Continuous Glucose Monitoring Profiles and Health Outcomes after Dapagliflozin Plus Saxagliptin vs Insulin Glargine.

CONTEXT: Glycemic variability and hypoglycemia during diabetes treatment may impact therapeutic effectiveness and safety, even when glycated hemoglobin (HbA1c) reduction is comparable between therapies. OBJECTIVE: We employed masked continuous glucose monitoring (CGM) during a randomized trial of dapagliflozin plus saxagliptin (DAPA+SAXA) vs insulin glargine (INS) to compare glucose variability and patient-reported outcomes (PROs). DESIGN: 24-week sub-study of a randomized, open-label, two-arm, parallel-group, phase 3b study. SETTING: Multicenter study (112 centers in 11 countries). PATIENTS: 283 adults with type 2 diabetes (T2D) inadequately controlled with metformin ± sulfonylurea. INTERVENTIONS: DAPA+SAXA vs INS. MAIN OUTCOME MEASURES: Changes in CGM profiles, HbA1c, and PROs. RESULTS: Changes from baseline in HbA1c with DAPA+SAXA were similar to those observed with INS, with mean difference [95% CI] between decreases of -0.12% [-0.37 to 0.12%], P = .33. CGM analytics were more favorable for DAPA+SAXA, including greater percent time in range (> 3.9 and ≤ 10 mmol/L; 34.3 ± 1.9 vs 28.5 ± 1.9%, P = .033), lower percent time with nocturnal hypoglycemia (area under the curve ≤ 3.9 mmol/L; 0.6 ± 0.5 vs 2.7 ± 0.5%, P = .007), and smaller mean amplitude of glycemic excursions (-0.7 ± 0.1 vs -0.3 ± 0.1 mmol/L, P = .017). Improvements in CGM were associated with greater satisfaction, better body weight image, less weight interference, and improved mental and emotional well-being. CONCLUSIONS: DAPA+SAXA and INS were equally effective in reducing HbA1c at 24 weeks, but people with T2D treated with DAPA+SAXA achieved greater time in range, greater reductions in glycemic excursions and variability, less time with hypoglycemia, and improved patient-reported health outcomes.

Outcomes in Retinal Detachment Repair and Laser Prophylaxis for Syndromes with Optically Empty Vitreous.

PURPOSE: To evaluate and compare surgical outcomes for syndromes with optically empty vitreous (SOEV)-associated rhegmatogenous retinal detachments. DESIGN: A retrospective, cross-sectional, 2-arm study of a single pediatric vitreoretinal surgeon's patients from a quaternary referral center with SOEV was performed to examine visual and anatomical outcomes of rhegmatogenous retinal detachment and laser prophylaxis. SUBJECTS: Patients identified either through slit-lamp examination (presence of an optically empty or void space in the vitreous gel structure) or genetic testing. Fifty-six eyes of 49 patients were identified in the retinal detachment arm. Sixty eyes of 48 patients were identified in the laser prophylaxis arm. METHODS: Comparison of initial retinal detachment (RD) surgical repair via pars plana vitrectomy (PPV), scleral buckle (SB), or PPV-SB with final anatomical success, best-corrected visual acuity (BCVA), and number of surgical procedures. Secondary analysis was performed looking at eyes failing their initial SB, eyes with a giant retinal tear at presentation, eyes failing RD repair within specific time intervals, and eyes where hyaloid was elevated during initial vitrectomy. An additional study arm examined the outcomes of final BCVA and the presence and timing of developing a retinal tear or RD in eyes who received laser prophylaxis. MAIN OUTCOME MEASURES: Visual acuity, surgical repair techniques (PPV, SB, PPV-SB), number of surgeries, anatomical retinal reattachment success. RESULTS: Initial SB had statistically significant better final BCVA (P < 0.01) and better final anatomical success (P < 0.01). No statistical difference in the number of surgeries needed to achieve anatomical success between the initial SB versus initial PPV-SB/PPV. Hyaloidal elevation during the initial vitrectomy was associated with improved final BCVA and higher final anatomical success without the use of silicone oil (P < 0.01 and 0.04 respectively). Lastly, eyes that developed RDs after laser prophylaxis had better final BCVA than untreated eyes (P < 0.05). CONCLUSION: Initial SB yields better overall outcomes in SOEV presenting with rhegmatogenous retinal detachment. Stickler Type-1 patients had similar outcomes compared with other SOEV, suggesting both populations should be treated with similar approaches. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Outcomes in patients with cardiometabolic disease who develop hyperkalemia while treated with a renin-angiotensin-aldosterone system inhibitor.

BACKGROUND: Many patients with indications for renin-angiotensin-aldosterone system inhibitor (RAASi) therapy are not receiving these medications. Concern about hyperkalemia is thought to contribute to this lack of evidence-based therapy. METHODS: A retrospective cohort study included adult patients in primary care practices affiliated with an integrated health care delivery system treated with RAASi between 2000 and 2019 for any of the following indications: (a) coronary artery disease (CAD); (b) heart failure (HF) with a left ventricle ejection fraction ≤ 40%; (c) diabetes mellitus (DM) with proteinuria; or (d) chronic kidney disease (CKD) with proteinuria. Relationship between hyperkalemia (K > 5.0 mEg/L) over the first 12 months of follow-up and a composite end point of cardiovascular events, renal dysfunction, and all-cause mortality was evaluated. RESULTS: Among 82,732 study patients, 7,727 (9.34%) developed hyperkalemia. Patients with hyperkalemia were older (69.0 vs 64.6) and more likely to have CAD (57.8 vs 53.7%), CKD (57.3 vs 51.1%), HF (19.3 vs 9.7%), and DM (45.3 vs 33.3%) (P < .001 for all). Five-year cumulative risk of the primary outcome was higher in patients who did (63.9%; 95% CI: 62.8%-65.1%) versus did not (37.2%; 95% CI: 36.8%-37.6%) develop hyperkalemia. Five-year cumulative risk of ED visit or hospitalization for hyperkalemia was 15.6% (14.7%-16.6%) for patients with versus 2.7% (95% CI: 2.6-2.9) for patients without hyperkalemia, rising to 25.9% (95% CI: 22.4-29.9) for patients with severe (K > 6.0 mEq/dL) hyperkalemia. Patients who experienced hyperkalemia were more likely (34.4%) than patients who did not (29.2%) to deintensify RAASi therapy (P < .001). Five-year cumulative risk of the primary outcome was higher in patients who lowered RAASi dose (50.4%; 95% CI: 48.5%-52.4%) or stopped RAASi therapy completely (49.3%; 95% CI: 48.5%-50.1%), compared to patients who continued RAASi therapy (36.1%; 95% CI: 25.7-36.5). Similar findings were observed in multivariable analyses and for individual components of the primary outcome. CONCLUSIONS: Hyperkalemia is a common complication of RAASi therapy and is associated with an increased risk of multiple adverse outcomes. Patients who have their RAASi medications deintensified after a hyperkalemic event have higher incidence of cardiovascular events, renal dysfunction and death.

Subgenomic RNA Abundance Relative to Total Viral RNA Among Severe Acute Respiratory Syndrome Coronavirus 2 Variants.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) subgenomic RNA (sgRNA) may indicate actively replicating virus, but sgRNA abundance has not been systematically compared between SARS-CoV-2 variants. sgRNA was quantified in 169 clinical samples by real-time reverse-transcription polymerase chain reaction, demonstrating similar relative abundance among known variants. Thus, sgRNA detection can identify individuals with active viral replication regardless of variant.

COVID-19 outcomes in patients taking cardioprotective medications.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) caused a worldwide pandemic and has led to over five million deaths. Many cardiovascular risk factors (e.g. obesity or diabetes) are associated with an increased risk of adverse outcomes in COVID-19. On the other hand, it has been suggested that medications used to treat cardiometabolic conditions may have protective effects for patients with COVID-19. OBJECTIVES: To determine whether patients taking four classes of cardioprotective medications-aspirin, metformin, renin angiotensin aldosterone system inhibitors (RAASi) and statins-have a lower risk of adverse outcomes of COVID-19. METHODS: We conducted a retrospective cohort study of primary care patients at a large integrated healthcare delivery system who had a positive COVID-19 test between March 2020 and March 2021. We compared outcomes of patients who were taking one of the study medications at the time of the COVID-19 test to patients who took a medication from the same class in the past (to minimize bias by indication). The following outcomes were compared: a) hospitalization; b) ICU admission; c) intubation; and d) death. Multivariable analysis was used to adjust for patient demographics and comorbidities. RESULTS: Among 13,585 study patients, 1,970 (14.5%) were hospitalized; 763 (5.6%) were admitted to an ICU; 373 (2.8%) were intubated and 720 (5.3%) died. In bivariate analyses, patients taking metformin, RAASi and statins had lower risk of hospitalization, ICU admission and death. However, in multivariable analysis, only the lower risk of death remained statistically significant. Patients taking aspirin had a significantly higher risk of hospitalization in both bivariate and multivariable analyses. CONCLUSIONS: Cardioprotective medications were not associated with a consistent benefit in COVID-19. As vaccination and effective treatments are not yet universally accessible worldwide, research should continue to determine whether affordable and widely available medications could be utilized to decrease the risks of this disease.

Compressive optic neuropathy caused by sinonasal adenosquamous carcinoma with orbital extension: A case report.

Purpose: Adenosquamous carcinoma (ASC) of the head and neck, specifically sinonasal ASC, is a rare and aggressive malignancy with metastasis occurring in 80% of patients in its initial reporting; sinonasal ASC with orbital extension has rarely been reported in literature. Despite treatment, ASC carries a poor prognosis with a 5-year survival of approximately 22%, with 50% dying within 23 months.10 Mucoepidermoid carcinoma (MEC) and ASC have similar morphologic features. It is imperative to distinguish these two entities apart as the biologic behavior and prognosis of ASC is much worse than that of poorly differentiated MEC and squamous cell carcinoma. This case provides a rare presentation of a secondary orbital tumor, ASC with orbital extension, that manifests with ocular symptoms and is therefore relevant to practitioners in the field of ophthalmology while reviewing the histology of ASC with the goal of distinguishing the entity from its differential diagnoses. Observation: To further understand the natural history of this unusual tumor, we report a case of adenosquamous carcinoma in a 76-year-old female who presented with a three-day history of left-sided: vision loss (worse centrally and nasally), afferent pupillary defect, esotropia and abduction deficit, cervical lymphadenopathy and an extraconal mass on MRI producing a compressive optic neuropathy. We provide photography that demonstrates the patient's presentation, histologic slides provided via biopsy of the malignancy, and radiologic findings on magnetic resonance imaging, all of which support the diagnosis. Conclusions/Importance: This case adds to the limited literature of sinonasal adenosquamous carcinoma while exploring orbitotomy techniques for adequate extraconal mass biopsies of the entity. Our manuscript reviews key histological findings of ASC provided by the patient's biopsies and details how to differentiate the cancer from other pathologies, like MEC; A differentiation that proves vital for practitioners due to the widely differing prognosis of the two pathologies. We present the first case of sinonasal ASC with orbital extension causing ophthalmologic symptoms.

SARS-CoV-2 Variants in Paraguay: Detection and Surveillance with an Economical and Scalable Molecular Protocol.

SARS-CoV-2 variant detection relies on resource-intensive whole-genome sequencing methods. We sought to develop a scalable protocol for variant detection and surveillance in Paraguay, pairing rRT-PCR for spike mutations with Nanopore sequencing. A total of 201 acute-phase nasopharyngeal samples were included. Samples were positive for the SARS-CoV-2 N2 target and tested with the Spike SNP assay to detect mutations associated with the following variants: alpha (501Y), beta/gamma (417variant/484K/501Y), delta (452R/478K), and lambda (452Q/490S). Spike SNP calls were confirmed using amplicon (Sanger) sequencing and whole-genome (Nanopore) sequencing on a subset of samples with confirmed variant lineages. Samples had a mean N2 Ct of 20.8 (SD 5.6); 198/201 samples (98.5%) tested positive in the Spike SNP assay. The most common genotype was 417variant/484K/501Y, detected in 102/198 samples (51.5%), which was consistent with the P.1 lineage (gamma variant) in Paraguay. No mutations (K417 only) were found in 64/198 (32.3%), and K417/484K was identified in 22/198 (11.1%), consistent with P.2 (zeta). Seven samples (3.5%) tested positive for 452R without 478K, and one sample with genotype K417/501Y was confirmed as B.1.1.7 (alpha). The results were confirmed using Sanger sequencing in 181/181 samples, and variant calls were consistent with Nanopore sequencing in 29/29 samples. The Spike SNP assay could improve population-level surveillance for mutations associated with SARS-CoV-2 variants and inform the judicious use of sequencing resources.

Evidence-Based Screening to Optimize the Yield of Positive Ophthalmologic Examinations in Children Evaluated for Suspected Child Abuse.

PURPOSE: To determine nonocular findings associated with significant retinal hemorrhage on dilated fundus examination in cases of suspected child abuse. METHODS: This was a retrospective chart review from May 2014 to August 2021 at a level-1 trauma center. Two hundred seventy-four patients met the following inclusion criteria: (1) children 36 months and younger; (2) concern for child abuse; and (3) had an ophthalmology consultation. Through univariate and multivariate logistic regression, the study produced a screening algorithm for ophthalmic work-up in child abuse. RESULTS: One or more abnormal neuroimaging findings had a statistically significant association with retinal hemorrhages and produced the strongest association with a univariate odds ratio of 170 (confidence interval: 10.245 to > 999.999). The multivariate model (P < .0001 with a c-statistic of 0.980) proposes using the following variables for predicting retinal hemorrhage on examination: abnormal neuroimaging, Glasgow Coma Scale score less than 15, altered mental status on examination, seizure activity, vomiting, bruising, scalp hematoma/swelling, and skull fractures. CONCLUSIONS: This study elucidates clinical and imaging factors that correlate to retinal findings, validating previously studied variables and introducing new variables to be considered. The authors propose an evidence-based screening algorithm to increase the yield of positive dilated examinations and decrease the burden of potentially unnecessary child abuse ophthalmologic examinations. [J Pediatr Ophthalmol Strabismus. 2022;59(5):310-319.].

Intravitreal Administration of Stanniocalcin-1 Rescues Photoreceptor Degeneration with Reduced Oxidative Stress and Inflammation in a Porcine Model of Retinitis Pigmentosa.

PURPOSE: To investigate the effect of stanniocalcin-1 (STC-1), a secreted polypeptide exhibiting multiple functions in cell survival and death, on photoreceptor degeneration in a porcine model of retinitis pigmentosa (RP). METHODS: P23H transgenic pigs (TG P23H) and wild-type hybrid littermates were obtained from the National Swine Resource and Research Center. Human recombinant STC-1 was injected intravitreally every 2 weeks from postnatal day 15 (P15) to P75. The contralateral eye was injected with balanced salt solution as a control. Electroretinography (ERG) and spectral domain optical coherence tomography (SD-OCT) were performed to evaluate retinal function and morphology in vivo at P90. Retinal tissue was collected for histologic analysis and molecular assays to evaluate the antioxidative and anti-inflammatory mechanisms by which STC-1 may rescue photoreceptor degeneration. RESULTS: Intravitreal injection of STC-1 improved retinal function in TG P23H pigs with increased photopic and flicker ERG a- and b-wave amplitudes. Greater integrity of the ellipsoid zone (EZ) band on SD-OCT and morphologic rescue with preservation of cone photoreceptors were observed in STC-1-treated TG P23H pigs. STC-1 altered gene expression in TG P23H pig retina on microarray analysis and increased photoreceptor specific gene expression by reverse transcription-polymerase chain reaction analysis. STC-1 significantly decreased oxidative stress and the expressions of NLRP3 inflammasome, cleaved caspase-1, and IL-1ß in TG P23H pig retina. CONCLUSIONS: Intravitreal administration of STC-1 enhances cone photoreceptor function, improves EZ integrity, and reduces retinal degeneration through antioxidative and anti-inflammatory effects in a large animal (pig) model of the most common form of autosomal dominant RP in the United States.

COVID-19 Vaccine Early Skepticism, Misinformation and Informational Needs among Essential Workers in the USA.

This study presents the results of a survey of 1591 hesitant U.S. essential workers, conducted over Pollfish in December 2020 when they were the only group eligible for the vaccine, aiming to describe their concerns regarding COVID-19 vaccine safety, effectiveness and distribution policies. We computed frequencies using the SAS software for each answer, using chi-squared statistics and Cochran-Armitage trend tests to determine how informational needs differ by age, gender, level of education, race, source of COVID-19 information and levels of vaccine acceptance. The results of this study show that freedom of choice, equal access to the vaccine and being able to live a life with no restrictions once vaccinated were important concerns since the early days of the distribution campaign, with 53% (836/1591), 42% (669/1591) and 35% (559/1591) of hesitant respondents, respectively, indicating they would be more likely to receive the COVID-19 vaccine if they felt these issues were satisfactorily addressed. Early risk communication and immunization campaign strategies should address not only the reported efficacy and safety of new vaccines, but, as equally important, the population's perceptions and beliefs regarding personal choice, effectiveness and adverse consequences.

Treatment of periocular basal cell carcinoma with neoadjuvant vismodegib.

PURPOSE: To report a case of a locally advanced periocular basal cell carcinoma treated with neoadjuvant Vismodegib therapy prior to surgery. OBSERVATIONS: A 63-year-old female presented to the oculoplastics clinic with biopsy-proven basal cell carcinoma of the right periorbital region causing significant cicatricial ectropion of the right lower eyelid. The medial canthal lesion involved nearly the entire right lower eyelid with extension onto the cheek, the medial half of the right upper eyelid, the palpebral and bulbar conjunctiva, as well as the right lacrimal system. CT imaging was suggestive of involvement of the extraocular muscles and other post-septal tissues. Fortunately, the patient had no metastatic disease. The extent of the tumor would have necessitated aggressive resection to achieve surgical cure. However, the patient preferred to attempt globe-sparing therapy with a goal of preserving cosmesis as much as possible. Various treatment options were discussed with the patient, including the use of Vismodegib, and the patient elected to pursue this treatment strategy. The goal of Vismodegib treatment was to reduce the tumor size enough to permit surgical resection of all tumor without significantly affecting cosmesis. After 11 months of treatment with Vismodegib, the tumor size had reduced significantly to the point where surgical intervention with minimal disfigurement could be offered. The patient underwent multidisciplinary approach with Mohs micrographic excision of the tumor paired with oculoplastic reconstructive surgery resulting in negative margins and satisfactory cosmetic results. CONCLUSIONS AND IMPORTANCE: Although addition study is required regarding Vismodegib as a primary or adjuvant therapeutic approach to periorbital basal cell carcinoma, this case illustrates the potential usefulness of this drug as an option in this context. This case provides information that may help the comprehensive ophthalmologist or oculoplastic specialist in counseling patients with locally advanced periorbital basal cell carcinoma.

Validation of the allergic rhinitis treatment satisfaction and preference scale.

Allergic rhinitis (AR) affects 7.8% of U.S. adults and 10-30% of the population worldwide. AR symptoms (rhinorrhea, congestion, sneezing, nasal/ocular pruritus, and postnasal drainage) significantly impact sleep and reduce cognitive and emotional functioning affecting work and school productivity. Although effective, intranasal corticoid (INS) steroid delivery systems are often associated with adverse sensory attributes, affecting patient adherence and reducing efficacy. Patient satisfaction with treatment characteristics predicts adherence levels that can better inform treatment decisions. This study was designed to evaluate psychometric evidence for the self-administered Allergic Rhinitis Treatment Satisfaction and Preference (ARTSP) scale as a patient-reported outcomes measure for use in clinical research. Analytic methods included qualitative analysis of patient focus groups and psychometric analysis of scale data collected from 185 AR subjects enrolled in a randomized, 2-week, crossover, comparative U.S. clinical trial. Qualitative analysis conceptually supported nine treatment satisfaction subscales. Reliability by Cronbach alpha met accepted standards. Evidence was found for construct validity using structural equation modeling, criterion validity from correlation patterns between treatment satisfaction and health-related quality of life scales, and discriminant validity analysis based on AR symptom-defined groups. Responsiveness was shown by significant change in treatment satisfaction subscales among AR symptom change groups. Scores on treatment preference items discriminated between the aqueous and aerosol INS formulations. The ARTSP scale is a conceptually sound, reliable, valid, and responsive measure of patient evaluations of alternative therapies, providing detailed information about treatment characteristics that are likely to influence adherence levels and subsequent AR clinical control.

Immigration and suicidal behavior among Mexicans and Mexican Americans.

OBJECTIVES: We examined migration to the United States as a risk factor for suicidal behavior among people of Mexican origin. METHODS: We pooled data from 2 nationally representative surveys in the United States (2001-2003; n = 1284) and Mexico (2001-2002; n = 5782). We used discrete time survival models to account for time-varying and time-invariant characteristics, including psychiatric disorders. RESULTS: Risk for suicidal ideation was higher among Mexicans with a family member in the United States (odds ratio [OR] = 1.50; 95% confidence interval [CI] = 1.06, 2.11), Mexican-born immigrants who arrived in the United States at 12 years or younger (OR = 1.84; 95% CI = 1.09, 3.09), and US-born Mexican Americans (OR = 1.56; 95% CI = 1.03, 2.38) than among Mexicans with neither a history of migration to the United States nor a family member currently living there. Risk for suicide attempts was also higher among Mexicans with a family member in the United States (OR = 1.68; 95% CI = 1.13, 2.52) and US-born Mexican Americans (OR = 1.97; 95% CI = 1.06, 3.65). Selection bias caused by differential migration or differential return migration of persons at higher risk of suicidal ideation or attempt did not account for these findings. CONCLUSIONS: Public health efforts should focus on the impact of Mexico-US migration on family members of migrants and on US-born Mexican Americans.

Risk for psychiatric disorder among immigrants and their US-born descendants: evidence from the National Comorbidity Survey Replication.

Although previous research has consistently documented that immigrants to the United States have better mental health than US natives, little is known about why this difference occurs. DSM-IV anxiety, mood, impulse control, and substance use disorders were assessed in a nationally representative survey of the US household population, the National Comorbidity Survey Replication. Differences in risk for disorder between immigrants (N = 299) and 5124 natives (N = 5124) were examined using discrete time survival models. Differences were estimated by generation, age of immigration, and duration of residence in the United States. Immigrants had lower lifetime risk of disorder than natives (OR = 0.7; 95% CI, 0.5-0.9). Risk was equally large for natives who were children of immigrants as for natives of subsequent generations. For mood and impulse control disorders, risk equal to that of natives was also found among immigrants who arrived in the United States as children (12 years of age or younger). Immigrants had lower risk than natives prior to arrival in the United States, but there was a trend toward equalization of risk with longer duration of residence in the United States. Differences in risk for disorder emerge within a single generation following immigration, consistent with a strong effect of environmental factors on changes in risk among immigrant populations. This pattern is consistent with either of two causal processes, one involving early socialization in the United States and the other involving postmigration experiences among immigrants who arrive in the United States as adults.

Mental disorders among English-speaking Mexican immigrants to the US compared to a national sample of Mexicans.

Our understanding of the relationship between immigration and mental health can be advanced by comparing immigrants pre- and post-immigration with residents of the immigrants' home countries. DSM-IV anxiety and mood disorders were assessed using identical methods in representative samples of English-speaking Mexican immigrants to the US, a subsample of the US National Comorbidity Survey Replication (NCSR), and Mexicans, the Mexican National Comorbidity Survey (MNCS). Retrospective reports of age of onset of disorders and, in the immigrant sample, age of immigration were analyzed to study the associations of pre-existing mental disorders with immigration and of immigration with the subsequent onset and persistence of mental disorders. Pre-existing anxiety disorders predicted immigration (OR=3.0; 95% CI 1.2-7.4). Immigration predicted subsequent onset of anxiety (OR=1.9; 95% CI 0.9-3.9) and mood (OR=2.3; 95% CI 1.3-4.0) disorders and persistence of anxiety (OR=3.7 95% CI 1.2-11.2) disorders. The results are inconsistent with the "healthy immigrant" hypothesis (that mentally healthy people immigrate) and partly consistent with the "acculturation stress" hypothesis (i.e., that stresses of living in a foreign culture promote mental disorder). Replication and extension of these results in a larger bi-national sample using a single field staff are needed.

Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample.

BACKGROUND: Epidemiological studies have found lower than expected prevalence of psychiatric disorders among disadvantaged race-ethnic minority groups in the USA. Recent research shows that this is due entirely to reduced lifetime risk of disorders, as opposed to persistence. Specification of race-ethnic differences with respect to clinical and social characteristics can help identify the protective factors that lead to lower lifetime risk among disadvantaged minority groups. METHOD: Data on 5424 Hispanics, non-Hispanic Blacks, and non-Hispanic Whites came from the National Comorbidity Survey Replication, a nationally representative survey conducted with the World Mental Health version of the Composite International Diagnostic Interview. Race-ethnic differences in risk of disorders were compared across specific diagnoses, ages of onset, cohorts and levels of education. RESULTS: Both minority groups had lower risk for common internalizing disorders: depression, generalized anxiety disorder, and social phobia. In addition, Hispanics had lower risk for dysthymia, oppositional-defiant disorder and attention deficit hyperactivity disorder; non-Hispanic Blacks had lower risk for panic disorder, substance use disorders and early-onset impulse control disorders. Lower risk among Hispanics, relative to non-Hispanic Whites, was found only among the younger cohort (age