A Retrospective Analysis of Racial Discrimination Experiences for Latinx Adolescents and Young Adults.

Encounters with racial discrimination occur from various sources and contexts for Latinx youth. From a historical context, Latinx have long experienced anti-immigrant sentiment and have been treated as perpetual foreigners. This study centers the voices of U.S.-born Latinx youth and explores their experiences of discrimination in 83 in-depth interviews (15-25 years, x~age = 21.27, SD = 2.10; 58% Female). Through retrospective accounts, we identified four themes across narratives: assumed (illegal) immigrant, assumed unintelligent, assumed criminal, assumed inferior. Overt and subtle discrimination occurred across contexts and from multiple sources including peers, store employees, and strangers. The findings have implications for understanding Latinx youth make meaning of past experiences of discrimination and how those experiences are interpreted later in life.

Arteriopatía periférica en adultos de tres Unidades de Salud Familiar del Paraguay en 2019

RESUMEN Introducción: la detección de enfermedad arterial periférica permite identificar a un grupo de alto riesgo cardiovascular. La prueba del índice tobillo-brazo con esfigmomanómetro digital es una técnica muy fiable, fácil de aplicar y de interpretar. Objetivos: determinar la frecuencia y características clínicas de la enfermedad arterial periférica en sujetos adultos de Atención Primaria de Areguá, Paraguay, en el 2019. Metodología: estudio observacional, descriptivo, prospectivo, multicéntrico. Se incluyó a varones y mujeres mayores de 50 años que asisten a tres Unidades de Salud Familiar de Areguá, Paraguay, en el 2019. Previo consentimiento informado, todos fueron sometidos a determinaciones socioeconómicas, clínicas y detección del índice tobillo-brazo con esfigmomanómetro digital. Se consideró anormal todo índice tobillo-brazo <0,9. Resultados: se incluyeron 124 pacientes, con edad media 64±8 años. Predominaron los sujetos del sexo femenino, con escolaridad primaria, casados y sin independencia económica. Las comorbilidades más frecuentes fueron la hipertensión arterial y diabetes mellitus. Se detectaron 7 casos (5,6%) compatibles con arteriopatía periférica. Entre éstos, sólo 43% referían claudicación intermitente de miembros. Conclusiones: la frecuencia de índice tobillo-brazo compatible con arteriopatía periférica fue 5,6%. Entre éstos, los síntomas de claudicación de miembros fueron referidos por 43%.

ABSTRACT Introduction: The detection of the peripheral arterial disease allows identifying a group of high cardiovascular risk. The ankle-brachial index test with a digital sphygmomanometer is a very reliable technique, easy to apply and interpret. Objectives: To determine the frequency and clinical characteristics of peripheral arterial disease in adult subjects of Primary Care in Areguá, Paraguay, in 2019. Methodology: This was an observational, descriptive, prospective, multicenter study. Men and women over 50 years of age who attended three Family Health Units of Areguá, Paraguay, in 2019 were included prior informed consent. They all underwent socioeconomic and clinical measurements and detection of the ankle-brachial index with a digital sphygmomanometer. All ankle-brachial indexes <0.9 were considered abnormal. Results: One hundred and twenty-four patients were included, with a mean age of 64±8 years. Female subjects predominated, with primary education, married and without economic independence. The most frequent comorbidities were high blood pressure and diabetes mellitus. Seven cases (5.6%) compatible with peripheral artery disease were detected. Among these, only 43% reported intermittent limb claudication. Conclusions: The frequency of the ankle-brachial index compatible with peripheral artery disease was 5.6%. Among these, limb claudication symptoms were reported by 43%.

Sleep Patterns among US Latinos by Nativity and Country of Origin: Results from the National Health Interview Survey.

Background: Sparse data exist to describe national population-level trends in short sleep duration among Latinos. Because short sleep duration is associated with several health conditions that are common in Latinos, such as obesity, diabetes, and hypertension, understanding sleep trends among this population may be key to reducing their disease burden. This study aimed to document Latino subgroup differences in self-reported sleep duration by nativity and country of origin relative to Whites. Design and Setting: Pooled cross-sectional analysis of self-reported data from the National Health and Interview Survey (NHIS), 2004-2017. Participants: 303,244 respondents, aged 18 to 84 years, who self-identified as non-Latino US-born White, US-born Mexican, foreign-born Mexican, US-born Puerto Rican, island-born Puerto Rican, US-born Cuban, foreign-born Cuban, US-born Dominican, foreign-born Dominican, US-born Central/South American, foreign-born Central/South American, US-born "other" Latino, and foreign-born "other" Latino. Methods: Multinomial logistic regression models were used to predict sleep duration controlling for demographics, acculturation, socioeconomic, and health-related factors. Results: We found that all Latino subgroups (except US-born Cubans) were more likely to report poor sleep duration relative to non-Latino Whites, net of demographic, acculturation, socioeconomic, and health-related characteristics. However, the magnitude of disadvantage varies by Latino subgroup. We also found that poor sleep duration is concentrated among certain age groups for the various Latino subpopulations. Conclusions: Given that Latinos in the United States are at higher risk for obesity, diabetes, and hypertension, understanding the patterns of sleep among this population can help identify strategies to improve sleep habits in order to reduce disease burden.

t(6;11) renal cell carcinoma (RCC): expanded immunohistochemical profile emphasizing novel RCC markers and report of 10 new genetically confirmed cases.

Renal cell carcinomas (RCCs) harboring the t(6;11)(p21;q12) translocation were first described in 2001 and recently recognized by the 2013 International Society of Urological Pathology Vancouver Classification of Renal Neoplasia. Although these RCCs are known to label for melanocytic markers HMB45 and Melan A and the cysteine protease cathepsin K by immunohistochemistry (IHC), a comprehensive IHC profile has not been reported. We report 10 new t(6;11) RCCs, all confirmed by break-apart TFEB fluorescence in situ hybridization. A tissue microarray containing 6 of these cases and 7 other previously reported t(6;11) RCCs was constructed and immunolabeled for 21 different antigens. Additional whole sections of t(6;11) RCC were labeled with selected IHC markers. t(6;11) RCC labeled diffusely and consistently for cathepsin K and Melan A (13 of 13 cases) and almost always at least focally for HMB45 (12 of 13 cases). They labeled frequently for PAX8 (14 of 23 cases), CD117 (10 of 14 cases), and vimentin (9 of 13 cases). A majority of cases labeled at least focally for cytokeratin Cam5.2 (8 of 13 cases) and CD10 and RCC marker antigen (10 of 14 cases each). In contrast to a prior study's findings, only a minority of cases labeled for Ksp-cadherin (3 of 19 cases). The median H score (product of intensity score and percentage labeling) for phosphorylated S6, a marker of mTOR pathway activation, was 101, which is high relative to most other RCC subtypes. In summary, IHC labeling for PAX8, Cam5.2, CD10, and RCC marker antigen supports classification of the t(6;11) RCC as carcinomas despite frequent negativity for broad-spectrum cytokeratins and EMA. Labeling for PAX8 distinguishes the t(6;11) RCC from epithelioid angiomyolipoma, which otherwise shares a similar immunoprofile. CD117 labeling is more frequent in the t(6;11) RCC compared with the related Xp11 translocation RCC. Increased pS6 expression suggests a possible molecular target for the uncommon t(6;11) RCCs that metastasize.

Molecular confirmation of t(6;11)(p21;q12) renal cell carcinoma in archival paraffin-embedded material using a break-apart TFEB FISH assay expands its clinicopathologic spectrum.

A subset of renal cell carcinomas (RCCs) is characterized by t(6;11)(p21;q12), which results in fusion of the untranslated Alpha (MALAT1) gene to the TFEB gene. Only 21 genetically confirmed cases of t(6;11) RCCs have been reported. This neoplasm typically demonstrates a distinctive biphasic morphology, comprising larger epithelioid cells and smaller cells clustered around basement membrane material; however, the full spectrum of its morphologic appearances is not known. The t(6;11) RCCs differ from most conventional RCCs in that they consistently express melanocytic immunohistochemical (IHC) markers such as HMB45 and Melan A and the cysteine protease cathepsin K but are often negative for epithelial markers such as cytokeratins. TFEB IHC has been proven to be useful to confirm the diagnosis of t(6;11) RCCs in archival material, because native TFEB is upregulated through promoter substitution by the gene fusion. However, IHC is highly fixation dependent and has been proven to be particularly difficult for TFEB. A validated fluorescence in situ hybridization (FISH) assay for molecular confirmation of the t(6;11) RCC in archival formalin-fixed, paraffin-embedded material has not been previously reported. We report herein the development of a break-apart TFEB FISH assay for the diagnosis of t(6;11)(p21;q12) RCCs. We validated the assay on 4 genetically confirmed cases and 76 relevant expected negative control cases and used the assay to report 8 new cases that expand the clinicopathologic spectrum of t(6;11) RCCs. An additional previously reported TFEB IHC-positive case was confirmed by TFEB FISH in 46-year-old archival material. In conclusion, TFEB FISH is a robust, clinically validated assay that can confirm the diagnosis of t(6;11) RCC in archival material and should allow a more comprehensive clinicopathologic delineation of this recently recognized neoplastic entity.

Acute and long-term safety and tolerability of risperidone in children with autism.

Treatment-emergent adverse events (AEs) were monitored during an 8-week, double-blind, placebo-controlled trial of risperidone (0.5-3.5 mg/day) in 101 children and adolescents with a lifetime diagnosis of autistic disorder. In addition, 37 placebo nonresponders received open-label risperidone for another 8 weeks. Of all the risperidone responders (n=65), 63 entered an open extension of another 16 weeks (6 months total risperidone exposure), and 32 of them were rerandomized to either continued risperidone therapy (n=16) or gradual replacement with placebo (n=16) over 8 weeks. We collected the following measures of safety and tolerability: (1) laboratory blood assessments (CBC with differential, electrolytes, and liver function tests) and urinalyses, (2) vital signs, (3) Side Effects Review of AEs thought to be associated with risperidone, (4) sleep records, (5) Simpson Angus Neurological Rating Scale (SARS), (6) Abnormal Involuntary Movement Scale (AIMS), and (7) height and weight. No clinically significant changes were found on the lab tests. During the 8-week acute trial, the most common AEs on the Side Effects Review, scored as moderate or higher, were as follows (placebo and risperidone, respectively): Somnolence (12% and 37%), enuresis (29% and 33%), excessive appetite (10% and 33%), rhinitis (8% and 16%), difficulty waking (8% and 12%), and constipation (12% and 10%). "Difficulty falling asleep" and anxiety actually favored the risperidone condition at statistically significant levels. The same AEs tended to recur through 6 months of treatment, although often at reduced levels. Using Centers for Disease Control (CDC) standardized scores, both weight and body mass index (BMI) increased with risperidone during the acute trial (0.5 and 0.6 SDs, respectively, for risperidone; 0.0 and 0.1 SDs, respectively, for placebo) and into open-label extension (0.19 and 0.16 SDs, respectively), although the amount of gain decelerated with time. Extrapyramidal symptoms, as assessed by the SARS, were no more common for drug than placebo, although drooling was reported more often in the risperidone group. There were no differences between groups on the AIMS. Two subjects had seizures (one taking placebo), but these were considered unrelated to active drug. Most AEs were mild to moderate and failed to interfere with therapeutic changes; there were no unanticipated AEs. The side effects of most concern were somnolence and weight gain.

Risperidone for the core symptom domains of autism: results from the study by the autism network of the research units on pediatric psychopharmacology.

OBJECTIVE: Risperidone has been found efficacious for decreasing severe tantrums, aggression, and self-injurious behavior in children and adolescents with autistic disorder (autism). The authors report on whether risperidone improves the core symptoms of autism, social and communication impairment and repetitive and stereotyped behavior. METHOD: The database from an 8-week double-blind, placebo-controlled trial (N=101) and 16-week open-label continuation study (N=63) of risperidone for children and adolescents with autism was used to test for drug effects on secondary outcome measures: scores on the Ritvo-Freeman Real Life Rating Scale, the Children's Yale-Brown Obsessive Compulsive Scale, and the maladaptive behavior domain of the Vineland Adaptive Behavior Scales. RESULTS: Compared to placebo, risperidone led to a significantly greater reduction in the overall score on the Ritvo-Freeman Real Life Rating Scale, as well as the scores on the subscales for sensory motor behaviors (subscale I), affectual reactions (subscale III), and sensory responses (subscale IV). No statistically significant difference was observed, however, on the subscale for social relatedness (subscale II) or language (subscale V). Risperidone also resulted in significantly greater reductions in scores on the Children's Yale-Brown Obsessive Compulsive Scale and Vineland maladaptive behavior domain. This pattern of treatment response was maintained for 6 months. CONCLUSIONS: Risperidone led to significant improvements in the restricted, repetitive, and stereotyped patterns of behavior, interests, and activities of autistic children but did not significantly change their deficit in social interaction and communication. Further research is necessary to develop effective treatments for the core social and communicative impairments of autism.

Parent-defined target symptoms respond to risperidone in RUPP autism study: customer approach to clinical trials.

OBJECTIVE: A consumer-oriented efficacy assessment in clinical trials should measure changes in chief complaint and consumer request (symptoms of most concern to patient/caregiver), which may be diluted in change scores of multisymptom scales. METHOD: In the Research Units on Pediatric Psychopharmacology (RUPP) Autism Network 8-week double-blind trial of risperidone versus placebo, the chief concerns of parents were collected at 0, 4, and 8 weeks (endpoint), in addition to standardized primary measures. Blinded clinical judges rated change from baseline to 4 and 8 weeks on a 9-point scale (1 = normalized, 5 = unchanged, 9 = disastrous); 94 participants had usable data. RESULTS: The most common symptoms identified by parents were tantrums, aggression, and hyperactivity. Interrater reliability was excellent. Mean ratings at endpoint were 2.8 +/- 1.2 on risperidone and 4.5 +/- 1.3 on placebo (p <.001). Ratings were collinear with Clinical Global Impression-Improvement and Aberrant Behavior Checklist Irritability subscale (primary dimensional measure). Effect size d was 1.4, compared to 1.2 on the Aberrant Behavior Checklist Irritability subscale. Effect sizes varied twofold by symptom category, largest for self-injury (2.11) and tantrums (1.95). CONCLUSIONS: Risperidone was superior to placebo in reducing symptoms of most concern to parents of autistic children with irritable behavior. Rating individualized participant-chosen target symptoms seems a reliable, sensitive, efficient, and consumer-friendly way to assess treatment effect and might have clinical application.

Risperidone in children with autism and serious behavioral problems.

BACKGROUND: Atypical antipsychotic agents, which block postsynaptic dopamine and serotonin receptors, have advantages over traditional antipsychotic medications in the treatment of adults with schizophrenia and may be beneficial in children with autistic disorder who have serious behavioral disturbances. However, data on the safety and efficacy of atypical antipsychotic agents in children are limited. METHODS: We conducted a multisite, randomized, double-blind trial of risperidone as compared with placebo for the treatment of autistic disorder accompanied by severe tantrums, aggression, or self-injurious behavior in children 5 to 17 years old. The primary outcome measures were the score on the Irritability subscale of the Aberrant Behavior Checklist and the rating on the Clinical Global Impressions - Improvement (CGI-I) scale at eight weeks. RESULTS: A total of 101 children (82 boys and 19 girls; mean [+/-SD] age, 8.8+/-2.7 years) were randomly assigned to receive risperidone (49 children) or placebo (52). Treatment with risperidone for eight weeks (dose range, 0.5 to 3.5 mg per day) resulted in a 56.9 percent reduction in the Irritability score, as compared with a 14.1 percent decrease in the placebo group (P<0.001). The rate of a positive response, defined as at least a 25 percent decrease in the Irritability score and a rating of much improved or very much improved on the CGI-I scale, was 69 percent in the risperidone group (34 of 49 children had a positive response) and 12 percent in the placebo group (6 of 52, P<0.001). Risperidone therapy was associated with an average weight gain of 2.7+/-2.9 kg, as compared with 0.8+/-2.2 kg with placebo (P<0.001). Increased appetite, fatigue, drowsiness, dizziness, and drooling were more common in the risperidone group than in the placebo group (P<0.05 for each comparison). In two thirds of the children with a positive response to risperidone at eight weeks (23 of 34), the benefit was maintained at six months. CONCLUSIONS: Risperidone was effective and well tolerated for the treatment of tantrums, aggression, or self-injurious behavior in children with autistic disorder. The short period of this trial limits inferences about adverse effects such as tardive dyskinesia.