Emerging cancer disease burden in a rural sub-Saharan African population: northeast Nigeria in focus.

Introduction: Sub-Saharan Africa (SSA) is plagued by myriads of diseases, mostly infectious; but cancer disease burden is rising among non-communicable diseases. Nigeria has a high burden of cancer, however its remote underserved culturally-conserved populations have been understudied, a gap this study sought to fill. Methods: This was a cross-sectional multi-institutional descriptive study of histologically diagnosed cancers over a four-year period (January 2019-December 2022) archived in the Departments of Pathology and Cancer Registries of six tertiary hospitals in the northeast of Nigeria. Data obtained included age at diagnosis, gender, tumor site and available cancer care infrastructure. Population data of the study region and its demographics was obtained from the National Population Commission and used to calculate incident rates for the population studied. Results: A total of 4,681 incident cancer cases from 2,770 females and 1,911 males were identified. The median age at diagnosis for females was 45 years (range 1-95yrs), and 56 years (range 1-99yrs) for males. Observed age-specific incidence rates (ASR) increased steadily for both genders reaching peaks in the age group 80 years and above with the highest ASR seen among males (321/100,000 persons) compared to females (215.5/100,000 persons). Breast, cervical, prostatic, colorectal and skin cancers were the five most common incident cancers. In females, breast, cervical, skin, ovarian and colorectal cancers were the top five malignancies; while prostate, haematolymphoid, skin, colorectal and urinary bladder cancers predominated in men. Conclusion: Remote SSA communities are witnessing rising cancer disease burden. Proactive control programs inclusive of advocacy, vaccination, screening, and improved diagnostics are needed.

Reducing Racial Disparities at End-of-life: Using Narratives to Build Trust and Promote advance Care Planning.

Black Americans are less likely than White Americans to have advance directives, die while receiving hospice services, or have their end-of life wishes honored. The root causes of disparities include imbalance of resources, lack of trust in health care institutions, lack of adequate education regarding end-of-life options, communication differences of health care providers with black vs white patients, variable access to hospice services in different communities, and poorer pain management for Black patients compared to White patients. Because root causes are numerous, comprehensive solutions are required. When advance care planning is in place, people are more likely to choose care focused on priorities and comfort than on seeking aggressive, sometimes futile, interventions in the last weeks of life. One important component of the solution should include listening to narrative stories of Black people as they encounter life-limiting diagnoses. Gathering the stories about life events and how strength was found through adversities can be a tool for growing trusting relationships and engaging in shared decision-making. Health care professionals should invite Black patients with serious illnesses to explore the sources of their strengths and identify their core values to work toward developing directives for the nature and place of their end-of-life and help to mitigate disparities in high quality end-of-life care.

The Landscape of Pain Medicine for Women Physicians: A Perspective.

BACKGROUND: The gender bias in academic anesthesiology is well known. Women are not only a minority in the field but also underrepresented in leadership positions. Reported reasons for this underrepresentation include barriers to career advancement, lack of mentorship, and differences in compensation, among others. Interventional pain, a competitive procedural subspecialty of anesthesiology, sees the trickle-down effects of this disparity. According to a report from the ACGME that sorted medical subspecialties by number of female trainees, pain medicine ranked in the bottom quartile across all disciplines from 2008-2016. OBJECTIVES: To better understand the landscape for women physicians in the field of pain medicine, we undertook this investigation to review the knowledge about the topic and what questions remain unanswered. STUDY DESIGN: This study is a review of the current literature and aims to summarize and describe the landscape of pain medicine for women physicians. SETTING: All literature review and manuscript preparation took place at the Yale University School of Medicine. METHODS: We performed a comprehensive search using the PubMed, Scopus, and Cochrane databases for the combined terms "gender disparity," "pain medicine," and "anesthesiology," limiting our search to the year 2000 onward for the most recent literature on the topic. Our initial search retrieved 38 articles. All relevant articles pertaining to this perspective piece were collated. The available literature is discussed below. RESULTS: Women are underrepresented in interventional pain. The grim scarcity of female pain physicians is unlikely to improve soon, since while the number of Accreditation Council for Graduate Medical Education pain fellowship programs continues to grow, women trainees comprise only between 22-25% of all pain medicine fellows. Additionally, although studies have compared the numbers of male interventional pain faculty to their female counterparts in academic hospitals and shown the ratio to range from 71.84-82% to 18-28.52%, respectively, no studies have truly explored the landscape for women physicians in private practice. Patients prefer and have better experiences with physicians who are racially and ethnically like themselves. In fact, the preference for and the lack of female clinicians have been associated with delayed pursuit of care and adverse health outcomes. The consequences of the burnout and attrition caused by the gender disparity, especially in a field like pain medicine, cannot be understate. LIMITATIONS: The review might not have been comprehensive, and relevant studies might not have been included. CONCLUSION: While the gender disparity in academia is well documented for both anesthesiology and pain medicine, the reasons for this disparity have not been fully explored. Moreover, it is also unknown whether the minority of female physicians who select pain medicine as a subspecialty gravitate toward an academic or a private-practice path. To address the existing gender disparity, it is necessary to explore the landscape of interventional pain medicine in both academic and private practices and understand pain physicians' beliefs and sentiments regarding their subspecialty.

Association of TP53 Mutation Status and Sex with Clinical Outcome in NSCLC Treated with Immune Checkpoint Inhibitors: A Retrospective Cohort Study.

Purpose: Some studies suggest that TP53 mutations are associated with the response to immune checkpoint inhibitors (ICI) in patients with non-small cell lung cancer (NSCLC) and also contribute to sex disparities in several cancers. Thus, we hypothesized that TP53 mutations might serve as sex-dependent genomic biomarkers of ICI treatment response in patients with NSCLC. Materials and Methods: Clinical data of 100 patients with metastatic NSCLC treated with ICI monotherapy at Seoul National University Bundang Hospital (SNUBH) were retrospectively reviewed. Genomic and clinical datasets of TCGA and an ICI-treated lung cancer cohort (cBioPortal) were also analyzed. Results: In SNUBH cohort, no statistically significant difference was observed in disease control rate per the TP53 mutation status (p=0.503); however, female patients with TP53 mutated (MT) had a significantly prolonged median progression-free survival (PFS) compared to wild-type (WT) (6.1 months in TP53 MT vs. 2.6 months in TP53 WT; p=0.021). PD-L1 high (≥50%) expression was significantly enriched in female patients with TP53 MT (p=0.001). The analysis from publicly available dataset also revealed that females with NSCLC with TP53 MT showed significantly longer PFS than those with TP53 WT (p<0.001). In TCGA analysis, expression of immune-related genes, and TMB score in TP53 MT females were higher than in males without TP53 MT. Conclusion: Female patients with NSCLC with TP53 mutations had high PD-L1 expression and showed favorable clinical outcomes following ICI therapy, suggesting a need for further research to explore the role of TP53 mutations for sex disparities in response to ICI therapy.

Traumatic Brain Injury in Admitted Patients with Ocular Trauma.

Objectives: To characterize the epidemiology of simultaneous traumatic brain injury (TBI) and ocular trauma. Materials and Methods: In this retrospective, observational study, de-identified data from patients admitted with ocular trauma and TBI was extracted from the National Trauma Data Bank (2008-2014) using International Classification of Diseases 9th Revision, Clinical Modification diagnostic codes and E-codes relating to injury circumstances. Mechanisms, types of ocular and head injuries, intention, and demographic distribution were determined. Association of variables was calculated with Student's t and chi-squared tests and logistic regression analysis. Results: Of 316,485 patients admitted with ocular trauma, 184,124 (58.2%) also had TBI. The mean (standard deviation [SD]) age was 41.8 (23) years. Most were males (69.8%). Race/ethnicity distribution was 68.5% white, 13.3% black, and 11.4% Hispanic patients. The mean (SD) Glasgow Coma Score (GCS) was 12.4 (4.4) and Injury Severity Score (ISS) was 17 (10.6). Frequent injuries were orbital fractures (49.3%) and eye/adnexa contusions (38.3%). Common mechanisms were falls (27.7%) and motor vehicle-occupant (22.6%). Firearm-related trauma (5.2%) had the greatest odds of very severe injury (ISS >24) (odds ratio [OR]: 4.29; p<0.001) and severe TBI (GCS <8) (OR: 5.38; p<0.001). Assault injuries were associated with the greatest odds of mild TBI (OR: 1.36; p<0.001) and self-inflicted injuries with severe TBI (OR: 8.06; p<0.001). Eye/adnexal contusions were most associated with mild TBI (OR: 1.25; p<0.001). Optic nerve/visual pathway injuries had greater odds of severe TBI (OR: 2.91; p<0.001) and mortality (OR: 2.27; p<0.001) than other injuries. Of associated head injuries, the odds of severe TBI were greatest with skull base fractures (OR: 4.07; p<0.001) and mortality with intracerebral hemorrhages (OR: 4.28; p<0.001). Mortality occurred in 5.9% of patients. Conclusion: TBI occurred in nearly two-thirds of ocular trauma admissions. The mortality rate was low with implications for challenging rehabilitation and long-term disability in survivors.

Gender Gap in Cardiothoracic Surgery Randomized Controlled Trial and posthoc analysis of Randomized Controlled Trial Authorship from 2014 to 2020.

OBJECTIVES: To estimate gender disparities among first and last authorships in cardiothoracic randomized controlled trials(RCTs) and association of gender with publications in high impact journals. METHODS: PubMed/MEDLINE database was searched from January 1st , 2014-December 31st , 2020 using R statistical software via "easyPubMed" package to retrieve pertinent data. The "gender" package was utilized to determine gender using the United States Social Security Administration Baby Name Data. The percentage of women first and last authors were computed along with determining the uniqueness of the names. The association of gender and publication in high impact peer-reviewed journals was delineated. Jonckheere'e trend was computed. RESULTS: The database search retrieved total of 4820 RCTs. Of which, gender was encoded for first author of 3247 [67%] RCTs, among which 911[28%] studies had women as first authors with a similar trend across seven years [P value 0.23]. Gender was encoded for last author of 3204 [66%] RCTs, of which 622 [19%] studies had women as last authors with a similar trend across seven years [P value 0.45]. A total of 627 studies were published in high impact factor journals, among which 79[16%] studies had women first authors and 67[13%] studies had women last authors. CONCLUSIONS: There is an obvious gender disparity of first and last authors in cardiothoracic surgery related RCTs with a similar trend across seven years. However, the post-hoc analysis did demonstrate a positive trend with increase in the number of female first authors demonstrating progress.

A methodological approach for enhancing visualization of country data representation in the presence of significant spatial disparity.

In this article, we present a methodological approach to address spatial disparity in global data representation, introducing an algorithm called Flexible Mapping to Understand Spatial Analysis (FLEMUSA). We utilize world maps to depict various data points across countries, revealing substantial variation among them. However, conventional choropleth maps often fail to effectively represent regions with sparse data, obscuring valuable insights. To mitigate this issue, we propose interactive graphical methods in both two and three dimensions, implemented through open-source Python code accessible via Google Colab. Our approach includes several contributions such as excluding countries without data from the representation, scaling magnitudes within country borders, focusing on regional analysis, and using logarithmic scales for bubble maps proportional to country sizes. Additionally, we offer interactive 2D and 3D representations, rotatable 3D representations, and zoomable options, facilitating enhanced visualization of regional similarities amidst data heterogeneity. Through this algorithm, we aim to improve the clarity and interpretability of spatial data analysis, integrating solutions for extreme data overdispersion, all programmed with open-source code.-Utilization of world maps for visual representation of data across countries mitigating the overdispersion step by step.-Implementation of graphical methods, including interactive 2D and 3D maps, to address spatial disparity.-Provision of open-source code for customizable graphical representations, facilitating implementation in online journals as interactive code snippets.

Associations between indoor fine particulate matter (PM2.5) and sleep-disordered breathing in an urban sample of school-aged children.

OBJECTIVES: Environmental risk factors may contribute to sleep-disordered breathing. We investigated the association between indoor particulate matter ≤2.5µm in aerodynamic diameter (PM2.5) and sleep-disordered breathing in children in an urban US community. METHODS: The sample consisted of children aged 6-12years living in predominantly low-income neighborhoods in Boston, Massachusetts. Indoor PM2.5 was measured in participants' main living areas for 7days using the Environmental Multipollutant Monitoring Assembly device. High indoor PM2.5 exposure was defined as greater than the sample weekly average 80th percentile level (≥15.6 µg/m3). Sleep-disordered breathing was defined as an Apnea-Hypopnea-Index (AHI) or Oxygen-Desaturation-Index (ODI) (≥3% desaturation) of ≥5 events/hour. Habitual loud snoring was defined as caregiver-report of loud snoring (most or all the time each week) over the past 4weeks. We examined the associations of PM2.5 with sleep-disordered breathing or snoring using logistic regression adjusting for potential confounders. RESULTS: The sample included 260 children (mean age 9.6years; 41% female), with 32% (n = 76) classified as having sleep-disordered breathing. In a logistic regression model adjusted for socioeconomics and seasonality, children exposed to high indoor PM2.5 levels (n = 53) had a 3.53-fold increased odds for sleep-disordered breathing (95%CI: 1.57, 8.11, p = .002) compared to those with lower indoor PM2.5. This association persisted after additional adjustments for physical activity, outdoor PM2.5, environmental tobacco smoke, and health characteristics. Similar associations were observed for snoring and indoor PM2.5. CONCLUSIONS: Children with higher indoor PM2.5 exposure had greater odds of sleep-disordered breathing and habitual loud snoring, suggesting that indoor air quality contributes to sleep disparities.

Racial/ethnic disparity in severe maternal morbidity among women who conceived by in vitro fertilization.

Background: In vitro fertilization (IVF) as a fertility treatment is associated with adverse perinatal outcomes. Racial/ethnic disparity in severe maternal morbidity (SMM) in women who conceived by IVF is understudied. Objective: To examine differences in the association between race/ethnicity and SMM between women who conceived spontaneously and those who conceived using IVF. Methods: We included all singleton live births and stillbirths in the United States, 2016-2021; data were obtained from the National Center for Health Statistics. Maternal race/ethnicity included non-Hispanic White (NHW), non-Hispanic Black (NHB), American Indian and Alaska Native (AIAN), Asian, Pacific Islander (PI), Hispanic, and mixed-race categories. The SMM composite outcome included eclampsia, uterine rupture, peripartum hysterectomy, blood transfusion, and intensive care unit (ICU) admission. We used logistic regression to adjust for potential confounders (such as age, education, parity, prepregnancy body mass index, smoking during pregnancy, chronic hypertension, and preexisting diabetes) and to assess modification of the association between race/ethnicity and SMM by IVF. Results: The study population included 21,585,015 women: 52% were NHW, 15% NHB, 0.8% AIAN, 6% Asian, 0.2% PI, 24% Hispanic, and 2% were of mixed race. IVF was used by 183,662 (0.85%) women; the rate of the SMM composite outcome was 18.5 per 1000 deliveries and 7.9 per 1000 deliveries in the IVF and spontaneous conception groups, respectively (unadjusted rate ratio 2.34, 95% confidence interval [CI] 2.26-2.43). In women with spontaneous conception, NHB, Asian and mixed-race women had elevated odds of SMM compared with NHW women (adjusted odds ratio [aOR]=1.39, 95% CI 1.37-1.41; aOR=1.04, 95% CI 1.02-1.07; and aOR=1.42, 95% CI 1.38-1.46, respectively). Racial/ethnic disparities in SMM and its components were not different between the IVF and spontaneous conception groups for the mixed-race category. NHB and Hispanic women had significantly higher aORs for uterine rupture/intrapartum hysterectomy compared with NHW women in the IVF group, while Asian women had a higher aOR for ICU admission compared with NHW women in the IVF group. Conclusion: Women who conceived by IVF have a greater than two-fold higher risk of SMM and this higher risk is evident across all racial/ethnic groups. However, NHB and Hispanic women who conceived by IVF had a higher risk of uterine rupture/hysterectomy, and Asian women who conceived by IVF had a higher risk of ICU admission. Our results warrant further investigation examining pregnancy and postpartum care issues among racial/ethnic minority women who conceive using IVF.

Implementation of an Approach to Equitable Allocation of SARS-CoV-2 Monoclonal Antibodies for Preexposure Prophylaxis: Experience From a Single Medical Center.

Background: During the COVID-19 pandemic, SARS-CoV-2 monoclonal antibodies for preexposure prophylaxis (SMA-PrEP) offered patients who were immunocompromised another option for protection. However, SMA-PrEP posed administrative, operational, and ethical challenges for health care facilities, resulting in few patients receiving them. Although the first SMA-PrEP medication, tixagevimab and cilgavimab, had its authorization revoked due to compromised in vitro efficacy, new SMA-PrEP medications are currently completing clinical trials. This article provides an operational framework for administrative organization, patient identification and prioritization, equitable medication allocation, medication ordering and administration, and patient tracking. Methods: A retrospective cohort study evaluating our hospital's SMA-PrEP administration strategy was performed. Multivariable logistic regression was used to examine factors associated with receipt of SMA-PrEP. Results: Despite the barriers in administering this medication and the scarcity of resources, our hospital was able to administer at least 1 dose of SMA-PrEP to 1359 of 5902 (23.0%) eligible patients. Even with the steps taken to promote equitable allocation, multivariable logistic regression demonstrated that there were still differences by race, ethnicity, and socioeconomic status. As compared with patients who identified as Black, patients who identified as White (odds ratio [OR], 1.85; 95% CI, 1.46-2.33), Asian (OR, 1.59; 95% CI, 1.03-2.46), and Hispanic (OR, 1.53; 95% CI, 1.02-2.44) were more likely to receive SMA-PrEP. When compared with patients with low socioeconomic status, patients with high socioeconomic status (OR, 1.37; 95% CI, 1.05-1.78) were more likely to be allocated SMA-PrEP. Conclusions: Despite efforts to mitigate health care disparities, differences by race/ethnicity and socioeconomic status still arose in patients receiving SMA-PrEP.

The Double-Edged Sword of Online Learning for Ethnoracial Differences in Adolescent Mental Health During Late Period of the COVID-19 Pandemic in the United States: National Survey.

BACKGROUND: Despite several theories suggesting online learning during the COVID-19 pandemic would aggravate ethnoracial disparities in mental health among adolescents, extant findings suggest no ethnoracial differences in mental health or that those from minoritized ethnoracial groups reported better mental health than their White counterparts. OBJECTIVE: This study aimed to identify why findings from prior studies appear to not support that ethnoracial disparities in mental health were aggravated by testing 2 pathways. In pathway 1 pathway, online learning was associated with reporting fewer confidants, which in turn was associated with poorer mental health. In pathway 2, online learning was associated with reporting better sleep, which in turn was associated with better mental health. METHODS: We analyzed survey data from a US sample (N=540) of 13- to 17-year-olds to estimate how school modality was associated with mental health via the 2 pathways. The sample was recruited from the AmeriSpeak Teen Panel during spring of 2021, with an oversample of Black and Latino respondents. Ethnoracial categories were Black, Latino, White, and other. Mental health was measured with the 4-item Patient Health Questionnaire, which assesses self-reported frequency of experiencing symptoms consistent with anxiety and depression. School modality was recorded as either fully online or with some in-person component (fully in-person or hybrid). We recorded self-reports of the number of confidants and quality of sleep. Covariates included additional demographics and access to high-speed internet. We estimated bivariate associations between ethnoracial group membership and both school modality and mental health. To test the pathways, we estimated a path model. RESULTS: Black and Latino respondents were more likely to report being in fully online learning than their White counterparts (P<.001). Respondents in fully online learning reported fewer confidants than those with any in-person learning component (ß=-.403; P=.001), and reporting fewer confidants was associated with an increased likelihood of reporting symptoms consistent with anxiety (ß=-.121; P=.01) and depression (ß=-.197; P<.001). Fully online learning respondents also reported fewer concerns of insufficient sleep than their in-person learning counterparts (ß=-.162; P=.006), and reporting fewer concerns was associated with a decreased likelihood of reporting symptoms consistent with anxiety (ß=.601; P<.001) and depression (ß=.588; P<.001). Because of these countervailing pathways, the total effect of membership in a minoritized ethnoracial group on mental health was nonsignificant. CONCLUSIONS: The findings compel more nuanced discussions about the consequences of online learning and theorizing about the pandemic's impact on minoritized ethnoracial groups. While online learning may be a detriment to social connections, it appears to benefit sleep. Interventions should foster social connections in online learning and improve sleep, such as implementing policies to enable later start times for classes. Future research should incorporate administrative data about school modality, rather than relying on self-reports.

Sexually transmitted infection testing and diagnosis in adolescents and young adults with sickle cell disease.

BACKGROUND: Sexually transmitted infections (STIs) are common and disproportionately affect Black adolescents and young adults (AYAs). Less is known about STIs among Black AYAs with chronic conditions, such as sickle cell disease (AYAs-SCD). This study compared STI testing and diagnosis between AYAs-SCD and their peers, overall and among STI-related encounters. PROCEDURE: This retrospective, cross-sectional study used diagnosis and billing codes in the Pediatric Health Information System (PHIS) to identify inpatient and emergency department encounters from January 1, 2022 to May 31, 2023 among all AYAs 15-24 years and those with STI-related diagnoses (e.g., "cystitis"). STI testing and diagnosis rates were compared between AYAs-SCD, non-Black AYAs, and Black AYAs, controlling for age, sex, and encounter setting. RESULTS: We identified 3602 AYAs-SCD, 177,783 Black AYAs, and 534,495 non-Black AYAs. AYAs-SCD were less likely to be tested for STIs than non-Black AYAs (odds ratio [OR] = 0.26; adj. p < .001) and Black AYAs (OR = 0.53; adj. p < .001). When tested, AYAs-SCD were more likely to be diagnosed with an STI than non-Black AYAs (OR = 2.39; adj. p = .006) and as likely as Black AYAs (OR = 0.67; adj. p = .15). Among STI-related encounters, AYAs-SCD were less likely to be tested than non-Black AYAs (OR = 0.18; adj. p < .001) and Black AYAs (OR = 0.44; adj. p < .001). No significant differences in STI diagnoses were found in this subset between AYAs-SCD and non-Black AYAs (OR = 0.32; adj. p = .28) or Black AYAs (OR = 1.07; adj. p = .99). CONCLUSIONS: STI care gaps may disproportionately affect AYAs-SCD. STIs should be considered when evaluating symptomatic AYAs-SCD in acute settings. More research is needed to further contextualize STI care for AYAs-SCD.

Relationship between cognitive function and sleep quality in middle-aged and older adults for minimizing disparities and achieving equity in health: Evidence from multiple nationwide cohorts.

BACKGROUND: Cognitive decline, a heavy burden on middle-aged and older adults as global aging is aggravated, was found to be associated with sleep quality. However, the country-between heterogeneity of the association prevented us from quantifying underlying relationship and identifying potential effect modifiers for vulnerable populations and targeted interventions. METHODS: We collected data from 79,922 eligible adults in five nationwide cohorts, examined the respective relationships between cognitive function and sleep quality, synthesized underlying average relationships by meta-analysis, and explored effect modifiers by meta-regressions. Additionally, we conducted subgroup and interaction analyses to identify vulnerable populations and to determine their disparities in vulnerability. RESULTS: Although country-between disparities exist, cognitive function is robustly associated with sleep quality in middle-aged and older adults worldwide, with an effect (ß) of 0.015 [0.003, 0.027]. Executive function is the subdomain most relevant to sleep quality. Disparities in the effects of sleep quality on subdomains exist in populations with different sexes (orientation: ßfemale/ßmale = 1.615, P = 0.020), marital statuses (orientation: ßunmarried/ßmarried = 2.074, P < 0.001), education levels (orientation:ßuneducated/ßeducated = 2.074, P < 0.001) and chronic disease statuses (memory: ßunhealthy/ßhealthy = 1.560, P = 0.005). CONCLUSIONS: Cognitive function decreases with worsening sleep quality in middle-aged and older adults. Vulnerability to poor sleep generally persists in singles, females, the uneducated and people with chronic diseases. To minimize disparities and achieve health equity, we advocate for targeted interventions, i.e., encouraging socialization in singles, confirming effectiveness of hormone replacement therapy in females, employing compulsory education in middle-aged and older adults.

Correlates of verbal and physical violence experienced and perpetrated among cisgender college women: serial cross-sections during one year of the COVID-19 pandemic.

Introduction: Violence against women is a prevalent, preventable public health crisis. COVID-19 stressors and pandemic countermeasures may have exacerbated violence against women. Cisgender college women are particularly vulnerable to violence. Thus, we examined the prevalence and correlates of verbal/physical violence experienced and perpetrated among cisgender women enrolled at a New York City college over one year during the COVID-19 pandemic. Methods: From a prospective cohort study, we analyzed data self-reported quarterly (T1, T2, T3, T4) between December 2020 and December 2021. Using generalized estimated equations (GEE) and logistic regression, we identified correlates of experienced and perpetrated violence among respondents who were partnered or cohabitating longitudinally and at each quarter, respectively. Multivariable models included all variables with unadjusted parameters X 2 p-value ≤0.05. Results: The prevalence of experienced violence was 52% (T1: N = 513), 30% (T2: N = 305), 33% (T3: N = 238), and 17% (T4: N = 180); prevalence of perpetrated violence was 38%, 17%, 21%, and 9%. Baseline correlates of experienced violence averaged over time (GEE) included race, living situation, loneliness, and condom use; correlates of perpetrated violence were school year, living situation, and perceived social support. Quarter-specific associations corroborated population averages: living with family members and low social support were associated with experienced violence at all timepoints except T4. Low social support was associated with higher odds of perpetrated violence at T1/T3. Other/Multiracial identity was associated with higher odds of violence experience at T3. Conclusions: Living situation was associated with experienced and perpetrated violence in all analyses, necessitating further exploration of household conditions, family dynamics, and interpersonal factors. The protective association of social support with experienced and perpetrated violence also warrants investigation into forms of social engagement and cohesion. Racial differences in violence also require examination. Our findings can inform university policy development on violence and future violence research. Within or beyond epidemic conditions, universities should assess and strengthen violence prevention and support systems for young women by developing programming to promote social cohesion.

Ethnic disparities in mental health problems in New Caledonia and French Polynesia.

OBJECTIVES: Indigenous people experience poorer mental health compared to the general population. Socioeconomic gaps partly explain these disparities. However, there is variability between populations and French overseas territories are understudied. This study examines the prevalence of mental health problems among Indigenous people in New Caledonia and French Polynesia, describing and comparing it with that of their counterparts while considering associated factors. METHODS: We used the data from the cross-sectional Mental Health in the General Population survey in the only 3 sites for which information on indigenous status was available: Noumea (2006) and the 'Bush' (2008) in New Caledonia, and French Polynesia (2015-2017). Current mental health issues were screened using the Mini-International Neuropsychiatric Interview. In multivariable analyses, we considered the following factors: gender, age, education level, marital status, occupational activity and monthly income. RESULTS: Overall, 2294 participants were analysed. Among the 1379 indigenous participants, 52.3% had at least one mental health issue. The prevalence of depressive disorder (18.0% vs 11.7%), alcohol use disorder (16.7% vs 11.7%) and suicide risk (22.3% vs 16.7%) were higher among indigenous participants compared to non-indigenous participants. After adjustment, the association between indigenous status and these mental health issues did not persist, except for alcohol use disorder. CONCLUSION: We found higher prevalence of depressive disorder, alcohol use disorder and suicide risk among indigenous people of French Polynesia and New Caledonia compared to their counterparts. These differences seemed largely explained by socioeconomic disparities. Future studies could explore the use of and access to healthcare by indigenous populations.

Racial and Ethnic Disparity in Shoulder Surgery: A Systematic Review.

BACKGROUND: Healthcare disparity exists in utilization and delivery of musculoskeletal care and continues to be an obstacle for orthopedic healthcare providers to mitigate. Racial and ethnic disparities exist within various surgical fields including orthopedic surgery and are expected to continue to rise in upcoming years. The aim of this systematic review is to analyze the racial and ethnic disparities on utilization and outcomes after common shoulder surgical procedures. QUESTIONS/PURPOSE: Are there racial or ethnic disparities in outcomes and utilization of shoulder surgeries? Is there evidence to explain the etiology underlying the differences in outcomes among racial and ethnic groups after shoulder surgery? PATIENTS/METHODS: A primary literature search was performed using PubMed, Embase, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov databases using comprehensive Medical Subject Headings and subject-heading search terms. Studies were included if they reported utilization and or outcomes across two or more racial/ethnic groups in patients (age >16) who underwent shoulder arthroplasty (TSA), rotator cuff repair (RCR), arthroscopic Bankart repair (ABR), Latarjet (LP) and internal fixation (ORIF) of PHF. Baseline demographics, data on procedure utilization, perioperative measures including mortality, operative time, length of stay (LOS), readmission and complications were extracted from included studies, and descriptive statistical analysis performed. RESULTS: Eighteen studies were identified for full text review of which 13 found race and ethnicity as factors affecting utilization and outcomes in TSA, RCR, ABR, LP and ORIF of PHF. Compared to White patients, Black patients were found to have decreased utilization, longer LOS, and greater operative time and mortality after TSA; Black patients also had longer operative times and time to discharge, and lower levels of reported satisfaction after RCR. Hispanic/Latino ethnicity was reported as an independent risk factor for post operative falls following TSA. Hispanic/Latino and Black patients have a higher risk of delayed surgery and greater risk of readmission after surgical treatment of PHF compared to patients of White race. CONCLUSION: This systematic review highlights the limited literature reporting the existence of racial and ethnic disparities in utilization and outcomes after common shoulder surgical procedures. Additionally, there is paucity of studies exploring the underlying etiology of racial and ethnic disparity in outcomes after shoulder surgery. More research is necessary to pave the way for evidence-based action plans to mitigate healthcare disparities after shoulder surgeries, but this review serves as a baseline for where efforts in direct improvement can begin.

Association of Family Member Incarceration During Childhood and Smoking and Unhealthy Drinking Behaviors, Access to Care, and Functional Status Among Adults in the United States.

IMPORTANCE: Incarceration can result in adverse socioeconomic and health consequences for individuals who have been incarcerated; these consequences extend to their children and may have impacts into later adulthood. OBJECTIVE: To examine the association of family member incarceration (FMI) during childhood and smoking and unhealthy drinking behaviors, access to care, and functional status in later adulthood. DESIGN AND PARTICIPANTS: Adults aged 18-64 and ≥ 65 with and without FMI during childhood from 42 states and Washington DC from the 2019-2022 Behavioral Risk Factor Surveillance System. MAIN MEASURES: Having FMI history was defined as "living with anyone during childhood who served time or was sentenced to serve time in a prison, jail, or other correctional facility." Study outcomes included 1) smoking and unhealthy drinking behaviors, 2) access to care (health insurance coverage, care affordability, having a usual source of care, and use of preventive services), and 3) functional status (e.g., having difficulty walking or climbing stairs). KEY RESULTS: After adjusting for demographic characteristics and other adverse childhood experiences, compared to adults without FMI, adults aged 18-64 with FMI were more likely to report any history of smoking or unhealthy drinking (adjusted odds ratio (AOR): 1.19, 95% confidence interval (CI): 1.11-1.28), any access to care problems (AOR: 1.26, 95% CI: 1.12-1.42), and any functional limitations (AOR: 1.18, 95% CI: 1.10-1.28); adults aged ≥ 65 with FMI reported higher likelihood of reporting any smoking or unhealthy drinking behaviors (AOR: 1.23, 95% CI: 1.05-1.43) and impaired functional status (AOR: 1.30, 95% CI: 1.10-1.54). Associations were attenuated after additional adjustment for socioeconomic measures, especially educational attainment, but remained statically significant for multiple outcomes. CONCLUSIONS: FMI during childhood was associated with adverse health-related outcomes for adults of all ages. Developing programs to improve access to education and economic opportunities for adults with FMI may help mitigate the disparities.

Manifestation and Progression of Metabolic Dysfunction-Associated Steatotic Liver Disease in a Predominately African American Population at a Multi-Specialty Healthcare Organization.

African Americans (AA) have a high incidence of risk factors associated with MASLD (metabolic dysfunction-associated steatotic liver disease); the AA population has a lower incidence of MASLD and MASH (metabolic-associated steatotic hepatitis) than Caucasian and Hispanic Americans (non-AA). We investigated if underlying risk factor variation between AA and non-AA individuals could provide a rationale for the racial diversity seen in MASLD/MASH. Using ICD-10 codes, patients from 2017 to 2020 with MASLD/MASH were identified and confirmed to have either MASLD or MASH. Despite the large (>80%) AA population in our clinics, only 54% of the MASLD/MASH patients were African American. When the non-invasive NAFLD Fibrosis Scores (NFS) evaluated at early diagnosis were compared to the most recent values, the only increase in fibrosis score by NFS over time was in non-AA MASH patients. The increase in fibrosis only in non-AA MASLD patients is consistent with racial disparity in the disease progression in non-AA as compared to AA patients. Even with the large proportion of AA patients in our study, there was no significant racial disparity in the earliest assessment of either risk factors, laboratory values, or fibrosis scores that would account for racial disparity in the development and progression of MASLD.

Health Disparities Research: What Every Pediatric Surgeon Should Know.

While the earliest published health disparity research in the United States dates to 1899, the field was not formally established until the late 20th century. Initially focused on race and ethnicity, the field has broadened to include socioeconomic status. Several measures have been developed to quantify socioeconomic disadvantage, including the Social Vulnerability Index, Area Deprivation Index, and Child Opportunity Index. These indices have been validated and demonstrate correlation with health outcomes. However, socioeconomic status cannot fully explain health inequities experienced by people of minoritized racial and ethnic identities. Three generations of health disparities research have been described-identification of disparities, root analysis, and development of interventions to mitigate health inequities. While there has been an increase in publication of health disparity research, there is little third generation work. It is imperative that health disparities research move beyond defining the problem and toward interventions that will reduce health inequities. LEVELS OF EVIDENCE: Level IV.