搜索结果：Ethnicity & disease

The COVID-19 pandemic, caused by SARS-CoV-2, has led to significant global mortality and morbidity. Angiotensin-converting Enzyme 2 (ACE2) has been identified as the primary receptor for viral entry into host cells and is believed to play a critical role in disease progression and severity. While ACE2 expression has been studied across various populations, data remains limited for underrepresented ethnic groups, such as the Kurdish population. A prospective pilot study was conducted with 45 participants, divided equally into three groups (n = 15 each): mild cases, severe cases, and healthy controls. Whole blood samples were collected to assess hematological and biochemical parameters. ACE2 mRNA expression was analyzed using quantitative real-time PCR (qRT-PCR). Group comparisons were performed using one-way ANOVA for ΔCq values and nonparametric tests for nonnormally distributed variables. ACE2 expression was significantly upregulated in patients with severe COVID-19, as indicated by lower ΔCq values compared to controls (mean difference = 0.568; adjusted p = 0.032). No significant difference was observed between mild cases and controls (p = 0.138). Furthermore, severe disease was characterized by markedly increased inflammatory markers (CRP, ESR, and ferritin) and hepatic enzymes (AST/GOT and ALP), alongside a decrease in lymphocyte counts. Also, CRP, ESR, and GPT were identified as the most significant predictors of disease severity in a machine learning analysis using XGBoost with SHAP interpretation. Demographic analysis revealed a significant age difference between controls and patients; however, no difference was observed between mild and severe cases. The sex distribution was comparable across all study groups. Reduced lymphocyte counts and systemic inflammatory responses, specifically elevated CRP, ESR, and ferritin levels, were closely associated with disease severity in COVID-19. Although ACE2 expression results provide preliminary evidence that the Kurdish cohort's ACE2 mRNA expression is elevated in cases of severe COVID-19, its contribution to disease classification was minimal, indicating that multiple inflammatory and RAAS-related mechanisms, rather than ACE2 expression alone, drive disease progression.

Vogt-Koyanagi-Harada (VKH) disease has been historically associated with specific ethnic groups, suggesting an underlying susceptibility. Prior to this study, no meta-analysis had synthesized the global epidemiology of VKH, and therefore, information on its geographic distribution remained incomplete. The present study aims to determine the global distribution of VKH disease diagnosis in individuals presenting with uveitis. A systematic review and meta-analysis of quantitative studies published between 2001 and 2025 in PubMed, SciELO, and LILACS was conducted following PRISMA-P guidelines. Case reports were excluded. Risk of bias was assessed using the Murad assessment tool for case series. A random-effects model was used to pool frequency estimates with 95% confidence intervals and prediction intervals. Of 7153 articles identified, 258 studies were analyzed, spanning six continents and 44 countries. The estimated frequency of VKH among uveitis cases was 5.11% (CI:4.31-5.90%; PI: 0.00-15.18%) overall, with predominance of females. When subgrouped into pediatric and adult populations, the estimated frequency was 2.43% (CI:1.83-3.02%; PI: 0.00-6.38%) and 6.15% (CI:4.06-8.24%; PI: 0.00-19.77%), respectively. Frequencies varied across regions, with higher rates reported in Southeast Asia, East Asia, and Africa, and lower rates in North America, Europe, and Oceania. Regarding the quality evaluation, most studies were considered as medium-high quality (162/169, 96%). This systematic review and meta-analysis support the existence of geographical differences in VKH disease expression and the need for additional epidemiological research, particularly in underrepresented regions. These findings should be interpreted in the context of methodological heterogeneity and potential publication and geographic bias.

The mechanisms underlying racial/ethnic differences in dementia incidence and pathology are multifactorial, and hypertension represents an actionable target for reducing these differences. We aimed to estimate the extent to which controlling for hypertension mediates racial/ethnic inequities in neuroimaging markers of brain aging. The Health and Aging Brain Study-Health Disparities cohort is a highly phenotyped, racially and ethnically diverse cohort of cognitive aging. We used marginal structural models with inverse probability weights to estimate total and controlled direct effects of race/ethnicity, hypertension, and systolic blood pressure (SBP) at baseline, with neuroimaging markers measured on average 2 years later. Neuroimaging markers of brain aging were measured at the 2-year follow-up. Among Black and Hispanic participants with any neuroimaging data at the second visit (overall N = 1,347), 68% and 71% were women, 75% and 67% had hypertension, and the mean age was 61 and 63 years, respectively. Black and Hispanic participants had greater white matter hyperintensity volume (WMHV) compared with non-Hispanic White (NHW) participants (n = 1,333, β [95% CI]: Black 2.08 [1.68-2.59], Hispanic 0.99 [0.91-1.08]). After analytically setting hypertension status to absent, Black-NHW inequities in WMHV were attenuated (β [95% CI]: 1.3 [1.01-1.65]). Black participants had lower amyloid deposition compared with NHW participants (n = 679, β [95% CI]: -0.29 [-0.46 to -0.12]), but analytically controlling for hypertension did not appreciably change estimates. Compared with NHW participants, Hispanic participants had lower Alzheimer disease meta-region of interest cortical thickness (n = 1,005, β [95% CI]: -0.20 [-0.34 to -0.07]), but neither hypertension nor SBP significantly mediated this difference. Medial temporal lobe tau-PET standardized uptake value ratio did not significantly differ in Black or Hispanic participants compared with NHW participants (n = 408). Black-NHW inequities in subclinical cerebral small vessel disease may be mitigated by population-level efforts to reduce hypertension prevalence. Future studies should extend this work to examine clinical outcomes.

Background/Objectives: Precision nutrition is moving beyond population-based guidance and isolated gene-diet interactions toward integrative models of dietary response. However, current approaches remain fragmented across nutrigenomics, microbiome research, multi-omics profiling, digital health, and machine learning. This review proposes the Nutri-Exposome Intelligence Framework as a conceptual, data science-driven model for integrating cumulative dietary, environmental, microbial, molecular, clinical, and digital exposures for precision chronic disease prevention. Methods: This conceptual review synthesizes the literature on precision nutrition, nutrigenetics, nutrigenomics, exposomics, gut microbiome research, multi-omics integration, wearable and biomarker-based monitoring, and machine learning in nutrition studies. Evidence was organized into a framework linking exposure assessment, host susceptibility, microbiome-mediated biotransformation, molecular response profiling, computational modelling, personalized intervention, and longitudinal feedback. Results: The proposed framework consists of seven interconnected layers: diet, environment, and lifestyle exposures; host genome and microbiome; multi-omics molecular responses; machine learning-based integration; risk prediction and responder stratification; personalized dietary intervention; and wearable and biomarker-based feedback. It positions the nutri-exposome as a cumulative exposure-response system and highlights how machine learning can support data harmonization, feature engineering, predictive modelling, responder classification, explainable interpretation, and adaptive refinement of dietary recommendations. Key applications include obesity, type 2 diabetes, cardiovascular disease, metabolic dysfunction-associated steatotic liver disease, cardiovascular-kidney-metabolic syndrome, and broader cardiometabolic prevention. Conclusions: Nutri-exposome intelligence offers a structured pathway for transforming complex nutrition data into predictive, explainable, and adaptive precision nutrition strategies. Implementation will require longitudinal and multi-ethnic cohorts, standardized metadata, causal validation, interpretable machine learning, ethical governance, and equitable access to support responsible clinical and public health translation globally.

This study aims to assess the association between HIV infection and cardiovascular disease (CVD) incidence, with a focus on sex differences and the role of immune status. Retrospective cohort study using electronic health records from the All of Us (AoU) Research Program. We identified people with HIV (PWH) and matched them to people without HIV (PWoH) using propensity score matching (PSM) (1&#x200a;:&#x200a;5) by sex, age, and race/ethnicity. The matched cohort was then restricted to participants who were free of CVD before the index date. We used Cox proportional hazards models, including an interaction term between sex and HIV status, to assess sex differences in the association between HIV status and incident CVD, adjusting for potential confounders. Subgroup analyses evaluated effect modification by viral suppression (HIV RNA&#x200a;<&#x200a;50&#x200a;copies/ml) and preserved immune function (CD4+ cell count >500&#x200a;cells/&#x3bc;l). After PSM, we identified 4803 PWH without preexisting CVD and matched them with 24&#x200a;276 PWoH. Compared to their matched PWoH, women with HIV had an elevated adjusted hazard ratio (aHR) for CVD [aHR&#x200a;=&#x200a;1.933, 95% confidence interval (CI): 1.709-2.188] than men with HIV (aHR&#x200a;=&#x200a;1.435, 95% CI: 1.313-1.568). In subgroup analyses, compared with women without HIV, women with HIV remained at higher risk of CVD despite viral suppression (aHR&#x200a;=&#x200a;1.929, 95% CI: 1.565-2.378) or preserved immune function (aHR&#x200a;=&#x200a;1.813, 95% CI: 1.455-2.259). In contrast, no significant differences were observed between men with HIV and well controlled men without HIV (aHR&#x200a;=&#x200a;1.133, 95% CI: 0.964-1.332). Understanding sex-specific drivers of CVD risk is crucial for developing targeted interventions to prevent CVD in women with HIV and men with HIV.

Vascular disorders of the intestine remain important contributors to gastrointestinal mortality in the United States. Despite advances in diagnostic imaging and endovascular therapy with improved outcomes, national trends in age-adjusted mortality rates (AAMR) and disparities across demographic and geographic groups have not been fully characterized. We obtained mortality data for vascular intestinal disorders from the CDC WONDER database (1999-2024) using ICD-10 code K55. Rates were age-adjusted to the 2000&#x2009;US standard and per 100,000 person-years. Analyses stratified data by sex, race/ethnicity, US region, and urbanization. Joinpoint regression identified trend periods and estimated annual percent changes (APC); the overall trend was summarized by the average annual percent change (AAPC). From 1999 to 2024, there were 214,372 recorded deaths from vascular disorders of the intestine. The overall AAMR declined from 3.27 (95% confidence interval: 3.20-3.34) in 1999 to 1.82 (1.78-1.86) in 2024 (AAPC: -2.33%). Among women, rates fell from 3.53 to 1.97 (AAPC: -2.35%), and among men from 2.84 to 1.63 (AAPC: -2.21%). By race/ethnicity, Black or African American individuals experienced a decrease from 3.95 to 2.35 (AAPC: -2.16%), Hispanics from 2.60 to 1.58 (AAPC: -2.49%), and Whites from 3.25 to 1.88 (AAPC: -2.17%). Regionally, the Northeast saw the steepest decline from 3.05 to 1.79 (AAPC: -2.50), followed by the West from 3.19 to 1.69 (AAPC: -2.47%), the South from 3.40 to 1.88 (AAPC: -2.34%), and the Midwest from 3.37 to 1.97 (AAPC: -2.11%). Both urban and rural areas demonstrated a pronounced decline (3.26 to 1.70, AAPC: -3.16%, and 3.39 to 2.43, AAPC: -1.58%, respectively). Mortality due to vascular disorders of the intestine in the US has declined substantially from 1999 to 2024 across all major demographic and geographic subgroups. However, the pace of decline has varied; most notably, urban populations and the Northeast experienced the greatest reductions. Persistent disparities in mortality among ethnic groups and in various geographical settings highlight the need for targeted prevention strategies, timely diagnosis, and equitable access to advanced vascular interventions.

Chronic kidney disease (CKD) has emerged as a leading chronic condition contributing to global mortality and disability. Its early stages are often asymptomatic, leading to delayed detection. In China's western ethnic minority regions, characterized by geographical dispersion, insufficient primary healthcare resources, and relatively low public health literacy, the early identification and effective management of CKD face more complex challenges. Focusing on the Qiandongnan Miao and Dong Autonomous Prefecture in Guizhou Province as the study area, this research aimed to construct an integrated model for CKD early screening and tiered management adapted to regional characteristics. It sought to identify key barrier factors and assess the feasibility and application potential of the model in real-world primary care settings. Employing a multi-data source study design combining cross-sectional surveys with integrated real-world clinical data, the study was conducted in Qiandongnan Prefecture. Data collection involved public questionnaires (n&#x202f;=&#x202f;1,769) and surveys of primary healthcare workers (n&#x202f;=&#x202f;960), alongside the collation of regional urine albumin-to-creatinine ratio (ACR) testing data and renal biopsy/pathological spectrum information. Primary outcome measures included public CKD awareness levels, screening behavior participation, primary healthcare worker management competency, ACR testing coverage, and CKD clinical staging with pathological type distribution. Secondary measures encompassed associations between public behavior and screening testing, as well as resource availability and capacity differentiation among primary care institutions. Analytical methods included descriptive statistics, multivariable regression analysis, and latent class analysis. Overall public CKD awareness was low, and screening behavior participation was limited; however, a significant positive correlation existed between the two. Primary healthcare workers exhibited stratified competency in risk assessment, indicator application, and management pathway knowledge. ACR testing rates were constrained by both behavioral willingness and technical resource limitations. Most CKD patients were in G1-G2 stages, with primary glomerular diseases constituting the predominant pathological type. The integrated model demonstrated good operational feasibility in optimizing screening pathways and enhancing tiered management capacity. The integrated CKD early screening and tiered management model constructed in Qiandongnan Prefecture demonstrates the feasibility of linking behavioral, institutional, and clinical dimensions for early detection and management, as it integrates public awareness, primary care capacity, and clinical data into a unified framework. Its methodological contribution lies in the use of multi-source data and latent class analysis, while its practical contribution includes the identification of critical breakpoints and actionable recommendations for screening, ACR testing, and health education. Future directions should focus on longitudinal validation, application in other regions, and incorporation of advanced predictive models, and results should be interpreted in the context of regional characteristics and resource limitations.

Early onset renal cell carcinoma (EORCC), defined as diagnosis at <47 years, accounts for 3% to 7% of all renal cell carcinoma cases, and the incidence has increased significantly. Up to 82.3% of EORCC cases are clear cell type (EOccRCC). Comprehensive data on the clinicopathologic features and survival outcomes in this subgroup remain limited. This study aimed to investigate the clinicopathologic characteristics and survival patterns of EOccRCC in Texas. This cohort study utilized anonymized data from the Texas Cancer Registry to examine cases of EOccRCC. Clinicopathologic features were analyzed, and survival outcomes were assessed using log-rank (Mantel-Cox) tests and Kaplan-Meier survival curve analyses. Patients in different ethnic groups were compared using post hoc pairwise chi-square tests for baseline characteristics, and adjusted hazard ratios of all-cause and cancer-specific mortality with multivariable Cox models were reported. A total of 4223 EOccRCC cases (age range 5-46 years, mean age 39.7) were identified. The majority of patients were male (60.1%), White (90.7%), non-Hispanic (57.3%), and obese (61.9%). At the time of diagnosis, 76.3% of patients had American Joint Committee on Cancer (AJCC) stage 1 disease and 6.7% had stage 4 disease. By the last follow-up, 13.1% of patients had died, with half of the deaths attributed to ccRCC. Mexican Hispanic ethnicity had a poorer prognosis (P&#x2009;<&#x2009;0.001), whereas obesity (body mass index &#x2265; 30 kg/m2) had an increased trend of long-term cancer-specific survival (P&#x2009;<&#x2009;0.001). Other significant prognostic factors included AJCC stage, distant metastasis, tumor size, age, and sex. Mexican Hispanic patients were more likely to present with advanced disease, larger tumor size, uninsured status, and high neighborhood poverty, in comparison to non-Hispanic and other Hispanic patients. In adjusted analyses, Mexican Hispanic ethnicity was associated with higher all-cause and disease-specific mortality versus non-Hispanic, while other Hispanic patients had lower mortality compared to non-Hispanic. EOccRCC trends increased in Texas and showed multiple discrepancies in clinicopathologic features and survival. Mexican Hispanic patients presented with more advanced disease, higher rates of being uninsured, and greater neighborhood poverty level and demonstrated poorer prognosis compared to non-Hispanic and other Hispanic populations.

Artificial Intelligence (AI) is transforming personalized medicine, yet its efficacy constitutes a dynamic factor in the field of health and personalized medicine. This study compared ChatGPT's ability to construct dietetic plans and provide nutritional advice against professional dietitians. Three dietitians and ChatGPT generated diet plans and gave recommendations for (i) obesity/dyslipidemia, (ii) obesity/ dyslipidemia/ hypertension, and (iii) obesity/dyslipidemia/type 2 diabetes which were compared with each other and official recommendations. Prompts were developed via systematic iterative refinement. Macro- and micronutrient content was analyzed using "Explore Food" software. ChatGPT's performance was also evaluated across sexes and four ethnic groups (Caucasian, Asian, Afro-American, Mexican). The non-parametric Mann-Whitney U Test was used. Dietitians recommended more carbohydrates, sugars, saturated fats, sodium, chloride, and iodine, while ChatGPT suggested higher polyunsaturated fats for obesity/ dyslipidemia and obesity/dyslipidemia/ hypertension. In addition, for obesity/ dyslipidemia/ hypertension dietitians proposed more energy and fiber compared to ChatGPT. In the case of obesity/dyslipidemia/diabetes dietitians proposed more sugars. Dietitians' plans were higher in vitamin C and other minerals in the case of obesity/ dyslipidemia. Vitamin D was low in all plans. Accuracy relative to official guidelines was comparable: 50-100% for dietitians versus 55-83% for ChatGPT across all conditions. No recommendation was made for adherence to the Mediterranean diet from ChatGPT, in contrast to dietitians. Overall, ChatGPT proposed higher energy plans for men than women (p<0.05). However, ethnic subgroup analysis showed this difference was significant only for Caucasian and Mexican cases. In conclusion, ChatGPT had a comparable ability to dietitians to design diet plans and provide nutritional counseling for people with obesity, hypertension, or type 2 diabetes. Its performance in specific ethnic groups may be limited. The value of human clinical judgment and interpersonal interaction in nutrition counseling is essential for patient engagement and optimal outcomes.

Case finding, which actively identifies undiagnosed conditions, is key to tackling the growing chronic disease burden, especially in disadvantaged groups. Diseases like type 2 diabetes, cardiovascular disease, and chronic obstructive pulmonary disease already cause millions of preventable deaths, with numbers rising due to aging populations, urbanization, and widening inequalities. The poorest communities bear the heaviest load, with higher disease rates and lower diagnosis. Traditional healthcare models, which wait for patients to seek care, leave millions undiagnosed and untreated. Proactive case finding is a proven way to reduce disparities, improve outcomes, and ease the strain on healthcare systems. This review identified two main approaches: targeted searches of primary care electronic health records (EHRs) to identify and engage high-risk individuals, and opportunistic screening in community, workplace, and emergency department settings. Systematic reviews and smaller observational studies, predominantly from high-income healthcare systems, support community-based health checks in trusted venues, workplace hypertension screening, and follow-up of elevated blood pressure readings in emergency departments, though evidence for these approaches is more limited. A stepped-wedge RCT found that targeted outreach nearly doubled diagnosis and treatment rates for cardiovascular risk factors compared with opportunistic case-finding (19.7% vs 10.8%). Meta-analyses of over 480,000 women found that self-sampling approximately doubled cervical screening uptake, with uptake increasing threefold when combined with community health worker support among under-screened ethnic minority and socioeconomically disadvantaged women. A cluster-randomised trial of over 74,000 participants showed that active case-finding using symptom questionnaires and handheld flowmeters identified four times more undiagnosed COPD than opportunistic screening, and was cost-effective at &#xa3;16,596 per QALY gained. This review identifies targeted case-finding in underserved communities as an evidence-based, high-impact strategy for early detection of chronic disease, provided it is integrated with sufficient downstream diagnostic and treatment capacity.

Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder influenced by environmental exposures and genetic susceptibility. Despite numerous studies, the effects of key susceptibility genes remain inconsistent across populations, and their overall clinical relevance is unclear. Following PRISMA guidelines and registered in PROSPERO (ID: CRD420251077565), we conducted a systematic review and meta-analysis of studies published between 2010 and 2025. Eighteen unique studies were included, ranging from small cohorts (n&#x202f;=&#x202f;36) to large biobank analyses (&#x223c;4.5 million participants), collectively evaluating five candidate genes: SERPINA1, HHIP, IREB2, SFTPD, and FAM13A. Pooled hazard ratios (HRs) were calculated, with subgroup analyses by ethnicity and variant-level differences. Associations with spirometric parameters (FEV1, FEV1/FVC) were examined to assess clinical relevance. SERPINA1 demonstrated the strongest significant with COPD (HR&#x202f;=&#x202f;2.47). A significant association was also observed for SFTPD, although based on fewer studies. Subgroup analysis by ethnicity/geographical region revealed the highest pooled risk in East Asians (HR&#x202f;=&#x202f;2.18), significant associations in Europeans (HR&#x202f;=&#x202f;1.46) and Americans (HR&#x202f;=&#x202f;1.47), and a weaker or potentially protective effect in Oceania (HR&#x202f;=&#x202f;0.67). SERPINA1 risk correlated with lung function decline (FEV1: r&#x202f;=&#x202f;-0.64; FEV1/FVC: r&#x202f;=&#x202f;-0.71), highlighting translational relevance. SERPINA1 emerges as the most clinically relevant genetic determinant of COPD, linking susceptibility to measurable spirometric impairment, with effects varying by ethnicity. These findings emphasize the need for genetic screening integrated with lung function assessment and ethnicity-specific risk stratification to advance precision management of COPD.

Life expectancy in Aotearoa New Zealand has increased over recent decades, but these increases have not been distributed equally across population groups. Examining how changes in cause-specific mortality have contributed to changes in life expectancy can improve understanding of evolving mortality patterns and persistent inequities. This study quantified the contribution of major causes of death to changes in life expectancy over approximately two decades. Mortality data from the New Zealand Mortality Collection and population estimates from Statistics New Zealand were used to calculate life expectancy at birth for M&#x101;ori, Pacific, Asian, and European and Other populations for the periods 2001-2003 and 2020-2022. Changes in life expectancy were decomposed by age and cause of death using the Arriaga method. Deaths were grouped into major disease categories and selected individual causes to estimate their contribution to the change in life expectancy. Life expectancy increased for all ethnic groups, with the largest absolute increases observed among M&#x101;ori. Improvements were driven primarily by reductions in mortality at adult and older ages. Across all ethnic and sex groups, declines in cardiovascular disease and cancer mortality accounted for more than half of the total change in life expectancy. Reductions in mortality from diabetes and smoking-related conditions also contributed to increases among M&#x101;ori and Pacific peoples. Despite these improvements, substantial ethnic inequities in life expectancy remain. Increases in life expectancy in Aotearoa New Zealand between 2001-2003 and 2020-2022 were driven largely by reductions in mortality from major non-communicable diseases, primarily cardiovascular disease and cancer. M&#x101;ori experienced some narrowing of the life expectancy gap relative to European and Other populations, whereas the gap for Pacific peoples remained largely unchanged. Despite overall improvement, substantial inequities persist. Further increases are likely to depend on strengthening primary prevention, particularly reductions in smoking and cardiovascular risk factors, alongside improved participation in screening and early detection programmes, including the potential role of lung cancer screening, and ensuring equitable access across care pathways.

Non-communicable diseases (NCDs) are a major health challenge in China. This study examined comorbidity prevalence among outpatients in Yunnan and its association with health-related quality of life (HRQoL). Using stratified cluster sampling, 5,978 outpatients (2019-2022) were recruited. Data on comorbidities, HRQoL (EQ-5D-5L), and sociodemographics were analyzed via structural equation modeling. Mean age was 38.1&#x202f;years; 56.8% female. Nearly half (49.1%) had &#x2265;1 NCD. Mean HRQoL score was 0.89&#x202f;&#xb1;&#x202f;0.20. HRQoL was positively associated with socioeconomic status (&#x3b2;&#x202f;=&#x202f;0.170, 95%CI: 0.140-0.199), Han ethnicity (0.052, 0.027-0.077), and preference for heavily seasoned foods (0.028, 0.006-0.051); negatively with age (-0.171, -0.190 to -0.143), addictive behaviors (-0.070, -0.094 to -0.046), divorce/widowhood (-0.082, -0.131 to -0.034), and NCDs (-0.040, -0.060 to -0.020). NCDs were positively associated with household fuel exposure (0.647, 0.615-0.679), age (0.143, 0.123-0.162), and addictive behaviors (0.075, 0.050-0.100); negatively with socioeconomic status (-0.064, -0.097 to -0.030) and Han ethnicity (-0.037, -0.064 to -0.010). Age, ethnicity, fuel exposure, addictive behaviors, and socioeconomic status had indirect associations with HRQoL via NCDs. Socioeconomic status, household fuel exposure, addictive behaviors, and demographics are significantly linked to NCDs and HRQoL. Interventions targeting modifiable factors are needed.

Hypertension remains a major public health challenge in China, especially in high-altitude ethnic minority areas where prevalence is high but awareness, treatment, and control rates remain low. Self-management is crucial for delaying complications and improving quality of life, yet previous studies have mainly focused on low-altitude areas and Han Chinese populations and have largely relied on total-score comparisons. Because self-management is multidimensional, such approaches may obscure population heterogeneity. Latent profile analysis (LPA) can identify subgroups with distinct behavior patterns, but evidence in hypertensive patients from high-altitude ethnic minority areas is scarce. This study aimed to identify latent profiles of self-management behaviors in this population and to examine factors associated with profile membership. A cross-sectional study was conducted between December 2024 and May 2025 among hypertensive patients attending Gannan Tibetan Autonomous Prefecture People's Hospital. Latent profile analysis was performed to identify distinct self-management behavior profiles. Multinomial logistic regression was subsequently used to examine factors associated with profile membership, including self-efficacy, social support, chronic disease health literacy, age, ethnicity, smoking, and drinking. Three distinct profiles of self-management behaviors were identified: 1) a comprehensive management type, characterized by consistently good performance across all behavioral dimensions; 2) a low treatment management type, marked by poor medication adherence and inadequate blood pressure monitoring; and 3) a low risk factor management type, characterized by weak control of smoking, alcohol use, and work-related stress. Multiple logistic regression analyses demonstrated that self-efficacy played a role in each patient group, while social support, chronic disease-related health literacy, ethnicity, and dietary habits only exerted corresponding effects in specific patient subgroups. Self-management behaviors among patients with hypertension in high-altitude ethnic minority regions exhibited substantial heterogeneity, yielding three distinct latent profiles with clearly differentiated characteristics. The study found that self-efficacy played a role across all three behavioral categories, facilitating early identification of individuals who require intervention. Concurrently, clinical practice and public health interventions can implement stratified, precision-based management strategies tailored to the primary factors that influence different patient populations.

Colorectal cancer (CRC) is a significant health concern in the United States. Despite advancements in treatment, disparities in clinical trial representation persist, potentially affecting the generalizability and effectiveness of research findings. We conducted a systematic review and meta-analysis of clinical trials on CRC to assess trial representation. Relevant CRC articles were obtained using MEDLINE and Embase. Included studies had to meet the following criteria: they evaluated the effect of an intervention for CRC, were conducted in the United States, were published or posted between January 1, 2018, and December 31, 2023, and were written in English. Data, extracted in a blinded/duplicate fashion, included information about age, race, sex, and ethnicity. A participation-to-disease representation ratio was generated from the data, allowing us to quantitatively assess the representation of patients along with the prevalence of CRC. Outputs were assigned a score of "poor," "fair," or "good" to denote the subgroup representation within each included CRC clinical trial. A total of 25 clinical trials met the inclusion criteria. Regarding race and ethnicity representation, 21 studies received a "poor" rating, four received a "fair" rating, and none received a "good" rating. For sex representation, nine studies received a "good" rating, seven received a "poor" rating, and the remaining did not report sex. CRC clinical trials in the United States predominantly over-represented White populations while under-representing Asian, Black, and Hispanic populations. These findings highlight the need for more equitable representation in clinical trials to ensure that diverse populations benefit from medical research advancements.

Approximately 40% of obstetric patients do not attend a postpartum visit. Postpartum parents of preterm infants (<37 weeks) are often sicker than parents of full-term infants. Nonetheless, they may forgo postpartum visits to attend to the needs of their infant when admitted to the neonatal intensive care unit. Our goal was to evaluate whether postpartum visit attendance varied with length of gestation at birth, hypothesizing after preterm birth, parents would be less likely to attend postpartum visits than after full-term birth. Retrospective cohort study of births in Epic Systems Cosmos research platform (2018-2024), a national electronic health record database with deidentified, patient-level data. To increase the likelihood that postpartum visits, if attended, would be captured by Cosmos, we only included births with prenatal visits in the database. Bivariate analyses examined characteristics associated with not attending postpartum visits. Multilevel, multivariable, modified Poisson regression models calculated adjusted risk ratios of not attending postpartum visits after various lengths of gestation compared to full-term birth (39-40 weeks). Models adjusted for age, race and ethnicity, insurance, residential Centers for Disease Control and Prevention Social Vulnerability Index, rural versus urban residence, smoking, body mass index (BMI), hypertension, diabetes, parity, cesarean birth, and birth year. Of the 2,403,574 included births, 653,552 (27%) parents did not attend a postpartum visit. For the several characteristics with significant differences in visit attendance rates, notably high rates of not attending a postpartum visit were observed for Black non-Hispanic race and ethnicity (32%), smoking during pregnancy (56%), BMI >30 kg/m2 (30%), no diabetes (28%), multiparity (29%), and no cesarean birth (29%). After multivariable adjustment, preterm (< 37 weeks), early-term (37-38 weeks), late- and postterm (41-43 weeks) birth were all associated with not attending a postpartum visit compared to full-term (39-40 weeks' gestation) birth. Periviable birth (22-23 weeks) demonstrated the highest risk (aRR 1.21, 95% CI: 1.13-1.29). Compared to full term birth, all other length of gestation categories, were significantly associated with not attending a postpartum visit, with periviable birth at highest risk. Interdisciplinary, innovative approaches to provide postpartum care to this vulnerable population are needed.

Prostate cancer (PCa) is the most common malignancy among men in the United Arab Emirates (UAE) and is often diagnosed at advanced stages with aggressive features. Germline mutations in DNA-repair genes, especially BRCA1 and BRCA2, increase PCa risk, with BRCA2 conferring up to 8.6-fold and BRCA1 a 3.7-fold risk. The objective is to determine the prevalence, zygosity, and clinical significance of BRCA1/2 mutations in high-grade PCa among UAE and Arab patients and describe their potential role in disease aggressiveness. A retrospective analysis was performed on 40 archived formalin-fixed, paraffin-embedded prostate tissues (2011-2022), comprising 23 PCa and 17 benign prostatic hyperplasia (BPH). Targeted exon sequencing was performed. Variants were classified using ACMG/AMP criteria using ClinVar and Varchat. Associations between mutation patterns, zygosity, and tumor grade were evaluated. BRCA1 mutations occurred in 47.5% of cases, all in exon 10, with 62.5% homozygosity; most frequent were c.794G>A and c.721G>A. BRCA2 mutations occurred in 55% of cases, mainly exon 11, with 68% homozygosity; c.5917A>C and c.5908T>A were most common. Homozygous mutations enriched in high-grade PCa (Grade Groups 3-5) suggested biallelic inactivation and homologous recombination repair deficiency. Several novel variants clustered in DNA repair domains, including BRCA1 coiled-coil and BRCA2 RAD51-binding. Our findings reveal a high prevalence of homozygous BRCA1/2 mutations, with the majority had aggressive disease phenotypes. Therefore, support the potential utility of PARP inhibitors as molecularly targeted therapeutic alternatives to conventional chemotherapy in mutation-positive patients. Furthermore, the identification of novel population-specific variants underscores the urgent need for ethnicity-informed genetic screening protocols, facilitating earlier detection of hereditary risk and enabling informed treatment stratification in United Arab Emirates and Arab men with PCa.

Physicians need the appropriate experience to be able to reliably diagnose skin diseases in patients with skin of color. This narrative review is based on scientific articles and book chapters about skin of color and comparative studies across skin pigmentation types or ethnic groups that were retrieved by a selective search. Publications up to 2026 were included. Skin of color differs from the lighter skin type that is most common in northern Europe in melanin structure, content, and distribution and in other anatomical respects. Two main aspects require attention in dermatology; the distinction of malignancy from physiological types of hyperpigmentation, and the recognition and treatment of inflammatory skin diseases. Basal cell carcinoma appears to be the most common type of tumor affecting darkly pigmented as well as lighter skin types; squamous-cell carcinoma is more frequent in darker than in lighter skin. Malignant melanoma is reportedly ca. 33 times less common in persons with darker skin, but often in a more advanced stage at the time of diagnosis. Inflammatory skin diseases present differently on darker compared to lighter skin, as erythema is often barely recognizable or invisible. Sequelae such as post-inflammatory hyper-and hypopigmentation, marked scarring, and keloids are often very disturbing for those affected. There have only been a few studies to date on patients with skin of color. Dermatological study findings must be evaluated in an inclusive manner. People with skin of color should also be screened for skin cancer and should protect themselves against the effects of ultraviolet light.

Respiratory disorders remain a significant public&#x2011;health concern across Europe, and traditional ethnomedical knowledge continues to play an important role in several Transylvanian communities. This study aims to document the plant species applied for respiratory conditions in Transylvania and to evaluate whether their uses are supported by current pharmacological evidence. By systematically mapping vernacular practices and comparing them with available biomedical data, we seek to clarify the therapeutic relevance and potential scientific grounding of these traditional remedies. We conducted semi&#x2011;structured interviews across 20 settlements with Sz&#xe9;kely and Cs&#xe1;ng&#xf3; ethnical groups, recorded vernacular names, local disease terms, drug parts, and preparations of plant. We recorded vernacular names of respiratory diseases and matched them with the International Classification of Diseases. The comparative analysis of the data was supported by a review of ethnobotanical and ethnopharmacological literature. We recorded 91 plant taxa (40 families, predominantly Asteraceae and Lamiaceae). From aerial parts of plants mainly infusions and syrups were prepared and applied for cough, common cold, sore throat and pneumonia. Uses of some plants (e.g. Sambucus nigra, Salvia officinalis) adjunct expectorant/anti&#x2011;inflammatory profiles converged with contemporary pharmacology, while safety signals were flagged for Tussilago farfara (pyrrolizidine alkaloids) and Convallaria majalis (cardiac glycosides). Conservation concerns emerged for protected plants (e.g. Arnica montana, Trollius europaeus). Traditional Transylvanian respiratory herbal remedies reflect a close relationship between culturally rooted practices and remedies with varying degrees of pharmacological support. By identifying plant species used locally and assessing their biomedical plausibility, this study highlights taxa with promising evidence as well as those requiring further scientific evaluation.