Sports and race betting are high-risk gambling activities used by young adults, yet limited research has examined how motives relate to outcomes assessed separately for each betting activity. This online survey examined associations between sports- and race-specific betting motives (enhancement, financial, social, coping) and betting expenditure, problem severity, and harm among young Australian adults. The sample comprised 188 participants aged 18-30 years (84.6% male; Mage= 24.11), including 185 sports betting participants and 127 race betting participants (defined as ≥2 bets in the past month and in a typical month over the past year). Separate linear regressions showed that financial motives were positively associated with sports betting expenditure (β = .16, p = .006), with no associations for race betting expenditure. Financial and coping motives were independently, positively associated with sports and race betting problem severity (sports: financial β = .34; coping β = .39; race: financial β = .19; coping β = .46) and harm (sports: financial β = .23; coping β = .47; race: financial β =.22; coping β = .49) in multivariable models (all p ≤ .004), demonstrating small-to-moderate associations for financial motives and moderate associations for coping motives. At the univariable level, social motives were positively associated with sports betting problem severity (β = .19, p= .007), and enhancement motives were positively associated with race betting problem severity (β = .32, p= .001). Findings highlight financial and coping motives as potential targets for early identification and prevention of harmful betting among young adults.
There are limited data on the impact of race/ethnicity on diagnosis/management of children with Wolff-Parkinson-White pattern (WPW). Investigate if detection of WPW by electrocardiogram (ECG) and risk stratification by exercise stress test (EST) and electrophysiology study (EPS) differ by race/ethnicity in children. We performed a retrospective cohort study of patients 0-21 years old, excluding those with congenital heart disease, using ECG, EST, and EPS databases at a children's hospital. The primary exposure was race/ethnicity. Outcomes were (1) detection of WPW pattern on ECG, (2) completion of EST, and/or (3) EPS. Likelihood and time to outcome were assessed with multivariable logistic regression and Cox regression, respectively, adjusted for birth year. Of 1,683,746 patients born between 1991 and 2021 and seen between 2010 and 2021, WPW pattern was detected in 898. Adjusting for birth year, Asian, Black, and Other race were associated with lower odds of WPW detection compared to White patients (OR 0.57, 0.66, 0.70; p ≤ 0.01). 616 WPW patients underwent EST, with Hispanic race having a lower odds of undergoing EST compared to White patients (OR 0.59; p ≤ 0.05). 739 WPW patients underwent EPS, with Black, Hispanic, and Other race having lower odds of EPS compared to White patients (OR 0.44, 0.53, 0.59; p ≤ 0.05). Non-White racial/ethnic groups had lower odds of ECG detection of WPW pattern. Among WPW patients, minority groups had lower odds of undergoing EST and EPS compared to White patients. Disparities may exist in referral or access to EST/EPS.
Implicit bias in medical education has been documented, but its influence on standardized assessments remains underexplored. This study examines whether patient demographic descriptors in clinical vignettes impact examinee multiple-choice question answer choice selection and clinical decision-making. A randomized, controlled survey was conducted among third- and fourth-year medical students and first-year residents. Participants (N = 376) answered clinical vignette multiple-choice questions in either a "standard group" (without demographic descriptors) or a "demographic group" (identical questions incorporating race, gender identity, or sexual orientation). Questions were grouped by question type (bias-dependent, bias-obscuring, and diagnostic-agnostic) based on whether the question stem enforced canonical pathologic associations with race and/or sociodemographic data (bias-dependent) or presented a noncanonical racial description (bias-obscuring) that could potentially lead medical trainees to select an incorrect answer choice. Performance was analyzed using Wilcoxon rank-sum tests (α < 0.0025). Participants in the standard group correctly answered more often bias-obscuring questions than those in the demographic group (66.5% vs. 58.8%, P < 0.001). Significant performance discrepancies were noted in questions related to homosexuality and sexually transmitted infection testing, sarcoidosis in Black females, Takayasu arteritis in individuals of Asian descent, and anemia in transgender individuals. Additionally, 52.4% of participants reported that race influenced their exam decision-making, while 64.1% and 55.9% indicated that gender identity and sexual orientation played roles. The majority (54.8%) attributed pro-White bias in medical decision-making to preclinical training. The inclusion of demographic descriptors, including race, sexual orientation, and gender identity, in standardized exam questions affects medical trainees' performance, potentially reinforcing bias.
Understanding national trends and disparities in infertility treatment utilization and modalities is crucial for equitable reproductive care. We examined age-standardized rates of infertility treatment utilization and specific treatment modalities among birthing individuals in the U.S. from 2011 to 2022, and assessed differences by race/ethnicity, socioeconomic status, and geographic region. To identify how trends in infertility treatment utilization among birthing individuals have changed in the United States from 2011 to 2022, and how utilization differ by treatment modalities, race, ethnicity, socioeconomic status, and geographic region. We performed a serial cross-sectional analysis using birth certificate data on live births (2011-2022) from the National Center for Health Statistics. Outcomes included infertility treatment utilization and modalities, including assisted reproductive technology (ART) and fertility-enhancing drugs and insemination (non-ART). We estimated age-standardized rates, average annual percent change (APC), and adjusted odds ratios (aOR) by race, ethnicity, socioeconomic status, and geographic region. From 2011 to 2022, age-standardized rates of infertility treatment utilization among 40,053,571 birthing individuals with live births increased from 1.55% to 2.18 % (APC: 2.81% [95% CI 2.15%-3.56%]), with non-ART decreasing (APC: -1.05% [-1.99% to -0.04%]) and ART increasing (APC: 6.01% [5.22%-6.94%]). In 2022, rates of infertility treatment utilization were the lowest among American Indian/Alaska Native in 2022 (0.76%), followed by Black (0.93%), Hispanic (0.98%), Multiracial (1.91%), White (2.89%), and Asian/Pacific Islander individuals (3.01%). After adjusting for covariates, non-White birthing individuals had significantly lower odds of infertility treatment (aOR ranged 0.46-0.84) than White counterparts. Disparities were marked by socioeconomic status: infertility treatment utilization was lowest among those used Medicaid insurance (0.34% vs 2.55% non-Medicaid) and those with a high school education or less (0.52% vs 2.37% college-educated). Compared with the Northeast (3.23%), the South (1.49%), West (2.25%), and Midwest (2.39%) had consistently lower rates of infertility treatment in 2011-2022. Similar patterns were observed by treatment modality. Among U.S. birthing individuals with live births (2011-2022), birth-certificate-recorded infertility treatment usage increased, with opposing trends in non-ART versus ART. Significant racial, ethnic, socioeconomic, and geographic disparities highlight opportunities to improve infertility care accessibility and equity.
Stroke is a significant cause of morbidity and mortality. There are racial, ethnic, and sex-based disparities in treatment and outcomes for patients with stroke. This study determined the association between race, ethnicity, and sex and prehospital stroke identification and discharge disposition. This was a multi-center, retrospective analysis of adult acute stroke patients presenting via Emergency Medical Services (EMS) between 01/01/2020 and 12/31/2022 who met criteria for inclusion into the local Get with the Guidelines - Stroke registry. Multivariable logistic regression modeled the association between sex, race, and ethnicity and EMS impression, adjusting for age, demographics, stroke severity, presentation with classic stroke symptoms, and EMS agency type (urban, suburban, or rural). Multivariable regression modeled discharge disposition, controlling for receiving hospital stroke certification, cardiovascular risk factors, acute intervention, and the above covariates. A total of 3,749 (83.5%) patients were identified with suspected stroke by EMS. After adjusting for covariates, males had greater odds of identification as a stroke compared to females (adjusted odds ration [aOR] 1.26, 95% CI 1.08-1.47); non-White patients had similar odds of identification as a stroke patient compared to White patients (aOR 1.00, 95% CI 0.55-1.82). Males also had higher odds of dying in hospital or being discharged to hospice compared to females (aOR 1.43, 95% CI 1.08-1.88). Male patients were more likely recognized as stroke by prehospital clinicians but had greater odds of a poor discharge disposition. Additional research into causes of these disparities in prehospital stroke identification may improve prehospital patient care and change ultimate outcomes.
African and Caribbean Black (ACB) immigrant adolescents experience unique constellations of risk factors that increase their vulnerability of both experiencing and initiating violence. Traditional disciplinary and punitive approaches are ineffective at addressing these root causes. Mental health interventions have the potential to reduce and prevent ACB adolescent violence; however, clinicians need culturally-responsive and community-informed strategies for violence prevention and advocacy. To meet this need, this paper employs Critical Race Theory and Intersectional frameworks to examine disparities in youth violence, emphasizing the roles of acculturative stress, social support deficits, and neighborhood disadvantage. This examination reveals equity-driven, culturally grounded strategies for violence prevention including increasing family support and parental monitoring of youth. Clinicians have an ethical responsibility to advocate for ACB families through authentic, trust-based engagement. Strategies for partnering with grassroots organizations and supporting efforts led by Black immigrant communities offer a pathway by which clinicians can promote meaningful and lasting change.
Leveraging a historical trauma framework, this study examined the associations between parent race-based traumatic stress (RBTS), parent racial identity (RI), and child internalizing symptoms within a sample of Black/African American parent-adolescent dyads. Utilizing a cross-sectional design, 201 parents (85.3% female) completed self-report measures regarding their experiences with RBTS and their RI, while their children (n = 201; 52.9% female; Mage = 11.58 years) reported on their own internalizing symptoms. Hierarchical linear regression analyses indicated that higher levels of parent individual and institutional RBTS were significantly associated with increased adolescent internalizing symptoms. Furthermore, parent RI was found to be a significant moderator; specifically, higher levels of parent private regard-one's personal feelings about their racial group-buffered the negative association between parent institutional RBTS and adolescent internalizing symptoms. These findings underscore the protective role of positive RI in interrupting the intergenerational transmission of stress and highlight the importance of culturally responsive interventions that foster racial resilience in Black families. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Early adolescence is marked by intensified identity exploration, yet little research has examined how meanings of gender and ethnic-racial identity are co-constructed within family relationships during the pubertal transition. The present qualitative study investigated how mothers and daughters construct and negotiate meanings of gender, ethnic-racial identity, and their intersection through dyadic conversation, and how these processes vary by daughters' pubertal status. Participants included mother-daughter dyads of Black girls (N = 45; Mage = 9.93, SD = .97; 69% identified as Black, 31% Black biracial) who engaged in structured identity dialogue tasks. Using reflexive thematic analysis followed by dyadic synthesis, we identified interactional processes through which identity meanings were initiated, scaffolded, negotiated, and stabilized. Across dyads, puberty functioned as a contextual intensifier, heightening emotional salience and social comparison in identity talk. In the early puberty dyads, mothers more frequently guided and defined identity meanings, whereas in the advanced puberty dyads, daughters increasingly asserted interpretive authority. Mother-daughter scaffolding operated as a relational coping process, with mothers and daughters jointly shaping how embodied change and social positioning were interpreted. Moments of misalignment and repair revealed how identity meanings were negotiated rather than transmitted. Grounded in the Phenomenological Variant of Ecological Systems Theory, findings position identity development during puberty as a relational, phenomenological process embedded within sociocultural context. By foregrounding dyadic interaction, this study extends developmental theory and highlights family dialogue as a critical microsystem linking pubertal vulnerability to identity formation.
End-stage kidney disease (ESKD) is often listed as a contributing rather than underlying cause of death, potentially understating its burden in underlying-cause surveillance. Using U.S. multiple-cause-of-death data, we evaluated trends, underlying-cause pathways, ESKD "penetration" into cause-specific mortality, and drivers of change in ESKD-involved deaths. Using CDC WONDER Multiple Cause of Death data (1999-2023), we identified ESKD-involved deaths among adults aged ≥25 years and calculated age-adjusted mortality rates (AAMR; 2000 U.S. standard). Joinpoint regression was performed using a log-linear model with a maximum of two joinpoints. Model selection was conducted using the Joinpoint Regression Program's default permutation-test procedure and grid-search settings. Average annual percent change (AAPC) and 95% CIs were estimated over the prespecified analysis intervals. For race-specific analyses, AAPCs were restricted to 1999-2020 bridged-race files; for urbanization analyses, AAPCs were restricted to 1999-2020. Underlying-cause composition was assessed using ICD-10 chapters and the NCHS 113 selected-cause list. ESKD penetration (Pg,t ) was estimated within each underlying-cause group, and a symmetric two-factor decomposition separated changes in ESKD-involved deaths into scale versus penetration components, comparing pre-COVID-19 and COVID-19-era periods. ESKD-involved AAMR increased from 14.51 (95% CI 14.33-14.69) per 100,000 in 1999 to 18.74 (18.58-18.91) in 2023 (AAPC 1.33%, 0.61-2.10). Increases were faster in males than females (2.06% vs. 1.07) and in adults aged ≥65 vs. 25-64 years (1.81% vs. 0.73). In race-specific analyses restricted to the 1999-2020 bridged-race files, Black individuals had the highest absolute mortality, whereas White individuals showed a significant increase. The underlying-cause structure shifted, with genitourinary causes becoming more prominent. Pg,t varied widely by cause and increased for selected categories, indicating growing ESKD co-occurrence with specific fatal pathways. Decomposition showed heterogeneous scale versus penetration contributions across causes and period-specific differences. ESKD involvement in U.S. mortality rose from 1999 to 2023 with marked subgroup inequities and shifts in underlying-cause pathways. Monitoring ESKD as a contributing cause, together with cause-structure and scale-penetration analyses, provides information beyond underlying-cause surveillance to support integrated prevention addressing CKD progression and its cardiometabolic and infectious complications.
To evaluate the impact of socioeconomic factors on survival in patients with HCC undergoing interventional LRT at a tertiary center. A retrospective cohort of 1,091 HCC patients treated with interventional LRT (2000-2022). Clinical and socioeconomic data (gender, insurance, race, education, language, marital status) were collected. Survival analysis utilized Kaplan-Meier and multivariable Cox regression to assess the impact of socioeconomic factors . Among identified patients (median age: 63 [IQR=12.14], 81% male), the majority had Medicare (43%) or private insurance (33%), were White (63%), had a college (42%) or high school (45%) education, and were married (51%). Median AFP was 11 (IQR=76); most were Child-Pugh B (72%), BCLC Stage A (66%) and ECOG 0 (75%). Overall mortality was 62%, and 23% underwent liver transplant. Female gender (HR 1.26, 95% CI 1.03-1.55, p = 0.028), lower education (high school vs. college; HR 1.24, 95% CI 1.04-1.50, p = 0.015), and being divorced (HR 1.43, 95% CI 1.08-1.90, p = 0.012) were independently associated with increased mortality. Asian race predicted improved survival (HR 0.44, 95% CI 0.29-0.67, p < 0.05). Asian race, male gender, marriage, and higher education independently predicted better survival in HCC patients receiving interventional LRT.
Introduction Prostate cancer (PCa) survivorship is associated with substantial psychological distress, yet racial differences in mental health outcomes are incompletely understood. We used multivariable logistic regression models to evaluate associations between race and post-diagnosis depressive episodes and patient-reported psychosocial outcomes, including quality of life, mental health, and social satisfaction, among PCa survivors in a diverse national cohort. Methods We conducted a cross-sectional study using the National Institutes of Health (NIH) All of Us Research Program Controlled Tier Dataset (version 8). Adults with electronic health records (EHR)-documented PCa who completed surveys after diagnosis were included. Non-Hispanic White (NHW) and Black participants were compared. Primary outcomes included depressive episodes after diagnosis and patient-reported quality of life, mental health, and social satisfaction. Multivariable regression models adjusted for age, time since diagnosis, socioeconomic factors, medical comorbidities, and baseline depression. Results Among 4,524 PCa survivors, 3,965 (87.6%) were NHW and 559 (12.4%) were Black. Black participants were younger (median 66.8 years vs 72.6, p<0.001) and experienced greater socioeconomic disadvantage (219 (39.2%) with <$25,000 annual household income vs. 262 (6.6%), p<0.001). Depressive episodes were more common among Black individuals (97 (17.4%) vs 509 (12.8%)). On univariate analysis, Black race was associated with higher odds of depressive episode (OR 1.31, 95% CI 1.07-1.59, p=0.008), but this association did not persist after adjustment (adjusted OR 0.80, 95% CI 0.60-1.06, p=0.119). In contrast, NHW participants reported worse psychosocial outcomes, with higher proportions reporting fair or poor quality of life, mental health, and social satisfaction. Black race was associated with lower odds of worse self-reported primary outcomes on univariate analysis; after adjustment, this association persisted for quality of life (adjusted OR 0.75, 95% CI 0.61-0.92, p=0.005). Conclusion Racial differences in EHR-documented depression were largely explained by socioeconomic factors, while patient-reported psychosocial outcomes were similar or more favorable among Black individuals. Divergence between clinical diagnoses and patient-reported measures highlights challenges in accurately assessing psychological distress across populations.
To compare the prevalence of food insecurity (FI) in adults with spinal cord injury (SCI) versus a matched control cohort without self-reported disability, identify demographic and socioeconomic correlates of food insecurity, and examine the association between FI and body mass index (BMI). Cross-sectional analysis. U.S. nationwide cohort from the All of Us Research Program. A cohort of 751 adults with SCI and a 1:3 age-, sex-, race-, and ethnicity-matched control cohort. Not applicable. FI, BMI. Overall, 19.0% of participants with SCI (n=143) experienced FI, which was higher than the prevalence observed in the control cohort (15.6%, p<0.05). In univariate analyses, risks of FI were elevated among participants who were Black or Hispanic, women, younger, unmarried, unemployed, had lower educational attainment, and lower income (all p<0.05). In multivariable logistic regression, higher income, being retired, and education beyond high school were associated with lower odds of FI, whereas race, ethnicity, sex, and marital status were no longer significant. In BMI analyses, FI was associated with higher BMI in unadjusted models, but this association attenuated after covariate adjustment. Exploratory analyses suggested effect modification by race: among White participants, FI was associated with higher BMI (+1.73kg/m²; p<0.05), whereas among Black participants, FI was associated with lower BMI (-3.22kg/m²; pinteraction=0.02). Sensitivity analyses using BMI≥25 or ≥30kg/m² yielded consistent racial-specific patterns. These findings highlight food insecurity as an important social determinant of health in SCI, shaped largely by socioeconomic conditions rather than demographic and injury characteristics. The association between FI and weight status in SCI may differ across racial groups, warranting further investigation into the pathways through which material hardship influences health in this population.
There is little information available about the effect self-reported color/race has on glycemic control in patients with type 1 diabetes (T1D) in Brazil. Therefore, we aimed at evaluating the role of self-reported color/race on glycemic control and on the types of prescribed insulin in this population. This was a cross-sectional study with 1760 patients with T1D with data collection between August 2011 and August 2014 in Brazil. An adjusted linear regression model was used to compare the hemoglobin A1c HbA1c) of patients who self-reported as Black and Brown to those who self-reported as White. Adjusted logistic regression models were used to evaluate the relationship between self-reported color-race and types of prescribed insulin. Black patients presented a difference in HbA1c of 0·74% (p-value < 0·001) in the unadjusted model and of 0·58% (p-value 0·004) in the adjusted model compared to White patients. Black patients had 53% (95% CI: 26%-70%) and 66% (95% CI: 44%-79%) less odds of receiving analogues for bolus and basal insulin, respectively, than White patients in the adjusted models. Brown patients presented a difference in HbA1c of 0·42% (p-value < 0·001) in the crude model and 0.23% (p-value 0·04) in the adjusted model compared to White patients. Brown patients had 49% (95% CI: 35%-60%) and 43% (95% CI: 27%-55%) less odds of receiving analogues for bolus and basal insulin, respectively, in adjusted models than White patients. Black and Brown Brazilian patients with T1D presented with higher HbA1c and received less advanced diabetes therapies compared to White patients.
Meningiomas are benign tumors that surround the brain and spinal cord. While studies have examined disparities in meningioma outcomes nationally, the meningioma mortality rate based on urbanization level is unclear. This study utilized the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database to investigate meningioma mortality rates and disparities between urbanization categories. Patients whose underlying cause of death was meningioma from 1999 to 2020 were included. Chi-squared testing determined mortality differences across urbanization groups (large central metro, large fringe metro, and medium metro). Multivariable logistic regression and adjusted odds ratios (OR) evaluated associations between death location and age, sex, race, and ethnicity. Age-adjusted meningioma mortality rates per 100,000 people with 95% confidence intervals (CIs) were reported. We analyzed a cohort of 12,274 patients. All older age groups demonstrated significantly lower odds of mortality in large central metros compared with other regions (OR: 0.54-0.69; p  < 0.05). Men had higher odds of dying in large central metro areas compared with women (OR: 1.09; p  = 0.047). Asian and African American patients had significantly higher odds of meningioma mortality in large central metros compared with their counterparts (OR: 7.53 vs. 3.42; p  < 0.001). Similarly, Hispanic/Latino ethnicity was associated with an increased likelihood of death in large central metros (OR: 6.97; p  < 0.001), but a lower likelihood in medium metros (OR: 0.77; p  = 0.029). No significant changes in mortality rates were observed based on urbanization. We report that urbanization plays a significant role in meningioma mortality, with varying effects by sex, race, ethnicity, and age.
Social determinants of health play a significant role in driving mental health disparities, yet comparatively little is understood about whether these factors affect different forms of psychological distress in distinct ways. Using data from Wave 12 of the Detroit Metro Area Communities Study (N = 2,238), this study examined associations between selected social determinants and self-reported anxiety, worry, and depression among Detroit adults. Outcomes reflected symptom frequency over the prior seven days. Separate survey- weighted ordinal logistic regression models were estimated for each outcome, adjusting for age, gender, race/ethnicity, education, income, employment, health insurance, and neighborhood satisfaction. Interaction terms between age and gender and between race/ethnicity and education were also evaluated. Nearly half of respondents reported at least one day of anxiety, worry, or depression in the preceding week, with anxiety being the most frequently reported mental health indicator, followed by worry and depression. Older age and greater neighborhood satisfaction were consistently associated with lower odds of distress across all models. Higher income was associated with reduced odds of worry and depression, while recent employment was linked to lower odds of worry. Initial gender differences diminished after adjusting for socioeconomic and contextual factors. Some interaction effects suggested that the relationship between educational attainment and mental health varied across racial and ethnic groups, though these findings require cautious interpretation due to model convergence limitations. These results highlight the importance of neighborhood and socioeconomic conditions in shaping mental health within historically marginalized urban communities, and point to the need for place-based and equity-focused approaches to addressing psychological distress.
Generative AI (genAI) is rapidly entering healthcare, but public comfort may vary in ways that could undermine equitable adoption. Using two independent cross-sectional survey waves of US adults conducted in May 2023 (N = 3130) and November 2025 (N = 3088) on the Outbreaks Near Me participatory surveillance platform, we assessed changes in awareness of genAI and four comfort and perception measures. The percentage of respondents reporting they had heard "a lot" about genAI rose from 26.5% (95% confidence interval [CI]: 24.5, 28.5) to 42.9% (95% CI: 40.6, 45.3), yet overall comfort with AI-led primary care and AI-led therapy changed minimally (-1.0 and -0.7% points, respectively). Subgroup trends diverged sharply by political identity, age, and race. Notably, Republicans trended more favorably from 2023 to 2025 while Democrats declined (interaction odds ratios across the four measures ranging from 1.69 [95% CI: 1.19, 2.39] to 2.11 [95% CI: 1.54, 2.90]). Emerging divides suggest receptivity to genAI in healthcare may become increasingly shaped by political identity rather than clinical evidence or personal experience, complicating equitable deployment.
Close relationships are often physiologically synchronous, showing correlated changes in cardiovascular reactivity that vary by relationship quality and predict well-being. Little is known about physiological synchrony among dementia caregiver-care recipient dyads, which may be impacted by the chronic strain of caregiving and functional declines due to dementia. The present study examined physiological synchrony among caregivers and care recipients in daily life using heart rate data and whether synchrony varied by interpersonal tensions, relationship type, and race. A total of 148 Alzheimer's disease and related dementia (ADRD) caregivers (ages 22 to 86; 27% Black; 79% female; 63% spousal caregivers) and their care recipients participated in a 5-day ecological momentary assessment study in which caregivers completed mobile phone surveys every three hours, six times per day, and both caregivers and care recipients wore mobile heart rate monitors 24hours per day. Stability and influence models revealed that caregivers and care recipients were physiologically synchronous in daily life (i.e., past moment heart rate of one dyad member was associated with current moment heart rate of the other dyad member). Physiological synchrony was stronger for spousal and White caregiver dyads, particularly during periods of higher interpersonal tension, whereas Black caregiver dyads exhibited physiological synchrony during periods of lower interpersonal tension. This study adds to the growing literature on physiological synchrony by examining an understudied interpersonal context of dementia caregiving in a diverse sample. Implications of these findings for interventions among ADRD caregiving dyads are discussed.
To (1) identify cardiac arrest (CA) survivors' and their caregivers' stressors and coping and compensation strategies related to brain health and (2) gather feedback on a proposed brain health lifestyle intervention for this population. We conducted two focus groups with dyads of CA survivors and their caregivers (N = 9 dyads) and ten interviews (N = 10 dyads), recruited from the Sudden Cardiac Arrest Foundation's Cardiac Arrest Survivor Alliance, BuildClinical, and provider referrals between 9/2024 and 5/2025. We purposefully sampled to include populations at-risk for cognitive decline based on race and ethnicity. We conducted rapid qualitative data analysis of our focus groups and interview transcripts. Dyads described several sources of brain health stress including survivors' cognitive changes, fear of further decline, and concerns about caregiver stress. Dyads reported using coping strategies including peer support, professional mental health treatment, acceptance strategies, and physical activity, and compensation strategies including delegating more tasks to the caregiver, using organizational aids, visual aids, and pacing strategies. Dyads endorsed proposed program content and recommended additional content on nutrition and diet, managing emotional distress, and psychoeducation on the impact of CA on the brain. Survivors and caregivers experience ongoing stressors related to brain health, though they develop coping and compensation strategies that merit further study.
RRehabilitation programs targeting hospitalized geriatric patients reduce functional decline and 30-day readmission rates. Limited data exist regarding using rehabilitation programs with Native Hawaiian and Other Pacific Islander (NHPI) and Asian populations. In the current study, the Acute Care for Elders (ACE) program was implemented to help minimize delirium, prevent deconditioning, and secure appropriate discharge. Utilizing a multidisciplinary team protocol, patients older than age 60 with an Activity Measure for Post-Acute Care (AMPAC) score of at least 18 and admitted within the preceding 3 days were eligible for inclusion. Via retrospective chart review, outcomes and demographic data were compared among those who completed the program (Completed), disenrolled prematurely (Early Termination), or declined enrollment (Declined). The median age was 73 years (25%ile, 75%ile: 68, 80) with 49% Asian, 19% NHPI, and 32% White or other race. Median Length of Stay (LOS) for Completed, Early Termination, and Declined groups were 3.9, 9.9 and 4.0 days respectively (P=.003). Discharge disposition varied significantly, with 90% of Completed patients returning home versus 46% in the Early Termination group (P=.002). Completion of the ACE protocol was significantly associated with reduced LOS and higher rates of home discharge among Asian populations (P=.033).
Despite legal and social deterrents, disability-based discrimination remains prevalent. Whether adults with hearing loss experience more discrimination is understudied. To examine whether individuals with hearing loss, compared to those without, faced more day-to-day and lifetime experiences of discrimination. This cross-sectional study included participants (n = 2954) from the Survey of the Health of Wisconsin (2008-2013). The determinant of interest was self-reported hearing loss. Outcomes were five self-reported experiences of discrimination capturing day-to-day (treated as less smart or with less respect) and lifetime (treated unfairly at school, in getting a job, or at work) discrimination. We used age-sex-adjusted and fully-adjusted (age, sex, race and ethnicity, educational attainment) multivariable generalized linear models with a binomial distribution and log-link function to test associations between hearing loss and discrimination. Results are presented as prevalence ratios (PR) with corresponding 95% confidence intervals (CI). Among the participants, 30.5% (n = 900) self-reported hearing loss. In age-sex-adjusted and fully-adjusted models, hearing loss was associated with higher prevalence of four experiences of discrimination, being treated (1) as though they were not smart (PR 1.33; 95% CI 1.15, 1.53), (2) with less respect or courtesy (PR 1.31; 95% CI 1.14, 1.50), (3) unfairly at school/training (PR 1.30; 95% CI 1.11, 1.52), and (4) unfairly at work (PR 1.16; 95% CI 1.06, 1.28). Hearing loss was not associated with being treated unfairly in getting a job (PR 1.10; 95% CI 0.95, 1.27). Overall, findings suggest individuals with hearing loss experience higher levels of discrimination, underscoring the need for interventions to reduce these discriminatory behaviors.