Health Disparities in Multiple Sclerosis among Hispanic and Black Populations in the United States.

Multiple sclerosis (MS) is an acquired demyelinating disease of the central nervous system (CNS). Historically, research on MS has focused on White persons with MS. This preponderance of representation has important possible implications for minority populations with MS, from developing effective therapeutic agents to understanding the role of unique constellations of social determinants of health. A growing body of literature involving persons of historically underrepresented races and ethnicities in the field of multiple sclerosis is assembling. Our purpose in this narrative review is to highlight two populations in the United States: Black and Hispanic persons with multiple sclerosis. We will review the current understanding about the patterns of disease presentation, genetic considerations, response to treatment, roles of social determinants of health, and healthcare utilization. In addition, we explore future directions of inquiry as well as practical methods of meeting these challenges.

A cross-sectional study of organized activity participation and emotional wellbeing among non-immigrant and immigrant-origin children in British Columbia, Canada.

Organized activity participation has been linked to children's emotional wellbeing. However, a scarcity of literature considers the role of immigrant background. This study's primary objective was to measure the association between organized activity participation and emotional wellbeing among a population-based sample of Grade 7 children in British Columbia, Canada. We also examined whether this relationship depended on immigration background. Our sample included 14,406 children (47.8% female; mean age = 12.0 years). 9,393 (65.2%) children were of non-immigrant origin (48.9% female; mean age = 12.1 years). 5,013 children (34.8%) were of immigrant origin (45.8% female; mean age = 12.0 years; 40.8% first-generation). Participants completed the Middle Years Development Instrument, a self-report survey measuring children's wellbeing and assets. We used odds ratios and the χ2 test to compare the organized activity participation of non-immigrant and immigrant-origin children. We used multiple linear regression to measure associations between participation and indicators of emotional wellbeing and assessed whether associations varied based on immigrant background, controlling for demographic factors and peer belonging. Participation in any activity was similar among non-immigrant and immigrant-origin children (OR1st-gen=1.06, p=0.37; OR2nd-gen=0.97, p=0.62). Immigrant generation status modified the relationship between participation and emotional wellbeing (χSWL 2=3.69, p=0.03; χDep 2=12.31, p<0.01). Beneficial associations between participation and both life satisfaction and depressive symptoms were observed among non-immigrant children only, although associations were small. We conclude that immigrant background modestly modified the association between organized activity participation and emotional wellbeing.

Association of Kaiso and partner proteins in oral squamous cell carcinoma.

Objectives: 1. Identification of protein expression and subcellular localization of E-cadherin (E-cad), p120 catenin (P120ctn), and Kaiso in oral cancer (OC). 2. To study the protein expression of cyclin D1 and c-Myc (Kaiso targets) and determine their relationship with the expression and localization of Kaiso. Methods: Histological grading was performed in accordance with Broder's criteria. Expression and localization data for E-cad, p120ctn, Kaiso, cyclin D1, and c-Myc were acquired using immunohistochemistry. Data were analyzed using SPSS version 21. The chi-square test was used to measure the statistical significance of associations, with p < 0.05 as statistically significant. Results: Of 47 OC cases, 36% showed low E-cad expression and 34% showed low p120ctn. Low Kaiso expression was recognized in 78% of tumor specimens. Aberrant cytoplasmic localization of p120ctn was seen in 80.8% cases. Cytoplasmic Kaiso localization was appreciated in 87% of tumor tissues, whereas 29.7% lacked any nuclear Kaiso. Kaiso expression was significantly associated with the expression of cyclin D1 but not with c-Myc. Conclusion: The present study identified a change in the localization of Kaiso in OC. The significance of this in relation to OC and tumor prognosis needs to be investigated with further studies using larger sample sizes and more sensitive molecular tools.

Nutrition and health-seeking practices during pregnancy and lactation and potential strategies to increase micronutrient intakes among women in northern Lao PDR.

Access to and utilisation of antenatal care (ANC) is important for optimising health and nutrition during pregnancy. This study aimed to assess adherence to and factors associated with ANC and antenatal supplement use among Laotian women, and consider culturally appropriate strategies to increase micronutrient intakes. Mother-child (aged 21 d to <18 months) dyads (n 699) enrolled in a hospital-based prospective cohort study with the community comparison group in Luang Prabang province were interviewed about their antenatal history, supplement use, household sociodemographic and dietary practices, including postpartum food avoidances. Ninety percent of women (mean age 24⋅7 ± 6⋅3 years) reported receiving ANC during their pregnancy, with the majority reporting four to seven contacts, while 84⋅6 and 17⋅3 % reported supplement use during pregnancy and lactation, respectively. Adequate ANC contacts (≥8) and supplement use was more likely among women with complete primary education and from higher socioeconomic status households, and less likely among women belonging to ethnic minority populations and those who delivered their child at home. All women continued to consume salt while adhering to postpartum food avoidances; however, 58⋅5 and 38⋅7 % of habitual consumers restricted fish and soy sauces, respectively. Eighty-six percent of women reported they would be willing to take supplements when adhering to postpartum dietary restrictions. Overall, women's reported ANC attendance and antenatal supplement use was suboptimal. Understanding predictors of and barriers to ANC and supplement use may help implement effective public health strategies to improve adherence. Alongside targeted supplementation, salt fortification with micronutrients may be a viable population-wide intervention that needs further evaluation.

Defining preventive cardiology: A clinical practice statement from the American Society for Preventive Cardiology.

Remarkable transformations in science and healthcare have resulted in declines in mortality from cardiovascular disease over the past several decades, largely driven by progress in prevention and treatment of persons at risk. However, these trends are now beginning to stall, as our county faces increases in cardiovascular risk factors including overweight and obesity, type 2 diabetes mellitus, and metabolic syndrome. Furthermore, poor long-term adherence to a healthy lifestyle and lifesaving pharmacotherapy have exacerbated these trends, with recent data suggesting unprecedented increases in cardiovascular morbidity and mortality. A paradigm shift is needed to improve the cardiovascular health of our nation. Preventive cardiology, a growing subspecialty of cardiovascular medicine, is the practice of primordial, primary, and secondary prevention of all cardiovascular diseases. Preventive cardiologists and preventive cardiology specialists are well equipped with the knowledge and skill-set necessary to reduce deaths related to the growing burden of heart disease and its risk factors. Despite dedicated efforts, cardiovascular disease remains the leading killer of men and women in the United States. Although there is little debate regarding the importance of prevention, many healthcare professionals question the need for preventive cardiology as a distinct subspecialty. Additionally, the field's growth has been hampered by a lack of organization and standardization, and variability of training within programs across the country. The purpose of this document is to delineate the key attributes that define the field of preventive cardiology according to the American Society for Preventive Cardiology.

Employment Characteristics and Risk of Hospitalization Among Older Adults Participating in the Mayo Clinic Biobank.

Objective: To determine the relationship between characteristics of employment and future hospitalization in older adults. Patients and Methods: We conducted a survey of adults aged 65 years or older participating in the Mayo Clinic Biobank. Using a frequency-matched, case-control design, we compared patients who were hospitalized within 5 years of biobank enrollment (cases) with those who were not hospitalized (controls). We assessed the duration of work, age at first job, number of jobs, disability, retirement, and reasons for leaving work. We performed logistic regression analysis to assess the association of these factors with hospitalization, accounting for age, sex, comorbid conditions, and education level. Results: Among 3536 participants (1600 cases and 1936 controls; median age, 68.5 years; interquartile range, 63.4-73.9 years), cases were older, more likely to be male, and had lower education levels. Comorbid illnesses had the largest association with hospitalization (odds ratio [OR], 4.09; 95% CI, 3.37-4.97 [highest vs lowest quartile]). On adjusted analyses, odds of hospitalization increased with the presence of disability (OR, 1.31; 95% CI, 1.01-1.69) and decreased with having 1 or 2 lifetime jobs vs no employment (OR, 0.77; 95% CI, 0.60-1.00). The length of work, furlough, age of retirement, childcare issues, and reasons for leaving a job were not associated with hospitalization. Conclusion: This study reports an association between disability during work and hospitalization. On the basis of our findings, it may be important to obtain a more detailed work history from patients because it may provide further insight into their future health.

Rates of Asymptomatic COVID-19 Infection and Associated Factors in Olmsted County, Minnesota, in the Prevaccination Era.

Objective: To estimate rates and identify factors associated with asymptomatic COVID-19 in the population of Olmsted County during the prevaccination era. Patients and Methods: We screened first responders (n=191) and Olmsted County employees (n=564) for antibodies to SARS-CoV-2 from November 1, 2020 to February 28, 2021 to estimate seroprevalence and asymptomatic infection. Second, we retrieved all polymerase chain reaction (PCR)-confirmed COVID-19 diagnoses in Olmsted County from March 2020 through January 2021, abstracted symptom information, estimated rates of asymptomatic infection and examined related factors. Results: Twenty (10.5%; 95% CI, 6.9%-15.6%) first responders and 38 (6.7%; 95% CI, 5.0%-9.1%) county employees had positive antibodies; an additional 5 (2.6%) and 10 (1.8%) had prior positive PCR tests per self-report or medical record, but no antibodies detected. Of persons with symptom information, 4 of 20 (20%; 95% CI, 3.0%-37.0%) first responders and 10 of 39 (26%; 95% CI, 12.6%-40.0%) county employees were asymptomatic. Of 6020 positive PCR tests in Olmsted County with symptom information between March 1, 2020, and January 31, 2021, 6% (n=385; 95% CI, 5.8%-7.1%) were asymptomatic. Factors associated with asymptomatic disease included age (0-18 years [odds ratio {OR}, 2.3; 95% CI, 1.7-3.1] and >65 years [OR, 1.40; 95% CI, 1.0-2.0] compared with ages 19-44 years), body mass index (overweight [OR, 0.58; 95% CI, 0.44-0.77] or obese [OR, 0.48; 95% CI, 0.57-0.62] compared with normal or underweight) and tests after November 20, 2020 ([OR, 1.35; 95% CI, 1.13-1.71] compared with prior dates). Conclusion: Asymptomatic rates in Olmsted County before COVID-19 vaccine rollout ranged from 6% to 25%, and younger age, normal weight, and later tests dates were associated with asymptomatic infection.

Socioeconomic status, cardiovascular risk profile, and premature coronary heart disease.

Background: The combined influence of traditional cardiovascular risk factors and socioeconomic status (SES) on premature CHD (<65 years) remains understudied. Methods: We used the National Health Interview Survey (NHIS) database (2012-2018) to examine the association of sociodemographic (income, education, insurance status) and cardiovascular risk profile (CRF: ranging from optimal (0-1 risk CV factor) to poor (≥4 risk CV factors)) with CHD in young (18- 44 years) and middle-aged (45-64 years) adults. Results: Among the 168,969 included adults (young: 46.6%), the prevalence of CHD was 3%, translating to 6.4 million young and middle-aged adults. Adults with low family income, lesser education and no insurance were more likely to have CHD. While majority of young adults (65%) had optimal CRF profile and only 4% had poor CRF profile, 26% of middle-aged adults carried poor CRF profile. When examined by income status, education, and insurance status, odds of CHD were increased with worsening CRF profile. In multivariate regressions, low income participants who had a poor CRF (reference: optimal CRF) had higher odds of CHD in both young (aOR: 9.12 [95% CI, 6.16-13.50]) and middle-aged adults (aOR: 8.22 [95% CI, 6.12-11.05]). Within participants with a high school education or lower, those with a poor CRF profile (reference: optimal CRF) had increased odds of CHD in young (aOR: 10.35 [95% CI, 6.66-16.11]) and middle-aged adults (aOR: 10.40 [95% CI, 7.91-13.66]). In the uninsured, those with a poor CRF profile (reference: optimal CRF) had an 8-9 fold increased odds of CHD in young (aOR: 7.65 [95% CI, 4.26-13.73]) and middle-aged adults (aOR: 9.34 [95% CI, 5.90-14.79]). Conclusions: In this national survey, individuals with poor CRF profile had higher odds of premature CHD than those with optimal profile, and burden of CHD increased with worsening of CRF profile.

Development of a panel of U.S. adult tobacco users to inform tobacco regulatory science.

The National Panel of Tobacco Consumer Studies (TCS Panel) is a probability-based panel of about 4,000 U.S. adult cigarette, cigar, and smokeless tobacco users developed by the U.S. Food and Drug Administration's Center for Tobacco Products to conduct observational and experimental studies to inform tobacco regulatory activities. This paper describes the methods and characteristics of the current panel. The TCS Panel employed a stratified 4-stage sample design and in-person screening of U.S. sampled households. Selected eligible adults participated in an enrollment interview and completed a baseline survey assessing tobacco use behaviors to enroll in the Panel; 3,893 individuals were enrolled from September 2016-August 2017. Replenishment occurred from July 2019-December 2019 with 2,260 new members, for a current panel of 3,929 members. Demographic and tobacco use characteristics of the current panel were analyzed in 2020. Most demographic characteristics of the TCS Panel are similar to those of U.S. tobacco users in the 2018 National Health Interview Survey, suggesting a lack of systematic bias in the Panel. Small, but statistically significant, differences were observed in the proportion of 18- to 25-year-olds; high school diploma and bachelor's degree/higher; never married and married (p < 0.05 for all). The TCS Panel appears to be representative of U.S. cigarette, cigar, and smokeless tobacco users; such panels can be a feasible method for conducting tobacco regulatory science research. The TCS Panel has been used to field studies examining purchasing behaviors, receipt and use of free samples/coupons, and the impact of a hypothetical tobacco product standard.

Neighborhood-Level Socioeconomic Deprivation, Rurality, and Long-Term Outcomes of Patients Undergoing Total Joint Arthroplasty: Analysis from a Large, Tertiary Care Hospital.

Objective: To assess the impact of neighborhood-level socioeconomic status factors (area deprivation index [ADI] and rural classification) and their interaction with individual-level socioeconomic status (education-level) on long-term outcomes following total joint arthroplasty (TJA) surgery. Patients and Methods: This was a cohort study of 46,828 TJA surgeries performed on patients at a tertiary care hospital between January 1, 2000 and December 31, 2019. Cox proportional hazards models were used to examine the association between ADI and rurality and their interaction with individual-level education on the risk of periprosthetic joint infections, revision surgery, and mortality. Results: At the time of surgery, 2589 (6%) patients lived in the most deprived neighborhoods (ADI quintile >80%) and 10,728 (23%) lived in small isolated rural towns. Patients from the most deprived neighborhoods were more likely to experience revision surgery (hazard ratio, [HR], 1.39; 95% CI, 1.10-1.76) and mortality (HR, 1.24; 95% CI, 1.09-1.42). Patients from small rural towns were also more likely to undergo revision surgery (HR, 1.14; 95% CI, 1.01-1.28). The mortality risk was 13%, 18%, and 24% higher for patients in the 3 highest ADI quintiles than those from the lowest quintile. Education gradient was more notable in the least deprived neighborhoods than in the most deprived neighborhoods. Conclusion: Neighborhood disadvantage and rurality are negatively associated with the risk of revision surgery and both independently and in interaction with individual-level education with the risk of mortality. There is a need for population-level health interventions to mitigate area-based socioeconomic disadvantages in TJA.

Effectiveness of the Promising Neighbourhoods community program in 0-to 12-year-olds: A difference-in-difference analysis.

Objective: The purpose of this study was to evaluate a collaborative community-based program that aims to a) increase the health, safety and talent development of youth, and b) contribute to the reduction of socioeconomic inequalities. Methods: A difference-in difference design with two separate cross-sectional samples in 2018 (n = 984) and 2021 (n = 413) among 0- to 12-year-olds with an intervention and comparator condition was used. The program, called Promising Neighbourhoods, consists of collaboration with community stakeholders, data-based priority setting, knowledge-and theory-based policies, and evidence-based interventions. The program was implemented in three neighbourhoods which were compared with three similar comparator neighbourhoods in which the program was not implemented. Logistic difference-in-difference regression was used to test effectiveness of the intervention on informal parenting support, outdoor-play, sport club membership, general health and risk of emotional and behavioural difficulties and to examine differences in intervention effects between children with a lower or higher socioeconomic status. Results: A significant intervention effect of the Promising Neighbourhoods program after two-years was found for outdoor-play (OR 0.61; 95%CI 0.37, 0.99). No other significant intervention effects were found for other outcomes. No different interventions effects were found for children with a lower or higher socioeconomic status on outcomes. Conclusion: The findings of this study indicate a positive intervention effect for one of the outcomes in 0- to 12-year-olds. Further mixed-methods evaluation research and using longer follow-up periods are needed to examine the value of these type of programs. Further development of Promising Neighbourhoods seems warranted. Trial registration: This study was prospectively registered in the Netherlands National Trial Register (Number: NL7279) on 26 September 2018.

Urban density differences in colorectal cancer screening participation and screening yield in The Netherlands.

Lower socioeconomic status has been associated with higher colorectal cancer incidence and lower participation in population-based screening with faecal immunochemical testing (FIT) but regional variations in participation may also exist. We analysed differences in participation and yield in colorectal cancer screening by urban density level. Data of all invitees to the Dutch colorectal cancer screening programme in 2014-2015 were included. Primary outcomes were participation (returning FIT), FIT positive predictive value, and screening yield (advanced neoplasia detected in invitees). Differences were explored across five levels of urban density. In total 1,873,639 screening invitees were included. FIT participation was 77.3% in the lowest versus 62.8% in the highest urban areas (RR 1.23; 95%CI 1.23-1.24). FIT positive predictive value was 58.6% in the lowest versus 55.2% in the highest urban areas (RR 1.06; 95% CI 1.04-1.09). Screening yield was also higher in the lowest (2.1%-2.3%) compared to the highest urban areas (1.8%). Compared to socioeconomic status, differences in urban density were associated with larger differences in screening participation. In conclusion, participation is lower and fewer cases of advanced neoplasia are detected in areas with a high urban density in the Dutch colorectal cancer screening programme. Differences in urban density could be used in tailoring regional strategies to target barriers in colorectal cancer screening.

Exploring the relationship of sleep, cognition, and cortisol in sickle cell disease.

Background: Neurocognitive impairment is common in people with Sickle Cell Disease (SCD) and evidence is accumulating that sleep disturbances play a role. The interaction between cortisol and sleep in the general population is associated with cognition as well as general wellbeing but there are few data in SCD. We aimed to understand the relationship between cortisol and sleep in individuals with SCD and explored associations with cognition. Methods: Forty-five participants of black heritage (SCD: N = 27, 9-29 years, 16 females; Controls: N = 18, 11-25 years, 13 females) were recruited from the community between 2018 - 2020. Participants completed standardized questionnaires about their sleep behaviour and wore actigraphy MotionWatch8 for 7 nights to assess nocturnal sleep patterns. Salivary cortisol samples were taken on wakening and 3 times after 14:00. Cognition was assessed using the Wechsler Intelligence Scales for children and adults. Results: People with SCD took longer to fall asleep and experienced greater wake bouts, mobile minutes and fragmented sleep compared to controls. Although non-significant, people with SCD experienced lower morning cortisol, with a flattened diurnal cortisol ratio compared to controls. Interestingly, SCD participants, but not controls, with low diurnal variation scored lowest on processing speed (PSI) and perceptual reasoning index (PRI). A moderator analysis revealed that the effect of morning cortisol and diurnal cortisol ratio on PRI by group health (i.e., SCD and healthy controls) depended on sleep quality. Discussion: Sleep and cortisol may play a crucial role in the expression of cognitive difficulties seen in SCD. This should be considered for the development of interventions to optimise cognitive functioning and sleep. This, in turn, could positively impact on secretion of cortisol and general health in SCD.

Racial and socioeconomic status differences in stress, posttraumatic growth, and mental health in an older adult cohort during the COVID-19 pandemic.

Background: The COVID-19 pandemic has disproportionately impacted the most vulnerable and widened the health disparity gap in both physical and mental well-being. Consequentially, it is vital to understand how to best support elderly individuals, particularly Black Americans and people of low socioeconomic status, in navigating stressful situations during the COVID-19 pandemic and beyond. The aim of this study was to investigate perceived levels of stress, posttraumatic growth, coping strategies, socioeconomic status, and mental health between Black and non-Hispanic, White older adults, the majority over the age of 70. Additionally, we investigated which variables, if any, were associated with posttraumatic growth in these populations. Methods: One hundred seventy-six community dwelling older adults (mean age = 76.30 ±8.94), part of two observational studies (The Harvard Aging Brain Study and Instrumental Activities of Daily Living Study) in Massachusetts, US, were included in this cross-sectional study. The survey, conducted from March 23, 2021 to May 13, 2021, measured perceived stress, behavioral coping strategies, posttraumatic growth, and mental health during the COVID-19 pandemic. We investigated associations with post-traumatic growth in a multiple linear regression model and examined their differences by race with t-tests, Wilcoxon rank-sum tests, and Fisher's exact tests. A second multiple linear regression model was used to examine which coping strategies were associated with posttraumatic growth. Findings: Our results indicated no significant difference between the groups in terms of mental health or stress. However, Black participants showed significantly greater posttraumatic growth compared to non-Hispanic, White participants. Additionally, the coping strategies of religion and positive reframing were found to be significantly associated with posttraumatic growth. Furthermore, even with the effects of stress and coping strategies controlled for, race remained significantly associated with posttraumatic growth. Interpretation: The COVID-19 pandemic has differentially impacted Black and non-Hispanic White older adults. These results may help encourage further analysis on geriatric psychiatry as well as understanding how cultural values and adaptations impact posttraumatic growth and mental health in diverse populations. Funding: The Harvard Aging Brain Study (HABS) has been funded by NIH-NIA P01 AG036694 (PI: Reisa Sperling). The IADL study is funded by the National Institute on Aging (R01 AG053184, PI: Gad A. Marshall).

Inequalities in recovery or methodological artefact? A comparison of models across physical and mental health functioning.

Considerable attention has been paid to inequalities in health. More recently, focus has also turned to inequalities in 'recovery'; with research, for example, suggesting that lower grade of employment is strongly associated with slower recovery from both poor physical and poor mental health. However, this research has tended to operationalise recovery as 'return to baseline', and we know less about patterns and predictors when recovery is situated as a 'process'. This paper seeks to address this gap. Drawing on data from the UK Household Longitudinal Study, we operationalise recovery as both an 'outcome' and as a 'process' and compare patterns and predictors across the two models. Our analysis demonstrates that the determinants of recovery from poor health, measured by the SF-12, are robust, regardless of whether recovery is operationalised as an outcome or as a process. For example, being employed and having a higher degree were found to increase the odds of recovery both from poor physical and mental health functioning, when recovery was operationalised as an outcome. These variables were also important in distinguishing health functioning trajectories following a poor health episode. At one and the same time, our analysis does suggest that understandings of inequalities in recovery will depend in part on how we define it. When recovery is operationalised as a simple transition from poor health state to good, it loses sight of the fact that there may be inequalities (i) within a 'poor health' state, (ii) in how individuals are able to step into the path of recovery, and (iii) in whether health states are maintained over time. We therefore need to remain alert to the additional nuance in understanding which comes from situating recovery as a process; as well as possible methodological artefacts in population research which come from how recovery is operationalised.

Associations of socioeconomic status indicators and migrant status with risk of a low vegetable and fruit consumption in children.

BACKGROUND: It is important to provide insight in potential target groups for interventions to reduce socioeconomic inequalities in children's vegetable/fruit consumption. In earlier studies often single indicators of socioeconomic status (SES) or migrant status have been used. However, SES is a multidimensional concept and different indicators may measure different SES dimensions. Our objective is to explore multiple associations of SES indicators and migrant status with risk of a low vegetable/fruit consumption in a large multi-ethnic and socioeconomically diverse sample of children. METHODS: We included 5,010 parents of 4- to 12-year-olds from a Dutch public health survey administered in 2018. Cross-sectional associations of parental education, material deprivation, perceived financial difficulties, neighbourhood socioeconomic status (NSES) and migrant status with low (≤4 days a week) vegetable and fruit consumption in children were assessed using multilevel multivariable logistic regression models. Results are displayed as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Of the 4- to 12-year-olds, 22.1% had a low vegetable consumption and 11.9% a low fruit consumption. Low (OR 2.51; 95%CI: 2.05, 3.07) and intermediate (OR 1.83; 95%CI: 1.54, 2.17) parental education, material deprivation (OR 1.45; 95%CI: 1.19, 1.76), low NSES (OR 1.28; 95%CI: 1.04, 1.58) and a non-Western migrant status (OR 1.94; 95%CI: 1.66, 2.26) were associated with a higher risk of a low vegetable consumption. Low (OR 1.68; 95%CI: 1.31, 2.17) and intermediate (OR 1.39; 95%CI: 1.12, 1.72) parental education and material deprivation (OR 1.63; 95%CI: 11.27, 2.08) were also associated with a higher risk of a low fruit consumption. CONCLUSION: Our findings indicate associations of multiple SES indicators and migrant status with a higher risk of a low vegetable/fruit consumption in children and thus help to identify potential target groups.

Relationship between personality traits and health behavior among working women in Japan.

Considering personality traits is effective for cultivating health promotion habits. Therefore, individualized interventions that account for personality traits would be more beneficial for modifying health behaviors. The present study describes the relationship between personality traits and health behaviors among working women compared with non-working women in Japan. Secondary analysis was conducted using nationally representative data from the Japanese Household Panel Survey (JHPS/KHPS). In the 2019 wave, data were gathered from 1,141 women (939 who were working and 202 who were not) between the ages of 28 and 65. Associations among health behaviors, personality traits, and employment status were confirmed by phi coefficient and coefficient ratio. Logistic regression analysis was conducted to examine the association between health behaviors and personality traits. As for working women, daily fruit consumption was associated with extraversion (odds ratio [OR], 1.197; p = 0.003) and conscientiousness (OR, 1.238; p = 0.032). Conscientiousness has been found to significantly contribute to low-risk alcohol consumption (OR, 1.213; p = 0.035). Desirable physical activity habit was associated with extraversion (OR, 1.312; p = 0.000). In contrast, among non-working women, desirable physical activity habits was associated with extraversion (OR, 1.573; p = 0.007) and neuroticism (OR, 0.390; p = 0.001). Further research is needed to clarify the mechanisms underlying differences between working women and non-working women in the association between health behaviors and personality.

Assessment of U.S. heart transplantation equity as a function of race: Observational analyses of the OPTN database.

Background: Racial disparities in heart transplantation (HT) outcomes are suspected but uncertain. The additional impact of a recent change in donor allocation on disparities in HT in the United States (US) is unknown. We hypothesize racial disparities in HT are present and may be worsened by new allocation practices. Methods: Cohort: Adults listed for HT before and after a heart allocation policy change (Era 1: Oct 18th, 2015 - Oct 18th, 2018, Era 2: Oct 18th, 2018-June 30, 2021). The primary outcome was the rate of HT by race (Black vs. White), assessed using multivariable competing risk analysis (compete: waitlist removal for death or clinical deterioration). Final adjusted models included co-morbidities, SES and community-level Social Determinants of Health. The secondary outcome was waitlist removal for death or clinical deterioration. Results: Of 17,384 waitlist candidates (Era 1: 9,150, Era 2: 8,234), Black waitlist candidates had a lower rate of HT compared to White waitlist candidates in Era 1 (adjusted HR 0·90, 95 % CI 0·84-0·97, p = 0·0053) and in Era 2 (adjusted HR 0·81, 95 % CI 0·75-0·88, p <0·0001, era race interaction p=0·056). The rate of waitlist removal for death or deterioration was similar between races in Era 1 (adjusted HR 0·92, 95 % 0·77-1·1, p = 0·38), but increased for Black candidates in Era 2 (adjusted HR 1·34, 95 % CI 1·09-1·65, p = 0·0054, era race interaction p = 0·0051). Interpretation: Both the measured rate of transplantation and rate of delisting for death or clinical deterioration have worsened for Black compared to White waitlist candidates under the new allocation system. Causes for these disparities require further study. Funding: University of Minnesota Department of Cardiology funds.

Estimating COVID-19 Vaccination and Booster Effectiveness Using Electronic Health Records From an Academic Medical Center in Michigan.

Introduction: Observational studies of COVID-19 vaccines' effectiveness can provide crucial information regarding the strength and durability of protection against SARS-CoV-2 infection and whether the protective response varies across different patient subpopulations and in the context of different SARS-CoV-2 variants. Methods: We used a test-negative study design to assess vaccine effectiveness against SARS-CoV-2 infection and severe COVID-19 resulting in hospitalization, intensive care unit admission, or death using electronic health records data of 170,741 adults who had been tested for COVID-19 at the University of Michigan Medical Center between January 1 and December 31, 2021. We estimated vaccine effectiveness by comparing the odds of vaccination between cases and controls during each 2021 calendar quarter and stratified all outcomes by vaccine type, patient demographic and clinical characteristics, and booster status. Results: Unvaccinated individuals had more than double the rate of infections (12.1% vs 4.7%) and >3 times the rate of severe COVID-19 outcomes (1.4% vs 0.4%) than vaccinated individuals. COVID-19 vaccines were 62.1% (95% CI=60.3, 63.8) effective against a new infection, with protection waning in the last 2 quarters of 2021. The vaccine effectiveness against severe disease overall was 73.7% (95% CI=69.6, 77.3) and remained high throughout 2021. Data from the last quarter of 2021 indicated that adding a booster dose augmented effectiveness against infection up to 87.3% (95% CI=85.0, 89.2) and against severe outcomes up to 94.0% (95% CI=89.5, 96.6). Pfizer-BioNTech and Moderna vaccines showed comparable performance when controlling for vaccination timing. Vaccine effectiveness was greater in more socioeconomically affluent areas and among healthcare workers; otherwise, we did not detect any significant modification of vaccine effectiveness by covariates, including gender, race, and SES. Conclusions: COVID-19 vaccines were highly protective against infection and severe COVID-19 resulting in hospitalization, intensive care unit admission, or death. Administration of a booster dose significantly increased vaccine effectiveness against both outcomes. Ongoing surveillance is required to assess the durability of these findings.

Adolescent body mass index and changes in pre-pregnancy body mass index in relation to risk of gestational diabetes.

BACKGROUND: Pregestational excessive body mass index (BMI) is linked to an increased risk for gestational diabetes mellitus (GDM), but less is known on the effect of adolescent BMI on GDM occurrence. The study aimed to investigate possible associations of adolescent BMI and changes in BMI experienced before first pregnancy, with gestational diabetes risk. METHODS: This retrospective study was based on linkage of a military screening database of adolescent health status (Israel Defence Forces) including measured height and weight, with medical records (Maccabi Healthcare Services, MHS) of a state-mandated health provider. The latter covers about 25% of the Israeli population; about 90% of pregnant women undergo screening by the two-step Carpenter-Coustan method. Adolescent BMI was categorized according to Center of Disease Control and Prevention percentiles. Only first documented pregnanies were analyzed and GDM was the outcome. FINDINGS: Of 190,905 nulliparous women, 10,265 (5.4%) developed GDM. Incidence proportions of GDM were 5.1%, 6.1%, 7.3%, and 8.9% among women with adolescent normal BMI, underweight, overweight, and obesity (p<0.001), respectively. In models that accounted for age at pregnancy, birth year, and sociodemographic variables, the adjusted odd ratios (aORs) for developing GDM were: 1.2 (95%CI, 1.1-1.3), 1.5 (1.4-1.6), and 1.9 (1.7-2.1) for adolescent underweight, overweight, and obesity (reference group, normal BMI). Adolescent BMI tracked with BMI notes in the pre-pregnancy period (r=63%). Resuming normal pre-pregnancy BMI from overweight or obesity in adolescence diminished GDM risk, but this diminished risk was not observed among those who returned to a normal per-pre-pregnancy BMI from being underweight in adolescence. Sustained overweight or obesity conferred an aOR for developing GDM of 2.5 (2.2-2.7); weight gain from adolescent underweight and normal BMI to pre-pregnancy excessive BMI conferred aORs of 3.1 (1.6-6.2) and 2.6 (2.2-2.7), respectively. INTERPRETATION: Change in BMI status from adolescence to pre-pregnancy may contribute to GDM risk. Identifying at-risk populations is important for early preventive interventions. FUNDING: None.