Multi-cancer early detection (MCED) tests: prioritizing equity from bench to bedside.

Multi-cancer early detection (MCED) tests are blood-based tests designed to screen for signals of multiple cancers. There is growing interest and investment in examining the potential benefits and applications of MCED tests. If MCED tests are shown to have clinical utility, it is important to ensure that all people-regardless of their demographic or socioeconomic background-equitably benefit from these tests. Unfortunately, with health care innovation, such considerations are often ignored until after inequities emerge. We urge for-profit companies, scientists, clinicians, payers, and government agencies to prioritize equity now-when MCEDs are still being developed and researched. In an effort to avoid creating and exacerbating cancer inequities, we propose 9 equity considerations for MCEDs.

Protective role for kidney TREM2high macrophages in obesity- and diabetes-induced kidney injury.

Diabetic kidney disease (DKD), the most common cause of kidney failure, is a frequent complication of diabetes and obesity, and yet to date, treatments to halt its progression are lacking. We analyze kidney single-cell transcriptomic profiles from DKD patients and two DKD mouse models at multiple time points along disease progression-high-fat diet (HFD)-fed mice aged to 90-100 weeks and BTBR ob/ob mice (a genetic model)-and report an expanding population of macrophages with high expression of triggering receptor expressed on myeloid cells 2 (TREM2) in HFD-fed mice. TREM2high macrophages are enriched in obese and diabetic patients, in contrast to hypertensive patients or healthy controls in an independent validation cohort. Trem2 knockout mice on an HFD have worsening kidney filter damage and increased tubular epithelial cell injury, all signs of worsening DKD. Together, our studies suggest that strategies to enhance kidney TREM2high macrophages may provide therapeutic benefits for DKD.

Macrophage Ontogeny, Phenotype, and Function in Ischemia Reperfusion-Induced Injury and Repair.

AKI is characterized by a sudden, and usually reversible, decline in kidney function. In mice, ischemia-reperfusion injury (IRI) is commonly used to model the pathophysiologic features of clinical AKI. Macrophages are a unifying feature of IRI as they regulate both the initial injury response as well as the long-term outcome following resolution of injury. Initially, macrophages in the kidney take on a proinflammatory phenotype characterized by the production of inflammatory cytokines, such as CCL2 (monocyte chemoattractant protein 1), IL-6, IL-1 ß , and TNF- α . Release of these proinflammatory cytokines leads to tissue damage. After resolution of the initial injury, macrophages take on a reparative role, aiding in tissue repair and restoration of kidney function. By contrast, failure to resolve the initial injury results in prolonged inflammatory macrophage accumulation and increased kidney damage, fibrosis, and the eventual development of CKD. Despite the extensive amount of literature that has ascribed these functions to M1/M2 macrophages, a recent paradigm shift in the macrophage field now defines macrophages on the basis of their ontological origin, namely monocyte-derived and tissue-resident macrophages. In this review, we focus on macrophage phenotype and function during IRI-induced injury, repair, and transition to CKD using both the classic (M1/M2) and novel (ontological origin) definition of kidney macrophages.

Isolation and Flow Cytometry Analysis of Macrophages from the Kidney.

Renal macrophages help maintain homeostasis, participate in tissue injury and repair, and play a vital role in immune surveillance [1-3]. Kidney macrophages can be broken down into two subsets, infiltrating macrophages, which can be further broken down into Ly6Chi and Ly6Clo cells, and kidney resident macrophages. While recent studies have shed light on the differing origins and niches of these cells, a more thorough understanding of kidney macrophage populations and how they may respond to various conditions is needed. This protocol describes how to efficiently isolate murine kidney macrophage populations for flow cytometry analysis.

Acceptability and usability of the Planning Advance Care Together (PACT) website for improving patients' engagement in advance care planning.

Objectives: Most prior advance care planning (ACP) interventions lack integration of the social context of patients' ACP process, which patients indicate is critically important. The current study developed the Planning Advance Care Together (PACT) website to foster inclusion of loved ones in the ACP process. Methods: To provide feedback about the PACT website, patients with advanced cancer (N = 11), their caregivers (N = 11), and experts (N = 10) participated in semi-structured interviews. Patients and caregivers also completed standardized ratings of acceptability and usability. Results: Overall, patient (n = 11) and caregiver (n = 11) ratings of acceptability and usability of the website exceeded benchmark cut-offs (≥24 on the Acceptability E-Scale and ≥ 68 on the System Usability Scale). Patients, caregivers, and experts liked the topic of ACP but felt that it could be emotionally challenging. They recommended focusing more on planning and less on end of life. They appreciated being able to include loved ones and recommended adding resources for caregivers. Conclusions: Study findings support the preliminary usability and acceptability of the PACT website. Findings will be used to inform a modified prototype of the PACT website that is interactive and ready for field testing with patients with advanced cancer and their loved ones. Innovation: We utilized a novel application of the shared mind framework to support patients with advanced cancer in engaging their loved ones in the ACP process.

Identifying Frequently Endorsed Benefits and Barriers to Breast Cancer Screening for African-Born Women in the NYC Metropolitan Area: a Pilot Study.

Most cancer screening data report on Black participants without distinguishing nativity, limiting our understanding of the needs of distinct groups within the African diaspora. The purpose of this pilot study was to assess demographic characteristics and perceptions of the benefits of and barriers to mammography among African immigrant women in New York City (NYC). Forty-two women who were 40 years or older, born in Africa, and English and/or French-speaking were recruited from African immigrant communities in NYC to complete a survey. Eighty percent of our sample aged 50 to 73 was adherent to the 2016 USPSTF mammography screening guideline. The most frequently endorsed benefits were that mammography will help find breast cancer early, could help find a breast lump before it is big enough to feel, and that if found early, breast cancer could be successfully treated. The most endorsed barriers were that having a mammogram is painful and that lack of insurance or being treated rudely at the mammogram center would keep participants from having a mammogram. Chi-square analyses assessed relationships between demographic characteristics and perceptions about mammography and revealed that endorsement of barriers to screening (e.g., health issues, transportation problems, pain, and time associated with mammography) varied by educational attainment. Findings suggest that future interventions should be multi-level and (1) support patients in accessing screening via resource sharing, (2) address other commonly cited barriers such as fear of pain during the procedure, and (3) support anti-racist healthcare environments especially in terms of treatment by providers.

Recent Telehealth Utilization at a Large Federally Qualified Health Center System: Evidence of Disparities Even Within Telehealth Modalities.

Objective: To explore overall trends as well as racial/ethnic disparities in utilization of different telehealth modalities (telephone vs. televideo) at federally qualified health centers (FQHCs) during the COVID-19 pandemic. Methods: Using electronic health record data from a large New York-based FQHC system, we aggregated (separately) Behavioral Health and Family Practice visits per month occurring in-person, by telephone, or by televideo and graphed monthly trends in visits across the pre-pandemic, peak-pandemic, and post-peak-pandemic periods. We calculated fractions of visits conducted by modality for each patient demographic (race/ethnicity, primary language, age, gender, insurance type, and geography) and conducted bivariate assessments to test relationships between patient characteristics and modality. Results: Our data contained 121,072 unique patients and 811,105 visits overall. Telehealth use peaked in April 2020 but continued to account for a significant fraction of FQHC visits-nearly 25% (N = 4,908) of monthly Family Practice visits and a massive 98% (N = 14,173) of Behavioral Health visits as late as June 2021. Of all telehealth visits, nearly half were by telephone. Moreover, demographic factors differed between FQHC patients using telephone visits versus those using televideo: Black, non-English speaking, older, and Medicaid patients had significantly higher utilization of telephone visits than televideo visits (e.g., 25.9% of all Black patients' visits were via telephone vs. 17.1% via televideo; p < 0.001). In contrast, younger, Asian, and privately insured patients had significantly higher televideo visits. Conclusions: Our results suggest that telephone visits remain critical to the provision of health care for FQHC patients. They also suggest that disparities extend beyond the telehealth versus in-person dichotomy and inequities exist even within the type of telehealth used. This has implications for patient health, FQHC quality outcomes, as well as optimal Medicaid telehealth reimbursement policy.

Equity and behavioral digital health interventions: Strategies to improve benefit and reach.

BACKGROUND: Behavioral digital health interventions (e.g., mobile apps, websites, wearables) have been applied widely to improve health outcomes. However, many groups (e.g., people with low income levels, people who are geographically isolated, older adults) may face obstacles to technology access and use. In addition, research has found that biases and stereotypes can be embedded within digital health interventions. As such, behavioral digital health interventions that intend to improve overall population health may unintentionally widen health-related inequities. PURPOSE: This commentary offers guidance and strategies to mitigate these risks when using technology as a means for delivering a behavioral health intervention. METHODS: A collaborative working group from Society of Behavioral Medicine's Health Equity Special Interest Group developed a framework to center equity in the development, testing and dissemination of behavioral digital health interventions. RESULTS: We introduce Partner, Identify, Demonstrate, Access, Report (PIDAR), a 5-point framework to avoid the creation, perpetuation, and/or widening of health inequities in behavioral digital health work. CONCLUSIONS: It is critically important to prioritize equity when conducting digital health research. The PIDAR framework can serve as a guide for behavioral scientists, clinicians and developers.

Behavioral digital health interventions have great potential to improve health. Unfortunately, many groups (e.g., people with low-income levels, people who are geographically isolated, older adults) may face significant obstacles to technology access, adoption and use. Additionally, research has found that biases and stereotypes can be embedded within digital health interventions. As such, behavioral digital health interventions that intend to improve overall population health may unintentionally widen health-related inequities. This commentary introduces the 5-point framework: Partner, Identify, Demonstrate, Access, Report (PIDAR) to be used in the development, testing and implementation of technology to avoid creating or worsening health inequities.

Undue burden: Black faculty, COVID-19, and the racial justice movement.

A crucial reckoning was initiated when the COVID-19 pandemic began to expose and intensify long-standing racial/ethnic health inequities, all while various sectors of society pursued racial justice reform. As a result, there has been a contextual shift towards broader recognition of systemic racism, and not race, as the shared foundational driver of both societal maladies. This confluence of issues is of particular relevance to Black populations disproportionately affected by the pandemic and racial injustice. In response, institutions have initiated diversity, equity, and inclusion (DEI) efforts as a way forward. This article considers how the dual pandemic climate of COVID-19-related health inequities and the racial justice movement could exacerbate the "time and effort tax" on Black faculty to engage in DEI efforts in academia and biomedicine. We discuss the impact of this "tax" on career advancement and well-being, and introduce an operational framework for considering the interconnected influence of systemic racism, the dual pandemics, and DEI work on the experience of Black faculty. If not meaningfully addressed, the "time and effort tax" could contribute to Black and other underrepresented minority faculty leaving academia and biomedicine - consequently, the very diversity, equity, and inclusion work meant to increase representation could decrease it.

Systematic Review of Colorectal Cancer Screening-Related Apps.

Background: In the United States, colorectal cancer (CRC) is the second leading cause of cancer death in men and women combined. The United States Preventive Services Task Force recommends that average risk adults have regular CRC screening to detect and prevent CRC. Despite published CRC screening guidelines, national CRC screening rates remain suboptimal. With the exponential increase in technology use and device ownership, many mobile health applications (apps) have been developed to improve health outcomes. There is great potential for smartphone or tablet apps to help improve CRC screening uptake, with the ultimate goal of reducing CRC morbidity and mortality. To date, there are no systematic reviews that have examined the publicly available, free apps that are related to CRC screening, and therefore, the quality and the content of these apps remain unknown. Objectives: The purpose of this study was to systematically review smartphone and tablet apps that could be used to improve CRC screening uptake. Methods: Apps available on the Google Play and Apple App stores that were compatible with smartphones and tablets were reviewed. Of the 2,790 apps reviewed, 20 met inclusion criteria. Results: Of the 20 apps that met inclusion criteria, most were informational in nature. Approximately half of the apps focused on colonoscopies and did not discuss other CRC screening options. Furthermore, more than half of the apps did not include video/audio content and the majority of the apps did not provide navigation support (e.g., reminders, instructions, maps). Conclusions: There are multiple free, publicly available apps that may encourage CRC screening uptake. Despite their promise, there is a paucity of empirical evidence evaluating the efficacy and usability of these apps. Future research efforts can evaluate the content, usability, accessibility, and potential impact of these apps.

Addressing Racism's Role in the US HIV Epidemic: Qualitative Findings From Three Ending the HIV Epidemic Prevention Projects.

BACKGROUND: Racist socio-political and economic systems in the United States are root causes of HIV disparities among minoritized individuals. However, within HIV implementation science literature, there is scarce empirical research on how to effectively counter racism. This article names racism and White supremacy as key challenges to the success of the Ending the HIV Epidemic (EHE) initiative and delineates opportunities to integrate anti-racism into HIV interventions. METHODS: Formative data were synthesized from 3 EHE studies in California, North Carolina, and South Carolina. Each study engaged with community stakeholders to inform pre-exposure prophylaxis interventions. Key informant interviews and focus groups were used to query individuals-including Black individuals-about implementation challenges. Although racism was not an a priori focus of included studies, discourse on race and racism emerged as key study findings from all projects. RESULTS: Across diverse stakeholder groups and EHE locales, participants described racism as a threat to the success of the EHE initiative. Institutional and structural racism, intersectional stigma, and maltreatment of minoritized individuals within healthcare systems were cited as challenges to pre-exposure prophylaxis scale-up. Some recommendations for addressing racism were given-yet these primarily focused on the individual level (eg, enhanced training, outreach). CONCLUSIONS: EHE implementation scientists should commit to measurable anti-racist actions. To this end, we present a series of recommendations to help investigators evaluate the extent to which they are taking actionable steps to counter racism to improve the adoption, implementation, and real-world impact of EHE interventions for people of color.

A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States.

Men who have sex with men and transgender women in the United States are at increased risk for HIV and may benefit from pre-exposure prophylaxis (PrEP), a once-a-day pill to prevent HIV. Due to stigma and discrimination, sexual and gender minority (SGM) populations are also at risk for depression and anxiety. This scoping review sought to identify literature addressing relationships between the PrEP care continuum, depression, and anxiety among SGM individuals and others at high risk for HIV. We conducted a systematic review of four databases (i.e., PubMed, PsycInfo, Web of Science, Google Scholar) and identified 692 unique articles that were screened for inclusion criteria, with 51 articles meeting the final inclusion criteria. Data were extracted for key study criteria (e.g., geographic location, participant demographics, study design, main findings). Results suggest that while depression and anxiety are not associated with PrEP awareness or willingness to use, they can be barriers to seeking care and to PrEP adherence. However, empirical studies show that taking PrEP is associated with reductions in anxiety. Findings suggest the need to implement mental health screenings in PrEP clinical care. In addition, addressing systemic and structural issues that contribute to mental health disorders, as well as PrEP-related barriers, is critical.

Determinants of health behaviours intended to prevent spread of respiratory pathogens that have pandemic potential: A rapid review.

Effective public health messages to encourage behaviours to reduce the spread of COVID-19 should be informed by existing research that identifies the factors that are associated with these preventive behaviours. This rapid review summarises the existing research on the determinants of behaviours that aim to prevent the spread of COVID-19. The review focuses on the body of research (excluding research conducted with health care workers) that was produced in the context of viruses other than SARS CoV-2 that cause severe respiratory illness and are transmitted in a similar way. A total of 58 published peer-reviewed studies included in the review were identified through searches of Medline, Embase, PsychInfo and CINAHL. Most were conducted in the context of the influenza A (H1N1) pandemic in 2009. Most studies examined the determinants of wearing a face covering, handwashing and social or physical distancing. The findings suggest that public health messages to encourage preventive behaviours should emphasise the potential seriousness of COVID-19 to elicit appropriate concern, strengthen perceptions of risk or threat from COVID-19, enhance self-efficacy about preventive behaviours, and improve knowledge about SARS-CoV-2, how it is transmitted, and how preventive behaviours can reduce the risk of transmission.

Development and testing of a self-report measure of preparing to parent in the context of a fetal anomaly diagnosis.

OBJECTIVE: To generate a self-report instrument to capture clinically relevant variations in expectant parents' caregiving development, specified by how they are preparing to parent an infant with a major congenital anomaly. METHODS: Recent literature structured domains to guide item generation. Evaluations by experts and expectant parents led to a refined instrument for field testing. Psychometric testing included exploratory factor analysis, internal consistency, and test-retest reliability. RESULTS: Samples included expert evaluators (n = 9), and expectant parent evaluators (n = 20) and expectant mother field testers (n = 67) with fetal anomaly diagnoses. Preparing to Parent-Act, Relate, Engage (PreP-ARE) resulted from a three factor solution that explained 71.8 % of the total variance, with global Cronbach's α = 0.72, and sub-scales 0.81, 0.65, 0.72 respectively. Cohen's weighted kappa indicated all items were acceptably reliable, with 14 of 19 items showing moderate (≥ 0.41) or good (≥ 0.61) reliability. Convergent validity was found between the maternal antenatal attachment and Act scales (r = 0.39, p = 0.001). CONCLUSION: This empirically-based instrument was demonstrated to be valid and reliable, and has potential for studying this transitional time. PRACTICE IMPLICATIONS: PreP-ARE could be used to understand patient responses to the diagnosis, level of engagement, readiness to make decisions, and ability to form collaborative partnerships to manage healthcare.

Characteristics of telehealth users in NYC for COVID-related care during the coronavirus pandemic.

OBJECTIVE: To explore whether racial/ethnic differences in telehealth use existed during the peak pandemic period among NYC patients seeking care for COVID-19 related symptoms. MATERIALS AND METHODS: This study used data from a large health system in NYC - the epicenter of the US crisis - to describe characteristics of patients seeking COVID-related care via telehealth, ER, or office encounters during the peak pandemic period. Using multinomial logistic regression, we estimated the magnitude of the relationship between patient characteristics and the odds of having a first encounter via telehealth versus ER or office visit, and then used regression parameter estimates to predict patients' probabilities of using different encounter types given their characteristics. RESULTS: Demographic factors, including race/ethnicity and age, were significantly predictive of telehealth use. As compared to Whites, Blacks had higher adjusted odds of using both the ER versus telehealth (OR: 4.3, 95% CI: 4.0-4.6) and office visits versus telehealth (OR: 1.4, 95% CI: 1.3-1.5). For Hispanics versus Whites, the analogous ORs were 2.5 (95% CI: 2.3-2.7) and 1.2 (95% CI: 1.1-1.3). Compared to any age groups, patients 65+ had significantly higher odds of using either ER or office visits versus telehealth. CONCLUSIONS: The response to COVID-19 has involved an unprecedented expansion in telehealth. While older Americans and minority populations among others are known to be disadvantaged by the digital divide, few studies have examined disparities in telehealth specifically, and none during COVID-19. Additional research into sociodemographic heterogeneity in telehealth use is needed to prevent potentially further exacerbating health disparities overall.

Knowledge of the Relationship Between Breastfeeding and Breast Cancer Risk Among Racial and Ethnic Minority Women.

Research indicates breastfeeding can reduce the risk of breast cancer in women. Black and Hispanic women are more likely to die from breast cancer than non-Hispanic white women and are least likely to breastfeed. The current study was designed to evaluate women's knowledge of the link between breastfeeding and decreased breast cancer risk among a racially diverse cohort of pregnant women. Pregnant women 18 and older (N = 89; 48.4% black; 28% Hispanic) were recruited during a prenatal visit to complete a survey. Women indicated limited understanding of the association between breastfeeding and breast cancer risk reduction; less than 40% of black and white women indicated knowledge, while 64.7% of Hispanic women were aware of the association. These findings underscore the need for interventions to educate women about the protective benefits of breastfeeding as a strategy to reduce their breast cancer incidence and mortality.

Development of a tablet app designed to improve African Americans' screening colonoscopy rates.

Compared with other racial/ethnic groups, African Americans have the highest colorectal cancer (CRC) morbidity and mortality rates. It is critical to help improve African Americans' CRC prevention efforts in order to reduce the burden of CRC in this community. The aim of this study was to develop and field test a tablet app, called e-Motivate, designed to improve African Americans' screening colonoscopy rates. The e-Motivate app was field tested, using an iterative approach. The first version of the app, e-Motivate 1.0, was field tested on 20 African Americans over the age of 50. Participants engaged in a think aloud exercise and provided feedback regarding the app's usability and acceptability. The results of the first field test were used to modify the app and develop e-Motivate 2.0. The field test procedures were repeated on a new group of participants (N = 18). The results from the second field test were used to make final modifications to the app. Overall, participants responded positively to the app. Qualitative analyses showed that participants found the app to be easy to use and helpful. Furthermore, descriptive statistics revealed that participants found the app to be highly usable and acceptable, exceeding recommended benchmarks for usability and acceptability. Critiques of the app were used to modify and finalize the intervention. The results from the proposed study suggest that the e-Motivate app is highly feasible and acceptable. The next step in this line of research is to conduct a randomized clinical trial to formally test the efficacy of the e-Motivate app for improving screening colonoscopy rates among African Americans.