight studies published since 2001 investigated racial/ethnic disparities in colonoscopy use. Four articles showed a small significant ethnic disparity in the receipt of timely colonoscopy, and the remaining four articles showed a nonsignificant trend in the same direction. The effect did not vary by time of diagnosis or proportion of minorities in each study, though studies with larger samples showed somewhat greater racial/ethnic disparities in colonoscopy use. CONCLUSIONS We found at least a small disparity in the use of colonoscopy among CRC survivors, suggesting that ethnic disparities continue beyond prevention, detection, and treatment of CRC. It is important to identify areas of unequal care in CRC survivorship and to promote timely surveillance among CRC survivors who belong to racial/ethnic minorities to decrease disparities in mortality. IMPLICATIONS FOR CANCER SURVIVORS CRC survivors who belong to racial/ethnic minorities may be less likely to receive follow-up colonoscopies on time, which could contribue to higher rates of death from CRC among minorities.
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Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Staras SAS, Vadaparampil ST, Haderxhanaj LT, Shenkman EA. Disparities in human papillomavirus vaccine series initiation among adolescent girls enrolled in Florida Medicaid programs, 2006-2008. J Adolesc Health 2010; 47:381-8. [PMID: 20864008 PMCID: PMC3791862 DOI: 10.1016/j.jadohealth.2010.07.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 07/29/2010] [Accepted: 07/30/2010] [Indexed: 01/25/2023]
Abstract
PURPOSE To better understand the human papillomavirus (HPV) vaccine series initiation among 9-17-year-old female Medicaid beneficiaries in Florida programs between June 2006 and December 2008 (n = 237,015). METHODS Among the Florida Medicaid enrollees with itemized claims collected (non-managed care organization enrollees), we assessed the association between HPV vaccine series initiation (≥1 vaccine claim) and important demographic characteristics (age, race/ethnicity, program enrollment, area of residence, and length of enrollment). RESULTS Among 11-17-year-olds, vaccine initiation increased over time from <1% by December 2006 to nearly 19% by December 2008. By December 2008, HPV vaccine initiation increased with respect to age from 9 (1.6%) to 13 years (22.9%), remained relatively stable from ages 13 to 15 years (between 21% and 22%), and decreased among 16- (18.6%) and 17-year-olds (15.7%). Compared with girls in Pilot or Fee for Service programs, the girls in MediPass or Children's Medical Service Network programs were more likely to have initiated the vaccine series. Within three of the four programs, Hispanics were more likely than non-Hispanic white and black girls to have initiated the vaccine series. CONCLUSIONS This study expands the understanding of HPV vaccine initiation to low-income adolescents eligible for free vaccine through the Federal Vaccine for Children program. Increased understanding of reasons for the observed differences, especially by program and race/ethnicity, will aid in developing interventions to improve HPV vaccine initiation.
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Affiliation(s)
- Stephanie A S Staras
- Department of Health Outcomes and Policy, and Institute for Child Health Policy, University of Florida, Gainesville, Florida 32610, USA.
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Abstract
OBJECTIVE To quantify the number of children who experience gaps in insurance coverage and to determine whether vulnerable subgroups of children experience noteworthy lapses in insurance coverage. METHODS We analyzed nationally representative data from 24,149 children sampled in the 1999-2001 Medical Expenditure Panel Survey linked to the 1997-1999 National Health Interview Survey. Vulnerable subgroups of children included children with chronic conditions, those from ethnic/racial minorities, and those living in poverty. On the basis of cumulative annual monthly insurance coverage status, each child fell into 1 of 3 groups: continuous coverage, uninsured, or gaps in coverage. Using SAS-callable SUDAAN, we conducted multivariate ordinal logistic regression model to quantify the likelihood of having gaps in coverage for vulnerable subgroups of children. RESULTS From 1999 to 2001, we found that >9 million American children annually had gaps in coverage and that 5 to 6 million children annually were uninsured for the entire year. Sixty percent of children experienced gaps of at least 4 months, and >40% of all publicly and privately insured children had coverage gaps. After accounting for relevant covariates, children with chronic conditions were just as likely as other children to have gaps in coverage or be uninsured; Hispanic children were most likely to have insurance gaps or be uninsured; and children from poor and near-poor families were 4 to 5 times more likely to have lapsed coverage than children from high-income families. Poverty and maternal education were the strongest factors associated with lapsed coverage. CONCLUSIONS Unstable health insurance is an underrecognized problem for children, including those with chronic conditions. Because unstable insurance coverage can lead to inadequate health care utilization and poor child health outcomes, strategies to promote stable insurance coverage merit serious consideration.
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Affiliation(s)
- Marlon Satchell
- From the Pediatric Generalist Research Group and Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Susmita Pati
- From the Pediatric Generalist Research Group and Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
- Leonard Davis Institute of Health Economics and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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