Pacific peoples experience significant health inequities. National health data often aggregate diverse Pacific communities into a single category, potentially masking important differences in social-context health needs between subgroups. This study aimed to describe the epidemiology and health indicators of Pacific Peoples enrolled at Pegasus Health Primary Health Organisation (PHO), Waitaha Canterbury, Aotearoa New Zealand (NZ), from the five largest ethnic subgroups: Samoan, Tongan, Cook Islands Māori, Niuean, and Fijian peoples. This cross-sectional study used anonymised administrative data from Pegasus Health PHO, NZ. All enrolled patients with Pacific ethnicity recorded at any level were identified (n = 14,209). Demographic characteristics, socioeconomic deprivation, smoking status, and diabetes diagnoses were analysed by ethnicity using descriptive statistics. Samoan patients comprised 52.8% of Pacific peoples enrolled (n = 7,498), followed by Fijian (18.4%), Tongan (14.3%), Cook Islands Māori (11.2%), and Niuean (3.4%). The population was predominantly young (mean age ranged from 27 to 32 years). Socioeconomic deprivation varied substantially: 33% of Samoan and 25% of Tongan patients lived in the most deprived areas (quintile 5), compared to 17% of Fijians who lived in quintile 5. Smoking prevalence ranged from 7.2% (Fijian) to 13.1% (Cook Islands Māori). Diabetes ranged from 5.5% (Cook Islands Māori) to 9.3% (Samoans). Substantial heterogeneity exists across Pacific subgroups in Canterbury regarding demographics, socioeconomic circumstances, and key health indicators. Disaggregated ethnicity data reveal distinct patterns that are obscured when Pacific peoples are treated as a single homogeneous group. This has important implications for targeting health services and designing interventions to achieve health equity.
Gender-sexuality alliances (GSAs) provide critical support for 2SLGBTQ+ youth, yet the role of advisors-particularly in their self-efficacy to address race-, ethnicity-, and immigration-related issues, including how these intersect with sexual and gender identity, a construct we term racial-ethnic, immigration, and intersectional self-efficacy (REISE)-remains understudied. This study examined (a) which advisor-, GSA-, and school-related factors are associated with advisors' REISE, and (b) how this efficacy relates to youth members' socioemotional experiences. Data were collected from 627 GSA members at three time points and from 64 advisors at one time point from 51 GSAs in Massachusetts, New York City, and California. Advisors' REISE was associated with personal, advisor-related, contextual, GSA-related, and school-related factors, and with GSA youth members' reported school experiences. Advisors of color and those who felt more confident in supporting GSA members-particularly regarding 2SLGBTQ+ issues-reported higher REISE. Higher REISE was also observed in advisors of GSAs with a greater proportion of members of color, in schools offering culturally responsive curricula and race/ethnicity-focused events, and of GSAs characterized by open and inclusive climates. The extent to which advisors felt more efficacious was unrelated to how long they had served as a GSA advisor or to the frequency of GSA meetings. Moreover, random-intercept multilevel models showed that members with advisors who reported higher REISE perceived their GSAs and advisors to be more supportive at that same time point. Beyond the GSA itself, advisors' higher REISE also predicted higher positive affect and lower victimization among members, with these benefits lasting for several months. These associations did not vary by GSA members' race/ethnicity or victimization, suggesting that advisor REISE may serve as a universal protective resource for diverse youth.
Concerns about haematological toxicity and absolute neutrophil count (ANC) monitoring may limit clozapine use, particularly in multi-ethnic populations where benign ethnic neutropenia (BEN) and lower baseline ANC are common. We characterised baseline ANC distribution, nationality-derived BEN-risk, post-initiation ANC outcomes, and haematological monitoring patterns in a multi-ethnic United Arab Emirates clozapine cohort. We conducted a retrospective cohort study at a tertiary psychiatric hospital in the United Arab Emirates. Adults with documented clozapine administration and at least one post-initiation ANC between 1 January 2018 and 31 July 2024 were included. Nationality-derived BEN-risk, baseline ANC, post-initiation ANC outcomes within a five-band hierarchy, monitoring intensity, and pre-specified sensitivity and exploratory analyses were examined. Among 239 patients, 179 formed the final study cohort, contributing 284.7 on-clozapine person-years. Overall, 158 patients (88.3%) had no post-initiation ANC <2.0 × 109/L, 16 (8.9%) entered the 1.5-2.0 × 109/L low-ANC monitoring range, 2 (1.1%) reached conventional-threshold neutropenia, 3 (1.7%) reached severe neutropenia, and none reached agranulocytosis range. Five patients (2.8%) met the clinically meaningful ANC <1.5 × 109/L threshold; all were BEN-risk, all had concomitant valproate exposure, and four had concomitant lithium exposure. Baseline ANC was lower in BEN-risk patients and statistically accounted for much of the BEN-risk-to-outcome association in an exploratory analysis. Low ANC during clozapine treatment was uncommon and strongly shaped by baseline ANC and BEN-risk context. Baseline ANC-informed and BEN-aware interpretation may reduce unnecessary treatment interruption while preserving haematological safety. BEN-risk was inferred from nationality, not confirmed genetically; all five low-ANC cases received concomitant valproate; associations are observational.
This cohort study examines the available race and ethnicity data and data collection methods during birth hospitalizations and readmissions of neonates at US hospitals.
Effective pandemic plans must be applicable to all members of our communities. However, people from multicultural communities with diverse language needs often engage with a wide range of organisations and individuals when seeking information during a pandemic or health emergency. Despite this, there is limited evidence on levels of trust and the influence of these sources on promoting community engagement with pandemic preparedness activities in high-income settings. A cross-sectional survey was conducted among members of ethnic minority communities in Australia who self-identified with one or more of six selected language or cultural groups. The survey, available in translated online and paper formats, incorporated several validated instruments and included both closed and open-ended items. Cross-tabulation analyses were used to examine associations between participant characteristics and levels of trust in community organisations and community leaders during the COVID-19 pandemic. 590 completed responses were included in the study. Participants were aged between 18 and ≥95 years old and identified as: Arabic (28.7%), Chinese (24.7%), Bangladeshi (22.3%), Pasifika (10%), Nepalese (8.2%) or Ezidi (6.1%). Predictors of moderate-to-very high trust in community-based organisations (CBOs) included participants who had arrived in Australia ≥20 years ago and had previously sought information from community groups, local councils and community workers. Likewise, moderate-to-very high trust in community leaders was more common among those who were more willing to seek assistance, arrived in Australia ≥20 years ago, were aged between 35 and 44 and had higher trust in community groups. Results indicated that trust in CBOs and community leaders was associated with willingness to seek assistance, satisfaction with communication efforts, trusted local councils and longer settlement in Australia; however, these associations may not reflect the reach or influence of community organisations and leaders across all ethnic minority groups.
Clinical guidelines now recommend administering intrapartum antibiotic prophylaxis (IAP) before skin incision at caesarean section to prevent maternal infection. However, this practice exposes the fetus to antibiotics, raising concerns about potential long-term effects on the infant microbiome and the risk of childhood obesity. To assess whether the timing of IAP at caesarean section-before skin incision versus after umbilical cord clamping-is associated with childhood obesity at age 4-5 years. We conducted a quasi-experimental study of a hospital-wide policy change in clinical practice using data from two birth cohorts (Born in Bradford [BiB] and Born in Bradford's Better Start [BiBBS]). The study included 1985 children of White British or Pakistani heritage born by caesarean section between 2007 and 2019. Children exposed to pre-incision IAP (n = 324) were compared with those unexposed (post-cord clamping IAP; n = 1661). The primary outcome was obesity (BMI z-score > 95th percentile) at age 4-5 years. Adjusted Risk Ratios (aRR) were estimated using multivariable Poisson regression stratified by ethnicity. The prevalence of obesity was 11.9%. Adjusted risk ratios for obesity were 1.25 (95% CI 0.53 to 2.98) for White British children and 1.25 (95% CI 0.64 to 2.43) for Pakistani children. Similarly, estimates for BMI z-score had wide confidence intervals indicating, limited precision. We did not observe a clear difference in childhood obesity at 4-5 years between pre-incision and post-cord clamping prophylactic antibiotics at caesarean section. Confidence intervals were wide, and modest clinically relevant effects cannot be excluded. Findings are compatible with no large adverse effect and may provide reassurance regarding the metabolic safety of current clinical practice.
The purpose of this cross-sectional observational study was to describe the geographic distribution of utilization of polysomnography (PSG) among children enrolled in Medicaid/Child Health Insurance Program from 2017 to 2019. The data source was the Transformed Medicaid Information System (T-MSIS) research analytic files. PSG among children ages 0 to 18 years was identified from the claims data. All children enrolled in Medicaid with at least one service utilization claim formed the denominators for calculation of age-adjusted rates per 10,000 children at the US Census Bureau Division, state and local levels. Geographic patterns were visualized with maps and plots. PSG rates were modeled by Rural-Urban Commuting Area (RUCA) classification and race-ethnicity composition at the ZIP code level. Data quality concerns resulted in exclusion of Rhode Island and Vermont. There were 478,568 PSGs identified among eligible children in the claims data, resulting in a national rate of 50.1 PSGs per 10,000 Medicaid enrolled children per year. There was a fourfold difference in rates at the state level, ranging from 23 PSGs per 10,000 person-years (Kansas) to 93 per 10,000 (Michigan). New England and the Great Lakes regions had the highest local levels, while the Pacific and West South Central divisions had the lowest. ZIP codes with higher percent White population (> 90%) and those in metropolitan areas had the highest PSG rates. This descriptive study of pediatric PSG utilization in the USA can inform efforts to provide more equitable access to PSG and refinement of practice guidelines for referral to PSG. Polysomnography provides a definitive diagnosis for obstructive sleep apnea and other sleep problems. Although there are concerns about variation in access, the utilization patterns of pediatric polysomnography in the USA is unknown. At the state level, polysomnography among children enrolled in Medicaid exhibited a fourfold difference in rates. ZIP codes in metropolitan areas and those with a high proportion of White non-Hispanic population had the highest utilization rates. These data can inform consensus among professional groups and healthcare policy researchers to improve equitable utilization.
To investigate the current prevalence of anxiety and depression among pregnant women and identify the associated influencing factors. A multistage stratified random cluster sampling method was adopted. Questionnaires, the Self-Rating Anxiety Scale (SAS) and the Edinburgh Postnatal Depression Scale (EPDS) were used to collect indicators including demographic data, basic pregnancy information and mental health status from 6362 pregnant women who received prenatal examinations in 4 maternal health care institutions in Shaanxi Province and Xinjiang Uygur Autonomous Region between 2021 and 2023. A multivariate logistic regression model was applied to analyze the relevant factors of anxiety and depression among the respondents. The average age of the respondents was (30.46±3.94) years. Among all participants, 5691 (89.45%) were of Han ethnicity and 671 (10.55%) were from ethnic minorities; 2167 (34.06%) were in the first trimester, 2078 (32.66%) in the second trimester, and 2117 (33.28%) in the third trimester. The prevalence of anxiety during pregnancy was 20.03% (n=1274), and the prevalence of depression was 40.69% (n=2589). Univariate analysis showed that statistically significant differences in the prevalence of anxiety were observed among pregnant women stratified by ethnicity, gestational trimester, educational attainment, parity, residential location, sleep status, and pre-pregnancy alcohol consumption of husbands (P<0.05). Statistically significant differences in the prevalence of depression were found among pregnant women stratified by ethnicity, per capita monthly household income, conception mode, residential location, sleep status, and pre-pregnancy smoking and alcohol consumption of husbands (P<0.05). Logistic regression analysis indicated that second trimester (OR=1.187, 95%CI 1.016-1.386), third trimester (OR=1.271, 95%CI 1.091-1.482), undergraduate degree (OR=1.649, 95%CI 1.365-1.992), junior college/vocational college education (OR=1.297, 95%CI 1.074-1.567), postgraduate degree or above (OR=1.699, 95%CI 1.297-2.224), and pre-pregnancy alcohol consumption of husbands (OR=1.339, 95%CI 1.176-1.526) were positively correlated with the prevalence of anxiety in pregnant women. Ethnic minority identity (OR=0.717, 95%CI 0.571-0.899) and never experiencing insomnia (OR=0.583, 95%CI 0.453-0.750) were negatively correlated with the prevalence of anxiety. Per capita monthly household income of 10 000 yuan or above (OR=1.412, 95%CI 1.22-1.635) and pre-pregnancy alcohol consumption of husbands (OR=1.465, 95%CI 1.308-1.640) were positively correlated with the prevalence of depression. Ethnic minority identity (OR=0.546, 95%CI 0.455-0.656), natural conception (OR=0.672, 95%CI 0.528-0.856), occasional insomnia (OR=0.691, 95%CI 0.555-0.860) and never experiencing insomnia (OR=0.539, 95%CI 0.434-0.669) were negatively correlated with the prevalence of depression. Anxiety and depression are prevalent among pregnant women. Ethnic minority identity and the absence of insomnia are negatively correlated with the prevalence of both anxiety and depression during pregnancy, while pre-pregnancy alcohol consumption of husbands is positively correlated with the prevalence of both conditions. Additionally, anxiety in pregnancy is associated with gestational trimester, with pregnant women in the second and third trimesters having a higher likelihood of developing anxiety. Depression in pregnancy is associated with conception mode, with naturally conceiving pregnant women having a lower likelihood of developing depression.
Delayed anterior cruciate ligament reconstruction (ACLR) in pediatric patients is associated with progressive intra-articular injury. Although disparities in access to orthopaedic care have been reported, it remains unclear whether structural determinants of health influence postpresentation surgical delay and downstream functional recovery. To determine whether sociodemographic and structural determinants are associated with prolonged postpresentation delay to pediatric ACLR and with intra-articular injury severity and postoperative functional outcomes. Cohort study; Level of evidence, 3. The records of 443 pediatric patients who underwent ACLR (2013-2025) at an urban academic referral center with a pediatric orthopaedic urgent care were reviewed. Exposures included race/ethnicity, insurance type, and neighborhood deprivation (Childhood Opportunity Index [COI]). Delay was defined as time from first orthopaedic presentation to surgery, with prolonged delay defined as >120 days. Outcomes included high-grade cartilage injury (Outerbridge grade 3 or 4), meniscal tear presence, failure to return to sport (≥365 days of follow-up), hop test symmetry, isometric strength symmetry, and graft failure. Multivariable regression models were adjusted for race/ethnicity, age, sex, insurance, and national COI. The median time from injury to presentation was 5 days, while the median postpresentation time to surgery was 101 days; 38.6% experienced prolonged delay. In adjusted logistic regression, non-Hispanic Black, Hispanic, and other/unknown race/ethnicity; public insurance; and lower neighborhood opportunity were each independently associated with prolonged delay. Continuous postpresentation delay was independently associated with increased odds of high-grade cartilage injury (OR, 1.004 per day; 95% CI, 1.000-1.008; P = .048). Among patients with ≥365 days of follow-up (n = 228), public insurance was not independently associated with failure to return to sport (OR, 1.69; P = .398). Among those completing functional testing (n = 150), public insurance (β = +9.14; P = .046), higher national COI (β = +0.14 per unit; P = .045), and male sex (β = +9.59; P = .010) were each independently associated with greater hop test asymmetry, whereas no independent associations were observed for isometric strength symmetry or graft failure. Disparities in pediatric ACLR are driven primarily by postpresentation system-level delays and are associated with an incrementally greater risk of cartilage injury.
The objective of this workshop was to collaboratively co-create concrete, practical teaching resources that embed equity, diversity, and inclusion (EDI) concepts into epidemiology and biostatistics teaching in Canada. The 3-h interactive session developed four examples of the inclusion of EDI considerations in epidemiology and biostatistics teaching based on commonly used textbooks. Participants, in small breakout groups, critically reviewed examples from two common textbooks (Modern Epidemiology and Fundamentals of Biostatistics). Groups of four participants selected two examples each from a list of core concepts (e.g., confounding, regression). The groups then integrated EDI considerations into the core examples from the textbooks by addressing focus areas like sex and gender or race and ethnicity, and presented their revised materials. Two groups of four participants selected two topics each. Group 1 selected regression and missing data, while group 2 selected interaction/effect measure modification and hypothesis testing and two-way ANOVA. For a regression model example from Modern Epidemiology, participants recommended changing "pregnant women" to "pregnant person" for gender inclusivity and reframed "normal" to highlight social and structural determinants. In a missing data example, they replaced ageist and judgment-laden terminology ("elderly," "unwilling") with "older adults" and "unable." Group 2 discussed the importance of including biological plausibility and measurement considerations when using sex, defined as male/female, as an effect measure modification in potential analyses. This workshop and concomitant paper demonstrate the need for integrating EDI into epidemiology and biostatistics teaching. It also provides concrete examples of how this can be done using common textbooks. Integrating EDI into the curriculum not only improves student understanding of EDI, but can also strengthen understanding of, and interest in, epidemiology and biostatistics. RéSUMé: OBJECTIFS: L’objectif de cet atelier était de cocréer de manière collaborative des ressources pédagogiques concrètes et pratiques intégrant des concepts d’équité, de diversité et d’inclusion (EDI) au sien de l’enseignement de l’épidémiologie et de la biostatistique au Canada. MéTHODES: La séance interactive de 3 heures a permis d’élaborer quatre exemples d’intégration de considérations d’EDI dans l’enseignement de l’épidémiologie et de la biostatistique, à partir de manuels scolaires couramment utilisés. Les participants, répartis en petits groupes de discussion, ont examiné de manière critique des exemples tirés de deux manuels importants « Modern Epidemiology» et « Fundamentals of Biostatistics». Des groupes ont sélectionné deux exemples à partir d’une liste de concepts fondamentaux (p. ex., facteur de confusion, régression). Les groupes ont intégré des considérations d’EDI aux exemples issus des manuels scolaires, en abordant des thèmes tels que le sexe et le genre ou la race et l’ethnicité. Chaque groupe a présenté ses exemples révisés. RéSULTATS: Deux groupes de quatre participants ont chacun sélectionné deux thèmes. Le premier groupe a choisi la régression et les données manquantes, tandis que le deuxième groupe a sélectionné l’interaction/la modification de la mesure d’effet ainsi que les tests d’hypothèse et l’ANOVA à deux facteurs. Dans le premier groupe, pour l’exemple de modèle de régression tiré de « Modern Epidemiology», les participants ont recommandé de remplacer « femmes enceintes» par « personnes enceintes» afin d’assurer une plus grande inclusivité du genre, et ont reformulé le terme « normal» afin de mettre en évidence les déterminants sociaux et structurels. Dans un exemple sur les données manquantes, ils ont remplacé une terminologie âgiste et porteuse de jugement « personnes âgées», « réticent» par des expressions plus appropriées « adultes plus âgés», « incapables». Le groupe 2 a discuté de l’importance d’inclure la plausibilité biologique et les considérations liées à la mesure lorsque le sexe, défini comme masculin/féminin, est utilisé comme modificateur de la mesure d’effet dans des analyses. CONCLUSION: Cet atelier et l’article qui l’accompagne démontrent la nécessité d’intégrer l’EDI dans l’enseignement de l’épidémiologie et de la biostatistique. Ils fournissent également des exemples concrets de la manière dont cela peut être réalisé à partir de manuels scolaires courants. L’intégration de l’EDI dans le programme améliore non seulement la compréhension des étudiants en matière d’EDI, mais peut également renforcer leur compréhension de concepts clés en épidémiologie et en biostatistique, ainsi que leur intérêt pour ces disciplines.
Firearm mortality surveillance relies on aggregate demographic categories or low-dimensional stratifications, obscuring how race, ethnicity, sex, age, and intent intersect to shape risk among youth and young adults. The Centers for Disease Control and Prevention (CDC)'s transition to single-race population estimates created a structural break between historical and contemporary data series. Consequently, the 25-year trajectory of intersectional firearm mortality across changing federal classification frameworks remains uncharacterized. We aimed to characterize 25-year national trajectories in firearm homicide and suicide across intersecting domains of race or ethnicity, sex, age, and intent among US youth and young adults (aged 0-24 y), identifying specific sociodemographic groups experiencing the highest and most rapidly changing burdens. This study used the CDC WONDER Underlying Cause of Death database (25-year window from 1999-2024). To address the 2018 transition, a 2-period design was deployed: period 1 (1999 to 2020) used bridged 4-category race data, and period 2 (2018 to 2024) used 6-category single-race data. Crude death rates and disparity ratios (referenced to non-Hispanic White youth) were calculated using the Byar approximation. Average annual percentage changes (AAPCs) were modeled via log-linear regression. Analyses incorporated finalized 2024 CDC WONDER data in January 2026. Among 200,704 firearm deaths among youth aged 0-24 years from 1999 to 2024, overall mortality declined through 2013, reversed in 2014, and rose 28.9% from 2019 to 2020. In 2024, the overall rate declined 12% from 2023 but remained above the 2019 prepandemic baseline. During 2018-2024, Black non-Hispanic male youth experienced the highest pooled firearm homicide rate (44.03 per 100,000; 95% CI 43.46-44.61), 23.8 times the rate among White non-Hispanic males. The annual rates within this cohort increased from 33.28 in 2018 to 53.75 in 2021 before declining to 37.06 in 2024 (AAPC, +2.4%; P=.56), while the Black-to-White disparity ratio widened from 19.3 to 24.4. Black non-Hispanic female youth had the highest female firearm homicide rate (6.03 per 100,000), exceeding male rates in 7 of 12 other demographic groups. American Indian or Alaska Native non-Hispanic male youth experienced the highest pooled firearm suicide rate (11.74 per 100,000). Firearm suicide increased significantly among Black non-Hispanic male youth (AAPC, +9.2%; 95% CI +3.2% to +15.4%; P=.01), with a substantial but nonsignificant upward trend among Black non-Hispanic female youth (AAPC, +11.7%; P=.08), while White non-Hispanic male rates remained stable (AAPC, -0.1%; P=.91). Consequently, the Black-to-White non-Hispanic male suicide rate ratio shifted from 0.67 in 2018 to 1.07 in 2024, marking the first time Black youth rates surpassed White youth rates in modern public health surveillance history. Firearm homicide and suicide among US youth exhibit distinct demographic concentration patterns that are systematically obscured by aggregated public health surveillance. Disaggregated surveillance remains imperative to design targeted prevention strategies.
To examine the prevalence of obstructive sleep apnea (OSA) underdiagnosis and sociodemographic, behavioral, and medical correlates of underdiagnosis among Hispanic participants of Mexican descent and non-Hispanic white participants in San Diego, CA. Participants underwent overnight home polysomnography (PSG) and were eligible for the study if they met OSA diagnostic criteria at an apnea-hypopnea index (AHI) ≥ 15/h, minimum 3% oxygen desaturation. Participants self-reported their medical history including past OSA diagnosis, demographics, anthropometrics, and completed the Epworth Sleepiness Scale, and the Short Acculturation Scale for Hispanics. Logistic regressions were used to test bivariate and adjusted associations of correlates with OSA diagnosis status (diagnosed or undiagnosed). Participants (N = 156) had mean (SD) age = 56.3 (15.1) years, 33% were female, and 49% were Hispanic. In this sample with AHI ≥ 15/h, 81.4% had undiagnosed OSA (85.5% among the Hispanic participants of Mexican descent, 77.5% among the non-Hispanic white participants, not statistically significant difference). No prior high blood pressure diagnosis (odds ratio [OR] = 3.44, p = .005) and lower AHI (OR = 1.02, p = .030) were associated with increased likelihood of underdiagnosis. Age, gender, ethnicity, education, body mass index, daytime sleepiness, acculturation, and diabetes diagnosis were not associated with underdiagnosis. Most participants with moderate to severe OSA by home PSG were undiagnosed, regardless of their ethnicity. A lower AHI and no prior diagnosis of high blood pressure were associated with greater OSA underdiagnosis. Enhanced OSA screening, across groups, is needed to reach the large majority that are missed.
Although school quality is associated with greater educational attainment and better health in population-wide studies, it remains unclear whether these effects are experienced similarly across racial and ethnic groups in the USA. To explore this question, we used the nationally representative National Longitudinal Study of Adolescent to Adult Health to examine the association between four individual school quality indicators (student promotion rates, teacher retention, average daily attendance, parental involvement) in Wave I (grades 7-12th, age 12-19), with adult health outcomes in Wave V (age 32-42), stratified by race/ethnicity (White, Black, Latinx). The primary outcomes were self-rated health and depressive symptoms. Regression models adjusted for baseline health, individual, family, and school characteristics. Of 10,724 participants, approximately 50% identified as female, 63% White, 21% Black, 17% Latinx. School quality indicators were not statistically associated with adult depressive symptoms for White participants. Teacher retention was unrelated to self-rated health for any group, but was associated with greater depression symptoms in adulthood for Black and Latinx participants (β = 0.42-point higher score per 1 SD increase in teacher retention, 95% CI [0.153, 0.690], p = 0.002; β = 0.23-point higher score per 1 SD increase in teacher retention, 95% CI [0.003, 0.466], p = 0.047, respectively). Some conventional school quality indicators were associated with worse adult mental health for Black and Latinx participants. The findings suggest that more research is needed to understand what aspects of school quality may best promote life course health development for minoritized groups.
To investigate the gene mutations in tumor tissues of patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL), and analyze its relationship with clinical features and prognosis. A total of 31 newly diagnosed PGI-DLBCL patients treated in the People's Hospital of Xinjiang Uygur Autonomous Region from March 2009 to March 2021 and 81 nodal DLBCL patients matching gender, age, and ethnic group during the same period were collected. The sequencing of patients' tumor tissues were targeted by a panel of 475 lymphoma-related genes. The differences of mutational profiles and biological signaling pathway between PGI-DLBCL and nodal DLBCL were analyzed. The relationship between mutated genes and age, lactate dehydrogenase (LDH) level, Lugano stage, IPI score, cell origin typing, overall survival (OS) and progression-free survival (PFS) of PGI-DLBCL patients were investigated. A total of 50 high frequency mutated genes (number of gene mutations ≥3, mutation frequency ≥10%) were detected in PGI-DLBCL. The mutation rates of GNA13, EZH2, and FBXO11 genes in PGI-DLBCL patients were significantly higher than those in nodal DLBCL patients. BTG2 and CD79B mutations were closely associated with high-risk of IPI scores and the elderly. MYD88 mutations were more easily detected in the elderly patients. And mutations of the P2RY8 and KMT2D gene were related to early stage of the disease and high LDH, respectively. Only GNA13 mutations were detected in GCB subtype, while KMT2C, IRF4 and ID3 mutations were most frequent in non-GCB subtype. Further studies found that patients with CARD11, FANCA and ID3 mutations showed lower 5-year OS rate (all P < 0.05), while ID3 and NFKBIE mutations were associated with poorer PFS (both P < 0.05). The results of multivariate survival analysis suggested that ID3 mutation was an independent adverse prognostic factor for OS (HR=6.213, 95%CI : 1.215-31.770, P =0.028) and PFS (HR=0.060, 95%CI : 0.012-0.307, P =0.001) in PGI-DLBCL patients. PGI-DLBCL has a characteristic gene mutation spectrum, which is different from the molecular mechanism of nodal DLBCL development. ID3 gene mutation is an independent prognostic factor for predicting poor prognosis of PGI-DLBCL. 应用二代测序技术分析胃肠道弥漫大B细胞淋巴瘤患者基因突变分布特点及其与预后关系. 探讨胃肠道弥漫大B细胞淋巴瘤（PGI-DLBCL）患者肿瘤组织中基因突变情况，分析其与临床特征及预后的相关性。. 收集2009年3月至2021年3月在新疆维吾尔自治区人民医院诊治的初诊PGI-DLBCL患者31例，及同期性别、年龄、民族相匹配的结内DLBCL患者81例，使用475个淋巴瘤相关基因组对患者肿瘤组织进行靶向测序，分析PGI-DLBCL及结内DLBCL患者突变图谱及生物信号转导通路差异，探讨PGI-DLBCL中突变基因与年龄、乳酸脱氢酶水平、Lugano分期、IPI评分、细胞起源分型及患者总生存期（OS）和无进展生存期（PFS）间的关系。. 在PGI-DLBCL中共检测到50个高频突变基因（基因突变个数≥3个，突变频率≥10%）。与结内DLBCL相比，PGI-DLBCL患者中 GNA13, EZH2以及 FBXO11基因突变率显著更高。BTG2和CD79B 基因突变与IPI评分高危及高龄密切相关，老年患者中更易检测到 MYD88基因突变，P2RY8、KMT2D基因突变分别与疾病早期和高乳酸脱氢酶相关。仅在GCB亚型中检测到 GNA13基因发生突变，而KMT2C、IRF4、ID3 基因在non-GCB亚型中突变更为频繁。进一步研究发现，CARD11、FANCA、ID3 基因突变的患者表现出更低的5年OS率（均P < 0.05）， ID3和NFKBIE基因突变与较差的PFS相关（均P < 0.05），多因素生存分析结果提示 ID3基因突变是影响PGI-DLBCL患者OS（HR=6.213，95%CI ：1.215-31.770，P =0.028）及PFS（HR=0.060，95%CI ：0.012-0.307，P =0.001）的独立不良预后因素。. PGI-DLBCL具有特征性的基因突变谱，与结内DLBCL发生发展分子机制存在差异。ID3 基因突变是预测PGI-DLBCL预后不良的独立预后因子。.
A 70-year-old man with progressive bronchiectatic lung disease, cirrhosis, and hepatocellular carcinoma supposedly secondary to hepatitis B was referred to our institution for further evaluation. A detailed medical history identified the patient as of Romanian Jewish ethnicity with no prior familial or genetic disease reported. As a young child, he reported hospitalization for failure to thrive but no respiratory complaints. In adulthood, he underwent a cholecystectomy for gallbladder stones and successful fertility treatment resulting in 2 children. His liver and lung diseases became clinically significant in his late 40s. Chronic productive cough and repeated episodes of hemoptysis led to a diagnosis of bilateral bronchiectasis, particularly affecting the upper and middle lobes. A few years prior, he underwent angiography and embolization of a tortuous left bronchial artery due to massive hemoptysis. The patient reported anorexia and significant weight loss of 20 kg, accompanied by intermittent diarrhea, which were attributed to his underlying lung and liver conditions.
Objectives: This study aimed to examine the morphological and morphometric characteristics of the incisive foramen and incisive canal in dry human skulls. Materials and Methods: The sample consisted of 150 dry adult skulls, with no distinction regarding sex or ethnicity. The analysis included the number of incisive canals within the foramen, their dimensions (area and diameter), and their anatomical connections with the incisive fossa and the nasal cavity. Results: All incisive canals were found to communicate with the nasal cavity. The most frequently observed configuration was foramina containing two or more canals. Conclusion: Precise anatomical knowledge about the incisive canal and its foramen is essential for clinical procedures involving the anterior maxilla. Morphological variations in this region may affect surgical access, technique selection, and procedural outcomes.
As many as 75% of autistic individuals report camouflaging to appear less autistic, with workplace camouflaging linked to poor mental health, thwarted advancement, and early job departure. However, few studies have investigated why and how autistic adults camouflage at work. This mixed-methods study explored workplace camouflaging frequency and experiences among N = 131 employed autistic adults. Linear regression examined whether camouflaging differed across identity groups, logistic regression tested whether camouflaging predicted changes in coworker behavior, and reflexive thematic analysis was used to analyze qualitative data. Overall, 86% of participants reported camouflaging often or sometimes at work. More camouflaging was associated with being female (B=0.94, p<.001), non-binary (B=0.78, p=.011), and transgender (B = 1.10, p=.007) compared to male identity, but was not associated with race, ethnicity, sexual orientation, or autism disclosure. More frequent camouflaging was associated with nearly three times greater likelihood of noticing changes in others' behavior. Thematic analysis revealed five themes: camouflaging as a response to encountering prejudice or abuse, as a way of coping, as a response to being silenced, as compulsory production of extra labor, and as forced repression of identity. Mixed-methods integration indicated that gender minority participants reported being silenced and compulsory extra labor at higher within-group rates, and non-disclosed participants relied on active coping strategies at more than double the rate of disclosed participants. These findings underscore the importance of understanding camouflaging within workplace contexts, where social expectations and identity dynamics shape autistic employees' experiences and inform efforts to reduce stigma and support authentic self-expression. ClinicalTrials.gov, NCT05949086.
Latin America bears a growing burden of genitourinary (GU) and cutaneous malignancies but remains underrepresented in clinical trials that shape global standards of care. This underrepresentation raises ethical concerns and limits the generalizability of trial findings. We evaluated Latin American (LATAM) representation in pivotal GU and skin cancer trials and explored barriers to equitable inclusion. We reviewed pivotal phase II and III trials in advanced GU and cutaneous malignancies (melanoma and non-melanoma skin cancers) published between 2015 and 2024. Extracted data included trial site distribution, geographic representation, and ethnicity reporting. A total of 46 pivotal trials (29 GU and 17 skin cancer trials), representing 38,900 patients, were included. LATAM trial sites were present in 44 studies; however, only 25 trials reported enrollment of Hispanic/Latino patients, totaling 2,459 patients (6.3%). Representation across LATAM was highly concentrated in a small number of countries, including Brazil (16 trials), Argentina (14), Chile (13), Mexico (12), and Colombia (6). Participation was greater in GU trials compared with skin cancer trials. Reporting transparency was limited: Hispanic/Latino representation was reported in only 2 main publications, 5 supplementary appendices, and 23 ClinicalTrials.gov records. Only 6.3% of participants in pivotal GU and skin cancer trials were from Latin America. Limited infrastructure, regulatory barriers, and restricted research investment likely contribute to this disparity. Improving equitable representation will require intentional trial design, stronger regional investment, and policies that move beyond nominal participation toward meaningful inclusion.
Although psychosocial interventions delivered by non-specialist providers effectively treat common mental disorders such as depression and anxiety, the treatment-specific elements driving their efficacy remain largely unknown. Our aim was to compare and rank the efficacy of the individual active components of task-shared psychosocial interventions and to predict efficacy using individual participant characteristics. We performed a systematic review and Bayesian individual participant data component network meta-analysis of RCTs comparing different task-shared psychosocial interventions with control conditions for the treatment of adults with common mental disorders. We searched MEDLINE, Embase, PsycINFO, and CENTRAL from database inception to March 15, 2023. We included additional datasets published up to May 29, 2026 and unpublished RCTs. We sought individual participant data from the trial authors. A purpose-built taxonomy of treatment-specific elements was used to dismantle interventions into their constituent components. The primary outcome was efficacy in reducing symptoms of common mental disorders, as measured at study endpoint. We used incremental mean difference to indicate the added benefit (or detrimental effect) of adding a component to a treatment. We assessed the risk of bias of the included studies with the revised Cochrane Risk of Bias tool. The protocol was published in a peer-reviewed journal. We included 34 RCTs, from which 30 trials (89%) contributed individual participant data from 10 612 participants. Of these participants, 7662 were women (72·2%) and 2950 were men (27·8%). The mean age of participants was 36·7 years (SD 5·5). Findings identified strengthening social support (incremental mean difference -9·48; 95% credible interval [CrI] -13·29 to -6·60), behavioural activation (-4·15; -7·48 to -0·05), and problem management (-4·08; -5·37 to -2·83) as the most beneficial components. Relaxation (7·97; 3·35 to 12·11) and, less clearly, cognitive reframing (5·17; 0·78 to 9·15) were identified as detrimental components. Interaction analyses revealed that component effects vary systematically by baseline severity and other sociodemographic characteristics. Ethnicity data were not available. Individuals with lived experience contributed to the interpretation of results. Personalised effect estimates can be computed via a freely accessible web application. Strengthening social support, problem management, and behavioural activation were associated with the greatest incremental benefit within task-shared psychosocial interventions for adults with depression or anxiety. European Commission.
This review compares the outcomes of total ankle replacement (TAR) and ankle fusion (AF) in patients with end-stage ankle osteoarthritis (OA) based on recent comparative studies (1 January 2023 to 31 December 2025). Racial/ethnic, socioeconomic, and payer status disparities have been reported in the likelihood of experiencing TAR versus AF for ankle OA. A prospective multicentre study with level II evidence found that the long-term clinical results of TAR and AF were similar. A meta-analysis identified TAR as the superior intervention, demonstrating significant advantages in patient-reported outcome measures. Three systematic reviews have reached the following conclusions: i) postoperative outcomes are similar in TAR and AF; ii) TAR and AF have similar complication rates (both minor and major); iii) both TAR and AF are safe and effective surgical treatments for ankle OA; besides, TAR had notable lower total complications, implant removals, adjacent level fusion surgeries, and non-union/open reduction and internal fixation surgeries after the index procedure. The existence of mixed evidence found in the literature makes it necessary to select the surgical technique to be used (TAR or AF) on an individual basis. To definitively determine which procedure is more appropriate in advanced ankle OA, more and better-designed studies are required, given that the results reported thus far do not permit to determine with absolute certainty which of the two procedures, TAR or AF, is more adequate.