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Huang YN, Munteanu V, Love MI, Ronkowski CF, Deshpande D, Wong-Beringer A, Corbett-Detig R, Dimian M, Moore JH, Garmire LX, Reddy TBK, Butte AJ, Robinson MD, Eskin E, Abedalthagafi MS, Mangul S. Perceptual and technical barriers in sharing and formatting metadata accompanying omics studies. CELL GENOMICS 2025; 5:100845. [PMID: 40215974 DOI: 10.1016/j.xgen.2025.100845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 09/26/2024] [Accepted: 03/12/2025] [Indexed: 04/15/2025]
Abstract
Metadata, or "data about data," is essential for organizing, understanding, and managing large-scale omics datasets. It enhances data discovery, integration, and interpretation, enabling reproducibility, reusability, and secondary analysis. However, metadata sharing remains hindered by perceptual and technical barriers, including the lack of uniform standards, privacy concerns, study design limitations, insufficient incentives, inadequate infrastructure, and a shortage of trained personnel. These challenges compromise data reliability and obstruct integrative meta-analyses. Addressing these issues requires standardization, education, stronger roles for journals and funding agencies, and improved incentives and infrastructure. Looking ahead, emerging technologies such as artificial intelligence and machine learning may offer promising solutions to automate metadata processes, increasing accuracy and scalability. Fostering a collaborative culture of metadata sharing will maximize the value of omics data, accelerating innovation and scientific discovery.
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Affiliation(s)
- Yu-Ning Huang
- Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Viorel Munteanu
- Department of Computers, Informatics, and Microelectronics, Technical University of Moldova, 2045 Chisinau, Moldova; Department of Biological and Morphofunctional Sciences, College of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Michael I Love
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA; Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
| | - Cynthia Flaire Ronkowski
- Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Dhrithi Deshpande
- Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA
| | - Annie Wong-Beringer
- Department of Biomolecular Engineering, University of California, Santa Cruz, Santa Cruz, CA 95064, USA
| | | | - Mihai Dimian
- Department of Computers, Electronics, and Automation, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Jason H Moore
- Department of Computational Biomedicine, Cedars-Sinai Medical Center, Los Angeles, CA 90069, USA
| | - Lana X Garmire
- Department of Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - T B K Reddy
- US Department of Energy Joint Genome Institute, Lawrence Berkeley National Laboratory, Berkeley, CA 94720, USA
| | - Atul J Butte
- Bakar Computational Health Sciences Institute, University of California, San Francisco (UCSF), San Francisco, CA 94143, USA; Center for Data-Driven Insights and Innovation, University of California, Oakland, Oakland, CA 94607, USA
| | - Mark D Robinson
- SIB Swiss Institute of Bioinformatics and Department of Molecular Life Sciences, University of Zurich, 8057 Zurich, Switzerland
| | - Eleazar Eskin
- Department of Computer Science, University of California, Los Angeles, Los Angeles, CA, USA; Department of Computational Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Malak S Abedalthagafi
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA, USA
| | - Serghei Mangul
- Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA; Department of Computers, Informatics, and Microelectronics, Technical University of Moldova, 2045 Chisinau, Moldova; Department of Biological and Morphofunctional Sciences, College of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania; Sage Bionetworks, Seattle, WA, USA.
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Malhi GS, Szymaniak K, Bell E, Shivakumar G, Tandon R. The race to ban ethnicity: A challenge to the diverse identity of psychiatry. Asian J Psychiatr 2025; 108:104527. [PMID: 40393236 DOI: 10.1016/j.ajp.2025.104527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Affiliation(s)
- Gin S Malhi
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, Australia; Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK.
| | - Kinga Szymaniak
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, Australia
| | - Erica Bell
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, Australia
| | - Gurubhaskar Shivakumar
- Academic Department of Psychiatry, Kolling Institute, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; CADE Clinic and Mood-T, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, NSW, Australia; Adult Mental Health Unit, Hornsby Ku-Ring-Gai Hospital, Northern Sydney Local Health District, Hornsby, NSW, Australia
| | - Rajiv Tandon
- Western Michigan University Department of Psychiatry, Kalamazoo, MI, United States of America
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Rajasingham M, Hossein-Pour P, D'Souza R, Geoffrion R, Ananth CV, Muraca GM. Racial and ethnic disparities in obstetric anal sphincter injury: cross-sectional study in the USA. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2025. [PMID: 40344313 DOI: 10.1002/uog.29231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 01/04/2025] [Accepted: 03/17/2025] [Indexed: 05/11/2025]
Abstract
OBJECTIVES Racial disparities in obstetric anal sphincter injury (OASI) are poorly understood; their investigation by parity, obstetric history and mode of delivery may provide insight into which individuals are at the greatest risk for OASI. We aimed to quantify the association of race and ethnicity with OASI, stratified by parity, obstetric history and mode of delivery. Secondary aims were to explore variations in OASI rates among racial subgroups and by immigration status (foreign-born vs USA-born). METHODS We conducted a cross-sectional study of 12 501 183 vaginal births in the USA from January 2016 to December 2021 using birth-certificate data obtained from the National Vital Statistics System. Cox proportional hazard regression models were fitted, with gestational age as the timescale, to quantify the association of self-reported race and ethnicity with OASI, with adjustment for several confounders. The maternal race and ethnicity groups included: American Indian or Alaska Native (AIAN), Asian, Black, Hispanic, Native Hawaiian and other Pacific Islander, White and mixed race. Models were stratified by number of previous births and the occurrence of Cesarean delivery (CD) among prior births. This resulted in three groups: primiparous (i.e. only the index birth); multiparous without a previous CD; and multiparous with at least one previous CD. Within each stratum, we further grouped individuals by mode of delivery in the index birth, as spontaneous vaginal delivery (SVD), operative vaginal delivery (OVD) with forceps and OVD with vacuum. RESULTS In primiparous individuals who had a vaginal birth, the overall OASI rate was 2.2%, but it varied widely by mode of delivery (SVD, 1.7%; OVD with forceps, 14.8%; OVD with vacuum, 6.6%). Asian primiparae had higher OASI hazards compared with White primiparae, irrespective of mode of delivery (SVD: adjusted hazard ratio (aHR), 1.69 (95% CI, 1.64-1.73); OVD with forceps: aHR, 1.48 (95% CI, 1.38-1.58); OVD with vacuum: aHR, 1.51 (95% CI, 1.44-1.58)), while AIAN and Black primiparae had inconsistent associations with OASI rate depending on mode of delivery, when compared with White primiparae. In multiparous individuals without a previous CD, the rates of OASI were lower than those seen in primiparae (SVD, 0.5%; OVD with forceps, 7.5%; OVD with vacuum, 3.2%) and the association of race and ethnicity with OASI varied by mode of delivery for all race groups except Asian, in whom it was consistently associated with a 1.5-2.1-times higher hazard of OASI. Among multiparous individuals with a previous CD, overall OASI rates were similar to those seen in primiparae (SVD, 1.3%; OVD with forceps, 11.8%; OVD with vacuum, 5.1%). In this group, the only associations of race and ethnicity with OASI were higher hazards among Asian vs White individuals who had a SVD (aHR, 2.16 (95% CI, 1.97-2.36)) and an OVD with vacuum (aHR, 1.65 (95% CI, 1.39-1.96)). The rate of OASI varied widely between Asian race subgroups, with the highest rate noted among individuals with origins and/or ancestry from India (e.g. 27.2% among primiparae who had OVD with forceps) and the lowest in those from Japan (e.g. 9.3% among primiparae who had OVD with forceps). Across racial and ethnic minority groups, the OASI rate was higher among foreign-born vs USA-born residents; this trend was not observed among White individuals. CONCLUSIONS Racial and ethnic disparities in OASI persist regardless of parity, obstetric history and mode of delivery. Variations in the OASI rate are apparent within Asian racial subgroups and by immigration status. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Rajasingham
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - P Hossein-Pour
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - R D'Souza
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - R Geoffrion
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - C V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Cardiovascular Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - G M Muraca
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Eugeniahemmet, Stockholm, Sweden
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Day-Lewis ME, Berbert L, DeGrazia M, Yee C, Fried AJ, Nguyen AA, Hale JE, Counihan A, Comeau AM, Treffeisen ER, Reed MP, Platt CD, Chou J. Incidence and risk factors for CMV and EBV infection in infants with low T-cell receptor excision circles on newborn screen. Clin Immunol 2025; 277:110510. [PMID: 40316158 DOI: 10.1016/j.clim.2025.110510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 04/22/2025] [Accepted: 04/25/2025] [Indexed: 05/04/2025]
Abstract
BACKGROUND Newborn screening for severe combined immunodeficiency (SCID) using T cell receptor excision circles (TRECs) identifies patients with other causes of lymphopenia. The risk of opportunistic infection in patients with non-SCID lymphopenia is poorly understood. We aim to describe incidence and risk factors associated with cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infection in patients with low TRECs. METHODS This retrospective study analyzed 289 patients with ≥1 abnormal TREC result. RESULTS Nineteen patients had CMV or EBV detected by PCR. Most had resolution of infection (n = 13). Two have chronic viremia, and four expired due to disseminated CMV. Risk factors included undetectable TRECs, consanguinity, family history, low NK, naïve CD4, naïve CD8 cells, and phytohemagglutinin. CONCLUSION Infection with CMV and EBV in patients with low TRECs is rare, however some may benefit from preventative measures. Consideration of risk factors may aid in decision-making and improve outcomes.
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Affiliation(s)
- Megan E Day-Lewis
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA.
| | - Laura Berbert
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, USA
| | - Michele DeGrazia
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, MA, USA; Division of Neonatology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Christina Yee
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Ari J Fried
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Alan A Nguyen
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jaime E Hale
- New England Newborn Screening Program, ForHealth Consulting, UMass Chan Medical School, Worcester, MA, USA
| | - Anne Counihan
- New England Newborn Screening Program, ForHealth Consulting, UMass Chan Medical School, Worcester, MA, USA
| | - Anne Marie Comeau
- New England Newborn Screening Program, ForHealth Consulting, UMass Chan Medical School, Worcester, MA, USA; Department of Pediatrics, T.H. Chan School of Medicine, Worcester, MA, USA
| | - Elsa R Treffeisen
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Mary Poyner Reed
- Medicine Patient Services, Boston Children's Hospital, Boston, MA, USA
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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McKenna BG, Lussier AA, Suderman MJ, Walton E, Simpkin AJ, Hüls A, Dunn EC. Strengthening Rigor and Reproducibility in Epigenome-Wide Association Studies of Social Exposures and Brain-Based Health Outcomes. Curr Environ Health Rep 2025; 12:19. [PMID: 40254641 PMCID: PMC12009779 DOI: 10.1007/s40572-024-00469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2024] [Indexed: 04/22/2025]
Abstract
PURPOSE OF REVIEW Studies examining the effects of social factors on the epigenome have proliferated over the last two decades. Social epigenetics research to date has broadly demonstrated that social factors spanning childhood adversity, to neighborhood disadvantage, educational attainment, and economic instability are associated with alterations to DNA methylation that may have a functional impact on health. These relationships are particularly relevant to brain-based health outcomes such as psychiatric disorders, which are strongly influenced by social exposures and are also the leading cause of disability worldwide. However, social epigenetics studies are limited by the many challenges faced by both epigenome-wide association studies (EWAS) and the study of social factors. FINDINGS In this manuscript, we provide a framework to achieve greater rigor and reproducibility in social epigenetics research. We discuss current limitations of the social epigenetics field, as well as existing and new solutions to improve rigor and reproducibility. Readers will gain a better understanding of the current considerations and processes that could maximize rigor when conducting social epigenetics research, as well as the technologies and approaches that merit attention and investment to propel continued discovery into the future.
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Affiliation(s)
- Brooke G McKenna
- Center for Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
- Department of Sociology, Purdue University, West Lafayette, IN, USA.
| | - Alexandre A Lussier
- Center for Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Matthew J Suderman
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther Walton
- Department of Psychology, University of Bath, Bath, UK
| | - Andrew J Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Anke Hüls
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Erin C Dunn
- Center for Psychiatric and Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Sociology, Purdue University, West Lafayette, IN, USA
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Fowler LA, Fernández JR, O'Neil PM, Parcha V, Arora P, Shetty NS, Cardel MI, Foster GD, Gower BA. Genetic Risk Phenotypes for Type 2 Diabetes Differ with Ancestry in US Adults with Diabetes and Overweight/Obesity. Arch Med Res 2025; 56:103128. [PMID: 39579522 PMCID: PMC12009211 DOI: 10.1016/j.arcmed.2024.103128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 10/19/2024] [Accepted: 11/07/2024] [Indexed: 11/25/2024]
Abstract
BACKGROUND Type 2 diabetes (T2D) risk is higher among non-Hispanic black (NHB) and Hispanic individuals, for reasons that are unclear. AIMS With this cross-sectional study, we tested the hypothesis that racial disparities in T2D prevalence can be partially traced to heterogeneity in etiology, as indicated by genetic subtypes that reflect distinct T2D phenotypes. METHODS Using a diverse sample of 361 US adults with T2D (69.5% women; 34.1% NHB; 13.9% Hispanic), we derived genetic risk scores (GRS) representing five distinct T2D pathophysiological pathways from 94 loci: β-cell, proinsulin, obesity, lipodystrophy, and liver/lipid. Genetic predisposition for insulin resistance (IR) was also assessed using a 52-SNP IR risk score. RESULTS The β-cell and proinsulin scores (as median [IQR]) were higher among NHB participants relative to NHW and Hispanics (β-cell GRS [NHB, 0.842(0.784-0.887) vs. NHW, 0.762(0.702-0.835) and Hispanic, 0.772(0.717-0.848)]); proinsulin GRS (NHB, 1.006[0.973-1.070] vs. NHW, 0.969[0.853-1.044] and Hispanic, 0.976[0.901-1.048]), whereas the liver/lipid and 52-SNP IR scores were higher in both NHB and Hispanic participants versus NHW (liver/lipid GRS [NHB, 1.09(0.78-1.18) and Hispanic, 0.895(0.736-1.227) vs. NHW, 0.794(0.666-1.157)]); 52-SNP IR GRS (NHB, 0.0095[0.009-0.010] and Hispanic, 0.0096 [0.0092-0.0101] vs. NHW, 0.0090[0.0084-0.0095]). CONCLUSIONS Impaired β-cell function may underlie T2D etiology more profoundly in NHB, whereas hepatic dysfunction, lipid metabolism abnormalities, and genetic IR contribute to T2D etiology to a greater degree in both NHB and Hispanics. Further validation of these findings may form the basis for a personalized medicine approach to prevention and treatment of T2D.
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Affiliation(s)
- Lauren A Fowler
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - José R Fernández
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patrick M O'Neil
- Department of Psychiatry and Behavioral Sciences, Weight Management Center, Medical University of South Carolina, Charleston, SC, USA
| | - Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA; Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
| | - Naman S Shetty
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle I Cardel
- WW International Inc., Science Department and Weight Health Institute, New York, NY, USA; Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA; Center for Integrative and Metabolic Disease, University of Florida, Gainesville, FL, USA
| | - Gary D Foster
- WW International Inc., Science Department and Weight Health Institute, New York, NY, USA; Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara A Gower
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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Visweswaran S, Sadhu EM, Morris MM, Vis AR, Samayamuthu MJ. Online database of clinical algorithms with race and ethnicity. Sci Rep 2025; 15:10913. [PMID: 40157976 PMCID: PMC11954862 DOI: 10.1038/s41598-025-94152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/12/2025] [Indexed: 04/01/2025] Open
Abstract
Some clinical algorithms incorporate an individual's race, ethnicity, or both as an input variable or predictor in determining diagnoses, prognoses, treatment plans, or risk assessments. Inappropriate use of race and ethnicity in clinical algorithms at the point of care may exacerbate health disparities and promote harmful practices of race-based medicine. Using database analysis primarily, we identified 42 risk calculators that use race and ethnicity as predictors, five laboratory test results with reference ranges that differed based on race and ethnicity, one therapy recommendation based on race and ethnicity, 15 medications with race- and ethnicity-based initiation and monitoring guidelines, and five medical devices with differential racial and ethnic performances. Information on these clinical algorithms is freely available at https://www.clinical-algorithms-with-race-and-ethnicity.org/ . This resource aims to raise awareness about the use of race and ethnicity in clinical algorithms and track progress toward eliminating their inappropriate use. The database is actively updated to include clinical algorithms that were missed and additional characteristics of these algorithms.
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Affiliation(s)
- Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Boulevard, Pittsburgh, PA, USA.
- Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Eugene M Sadhu
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Boulevard, Pittsburgh, PA, USA
| | - Michele M Morris
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Boulevard, Pittsburgh, PA, USA
| | - Anushka R Vis
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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Bugiardini R, Gale CP, Gulati M. Introducing The Lancet Regional Health-Europe commission on inequalities and disparities in cardiovascular health. Eur Heart J 2025; 46:1088-1090. [PMID: 39878143 DOI: 10.1093/eurheartj/ehae793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2025] Open
Affiliation(s)
- Raffaele Bugiardini
- Department of Medical and Surgical Sciences, University of Bologna, Via Giuseppe Massarenti 9, Bologna 40138, Italy
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Martha Gulati
- Department of Cardiology, Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
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Rountree L, Lin YT, Liu C, Salvatore M, Admon A, Nallamothu B, Singh K, Basu A, Bu F, Mukherjee B. Reporting of Fairness Metrics in Clinical Risk Prediction Models Used for Precision Health: Scoping Review. Online J Public Health Inform 2025; 17:e66598. [PMID: 39962044 PMCID: PMC11966066 DOI: 10.2196/66598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 02/03/2025] [Accepted: 02/17/2025] [Indexed: 03/20/2025] Open
Abstract
BACKGROUND Clinical risk prediction models integrated into digitized health care informatics systems hold promise for personalized primary prevention and care, a core goal of precision health. Fairness metrics are important tools for evaluating potential disparities across sensitive features, such as sex and race or ethnicity, in the field of prediction modeling. However, fairness metric usage in clinical risk prediction models remains infrequent, sporadic, and rarely empirically evaluated. OBJECTIVE We seek to assess the uptake of fairness metrics in clinical risk prediction modeling through an empirical evaluation of popular prediction models for 2 diseases, 1 chronic and 1 infectious disease. METHODS We conducted a scoping literature review in November 2023 of recent high-impact publications on clinical risk prediction models for cardiovascular disease (CVD) and COVID-19 using Google Scholar. RESULTS Our review resulted in a shortlist of 23 CVD-focused articles and 22 COVID-19 pandemic-focused articles. No articles evaluated fairness metrics. Of the CVD-focused articles, 26% used a sex-stratified model, and of those with race or ethnicity data, 92% had study populations that were more than 50% from 1 race or ethnicity. Of the COVID-19 models, 9% used a sex-stratified model, and of those that included race or ethnicity data, 50% had study populations that were more than 50% from 1 race or ethnicity. No articles for either disease stratified their models by race or ethnicity. CONCLUSIONS Our review shows that the use of fairness metrics for evaluating differences across sensitive features is rare, despite their ability to identify inequality and flag potential gaps in prevention and care. We also find that training data remain largely racially and ethnically homogeneous, demonstrating an urgent need for diversifying study cohorts and data collection. We propose an implementation framework to initiate change, calling for better connections between theory and practice when it comes to the adoption of fairness metrics for clinical risk prediction. We hypothesize that this integration will lead to a more equitable prediction world.
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Affiliation(s)
- Lillian Rountree
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Yi-Ting Lin
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Chuyu Liu
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Maxwell Salvatore
- Departments of Biostatistics, Epidemiology, and Informatics and Genetics, University of Pennsylvania, Philadelphia, PA, United States
| | - Andrew Admon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brahmajee Nallamothu
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, United States
| | - Karandeep Singh
- Department of Medicine, School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, United States
| | - Fan Bu
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Bhramar Mukherjee
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States
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Hinson HE. Do the Right Thing: Carefully Measuring Social Determinants of Health in Neurologic Research. Neurology 2025; 104:e213390. [PMID: 39937998 DOI: 10.1212/wnl.0000000000213390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 12/16/2024] [Indexed: 02/14/2025] Open
Affiliation(s)
- H E Hinson
- University of California San Francisco; and
- Zuckerberg San Francisco General Hospital, San Francisco, CA
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11
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Siddiqi S, Ortiz Z, Simard S, Li J, Lawrence K, Redmond M, Tomlinson JJ, Schlossmacher MG, Salmaso N. Race and ethnicity matter! Moving Parkinson's risk research towards diversity and inclusiveness. NPJ Parkinsons Dis 2025; 11:45. [PMID: 40050644 PMCID: PMC11885646 DOI: 10.1038/s41531-025-00891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 02/21/2025] [Indexed: 03/09/2025] Open
Abstract
Parkinson's disease (PD) is a prevalent neurodegenerative disorder that shows considerable heterogeneity of risk factors however, the degree to which race/ethnicity has been actively pursued in PD risk research is unknown. We examined PD literature from 2000-24 and found that less than half accounted for race/ethnicity and only 4.8% of n = 1142 articles included ethno-racial factors as an integral part of the analysis. This demonstrates that race/ethnicity has been critically understudied in PD and further studies that examine ethno-racial contributions to risk for PD are warranted.
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Affiliation(s)
- Sara Siddiqi
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Zoe Ortiz
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Stephanie Simard
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Juan Li
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Neuroscience Program, Ottawa Hospital Research Institute, University of Ottawa Brain & Mind Research Institute, Ottawa, ON, Canada
| | - Kamaya Lawrence
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Melissa Redmond
- School of Social Work, Carleton University, Ottawa, ON, Canada
| | - Julianna J Tomlinson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michael G Schlossmacher
- School of Social Work, Carleton University, Ottawa, ON, Canada
- Division of Neurology, The Ottawa Hospital, Ottawa, ON, Canada
| | - Natalina Salmaso
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada.
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
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12
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Mazzella A, Amin-Chowdhury Z, Andrews A, Charlett A, Brown CS, Hope R, Chudasama D. Health inequalities in incidence of bacteraemias: a national surveillance and data linkage study, England, 2018 to 2022. Euro Surveill 2025; 30:2400312. [PMID: 40051395 PMCID: PMC11887031 DOI: 10.2807/1560-7917.es.2025.30.9.2400312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 09/26/2024] [Indexed: 03/09/2025] Open
Abstract
BackgroundHealth inequalities exist globally, but limited data exist on this topic for bacteraemia.AimIn this study we investigated health inequalities surrounding bacteraemia in England, to identify high-risk population groups and areas of intervention.MethodsWe retrospectively analysed English surveillance data between 2018 and 2022 for Escherichia coli, Klebsiella species, Pseudomonas aeruginosa, and both meticillin-sensitive and resistant Staphylococcus aureus (MSSA, MRSA) bacteraemia. Crude incidence rates stratified by index of multiple deprivation and ethnic groups were calculated; age-adjusted rate ratios were estimated using negative binomial regression models.ResultsWe identified 342,787 bacteraemia cases. Across all pathogens, as the level of deprivation rose, so did the age-adjusted bacteraemia incidence rate ratio. Compared with residents of the 20% least deprived areas of England, residents of the 20% most deprived areas had a 2.68-fold increased bacteraemia rate for MRSA (95% CI: 2.29-3.13) and 1.95-fold for E. coli (95% CI: 1.84-2.05), and 15% higher odds of dying within 30 days of any bacteraemia (95% CI: 1.13-1.19). After age adjustment, the incidence of all bacteraemia was higher in the Asian and Black groups compared with the White group: for MRSA, 79% higher in the Asian (95% CI: 1.51-2.10) and 59% higher in the Black (95% CI: 1.29-1.95) groups. The exception was MSSA, whose incidence was highest in the White group.ConclusionDisproportionately higher age-adjusted incidence of bacteraemia occurred in deprived areas and ethnic minorities. These disparities are likely multifactorial, possibly including socioeconomic, cultural, and systemic risk factors and different burden of comorbidities. Better understanding these factors can enable targeted interventions.
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Affiliation(s)
| | | | | | | | | | - Russell Hope
- UK Health Security Agency, London, United Kingdom
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13
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Stoneman HR, Price AM, Trout NS, Lamont R, Tifour S, Pozdeyev N, Crooks K, Lin M, Rafaels N, Gignoux CR, Marker KM, Hendricks AE. Characterizing substructure via mixture modeling in large-scale genetic summary statistics. Am J Hum Genet 2025; 112:235-253. [PMID: 39824191 PMCID: PMC11866976 DOI: 10.1016/j.ajhg.2024.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 12/09/2024] [Accepted: 12/09/2024] [Indexed: 01/20/2025] Open
Abstract
Genetic summary data are broadly accessible and highly useful, including for risk prediction, causal inference, fine mapping, and incorporation of external controls. However, collapsing individual-level data into summary data, such as allele frequencies, masks intra- and inter-sample heterogeneity, leading to confounding, reduced power, and bias. Ultimately, unaccounted-for substructure limits summary data usability, especially for understudied or admixed populations. There is a need for methods to enable the harmonization of summary data where the underlying substructure is matched between datasets. Here, we present Summix2, a comprehensive set of methods and software based on a computationally efficient mixture model to enable the harmonization of genetic summary data by estimating and adjusting for substructure. In extensive simulations and application to public data, we show that Summix2 characterizes finer-scale population structure, identifies ascertainment bias, and scans for potential regions of selection due to local substructure deviation. Summix2 increases the robust use of diverse, publicly available summary data, resulting in improved and more equitable research.
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Affiliation(s)
- Hayley R Stoneman
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adelle M Price
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
| | - Nikole Scribner Trout
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
| | - Riley Lamont
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
| | - Souha Tifour
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
| | - Nikita Pozdeyev
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kristy Crooks
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Department of Pathology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Meng Lin
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nicholas Rafaels
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher R Gignoux
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Katie M Marker
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Audrey E Hendricks
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA; Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA; Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA.
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14
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Visweswaran S, Sadhu EM, Morris MM, Vis AR, Samayamuthu MJ. Online Database of Clinical Algorithms with Race and Ethnicity. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2023.07.04.23292231. [PMID: 37461462 PMCID: PMC10350134 DOI: 10.1101/2023.07.04.23292231] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Some clinical algorithms incorporate an individual's race, ethnicity, or both as an input variable or predictor in determining diagnoses, prognoses, treatment plans, or risk assessments. Inappropriate use of race and ethnicity in clinical algorithms at the point of care may exacerbate health disparities and promote harmful practices of race-based medicine. We identified 42 risk calculators that use race as a predictor, five laboratory test results with different reference ranges recommended for different races, one therapy recommendation based on race, 15 medications with guidelines for initiation and monitoring based on race, and four medical devices with differential racial performance. Information on these clinical algorithms are freely available at http://www.clinical-algorithms-with-race-and-ethnicity.org. This resource aims to raise awareness about the use of race in clinical algorithms and to track the progress made toward eliminating its inappropriate use. The database will be actively updated to include clinical algorithms based on race that were missed, along with additional characteristics of these algorithms.
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Affiliation(s)
- Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
- The Intelligent Systems Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eugene M. Sadhu
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michele M. Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anushka R. Vis
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Borja NA, Tinker RJ, Bivona SA, Smith CA, Krijnse Locker T, Fernandes S, Undiagnosed Diseases Network, Phillips JA, Stoler J, Taylor H, Zuchner S, Tekin M. Advancing Equity in Rare Disease Research: Insights From the Undiagnosed Disease Network. Am J Med Genet A 2025; 197:e63904. [PMID: 39400494 PMCID: PMC11698638 DOI: 10.1002/ajmg.a.63904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 09/14/2024] [Accepted: 09/28/2024] [Indexed: 10/15/2024]
Abstract
Rare diseases affect 6%-8% of the population and present diagnostic challenges, particularly for historically marginalized ethnic and racial groups. The Undiagnosed Diseases Network (UDN) aims to enhance diagnosis rates and research participation among such minoritized groups. A retrospective review was conducted from 2015 to 2023, analyzing 2235 UDN participants to evaluate its progress toward this objective. Data on demographics, disease phenotypes, diagnostic outcomes, and socioeconomic factors were collected and statistical analyses assessed differences among ethnic and racial groups. This demonstrated that Hispanic and Black non-Hispanic groups were underrepresented, while White non-Hispanic participants were overrepresented in the UDN compared to the US population. Individuals whose primary language was not English were also significantly underrepresented. Diagnosis rates varied, with the highest rates among Asian non-Hispanic (39.5%) and Hispanic (35.3%) groups and the lowest rate in the White non-Hispanic group (26.8%) (p < 0.001). Binomial logistic regression found, however, that only participant age and disease phenotype predicted the likelihood of receiving a diagnosis (p < 0.001). Persistent ethnic and racial disparities in UDN participation appear to be associated with major differences in application rates. Under-enrollment of historically marginalized ethnic and racial groups may be due to economic hardships and language barriers. No differences in the diagnostic yield among ethnic and racial groups were observed after controlling for other factors. This work highlights the value of comprehensive genetic evaluations for addressing healthcare disparities and suggests priorities for advancing inclusion in rare disease research.
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Affiliation(s)
- Nicholas A. Borja
- John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Rory J. Tinker
- Division of Medical Genetics and Genomic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephanie A. Bivona
- John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carson A. Smith
- John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Theodore Krijnse Locker
- Abess Center for Ecosystem Science and Policy, University of Miami, Coral Gables, Florida, USA
| | - Samuela Fernandes
- Division of Medical Genetics and Genomic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John A. Phillips
- Division of Medical Genetics and Genomic Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Justin Stoler
- Department of Geography and Sustainable Development, University of Miami, Coral Gables, Florida, USA
| | - Herman Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Stephan Zuchner
- John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mustafa Tekin
- John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Ghezae FT, Zungu Z, John A, Abdinasir K, Bhui K, Adebiyi A, Creswell C. The association between experiences of racism and mental health on children and young people in the UK: rapid scoping review. BJPsych Open 2025; 11:e26. [PMID: 39865992 PMCID: PMC11822989 DOI: 10.1192/bjo.2024.836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/07/2024] [Accepted: 11/08/2024] [Indexed: 01/28/2025] Open
Abstract
BACKGROUND Racism is increasingly recognised as a key contributor to poor mental health. However, the existing literature primarily focuses on its effects on adults. AIM To identify literature on the association between experiences of racism and mental health in children and young people in the UK. METHOD Inclusion criteria were: (a) peer-reviewed publications containing original data; (b) UK-based research; (c) included examination of associations between mental health and experiences of direct or indirect racism (quantitative or qualitative); (d) inclusion of an assessment of mental health outcomes; (e) participant ages up to and including 18 years of age or (if the range went beyond 18) with a mean age of 17 years or less. Six databases were searched between 2000 and 2022; an initial 11 522 studies were identified with only eight meeting the inclusion criteria. RESULTS Five of the identified studies provided quantitative data and three provided qualitative data. The majority of studies (7/8) focused on children and young people aged 10 years and over; only one focused on children under the age of 10 years. Measurements of racism varied among the studies providing quantitative data. Only four studies directly focused on the effects of racism on the mental health of children and young people. CONCLUSION Although the included studies highlighted potential negative impacts of experiences of racism on children and young people in the UK, this review shows the lack of available literature to inform policy and practice. No studies examined the impact of internalised racism, systemic and institutional racism, or intersectionality.
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Affiliation(s)
- Fiyory Tzeggai Ghezae
- Department of Experimental Psychology, University of Oxford, Oxford, UK; and Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Zonke Zungu
- Section of Organisational Psychology, University of Cape Town, Rondebosch, South Africa
| | - Ann John
- Swansea University Medical School, Swansea, UK
| | | | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, Oxford, UK; Academic Psychiatry, University of Oxford, Oxford, UK
| | - Adenike Adebiyi
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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17
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Kim M, Amakiri UO, Wong F, Barnett J, Boe LA, Stern CS, Mehrara BJ, Tadros AB, Nelson JA. Race and Ethnicity Impacts Patient-Reported Outcomes in Implant-Based Breast Reconstruction. Ann Surg Oncol 2025; 32:551-561. [PMID: 39453584 DOI: 10.1245/s10434-024-16302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 09/20/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND Addressing social determinants of health is critical in achieving health equity, and of the many determinants, race and ethnicity are key contributors in postmastectomy breast reconstruction. The purpose of this study was to investigate the impact of race and ethnicity on patient-reported outcomes (PROs) after implant-based breast reconstruction (IBBR) and to provide reference values for each cohort. METHODS We identified all patients who underwent IBBR between January 2017 and August 2022 and completed the BREAST-Q longitudinally. Race and ethnicity were self-categorized as White, Asian, Black, or Hispanic. Reference values were established. Outcomes of interest were BREAST-Q scores preoperatively, and 6 months, 1 year, and 2 years postoperatively. Generalized estimating equation (GEE) modeling was performed to assess race and ethnicity as independent predictors of BREAST-Q scores. RESULTS Overall, 3281 patients were included, of whom 2479 (75.6%) were White, 296 (9.0%) were Asian, 239 (7.3%) were Black, and 267 (8.1%) were Hispanic. There were significant differences in Physical Well-being of the Chest at all timepoints; Satisfaction with Breasts and Psychosocial Well-being at preoperative, 6 months, and 1 year; and in Sexual Well-being at 1 year. GEE modeling showed that relative to White patients, Asian subjects scored significantly lower on all BREAST-Q domains, while Black and Hispanic patients scored significantly lower on the Physical Well-being of the Chest domain. CONCLUSION Racial and ethnic disparities persist within IBBR, with minority patients scoring lower on the BREAST-Q than White patients. This study suggests that more work is needed to understand and improve these PROs in minority patient populations. Individualized reference values may prove beneficial in assessing outcomes over time.
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Affiliation(s)
- Minji Kim
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Uchechukwu O Amakiri
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Frankie Wong
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Barnett
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lillian A Boe
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carrie S Stern
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Babak J Mehrara
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Audree B Tadros
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jonas A Nelson
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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18
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Hazan J, Liu KY, Isaacs JD, Mukadam N. Dementia diagnosis rates and the impact of ethnicity, rurality and deprivation. Aging Ment Health 2025; 29:138-144. [PMID: 39414785 DOI: 10.1080/13607863.2024.2374936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/19/2024] [Indexed: 10/18/2024]
Abstract
OBJECTIVES NHS England publishes monthly national and regional estimated dementia diagnosis rates (DDR) to assess the healthcare system's effectiveness in identifying dementia cases. Previous research indicates that sociodemographic factors, such as ethnic minority status, socioeconomic deprivation, and rurality, influence both healthcare quality and dementia risk. This study aimed to examine the association between these sociodemographic factors and DDR, and to estimate an ethnicity-adjusted DDR using available ethnic group data. METHOD We analysed NHS Digital Primary Care Dementia Data electronic health records for July 2023. We used a linear regression model to determine the association between DDR and ethnicity, deprivation, and rurality factors using local authority region level data. We also adjusted the DDR at the level of sub-integrated care boards based on previously published odds ratios of dementia diagnosis by ethnic group. RESULTS Regression modelling revealed that areas with higher proportions of minority ethnic groups and greater rurality had lower DDRs. Conversely, higher levels of deprivation were linked to higher DDRs. After adjusting for different odds ratios for dementia in minority ethnic groups, the national DDR decreased by 1%, with regional diagnosis rates dropping by up to 5.4%. CONCLUSION Higher regional proportional ethnic minority population and greater rurality were associated with a lower DDR which might reflect poorer access to diagnostic services. Higher deprivation levels were associated with a higher DDR which might reflect higher rates of dementia in more deprived populations. We discuss measures to improve the accuracy and utility of the DDR, with a specific focus on ethnicity.
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Affiliation(s)
- Jemma Hazan
- Division of Psychiatry, University College London, London, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London, UK
| | - Jeremy D Isaacs
- St George's University Hospitals NHS Foundation Trust, London, UK
- NHS England, London, UK
- Neurosciences and Cell Biology Research Institute, St George's, University of London, London, UK
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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19
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Mandal S, Teslow EA, Huang M, Yu Y, Sridhar S, Crawford HC, Hockenberry AJ, Stoppler MC, Levin AM, Huang L. Molecular Differences in Pancreatic Ductal Adenocarcinomas from Black versus White Patients. CANCER RESEARCH COMMUNICATIONS 2025; 5:128-137. [PMID: 39699266 PMCID: PMC11752082 DOI: 10.1158/2767-9764.crc-24-0376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 10/31/2024] [Accepted: 12/13/2024] [Indexed: 12/20/2024]
Abstract
SIGNIFICANCE By analyzing the records of patients with pancreatic cancer in the Tempus multimodal database, we identified genomic mutations and PD-L1 overexpression occurred more frequently in Black patients compared with their White counterparts. These molecular features may contribute to racial disparities in pancreatic cancer.
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Affiliation(s)
- Saurabh Mandal
- Henry Ford Pancreatic Cancer Center, Henry Ford Health, Detroit, Michigan
| | | | | | | | - Swathi Sridhar
- Henry Ford Pancreatic Cancer Center, Henry Ford Health, Detroit, Michigan
| | - Howard C. Crawford
- Henry Ford Pancreatic Cancer Center, Henry Ford Health, Detroit, Michigan
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan
| | | | | | - Albert M. Levin
- Department of Public Health Sciences, Henry Ford Health, Detroit, Michigan
| | - Ling Huang
- Henry Ford Pancreatic Cancer Center, Henry Ford Health, Detroit, Michigan
- Department of Pharmacology and Toxicology, Michigan State University, East Lansing, Michigan
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20
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Gong JY, Salim A, Fourlanos S, Magliano DJ, Shaw JE. The impact of ethnicity and its definition on diabetes prevalence: A national Australian whole-of-population study. Diabetes Res Clin Pract 2024; 218:111937. [PMID: 39577495 DOI: 10.1016/j.diabres.2024.111937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2024] [Revised: 11/06/2024] [Accepted: 11/19/2024] [Indexed: 11/24/2024]
Abstract
AIMS We assessed the extent to which using large geographic regions to group ethnicities (ancestries or countries-of-birth) masked intra-regional variation in diabetes risk. METHODS We performed a cross-sectional analysis of the 2021 Australian National Census, which included self-reported health data. Ethnicity-specific diabetes prevalence was age/sex-standardised to a reference population of all census respondents 20 years and above. RESULTS There were 17.5 million adults included in this study. Within four geographical regions, there wastwo-four-fold intra-regional variation in diabetes risk. Diabetes prevalence among people reporting a single East Asianancestry ranged from less than the Australian prevalence (Japanese 4.2%, Thai 6.1%) to twice the Australian prevalence (Filipino 12.6%). Among peoplereporting a single South/Central Asianancestry, diabetes prevalence ranged from 7.3% (Armenian) to 18.4% (Bangladeshi). Among people reporting a single Middle Eastern/North African ancestry, diabetes prevalence values rangedfrom 5.4% (Jewish) to 12.3% (Iraqi). In Oceania, the diabetes prevalence in people of Australian Aboriginal, Fijian, Maori, Samoan and Tongan ancestry was greater than the Australian prevalence(17.5%, 12.3%, 10.0%, 16.3% and 17.4%, respectively versus 6.3%). CONCLUSIONS There wastwo-four-fold variation in diabetes prevalence between populations within four geographical regions. Aggregating ethnicity into large geographic regional groups may incorrectly estimate diabetes risk.
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Affiliation(s)
- Joanna Y Gong
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Diabetes and Endocrinology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3052, Australia; Department of Medicine, The University of Melbourne, 300 Grattan Street, Parkville, Victoria 3052, Australia; School of Translational Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
| | - Agus Salim
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia; Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie St, Carlton, Victoria 3053, Australia.
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria 3052, Australia; Department of Medicine, The University of Melbourne, 300 Grattan Street, Parkville, Victoria 3052, Australia; Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Grattan Street, Melbourne, Victoria 3010, Australia.
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia.
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia; School of Life Sciences, La Trobe University, Plenty Road, Bundoora, Victoria 3086, Australia.
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Cunninghame J, Takashima M, Holland L, Nguyen L, Diaz A, Guo S, Dufficy M, Munns CF, Ullman A. Reporting Indigenous status, ethnicity, language and country of birth to build equity in international paediatric clinical trials with Australian sites: a scoping review. AUST HEALTH REV 2024; 49:AH24184. [PMID: 39622494 DOI: 10.1071/ah24184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 11/11/2024] [Indexed: 02/07/2025]
Abstract
Objective Ensuring equitable access to clinical trials for children from Indigenous and ethnically and linguistically diverse backgrounds should be central to clinical trial design. This review aims to expansively review the reporting of Indigenous status (Aboriginal and/or Torres Strait Islander origin), ethnicity, culture, location, language and country of birth in paediatric clinical trials with Australian sites. Methods This scoping review systematically searched PubMed, CINAHL and Embase for international clinical trials with Australian sites conducted between 2018 and 2022 involving children (aged <18years) to determine the reporting of Indigenous status, race, ethnicity, language and country of birth. Results Of the 262 studies included, 154 (58.8%) clinical trials did not report any of the variables of interest. When reported, terms used by authors were heterogeneous. 'Indigenous status' was most reported (n =40, 15.3%) and self-identification was the most common method to determine this (n =14, 35.9%). International clinical trials had higher rates of reporting for ethnicity, cultural background and race. Overall, more than 60 terms were used to categorise study participants in relation to 'Indigenous status', 'ethnicity and cultural background', 'race', 'race and ethnicity' or 'natural skin colour'. Conclusions This review demonstrated low rates of reporting of demographic variables in paediatric clinical trials. Clear reporting standards, partnering with consumers to co-design trials and self-identification during collection are required. Ensuring adequate access to clinical trials for Indigenous children and children from ethnically, linguistically and geographically diverse backgrounds is essential in building health equity and ensuring patient safety.
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Affiliation(s)
- Jacqueline Cunninghame
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Qld, Australia; and Centre for Children's Health Research, 62 Graham Street, South Brisbane, Qld 4101, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Qld, Australia; and Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Qld, Australia
| | - Lorelle Holland
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Qld, Australia; and Child Health Research Centre, Faculty of Medicine, The University of Queensland, St Lucia, Qld, Australia; and UQ Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Qld, Australia
| | - Linda Nguyen
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Qld, Australia
| | - Abbey Diaz
- School of Public Health, Faculty of Medicine, The University of Queensland, St Lucia, Qld, Australia
| | - Shuaijun Guo
- ANU Centre for Social Research and Methods, Australian National University, Canberra, ACT, Australia; and Centre for Community Child Health, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Vic, Australia
| | - Mitchell Dufficy
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Qld, Australia
| | - Craig F Munns
- Child Health Research Centre, Faculty of Medicine, The University of Queensland, St Lucia, Qld, Australia; and Department of Endocrinology, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Qld, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Qld, Australia; and Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, South Brisbane, Qld, Australia
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22
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Goddard-Hodge D, Boukebous B, Baker JF. Anteroposterior cervical spine canal diameter: exploring ethnic variation between European and Polynesian populations. ANZ J Surg 2024; 94:1963-1970. [PMID: 39126255 DOI: 10.1111/ans.19186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/11/2024] [Accepted: 07/18/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Reduced spinal canal anteroposterior (AP) diameter and AP-transverse diameter ratio have been linked to the development of spinal cord injury and myelopathy. Previously unpublished data has suggested Maori and Pacifica individuals may have narrower cervical spine canals than their NZ European counterparts. PURPOSE We evaluate the existence of potential differences in dimensions of the sub-axial cervical spine canal between New Zealand European, Māori and Polynesian individuals. STUDY DESIGN A computed tomography (CT) analysis of 645 intact adult sub-axial cervical vertebrae from 129 patients. METHODS A total of 645 human sub-axial (C3-C7) cervical vertebrae were analysed radiographically, using 1 mm resolution CT scans to measure AP diameter, transverse diameter and AP:transverse ratio. CT data were obtained from normal trauma scans demonstrating no acute pathology. CT data was reformatted in digital software allowing multi-planar reconstruction (MPR) to increase accuracy of measurements. Statistical analysis was performed using analysis of variance (ANOVA). RESULTS A total of 245 vertebrae were from Māori individuals, 245 from NZ European and 155 from Polynesians. There were 455 male vertebrae and 215 female vertebrae. Statistically significant differences were found in AP canal diameter between all ethnic groups, at all spinal levels. The average cervical spine canal was around 2.5 mm narrower in Polynesians and around 1.5 mm narrower in Māori than NZ Europeans. No differences in Transverse canal diameter were observed, however statistically significant differences were found in the AP:transverse ratio at all spinal levels. CONCLUSIONS Our study, utilizing a normal patient cohort, confirms differences in canal dimensions between ethnic groups. CLINICAL SIGNIFICANCE Ethnic variation in cervical canal dimensions as herein described, must be considered when defining and diagnosing congenital stenosis. Neglecting to account for these differences may lead to misdiagnosis of congenital stenosis in normal individuals in certain ethnic groups.
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Affiliation(s)
- Daniel Goddard-Hodge
- Department of Orthopaedic Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - Baptiste Boukebous
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
- ECAMO team URM 1153, CRESS, INSERM, Paris, France
| | - Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, University of Auckland, Auckland, New Zealand
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23
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Roushani J, Berube AJ, Lanktree MB. Reporting of Race, Ethnicity, and Ancestry Remains Inadequate in Kidney Research. Kidney Int Rep 2024; 9:3328-3331. [PMID: 39534202 PMCID: PMC11551123 DOI: 10.1016/j.ekir.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 07/01/2024] [Accepted: 08/05/2024] [Indexed: 11/16/2024] Open
Affiliation(s)
- Jian Roushani
- Department of Medicine; McMaster University, Hamilton, Ontario, Canada
| | | | - Matthew B. Lanktree
- Department of Medicine; McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact; McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Nephrology, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
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24
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Patel RM, Prusynski RA, Williams-York B, Matthews ND, VanHoose L. Disparities in Physical Therapy Outcomes Based on Race and Ethnicity: A Scoping Review. Phys Ther 2024; 104:pzae090. [PMID: 38990209 DOI: 10.1093/ptj/pzae090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 02/11/2024] [Accepted: 03/21/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE This scoping review synthesizes and summarizes the evidence on racial and ethnic disparities in outcomes after physical therapist treatment. METHODS Four databases from 2001 through 2021 were searched for articles reporting physical therapy outcomes across racial and ethnic groups. The Arksey and O'Malley methodological framework was adapted for this scoping review. Two reviewers screened the abstracts, and 5 reviewers screened full texts for inclusion. Five reviewers extracted information including study design, diagnoses, setting, outcomes reported, the domains the outcomes measured, and racial and ethnic groups included. To identify disparities, summarized differences in outcomes (better, worse, no difference) for each racial and ethnic group compared to White patients were calculated. RESULTS Of 1511 abstracts screened, 65 met inclusion criteria, 57 of which were observational designs. All 65 articles included non-Hispanic White patients as the reference group. A majority of the physical therapy outcomes reported by race were for Black patients and/or Hispanic or Latino patients, whereas outcomes for Asian, American Indian, Alaskan Native, and/or Native Hawaiians or Pacific Islander patients were reported infrequently. Most articles reported disparities in health outcomes for patients in the inpatient rehabilitation setting (n = 48) and for adults (n = 59) with neurologic diagnoses (n = 36). Compared to White patients, worse outcomes were reported more frequently for all marginalized racial and ethnic groups after physical therapy, with the exception of marginalized groups having the same or better outcomes for successful post-rehabilitation community discharge. CONCLUSION Gaps remain in understanding outcome disparities beyond older adult and neurologic populations as well as for musculoskeletal diagnoses frequently treated by physical therapists. IMPACT The presence of racial and ethnic disparities in physical therapy outcomes should motivate physical therapists to understand the mechanisms underlying disparities and focus on social and structural drivers of health inequity in their clinical decision-making.
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Affiliation(s)
- Rupal M Patel
- School of Physical Therapy, Texas Woman's University, Houston, Texas, USA
| | - Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | | | - Ndidiamaka D Matthews
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, California, USA
| | - Lisa VanHoose
- Physical Therapy Department, School of Allied Health, University of Louisiana Monroe, Monroe, Louisiana, USA
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25
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Sheean P, O'Connor P, Joyce C, Wozniak A, Vasilopoulos A V, Seigal J, Formanek P. Validating the use of body mass index with computed tomography in a racially and ethnically diverse cohort of patients admitted with SARS-CoV-2. Nutr Clin Pract 2024; 39:1259-1269. [PMID: 38877983 DOI: 10.1002/ncp.11164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/24/2024] [Accepted: 05/10/2024] [Indexed: 10/11/2024] Open
Abstract
BACKGROUND Body mass index (BMI) is criticized for being unjust and biased in relatively healthy racial and ethnic groups. Therefore, the current analysis examines if BMI predicts body composition, specifically adiposity, in a racially and ethnically diverse acutely ill patient population. METHODS Patients admitted with SARS-CoV-2 having an evaluable diagnostic chest, abdomen, and/or pelvic computed tomography (CT) study (within 5 days of admission) were included in this retrospective cohort. Cross-sectional areas (centimeters squared) of the subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and intramuscular adipose tissue (IMAT) were quantified. Total adipose tissue (TAT) was calculated as sum of these areas. Admission height and weight were applied to calculate BMI, and self-reported race and ethnicity were used for classification. General linear regression models were conducted to estimate correlations and assess differences between groups. RESULTS On average, patients (n = 134) were aged 58.2 (SD = 19.1) years, 60% male, and racially and ethnically diverse (33% non-Hispanic White [NHW], 33% non-Hispanic Black [NHB], 34% Hispanic). Correlations between BMI and SAT and BMI and TAT were strongest revealing estimates of 0.707 (0.585, 0.829) and 0.633 (0.534, 0.792), respectively. When examining the various adiposity compartments across race and ethnicity, correlations were similar and significant differences were not detected for TAT with SAT, VAT, or IMAT (all P ≥ 0.05). CONCLUSIONS These findings support the routine use of applying BMI as a proxy measure of total adiposity for acutely ill patients identifying as NHW, NHB, and Hispanic. Our results inform the validity and utility of this tool in clinical nutrition practice.
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Affiliation(s)
- Patricia Sheean
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Paula O'Connor
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Cara Joyce
- Loyola University Chicago, Maywood, Illinois, USA
| | - Amy Wozniak
- Loyola University Medical Center, Maywood, Illinois, USA
| | | | - Jared Seigal
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Perry Formanek
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
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26
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Galiatsatos P, Brems H, Myers CN, Montemayor K. Race, Ethnicity, and Gender Disparities in Management and Outcomes of Critically Ill Adults with Sepsis. Crit Care Clin 2024; 40:741-752. [PMID: 39218483 DOI: 10.1016/j.ccc.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Critical care pathologies are not immune to potential social challenges in both health equity and health disparities. Over the last century, as sepsis physiology and interventions have continued to improve clinical outcomes, recognition that such improvements are not seen in all diverse populations warrants an understanding of this disproportionate success. In this review, the authors evaluate sepsis incidence and outcomes across ethnicity, race, and sex and gender, taking into account social and biological categorization and the association of sepsis-related mortality and morbidity. Further, the authors review how such issues transcend across age groups, with vulnerability to sepsis.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Office of Diversity, Inclusion, and Health Equity, Johns Hopkins Health System, Baltimore, MD, USA.
| | - Henry Brems
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Carlie N Myers
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Kristina Montemayor
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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27
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Owete AC, Ionin R, Huryn LA, Cukras CA, Blain D, Agather AR, Hufnagel RB, Brooks BP, Nwanyanwu K, Zein WM. Seeing in Color: Inclusion and Characterization of Hereditary Eye Disease in African Americans. Transl Vis Sci Technol 2024; 13:4. [PMID: 39226063 PMCID: PMC11373706 DOI: 10.1167/tvst.13.9.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/15/2023] [Indexed: 09/04/2024] Open
Abstract
Purpose Hereditary eye diseases (HEDs) are individually rare but affect millions globally. The era of molecular genetics has ushered major advances in the study of these disorders; however, the inclusivity and population diversity of this research is unknown. Questions on the accuracy and applicability of these findings in diverse populations, especially African American patients, came up consistently during counselling sessions. This also raised the possibility of missed opportunities for broader understanding of these rare diseases. We conducted a literature review to measure the representation of African Americans in genomic research surrounding nine HEDs. Methods A detailed literature search using a predetermined set of search terms for each of nine HED categories was performed across PubMed, Embase, Web of Science, and Scopus focusing on studies published between Jan 1990 and July 2021. Predetermined inclusion criteria were applied to filter the sources. Results We identified 46 studies clearly reporting HED characterization in African Americans. Analysis of these inclusive studies revealed unique findings demonstrating the known usefulness of including diverse cohorts in genomics research. Conclusions HED characterization in diverse participants, specifically African Americans, is identified as a knowledge gap area. Genomic research is more applicable to patients when conducted in populations that share their ancestral background. Greater inclusion of African Americans in ophthalmic genetics research is a scientific imperative and a needed step in the pursuit of the best possible patient care for populations of all ancestries. Translational Relevance This work reveals gaps in genomic research in African Americans with HEDs.
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Affiliation(s)
- Agnes C. Owete
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institute of Health, Bethesda, MD, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Raisa Ionin
- National Institutes of Health Library, National Institutes of Health, Bethesda, MD, USA
| | - Laryssa A. Huryn
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institute of Health, Bethesda, MD, USA
| | - Catherine A. Cukras
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institute of Health, Bethesda, MD, USA
| | - Delphine Blain
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institute of Health, Bethesda, MD, USA
| | - Aime R. Agather
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institute of Health, Bethesda, MD, USA
| | - Robert B. Hufnagel
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institute of Health, Bethesda, MD, USA
| | - Brian P. Brooks
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institute of Health, Bethesda, MD, USA
| | - Kristen Nwanyanwu
- Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, CT, USA
| | - Wadih M. Zein
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institute of Health, Bethesda, MD, USA
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28
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Azab S, Kandasamy S, Wahi G, Lamri A, Desai D, Williams N, Zulyniak M, de Souza R, Anand SS. Understanding the impact of maternal and infant nutrition on infant/child health: multiethnic considerations, knowledge translation, and future directions for equitable health research. Appl Physiol Nutr Metab 2024; 49:1271-1278. [PMID: 38728751 DOI: 10.1139/apnm-2023-0572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
A mother's intrauterine environment influences her health and that of her offspring, at birth and in the future. Herein, we present an overview of our Canadian Institutes of Health Research (CIHR)-funded grant "Understanding the impact of maternal and infant nutrition on infant/child health"-set within The NutriGen Birth Cohort Alliance. NutriGen is a consortium of four Canadian prospective birth cohorts representing >5000 mother-child pairs of diverse ethnic groups including South Asians, White Europeans, and Indigenous peoples. We summarize our objectives and main findings on outcomes of maternal diet, gestational diabetes, birth weight, cardiometabolic health, the microbiome, and epigenetic modifications. We append this work with 10 key messages when conducting multiethnic research and review our knowledge translation products. We describe the clinical impact of our research on maternal and child health and conclude with future directions on biomarker discovery, expansion to other ethnic groups, and interventions for high-risk populations.
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Affiliation(s)
- Sandi Azab
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Pharmacognosy, Alexandria University, Alexandria, Egypt
| | - Sujane Kandasamy
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
- Child and Youth Studies, Brock University, St. Catherines, ON, Canada
| | - Gita Wahi
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Amel Lamri
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Dipika Desai
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Natalie Williams
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | - Michael Zulyniak
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Russell de Souza
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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29
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Carabali M, Barber S, Ferreira AJF, Ortigoza AF, Ramos D, Goes E, Siddiqi A, Lucumi DI, Perez-Chacon D, Jackson JW, Bashir H, Sanchez Y, Elmi YM, Goulart CM, Perea-Aragon CY, Grillo RL, Higuera-Mendieta D, Djigo KM, Melo-Ferreira V, Martinez M. Pan-American data initiative for the analysis of population racial/ethnic health inequities: the Pan-DIASPORA project. LANCET REGIONAL HEALTH. AMERICAS 2024; 37:100868. [PMID: 39252887 PMCID: PMC11382322 DOI: 10.1016/j.lana.2024.100868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/05/2024] [Indexed: 09/11/2024]
Affiliation(s)
- Mabel Carabali
- McGill University Department of Epidemiology Biostatistics and Occupational Health, Montreal, QC, Canada
| | - Sharrelle Barber
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | | | | | - Dandara Ramos
- Federal University of Bahia Institute of Collective Health, Salvador, BA, Brazil
| | | | - Arjumand Siddiqi
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Diego I Lucumi
- Universidad de los Andes, Santa Fe de Bogota, Cundinamarca, Colombia
| | | | - John W Jackson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Huda Bashir
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Yazmin Sanchez
- McGill University Department of Epidemiology Biostatistics and Occupational Health, Montreal, QC, Canada
| | - Yasmine M Elmi
- McGill University Faculty of Medicine and Health Sciences, Montreal, QC, Canada
| | - Celine M Goulart
- McGill University Department of Epidemiology Biostatistics and Occupational Health, Montreal, QC, Canada
| | | | - Randy L Grillo
- Instituto de Medicina Tropical Pedro Kouri, Havana, La Habana, Cuba
| | | | | | | | - Marelys Martinez
- Instituto de Medicina Tropical Pedro Kouri, Havana, La Habana, Cuba
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30
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Bariani MV, Grimm SL, Coarfa C, Velez Edwards DR, Yang Q, Walker CL, Ali M, Al-Hendy A. Altered extracellular matrix-related pathways accelerate the transition from normal to prefibroid myometrium in Black women. Am J Obstet Gynecol 2024; 231:324.e1-324.e12. [PMID: 38825029 PMCID: PMC11344675 DOI: 10.1016/j.ajog.2024.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 05/14/2024] [Accepted: 05/19/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND Black women experience a disproportionate impact of uterine fibroids compared to White women, including earlier diagnosis, higher frequency, and more severe symptoms. The etiology underlying this racial disparity remains elusive. OBJECTIVE The aim of this study was to evaluate the molecular differences in normal myometrium (fibroid-free uteri) and at-risk myometrium (fibroid-containing uteri) tissues in Black and White women. STUDY DESIGN We conducted whole-genome RNA-seq on normal and at-risk myometrium tissues obtained from both self-identified Black and White women (not Hispanic or Latino) to determine global gene expression profiles and to conduct enriched pathway analyses (n=3 per group). We initially assessed the differences within the same type of tissue (normal or at-risk myometrium) between races. Subsequently, we analyzed the transcriptome of normal myometrium compared to at-risk myometrium in each race and determined the differences between them. We validated our findings through real-time PCR (sample size range=5-12), western blot (sample size range=5-6), and immunohistochemistry techniques (sample size range=9-16). RESULTS The transcriptomic analysis revealed distinct profiles between Black and White women in normal and at-risk myometrium tissues. Interestingly, genes and pathways related to extracellular matrix and mechanosensing were more enriched in normal myometrium from Black than White women. Transcription factor enrichment analysis detected greater activity of the serum response transcription factor positional motif in normal myometrium from Black compared to White women. Furthermore, we observed increased expression levels of myocardin-related transcription factor-serum response factor and the serum response factor in the same comparison. In addition, we noted increased expression of both mRNA and protein levels of vinculin, a target gene of the serum response factor, in normal myometrium tissues from Black women as compared to White women. Importantly, the transcriptomic profile of normal to at-risk myometrium conversion differs between Black and White women. Specifically, we observed that extracellular matrix-related pathways are involved in the transition from normal to at-risk myometrium and that these processes are exacerbated in Black women. We found increased levels of Tenascin C, type I collagen alpha 1 chain, fibronectin, and phospho-p38 MAPK (Thr180/Tyr182, active) protein levels in at-risk over normal myometrium tissues from Black women, whereas such differences were not observed in samples from White women. CONCLUSION These findings indicate that the racial disparities in uterine fibroids may be attributed to heightened production of extracellular matrix in the myometrium in Black women, even before the tumors appear. Future research is needed to understand early life determinants of the observed racial differences.
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Affiliation(s)
| | - Sandra L Grimm
- Molecular and Cellular Biology Department, Baylor College of Medicine, Houston, TX; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Center for Precision and Environmental Health, Baylor College of Medicine, Houston, TX
| | - Cristian Coarfa
- Molecular and Cellular Biology Department, Baylor College of Medicine, Houston, TX; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Center for Precision and Environmental Health, Baylor College of Medicine, Houston, TX
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University, Nashville, TN; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN; Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN
| | - Qiwei Yang
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL
| | - Cheryl L Walker
- Center for Precision and Environmental Health, Baylor College of Medicine, Houston, TX
| | - Mohamed Ali
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL.
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL.
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31
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Conti-Ramsden F, de Marvao A, Chappell LC. Pharmacotherapeutic options for the treatment of hypertension in pregnancy. Expert Opin Pharmacother 2024; 25:1739-1758. [PMID: 39225514 PMCID: PMC11881908 DOI: 10.1080/14656566.2024.2398602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 08/21/2024] [Accepted: 08/27/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Hypertensive disorders of pregnancy affect approximately one in 10 pregnancies and are associated with increased risk of adverse fetal, neonatal and maternal outcomes. There is strong evidence that effective treatment of hypertension (blood pressure ≥ 140/90 mmHg), and enhanced monitoring throughout pregnancy reduces these risks. AREAS COVERED This article provides a contemporaneous review of treatment of hypertension in pregnancy with antihypertensive agents. We completed a systematic search and review of all meta-analyses and systematic reviews of studies comparing antihypertensives for treatment of pregnancy hypertension in the last five years. We provide a clinically focused summary of when to treat hypertension in pregnancy and which antihypertensive agents can be offered. Special scenarios reviewed include treatment-resistant hypertension and pre-pregnancy antihypertensive optimization. EXPERT OPINION Several antihypertensives are considered safe and are known to be effective for treatment of hypertension in pregnancy. Given the current uncertainty as to which antihypertensive(s) are superior for treatment of hypertension in pregnancy, women should be counselled and offered a range of antihypertensive options in keeping with evidence on clinical effectiveness, local context and availability of antihypertensive(s), potential side effect profile, and women's preference. Further research is required to help guide clinical decision making, and move toward personalized treatment.
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Affiliation(s)
- Frances Conti-Ramsden
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
| | - Antonio de Marvao
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, UK
- Medical Research Council Laboratory of Medical Sciences, Imperial College London, London, UK
| | - Lucy C. Chappell
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, UK
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Viswanathan VS, Parmar V, Madabhushi A. Towards equitable AI in oncology. Nat Rev Clin Oncol 2024; 21:628-637. [PMID: 38849530 DOI: 10.1038/s41571-024-00909-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/09/2024]
Abstract
Artificial intelligence (AI) stands at the threshold of revolutionizing clinical oncology, with considerable potential to improve early cancer detection and risk assessment, and to enable more accurate personalized treatment recommendations. However, a notable imbalance exists in the distribution of the benefits of AI, which disproportionately favour those living in specific geographical locations and in specific populations. In this Perspective, we discuss the need to foster the development of equitable AI tools that are both accurate in and accessible to a diverse range of patient populations, including those in low-income to middle-income countries. We also discuss some of the challenges and potential solutions in attaining equitable AI, including addressing the historically limited representation of diverse populations in existing clinical datasets and the use of inadequate clinical validation methods. Additionally, we focus on extant sources of inequity including the type of model approach (such as deep learning, and feature engineering-based methods), the implications of dataset curation strategies, the need for rigorous validation across a variety of populations and settings, and the risk of introducing contextual bias that comes with developing tools predominantly in high-income countries.
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Affiliation(s)
| | - Vani Parmar
- Department of Breast Surgical Oncology, Punyashlok Ahilyadevi Holkar Head & Neck Cancer Institute of India, Mumbai, India
| | - Anant Madabhushi
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA.
- Atlanta Veterans Administration Medical Center, Atlanta, GA, USA.
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Vander Elst Z, Hildebrand H, Short MA, Henscheid N, Ward R, Ariagno R, Diacovo T, Lang T, Allegaert K, Smits A. Publication Recommendations to Report Laboratory Data of Neonates - a Modified Delphi Approach. Pediatr Res 2024; 96:81-88. [PMID: 38448637 PMCID: PMC11257958 DOI: 10.1038/s41390-024-03094-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/21/2024] [Accepted: 01/28/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Clinical and analytical information on laboratory data of neonates in scientific publications is sparse and incomplete. Furthermore, interpreting neonatal laboratory data can be complex due to their time-dependent and developmental physiology, and paucity of well-established age-appropriate reference ranges for neonates. This study aims to develop publication recommendations to report laboratory data of neonates to enhance the quality of these data in research and clinical care. METHODS A modified Delphi approach was used to develop recommendations in cooperation with the International Neonatal Consortium. A Core Group, including different stakeholders, was responsible for developing the recommendations, in collaboration with a Reflection Group, responsible for providing additional input. RESULTS The recommendations were classified into three categories: 'Clinical Characteristics', 'Bio-analytical Information' and 'Data-analytical Information'. These were each divided into 'Core Data' (always to be reported) and 'Supplemental Considerations' (to be reported when considered relevant to the study). CONCLUSION Our recommendations provide guidance on standardization of neonatal laboratory data in publications. This will enhance the comparison, replication, and application of study results in research initiatives and clinical practice. Furthermore, these recommendations also serve as foundational work to develop reference ranges for neonatal laboratory values by standardizing the quality of information needed for such efforts. IMPACT Standardized reporting of neonatal laboratory data in scientific publications will enhance the comparison, replication, and application of study results in research initiatives and clinical practice, as well as improve reporting to regulatory agencies. To integrate multistakeholder perspectives, a modified Delphi approach was used to develop publication recommendations which strengthens the applicability of the recommendations. Implementation of standardization will likely improve the overall quality of neonatal clinical research and neonatal healthcare. In addition, these recommendations are foundational to develop reference ranges for neonatal laboratory values by standardizing the quality of information needed for such efforts.
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Affiliation(s)
- Zoë Vander Elst
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium.
| | - Heidrun Hildebrand
- Bayer AG, Research & Development, Pharmaceuticals, Pediatric Development, Berlin, Germany
| | - Mary A Short
- International Neonatal Consortium, Communications Workgroup, Tucson, AZ, USA
| | | | - Robert Ward
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Ronald Ariagno
- International Neonatal Consortium, Communications Workgroup, Tucson, AZ, USA
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University, Stanford, CA, USA
| | | | - Tim Lang
- Blood Sciences, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Committee of Emerging Technologies in Pediatric Laboratory Medicine, International Federation of Clinical Chemistry and Laboratory Medicine, Milan, Italy
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
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Bonilla DA, Orozco CA, Forero DA, Odriozola A. Techniques, procedures, and applications in host genetic analysis. ADVANCES IN GENETICS 2024; 111:1-79. [PMID: 38908897 DOI: 10.1016/bs.adgen.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
This chapter overviews genetic techniques' fundamentals and methodological features, including different approaches, analyses, and applications that have contributed to advancing health and disease. The aim is to describe laboratory methodologies and analyses employed to understand the genetic landscape of different biological contexts, from conventional techniques to cutting-edge technologies. Besides describing detailed aspects of the polymerase chain reaction (PCR) and derived types as one of the principles for many novel techniques, we also discuss microarray analysis, next-generation sequencing, and genome editing technologies such as transcription activator-like effector nucleases (TALENs) and the clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated (Cas) systems. These techniques study several phenotypes, ranging from autoimmune disorders to viral diseases. The significance of integrating diverse genetic methodologies and tools to understand host genetics comprehensively and addressing the ethical, legal, and social implications (ELSI) associated with using genetic information is highlighted. Overall, the methods, procedures, and applications in host genetic analysis provided in this chapter furnish researchers and practitioners with a roadmap for navigating the dynamic landscape of host-genome interactions.
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Affiliation(s)
- Diego A Bonilla
- Hologenomiks Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain; Research Division, Dynamical Business & Science Society-DBSS International SAS, Bogotá, Colombia.
| | - Carlos A Orozco
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Diego A Forero
- School of Health and Sport Sciences, Fundación Universitaria del Área Andina, Bogotá, Colombia
| | - Adrián Odriozola
- Hologenomiks Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain
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Osei Baah F, Sharda S, Davidow K, Jackson S, Kernizan D, Jacobs JA, Baumer Y, Schultz CL, Baker-Smith CM, Powell-Wiley TM. Social Determinants of Health in Cardio-Oncology: Multi-Level Strategies to Overcome Disparities in Care: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:331-346. [PMID: 38983377 PMCID: PMC11229550 DOI: 10.1016/j.jaccao.2024.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 07/11/2024] Open
Abstract
Addressing the need for more equitable cardio-oncology care requires attention to existing disparities in cardio-oncologic disease prevention and outcomes. This is particularly important among those affected by adverse social determinants of health (SDOH). The intricate relationship of SDOH, cancer diagnosis, and outcomes from cardiotoxicities associated with oncologic therapies is influenced by sociopolitical, economic, and cultural factors. Furthermore, mechanisms in cell signaling and epigenetic effects on gene expression link adverse SDOH to cancer and the CVD-related complications of oncologic therapies. To mitigate these disparities, a multifaceted strategy is needed that includes attention to health care access, policy, and community engagement for improved disease screening and management. Interdisciplinary teams must also promote cultural humility and competency and leverage new health technology to foster collaboration in addressing the impact of adverse SDOH in cardio-oncologic outcomes.
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Affiliation(s)
- Foster Osei Baah
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Sonal Sharda
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kimberly Davidow
- Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA
| | - Sadhana Jackson
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Daphney Kernizan
- Preventive Cardiology Program, Cardiac Center, Nemours Children's Health, Panama City, Florida, USA
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Joshua A Jacobs
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Yvonne Baumer
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Corinna L Schultz
- Lisa Dean Moseley Foundation Institute for Cancer and Blood Disorders, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA
| | - Carissa M Baker-Smith
- Preventive Cardiology Program, Cardiac Center, Nemours Children's Health, Wilmington, Delaware, USA
| | - Tiffany M Powell-Wiley
- Social Determinants of Obesity and Cardiovascular Risk Laboratory, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
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Safitri A, Konstantakopoulou E, Gazzard G, Hu K. Priorities for health outcomes in glaucoma in an ethnically diverse UK cohort: an observational study. BMJ Open 2024; 14:e081998. [PMID: 38772893 PMCID: PMC11110553 DOI: 10.1136/bmjopen-2023-081998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/24/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES To assess whether patients from minority ethnic groups have different perceptions about the quality-of-life outcomes that matter most to them. DESIGN Cross-sectional observational study. SETTING High volume eye centres serving the most ethnically diverse region in the UK, recruiting from July 2021 to February 2022. PARTICIPANTS 511 patients with primary open-angle glaucoma and the predisease state of ocular hypertension. MAIN OUTCOME MEASURES The main outcome was participants' self-reported priorities for health outcomes. RESULTS Participants fell into one of four clusters with differing priorities for health outcomes, namely: (1) vision, (2) drop freedom, (3) intraocular pressure and (4) one-time treatment. Ethnicity was the strongest determinant of cluster membership after adjusting for potential confounders. Compared with white patients prioritising vision alone, the OR for black/black British patients was 7.31 (95% CI 3.43 to 15.57, p<0.001) for prioritising drop freedom; 5.95 (2.91 to 12.16, p<0.001) for intraocular pressure; and 2.99 (1.44 to 6.18, p=0.003) for one-time treatment. For Asian/Asian British patients, the OR was 3.17 (1.12 to 8.96, p=0.030) for prioritising intraocular pressure as highly as vision. Other ethnic minority groups also had higher ORs for prioritising health outcomes other than vision alone: 4.50 (1.03 to 19.63, p=0.045) for drop freedom and 5.37 (1.47 to 19.60, p=0.011) for intraocular pressure. CONCLUSIONS Ethnicity is strongly associated with differing perceptions about the health outcomes that matter. An individualised and ethnically inclusive approach is needed when selecting and evaluating treatments in clinical and research settings.
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Affiliation(s)
- Atika Safitri
- NIHR Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Evgenia Konstantakopoulou
- NIHR Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
- Division of Optics and Optometry, University of West Attica, Athens, Greece
| | - Gus Gazzard
- NIHR Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
| | - Kuang Hu
- NIHR Moorfields Biomedical Research Centre, London, UK
- Institute of Ophthalmology, University College London, London, UK
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Stoneman HR, Price A, Trout NS, Lamont R, Tifour S, Pozdeyev N, Crooks K, Lin M, Rafaels N, Gignoux CR, Marker KM, Hendricks AE. Characterizing substructure via mixture modeling in large-scale genetic summary statistics. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.29.577805. [PMID: 38766180 PMCID: PMC11100604 DOI: 10.1101/2024.01.29.577805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Genetic summary data are broadly accessible and highly useful including for risk prediction, causal inference, fine mapping, and incorporation of external controls. However, collapsing individual-level data into groups masks intra- and inter-sample heterogeneity, leading to confounding, reduced power, and bias. Ultimately, unaccounted substructure limits summary data usability, especially for understudied or admixed populations. Here, we present Summix2, a comprehensive set of methods and software based on a computationally efficient mixture model to estimate and adjust for substructure in genetic summary data. In extensive simulations and application to public data, Summix2 characterizes finer-scale population structure, identifies ascertainment bias, and identifies potential regions of selection due to local substructure deviation. Summix2 increases the robust use of diverse publicly available summary data resulting in improved and more equitable research.
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Affiliation(s)
- Hayley R Stoneman
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adelle Price
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
| | - Nikole Scribner Trout
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
| | - Riley Lamont
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
| | - Souha Tifour
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
| | - Nikita Pozdeyev
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kristy Crooks
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Pathology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Meng Lin
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nicholas Rafaels
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher R Gignoux
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Katie M Marker
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Audrey E Hendricks
- Department of Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Colorado Center for Personalized Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Mathematical and Statistical Sciences, University of Colorado Denver, Denver, CO 80204, USA
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Griffith DM, Efird CR, Baskin ML, Webb Hooper M, Davis RE, Resnicow K. Cultural Sensitivity and Cultural Tailoring: Lessons Learned and Refinements After Two Decades of Incorporating Culture in Health Communication Research. Annu Rev Public Health 2024; 45:195-212. [PMID: 37931182 DOI: 10.1146/annurev-publhealth-060722-031158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
In this article, we examine progress and challenges in designing, implementing, and evaluating culturally sensitive behavioral interventions by tailoring health communication to groups or individuals. After defining common tailoring constructs (i.e., culture, race, and ethnicity), cultural sensitivity, and cultural tailoring, we examine when it is useful to culturally tailor and address cultural sensitivity in health communication by group tailoring or individual tailoring and when tailoring health communication may not be necessary or appropriate for achieving behavior change. After reviewing selected approaches to cultural tailoring, we critique the quality of research in this domain with a focus on the internal validity of empirical findings. Then we explore the ways in which cultural sensitivity, group targeting, and individual tailoring have incorporated culture in health promotion and health communication. We conclude by articulating yet unanswered questions and suggesting future directions to move the field forward.
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Affiliation(s)
- Derek M Griffith
- Center for Men's Health Equity, Racial Justice Institute, Georgetown University, Washington, DC, USA;
- Racial Justice Institute, Georgetown University, Washington, DC, USA
- Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA
| | - Caroline R Efird
- Racial Justice Institute, Georgetown University, Washington, DC, USA
| | - Monica L Baskin
- Division of Hematology/Oncology, School of Medicine; and Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica Webb Hooper
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland, USA
| | - Rachel E Davis
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Ken Resnicow
- Department of Health Behavior and Health Education, School of Public Health; and Community Outreach and Health Disparities Research, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
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Tremblay F, Courtemanche Y, Bélanger RE, Turcotte-Tremblay AM. A systematic review of the association between history of sexually transmitted infections and subsequent condom use in adolescents. BMC Public Health 2024; 24:1000. [PMID: 38600483 PMCID: PMC11007949 DOI: 10.1186/s12889-024-18322-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/10/2024] [Indexed: 04/12/2024] Open
Abstract
Sexually transmitted infections (STIs) are common among adolescents. According to the Health Belief Model, cues to action influence preventive behaviors. Cues to action can include health experiences such as being diagnosed with an STI. The impact of a history of STIs on subsequent condom use among adolescents remains largely unexamined, despite high rates of recurrence and their health impacts. This project aimed to systematically review the literature on the association between curable STIs and subsequent condom use among adolescents. The systematic review, reported following PRISMA guidelines, was conducted using the Joanna Briggs Institute method. Eligible studies, in the form of cohort studies, case-control studies, or cross-sectional studies, targeted adolescents aged 10 to 24, with or without a history of curable STIs; the outcome was subsequent condom use. MEDLINE (Ovid), Embase (Elsevier), and Web of Science were searched from January 2012 to December 2022 with the assistance of an information specialist. Two reviewers independently selected articles and extracted data. Risk of bias analysis was performed using ROBINS-E. The review explores results, with tables, based on population characteristics, exposure, and outcome, and addresses the influence of gender, ethnicity, and age. Of 3088 articles identified, seven studies were retained. Almost all the studies focused on African-American, Nigerian, or Rwandan adolescents, and several included only girls. Among girls, a history of STI increased subsequent condom use in combination with other contraceptive methods (n = 4). Among boys and older adolescents of both genders, a history of STI was associated with a decrease in condom use (n = 3). No study distinguished between different STIs. While all the studies (n = 7) presented a high risk of bias, six did not present a threat to conclusion validity. All the studies indicated that a history of STI could influence subsequent protective behaviors, possibly by acting as a cue to action, as posited by the Health Belief Model. This information enhances our understanding of factors leading to the adoption of preventive health measures among adolescents and could apply to other infectious experiences.Registration The protocol is registered in PROSPERO (CRD42023397443).
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Affiliation(s)
- Frédérique Tremblay
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada.
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada.
| | - Yohann Courtemanche
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada
| | - Richard E Bélanger
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada
- Department of Pediatrics, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, Room 4633, Québec, (QC), G1V 0A6, Canada
| | - Anne-Marie Turcotte-Tremblay
- Projet COMPASS Québec, VITAM - Centre de recherche en santé durable, CIUSSS-CN and Université Laval, GMF-U Maizerets, 2480, chemin de la Canardière, Québec, (QC), G1J 2G1, Canada
- Faculy of Nursing, Université Laval, 1050, avenue de la Médecine, Room 3645, Québec, (QC), G1V 0A6, Canada
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Ashtari F, Kavosh A, Baghbanian SM, Hosseini Nejad Mir N, Hosseini S, Razazian N, Majdinasab N, Farajzadegan Z, Shaygannejad V, Adibi I, Eskandarieh S, Sahraian MA. A national registry-based study of ethnic differences in people with multiple sclerosis in Iran. Clin Neurol Neurosurg 2024; 239:108216. [PMID: 38490075 DOI: 10.1016/j.clineuro.2024.108216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE The relationship between MS and ethnicity has been understudied in the Middle East compared to the United States and Europe. As Iran as the highest prevalence of MS in the Middle East, we decided to investigate the demographic and clinical differences in people with MS (pwMS) from major ethnicities Iran. METHODS In a cross-sectional study using data from National Multiple Sclerosis Registry in Iran. PwMS from six provinces were chosen and interviewed for determining their ethnicity. Persians (Fars), Kurds, Lurs, Azeris and Arabs with a clear ethnic background were included. Recorded data from the registry was used to compare the demographic and clinical features. RESULTS A total of 4015 pwMS (74.2% female) were included in the study with an average age of 36.76 ± 9.68 years. Persians and Kurds had the highest percentage of pwMS in youngest and oldest age groups, respectively, with 2.9% and 5.7% (p<0.01). The highest average age of onset was seen in Persians (29.47 ± 8.89) and the lowest observed in Mazandaranis (26.82 ± 7.68, p<0.01). Azeris and Kurds had the highest proportions of pwMS diagnosed <18 and >55, at rates of 12% and 1.6%, respectively (p<0.01). There were statistically significant differences in distribution of phenotypes (p<0.01) and time to progression to secondary progressive MS (p<0.01) such that Persians had the highest rate of clinically isolated syndrome (CIS) at 19.3% and Arabs had highest rates of relapsing-remitting MS (86.2%) and secondary progressive MS (16.4%). Lurs, Azeris and Mazandaranis had significantly more patients progressing to secondary-progressive MS <5 years from diagnosis (p<0.01). There was a significant difference in number of relapses between the ethnicities (p<0.01) with Lurs having the highest proportion of participants reporting >4 relapses with 23.0% and Azeris having the highest percentage of pwMS reporting no relapse (53.0%). Kurds had the highest Expanded Disability Status Scale (EDSS) average at 2.93 ± 1.99 and Lurs had the lowest with 1.28 ± 1.25 (p<0.01). The differences in prevalence of positive family history for the whole cohort between ethnicities were significant (P=0.02), ranging from 12.8% in Kurds to 19.6% in Persians. CONCLUSION We found Persians to have higher rates of pediatric MS and higher rates of CIS. Kurds and Lurs had higher and lower EDSS scores, respectively. Lurs and Persian had higher annual relapse rates. We also found lower rates of SPMS among Arabs and earlier progression to SPMS in Lurs, Azeris and Mazandaranis. Such differences highlight the importance of the potential role of ethnicities in diagnosis and prognosis of MS, especially considering their observation within the geographical limits of a single country.
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Affiliation(s)
- Fereshteh Ashtari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Aryan Kavosh
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Seyed Mohammad Baghbanian
- Neurology Department, Booalisina Hospital, Mazandaran University of Medical Sciences, Pasdaran Boulevard, Sari, Iran
| | | | - Samaneh Hosseini
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazanin Razazian
- Neurology Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nastaran Majdinasab
- Department of Neurology, Golestan Hospital, Ahvaz Jondishapour University of Medical Sciences, Iran
| | - Ziba Farajzadegan
- Department of Community Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Adibi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sharareh Eskandarieh
- Assistant Professor in Epidemiology, Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Zhang H, Ruan WJ, Chou SP, Saha TD, Fan AZ, Huang B, White AM. Exploring patterns of alcohol use and alcohol use disorder among Asian Americans with a finer lens. Drug Alcohol Depend 2024; 257:111120. [PMID: 38402754 DOI: 10.1016/j.drugalcdep.2024.111120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND National survey data suggest Asian Americans (AA) are less likely to consume alcohol and develop AUD than Americans in other groups. However, it is common for AA to be born outside of the US and carry gene variants that alter alcohol metabolism, both of which can lead to lower levels of alcohol involvement. The current study examined differences in alcohol use and AUD between AA and other groups before and after controlling for birth location and gene variants. DESIGN Past year alcohol measures were examined from adults 18+ (N=22,848) in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III before and after controlling for birth location (inside or outside of the US) and gene variants (ALDH2*2 and ADH1B*2/ADH1B*3). Gender gaps in alcohol measures also were assessed. RESULTS Before adjustments, AA were less likely than White Americans to drink in the previous year (OR=0.50, 95% CI 0.41-0.62), binge (OR=0.68, 95% CI 0.52-0.88), engage in frequent heavy drinking (OR=0.55, 95% CI 0.42-0.73), and reach criteria for AUD (OR=0.71, 95% CI 0.53-0.94). After controlling for birth location and gene variants, AA remained less likely to drink in the past year (OR=0.54, 95% CI 0.41-0.70) but all other differences disappeared. Gender gaps were only observed for AA born outside of the US, highlighting the importance of experience rather than racial category per se. CONCLUSIONS Findings indicate that heterogeneity among AA leads to spurious generalizations regarding alcohol use and AUD and challenge the model minority myth.
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Affiliation(s)
- Haitao Zhang
- Epidemiology and Biometry Branch, Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, USA
| | - W June Ruan
- Epidemiology and Biometry Branch, Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, USA
| | - S Patricia Chou
- Epidemiology and Biometry Branch, Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, USA
| | - Tulshi D Saha
- Epidemiology and Biometry Branch, Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, USA
| | - Amy Z Fan
- Epidemiology and Biometry Branch, Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, USA
| | - Boji Huang
- Epidemiology and Biometry Branch, Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, USA
| | - Aaron M White
- Epidemiology and Biometry Branch, Division of Epidemiology and Prevention Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, USA.
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Madbouly A, Bolon YT. Race, ethnicity, ancestry, and aspects that impact HLA data and matching for transplant. Front Genet 2024; 15:1375352. [PMID: 38560292 PMCID: PMC10978785 DOI: 10.3389/fgene.2024.1375352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Race, ethnicity, and ancestry are terms that are often misinterpreted and/or used interchangeably. There is lack of consensus in the scientific literature on the definition of these terms and insufficient guidelines on the proper classification, collection, and application of this data in the scientific community. However, defining groups for human populations is crucial for multiple healthcare applications and clinical research. Some examples impacted by population classification include HLA matching for stem-cell or solid organ transplant, identifying disease associations and/or adverse drug reactions, defining social determinants of health, understanding diverse representation in research studies, and identifying potential biases. This article describes aspects of race, ethnicity and ancestry information that impact the stem-cell or solid organ transplantation field with particular focus on HLA data collected from donors and recipients by donor registries or transplant centers.
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Affiliation(s)
- Abeer Madbouly
- Center for International Blood and Marrow Transplant Research (CIBMTR), Minneapolis, MN, United States
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Chu DK, Schneider L, Asiniwasis RN, Boguniewicz M, De Benedetto A, Ellison K, Frazier WT, Greenhawt M, Huynh J, Kim E, LeBovidge J, Lind ML, Lio P, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Wang J, Wheeler KE, Guyatt GH, Capozza K, Begolka WS, Chu AWL, Zhao IX, Chen L, Oykhman P, Bakaa L, Golden D, Shaker M, Bernstein JA, Greenhawt M, Horner CC, Lieberman J, Stukus D, Rank MA, Wang J, Ellis A, Abrams E, Ledford D, Chu DK. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol 2024; 132:274-312. [PMID: 38108679 DOI: 10.1016/j.anai.2023.11.009] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).
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Affiliation(s)
- Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
| | - Lynda Schneider
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts.
| | | | - Mark Boguniewicz
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Division of Pediatric Allergy and Clinical Immunology, National Jewish Health, Denver, Colorado
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | | | - Winfred T Frazier
- Department of Family Medicine, UPMC St. Margaret, Pittsburgh, Pennsylvania
| | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Joey Huynh
- Sepulveda VA Medical Center, North Hills, California
| | | | - Jennifer LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mary Laura Lind
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, Arizona
| | - Peter Lio
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen A Martin
- University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Monica O'Brien
- Tufts University School of Medicine, Boston, Massachusetts
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, USC Keck School of Medicine, Los Angeles, California
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Jonathan M Spergel
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Kathryn E Wheeler
- Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Gordon H Guyatt
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Korey Capozza
- Global Parents for Eczema Research, Santa Barbara, California
| | | | - Alexandro W L Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Irene X Zhao
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Lina Chen
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Paul Oykhman
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - Layla Bakaa
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
| | - David Golden
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marcus Shaker
- Dartmouth Geisel School of Medicine and Dartmouth Hitchcock Medical Center, Section of Allergy, Lebanon, New Hampshire
| | | | - Matthew Greenhawt
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; Section of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colorado
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jay Lieberman
- University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee
| | - David Stukus
- Nationwide Children's Hospital and Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew A Rank
- Mayo Clinic in Arizona and Phoenix Children's Hospital, Scottsdale and Phoenix, Arizona
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Anne Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Elissa Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dennis Ledford
- Morsani College of Medicine, University of South Florida and James A. Haley Veterans' Affairs Hospital, Tampa, Florida
| | - Derek K Chu
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada
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Park M, Wanigaratne S, D'Souza R, Geoffrion R, Williams S, Muraca GM. Asian-White disparities in obstetric anal sphincter injury: a systematic review and meta-analysis. AJOG GLOBAL REPORTS 2024; 4:100296. [PMID: 38283323 PMCID: PMC10820309 DOI: 10.1016/j.xagr.2023.100296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE Obstetrical anal sphincter injury describes a severe injury to the perineum and perianal muscles after birth. Obstetrical anal sphincter injury occurs in approximately 4.4% of vaginal births in the United States; however, racial and ethnic inequities in the incidence of obstetrical anal sphincter injury have been shown in several high-income countries. Specifically, an increased risk of obstetrical anal sphincter injury in individuals who identify as Asian vs those who identify as White has been documented among residents of the United States, Australia, Canada, Western Europe, and the Scandinavian countries. The high rates of obstetrical anal sphincter injury among the Asian diaspora in these countries are higher than obstetrical anal sphincter injury rates reported among Asian populations residing in Asia. A systematic review and meta-analysis of studies in high-income, non-Asian countries was conducted to further evaluate this relationship. DATA SOURCES MEDLINE, Ovid, Embase, EmCare, and the Cochrane databases were searched from inception to March 2023 for original research studies. STUDY ELIGIBILITY CRITERIA Observational studies using keywords and controlled vocabulary terms related to race, ethnicity and obstetrical anal sphincter injury. All observational studies, including cross-sectional, case-control, and cohort were included. 2 reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Meta-analysis of Observational Studies in Epidemiology recommendations. METHODS Meta-analysis was performed using RevMan (version 5.4; Cochrane Collaboration, London, United Kingdom) for dichotomous data using the random effects model and the odds ratios as effect measures with 95% confidence intervals. Subgroup analysis was performed among Asian subgroups. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools. Meta-regression was used to determine sources of between-study heterogeneity. Results A total of 27 studies conducted in 7 countries met the inclusion criteria encompassing 2,337,803 individuals. The pooled incidence of obstetrical anal sphincter injury was higher among Asian individuals than White individuals (pooled odds ratio, 1.64; 95% confidence interval, 1.48-1.80). Subgroup analyses showed that obstetrical anal sphincter injury rates were highest among South Asians and among population-based vs hospital-based studies. Meta-regression showed that moderate heterogeneity remained even after accounting for differences in studies by types of Asian subgroups included, study year, mode of delivery included, and study setting. Conclusion Obstetrical anal sphincter injury is more frequent among Asian versus white birthing individuals in multiple high-income, non-Asian countries. Qualitative and quantitative research to elucidate underlying causal mechanisms responsible for this relationship are warranted.
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Affiliation(s)
- Meejin Park
- Faculty of Health Sciences, Department of Global Health, McMaster University, Hamilton, Ontario, Canada (Ms Park)
| | - Susitha Wanigaratne
- Edwin S.H. Leong Centre for Healthy Children, SickKids Research Institute, Toronto, Ontario, Canada (Dr Wanigaratne)
| | - Rohan D'Souza
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada (Drs D'Souza and Muraca)
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Drs D'Souza and Muraca)
| | - Roxana Geoffrion
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (Dr Geoffrion)
| | - Sarah Williams
- Department of Anthropology, University of Connecticut, Mansfield, CT (Dr Williams)
| | - Giulia M. Muraca
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada (Drs D'Souza and Muraca)
- Faculty of Health Sciences, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Drs D'Souza and Muraca)
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden (Dr Muraca)
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Ishmail H, Ngene NC. Terminological use of 'African ancestry' Vis-à-Vis 'black race' in relation to genetically linked healthcare conditions. Case Rep Womens Health 2023; 40:e00567. [PMID: 38162379 PMCID: PMC10757182 DOI: 10.1016/j.crwh.2023.e00567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Habiba Ishmail
- Wits Reproductive Health and HIV institute, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynecology, Leratong Hospital, Krugersdorp, South Africa
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Childebayeva A, Zavala EI. Review: Computational analysis of human skeletal remains in ancient DNA and forensic genetics. iScience 2023; 26:108066. [PMID: 37927550 PMCID: PMC10622734 DOI: 10.1016/j.isci.2023.108066] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Degraded DNA is used to answer questions in the fields of ancient DNA (aDNA) and forensic genetics. While aDNA studies typically center around human evolution and past history, and forensic genetics is often more concerned with identifying a specific individual, scientists in both fields face similar challenges. The overlap in source material has prompted periodic discussions and studies on the advantages of collaboration between fields toward mutually beneficial methodological advancements. However, most have been centered around wet laboratory methods (sampling, DNA extraction, library preparation, etc.). In this review, we focus on the computational side of the analytical workflow. We discuss limitations and considerations to consider when working with degraded DNA. We hope this review provides a framework to researchers new to computational workflows for how to think about analyzing highly degraded DNA and prompts an increase of collaboration between the forensic genetics and aDNA fields.
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Affiliation(s)
- Ainash Childebayeva
- Department of Archaeogenetics, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
- Department of Anthropology, University of Kansas, Lawrence, KS, USA
| | - Elena I. Zavala
- Department of Molecular and Cell Biology, University of California, Berkeley, Berkeley, CA, USA
- Department of Biology, University of Oregon, Eugene, OR, USA
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Lam J, Aldridge R, Blackburn R, Harron K. How is ethnicity reported, described, and analysed in health research in the UK? A bibliographical review and focus group discussions with young refugees. BMC Public Health 2023; 23:2025. [PMID: 37848866 PMCID: PMC10583485 DOI: 10.1186/s12889-023-16947-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/10/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND The ethnicity data gap pertains to 3 major challenges to address ethnic health inequality: 1) Under-representation of ethnic minorities in research; 2) Poor data quality on ethnicity; 3) Ethnicity data not being meaningfully analysed. These challenges are especially relevant for research involving under-served migrant populations in the UK. We aimed to review how ethnicity is captured, reported, analysed and theorised within policy-relevant research on ethnic health inequities. METHODS We reviewed a selection of the 1% most highly cited population health papers that reported UK data on ethnicity, and extracted how ethnicity was recorded and analysed in relation to health outcomes. We focused on how ethnicity was obtained (i.e. self reported or not), how ethnic groups were categorised, whether justification was provided for any categorisation, and how ethnicity was theorised to be related to health. We held three 1-h-long guided focus groups with 10 young people from Nigeria, Turkistan, Syria, Yemen and Iran. This engagement helped us shape and interpret our findings, and reflect on. 1) How should ethnicity be asked inclusively, and better recorded? 2) Does self-defined ethnicity change over time or context? If so, why? RESULTS Of the 44 included papers, most (19; 43%) used self-reported ethnicity, categorised in a variety of ways. Of the 27 papers that aggregated ethnicity, 13 (48%) provided justification. Only 8 of 33 papers explicitly theorised how ethnicity related to health. The focus groups agreed that 1) Ethnicity should not be prescribed by others; individuals could be asked to describe their ethnicity in free-text which researchers could synthesise to extract relevant dimensions of ethnicity for their research; 2) Ethnicity changes over time and context according to personal experience, social pressure, and nationality change; 3) Migrants and non-migrants' lived experience of ethnicity is not fully inter-changeable, even if they share the same ethnic category. CONCLUSIONS Ethnicity is a multi-dimensional construct, but this is not currently reflected in UK health research studies, where ethnicity is often aggregated and analysed without justification. Researchers should communicate clearly how ethnicity is operationalised for their study, with appropriate justification for clustering and analysis that is meaningfully theorised. We can only start to tackle ethnic health inequity by treating ethnicity as rigorously as any other variables in our research.
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Affiliation(s)
- Joseph Lam
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK.
| | - Robert Aldridge
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, 98195, USA
- UCL Institute of Health Informatics, 222 Euston Rd, London, NW1 2DA, UK
| | - Ruth Blackburn
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK
| | - Katie Harron
- UCL Great Ormond Street Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK
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Salminen AT, Manga P, Camacho L. Race, pigmentation, and the human skin barrier-considerations for dermal absorption studies. FRONTIERS IN TOXICOLOGY 2023; 5:1271833. [PMID: 37886124 PMCID: PMC10598584 DOI: 10.3389/ftox.2023.1271833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
A functional human skin barrier is critical in limiting harmful exposure to environmental agents and regulating the absorption of intentionally applied topical drug and cosmetic products. Inherent differences in the skin barrier between consumers due to extrinsic and intrinsic factors are an important consideration in the safety assessment of dermatological products. Race is a concept often used to describe a group of people who share distinct physical characteristics. The observed predisposition of specific racial groups to certain skin pathologies highlights the potential differences in skin physiology between these groups. In the context of the human skin barrier, however, the current data correlating function to race often conflict, likely as a consequence of the range of experimental approaches and controls used in the existing works. To date, a variety of methods have been developed for evaluating compound permeation through the human skin, both in vivo and in vitro. Additionally, great strides have been made in the development of reconstructed human pigmented skin models, with the flexibility to incorporate melanocytes from donors of different race and pigmentation levels. Together, the advances in the production of reconstructed human skin models and the increased adoption of in vitro methodologies show potential to aid in the standardization of dermal absorption studies for discerning racial- and skin pigmentation-dependent differences in the human skin barrier. This review analyzes the existing data on skin permeation, focusing on its interaction with race and skin pigmentation, and highlights the tools and research opportunities to better represent the diversity of the human populations in dermal absorption assessments.
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Affiliation(s)
- Alec T Salminen
- U.S. Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, United States
| | - Prashiela Manga
- U.S. Food and Drug Administration, Office of Cosmetics and Colors, Center for Food Safety and Applied Nutrition, College Park, MD, United States
| | - Luísa Camacho
- U.S. Food and Drug Administration, National Center for Toxicological Research, Jefferson, AR, United States
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Khan A, Inkster AM, Peñaherrera MS, King S, Kildea S, Oberlander TF, Olson DM, Vaillancourt C, Brain U, Beraldo EO, Beristain AG, Clifton VL, Del Gobbo GF, Lam WL, Metz GAS, Ng JWY, Price EM, Schuetz JM, Yuan V, Portales-Casamar É, Robinson WP. The application of epiphenotyping approaches to DNA methylation array studies of the human placenta. Epigenetics Chromatin 2023; 16:37. [PMID: 37794499 PMCID: PMC10548571 DOI: 10.1186/s13072-023-00507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Genome-wide DNA methylation (DNAme) profiling of the placenta with Illumina Infinium Methylation bead arrays is often used to explore the connections between in utero exposures, placental pathology, and fetal development. However, many technical and biological factors can lead to signals of DNAme variation between samples and between cohorts, and understanding and accounting for these factors is essential to ensure meaningful and replicable data analysis. Recently, "epiphenotyping" approaches have been developed whereby DNAme data can be used to impute information about phenotypic variables such as gestational age, sex, cell composition, and ancestry. These epiphenotypes offer avenues to compare phenotypic data across cohorts, and to understand how phenotypic variables relate to DNAme variability. However, the relationships between placental epiphenotyping variables and other technical and biological variables, and their application to downstream epigenome analyses, have not been well studied. RESULTS Using DNAme data from 204 placentas across three cohorts, we applied the PlaNET R package to estimate epiphenotypes gestational age, ancestry, and cell composition in these samples. PlaNET ancestry estimates were highly correlated with independent polymorphic ancestry-informative markers, and epigenetic gestational age, on average, was estimated within 4 days of reported gestational age, underscoring the accuracy of these tools. Cell composition estimates varied both within and between cohorts, as well as over very long placental processing times. Interestingly, the ratio of cytotrophoblast to syncytiotrophoblast proportion decreased with increasing gestational age, and differed slightly by both maternal ethnicity (lower in white vs. non-white) and genetic ancestry (lower in higher probability European ancestry). The cohort of origin and cytotrophoblast proportion were the largest drivers of DNAme variation in this dataset, based on their associations with the first principal component. CONCLUSIONS This work confirms that cohort, array (technical) batch, cell type proportion, self-reported ethnicity, genetic ancestry, and biological sex are important variables to consider in any analyses of Illumina DNAme data. We further demonstrate the specific utility of epiphenotyping tools developed for use with placental DNAme data, and show that these variables (i) provide an independent check of clinically obtained data and (ii) provide a robust approach to compare variables across different datasets. Finally, we present a general framework for the processing and analysis of placental DNAme data, integrating the epiphenotype variables discussed here.
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Affiliation(s)
- A Khan
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, M5G 1L7, Canada
- Princess Margaret Cancer Center, Toronto, ON, M5G 2C4, Canada
| | - A M Inkster
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada
| | - M S Peñaherrera
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada
| | - S King
- Department of Psychiatry, McGill University, Montreal, QC, H3A 1A1, Canada
- Psychosocial Research Division, Douglas Hospital Research Centre, Montreal, QC, H4H 1R3, Canada
| | - S Kildea
- Mater Research Institute, University of Queensland, Brisbane, QLD, 4101, Australia
- Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, QLD, 4000, Australia
| | - T F Oberlander
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H 3V4, Canada
| | - D M Olson
- Department of Obstetrics and Gynecology, University of Alberta, 220 HMRC, Edmonton, AB, T6G 2S2, Canada
| | - C Vaillancourt
- Centre Armand Frappier Santé Biotechnologie - INRS and University of Quebec Intersectorial Health Research Network, Laval, QC, H7V 1B7, Canada
| | - U Brain
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H 3V4, Canada
| | - E O Beraldo
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada
| | - A G Beristain
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - V L Clifton
- Mater Research Institute, University of Queensland, Brisbane, QLD, 4101, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, 4006, Australia
| | - G F Del Gobbo
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, K1H 5B2, Canada
| | - W L Lam
- British Columbia Cancer Research Centre, Vancouver, BC, V5Z 1L3, Canada
| | - G A S Metz
- Canadian Centre for Behavioural Neuroscience, Department of Neuroscience, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | - J W Y Ng
- Faculty of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada
| | - E M Price
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, ON, K1H 5B2, Canada
| | - J M Schuetz
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada
| | - V Yuan
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada
| | - É Portales-Casamar
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
- Centre de Recherche du CHU Sainte-Justine, 3175 Côte-Sainte-Catherine Road, Montréal, QC, H3T 1C5, Canada.
| | - W P Robinson
- BC Children's Hospital Research Institute (BCCHR), 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada.
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, V6H 3N1, Canada.
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Park M, Wanigaratne S, D’Souza R, Geoffrion R, Williams SA, Muraca GM. Asian-white disparities in obstetric anal sphincter injury: Protocol for a systematic review and meta-analysis. PLoS One 2023; 18:e0291174. [PMID: 37682913 PMCID: PMC10490831 DOI: 10.1371/journal.pone.0291174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/08/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Obstetric anal sphincter injury (OASI) describes severe injury to the perineum and perineum and perianal muscles following birth and occurs in 4.4% to 6.0% of vaginal births in Canada. Studies from high-income countries have identified an increased risk of OASI in individuals who identify as Asian race versus those who identify as white. This protocol outlines a systematic review and meta-analysis which aims to determine the incidence of OASI in individuals living in high-income countries who identify as Asian versus those of white race/ethnicity. We hypothesize that the pooled incidence of OASI will be higher in Asian versus white birthing individuals. METHODS We will search MEDLINE, OVID, Embase, Emcare and Cochrane databases from inception to 2022 for observational studies using keywords and controlled vocabulary terms related to race, ethnicity and OASI. Two reviewers will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and Meta-analysis of Observational Studies (MOOSE) recommendations. Meta-analysis will be performed using RevMan for dichotomous data using the random effects model and the odds ratio (OR) as effect measure with a 95% confidence interval (CI). Subgroup analysis will be performed based on Asian subgroups (e.g., South Asian, Filipino, Chinese, Japanese individuals). Study quality assessment will be performed using The Joanna Briggs Institute Critical Appraisal tools. DISCUSSION The systematic review and meta-analysis that this protocol outlines will synthesize the extant literature to better estimate the rates of OASI in Asian and white populations in non-Asian, high-income settings and the relative risk of OASI between these two groups. This systematic summary of the evidence will inform the discrepancy in health outcomes experienced by Asian and white birthing individuals. If these findings suggest a disproportionate burden among Asians, they will be used to advocate for future studies to explore the causal mechanisms underlying this relationship, such as differential care provision, barriers to accessing care, and social and institutional racism. Ultimately, the findings of this review can be used to frame obstetric care guidelines and inform healthcare practices to ensure care that is equitable and accessible to diverse populations.
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Affiliation(s)
- Meejin Park
- Faculty of Health Sciences, Department of Global Health, McMaster University, Hamilton, ON, Canada
| | - Susitha Wanigaratne
- Sick Kids Research Institute, Edwin S.H. Leong Centre for Healthy Children, Toronto, ON, Canada
| | - Rohan D’Souza
- Faculty of Health Science, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- Faculty of Health Sciences, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Roxana Geoffrion
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Sarah A. Williams
- Department of Anthropology, Brown University, Providence, RI, United States of America
| | - Giulia M. Muraca
- Faculty of Health Science, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
- Department of Medicine, Clinical Epidemiology Division, Solna, Karolinska Institutet, Stockholm, Sweden
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