Racism, COVID-19, and Health Inequity in the USA: a Call to Action.

The current national COVID-19 mortality rate for Black Americans is 2.1 times higher than that of Whites. In this commentary, we provide historical context on how structural racism undergirds multi-sector policies which contribute to racial health inequities such as those highlighted by the COVID-19 pandemic. We offer a concrete, actionable path forward to address structural racism and advance health equity for Black Americans through anti-racism, implicit bias, and cultural competency training; capacity building; community-based participatory research (CBPR) initiatives; validated metrics for longitudinal monitoring of efforts to address health disparities and the evaluation of those interventions; and advocacy for and empowerment of vulnerable communities. This necessitates a multi-pronged, coordinated approach led by clinicians; public health professionals; researchers; social scientists; policy-makers at all governmental levels; and local community leaders and stakeholders across the education, legal, social service, and economic sectors to proactively and systematically advance health equity for Black Americans across the USA.

The role of folic acid fortification in neural tube defects: a review.

The worldwide prevalence of neural tube defects (NTDs) has fallen noticeably during the past 30 years, but the specific etiology and causative mechanism of NTDs remain unknown. Since introduction of mandatory fortification of grains with folic acid, a further decrease in NTD prevalence has been reported in North America and other countries with large variations among ethnic subgroups. However, a significant portion of NTDs still persists. Population data suggest that women of childbearing age may not yet be adequately targeted, while the general population may be overfortified with folic acid. While an excessive folate intake may be associated with adverse effects, there remains uncertainty about the minimum effective folate intake and status required for NTD prevention, and the safe upper folate level. Besides folate, several other lifestyle and environmental factors as well as genetic variations may influence NTD development, possibly by affecting one-carbon metabolism and thus epigenetic events. In conclusion, mandatory folic acid fortification plays a significant part in the reduction of NTD prevalence, but possibly at a cost and with a portion of NTDs remaining. More effective preventive strategies require better understanding of the etiology of this group of birth defects.

Ontogenetic changes in the extra-pituitary expression of pro-opiomelanocortin in the developing ovine fetus.

Previous studies performed in this laboratory have demonstrated that the fetal lung contains immunoreactive adrenocorticotropin (irACTH), and that the lung both clears and secretes irACTH under basal and stimulated conditions. Furthermore, we have demonstrated that the irACTH in fetal lung is accounted for by proopiomelanocortin (POMC), and that there is an evidence of post-translational processing that is distinct from the pattern of processing typical of the anterior pituitary. The present study was designed to test the hypothesis that POMC is synthesized in the fetal lung, and that there is decreased synthesis in the late-gestation ovine fetal lung. Lungs were collected from fetal sheep at 80, 100, 120, 130, and 145 days gestation (n=4/group; term=147 days). POMC mRNA was measured using reverse transcription and real-time polymerase chain reaction with probe and primers designed in this laboratory. The greatest abundance of POMC mRNA was in the 80-days fetal sheep, and the relative abundance decreased as a function of fetal gestational age. POMC protein was measured using immunoblot analysis in lungs from 80, 120, and 145-days fetal sheep. The pattern of POMC protein abundance was consistent with that of the mRNA (highest at 80 days, lowest at 145 days). The POMC immunoblot revealed specific staining of a peptide with molecular weight of 27 kDa and another peptide with a molecular weight slightly higher than that of native POMC (32 kDa). For comparison, we measured POMC mRNA in skeletal muscle and small intestine. We found POMC expression in both fetal tissues, but no statistically significant ontogenetic pattern of expression. We conclude that POMC is synthesized in the ovine fetal lung, and that the rate of synthesis decreases as the fetus matures in utero. We speculate that the decreasing abundance of POMC mRNA and protein reflects decreased release of POMC and POMC-related peptides into the fetal bloodstream.