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1.
MMWR Morb Mortal Wkly Rep ; 69(18): 545-550, 2020 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-32379729

RESUMEN

SARS-CoV-2, the novel coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in the United States during January 2020 (1). Since then, >980,000 cases have been reported in the United States, including >55,000 associated deaths as of April 28, 2020 (2). Detailed data on demographic characteristics, underlying medical conditions, and clinical outcomes for persons hospitalized with COVID-19 are needed to inform prevention strategies and community-specific intervention messages. For this report, CDC, the Georgia Department of Public Health, and eight Georgia hospitals (seven in metropolitan Atlanta and one in southern Georgia) summarized medical record-abstracted data for hospitalized adult patients with laboratory-confirmed* COVID-19 who were admitted during March 2020. Among 305 hospitalized patients with COVID-19, 61.6% were aged <65 years, 50.5% were female, and 83.2% with known race/ethnicity were non-Hispanic black (black). Over a quarter of patients (26.2%) did not have conditions thought to put them at higher risk for severe disease, including being aged ≥65 years. The proportion of hospitalized patients who were black was higher than expected based on overall hospital admissions. In an adjusted time-to-event analysis, black patients were not more likely than were nonblack patients to receive invasive mechanical ventilation† (IMV) or to die during hospitalization (hazard ratio [HR] = 0.63; 95% confidence interval [CI] = 0.35-1.13). Given the overrepresentation of black patients within this hospitalized cohort, it is important for public health officials to ensure that prevention activities prioritize communities and racial/ethnic groups most affected by COVID-19. Clinicians and public officials should be aware that all adults, regardless of underlying conditions or age, are at risk for serious illness from COVID-19.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Comorbilidad , Infecciones por Coronavirus/etnología , Georgia/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Pandemias , Neumonía Viral/etnología , Factores de Riesgo , Resultado del Tratamiento , Adulto Joven
3.
J Racial Ethn Health Disparities ; 7(3): 398-402, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32306369

RESUMEN

The Coronavirus disease 2019 (COVID-19) pandemic has significantly impacted and devastated the world. As the infection spreads, the projected mortality and economic devastation are unprecedented. In particular, racial and ethnic minorities may be at a particular disadvantage as many already assume the status of a marginalized group. Black Americans have a long-standing history of disadvantage and are in a vulnerable position to experience the impact of this crisis and the myth of Black immunity to COVID-19 is detrimental to promoting and maintaining preventative measures. We are the first to present the earliest available data in the peer-reviewed literature on the racial and ethnic distribution of COVID-19-confirmed cases and fatalities in the state of Connecticut. We also seek to explode the myth of Black immunity to the virus. Finally, we call for a National Commission on COVID-19 Racial and Ethnic Health Disparities to further explore and respond to the unique challenges that the crisis presents for Black and Brown communities.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Coronavirus , Grupos Étnicos/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Pandemias , Neumonía Viral/epidemiología , Afroamericanos , Grupo de Ascendencia Continental Africana , Betacoronavirus , Connecticut/epidemiología , Grupos de Población Continentales , Infecciones por Coronavirus/prevención & control , Grupo de Ascendencia Continental Europea , Hispanoamericanos , Humanos , Masculino , Neumonía Viral/prevención & control
4.
Nutrients ; 12(4)2020 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-32252241

RESUMEN

Sphingolipid metabolism plays a critical role in cell growth regulation, lipid regulation, neurodevelopment, type 2 diabetes, and cancer. Animal experiments suggest that vitamin D may be involved in sphingolipid metabolism regulation. In this study, we tested the hypothesis that vitamin D supplementation would alter circulating long-chain ceramides and related metabolites involved in sphingolipid metabolism in humans. We carried out a post-hoc analysis of a previously conducted randomized, placebo-controlled clinical trial in 70 overweight/obese African-Americans, who were randomly assigned into four groups of 600, 2000, 4000 IU/day of vitamin D3 supplements or placebo for 16 weeks. The metabolites were measured in 64 subjects (aged 26.0 ± 9.4 years, 17% male). Serum levels of N-stearoyl-sphingosine (d18:1/18:0) (C18Cer) and stearoyl sphingomyelin (d18:1/18:0) (C18SM) were significantly increased after vitamin D3 supplementation (ps < 0.05) in a dose-response fashion. The effects of 600, 2000, and 4000 IU/day vitamin D3 supplementation on C18Cer were 0.44 (p = 0.049), 0.52 (p = 0.016), and 0.58 (p = 0.008), respectively. The effects of three dosages on C18SM were 0.30 (p = 0.222), 0.61 (p = 0.009), and 0.68 (p = 0.004), respectively. This was accompanied by the significant correlations between serum 25-hydroxyvitamin D3 [25(OH)D] concentration and those two metabolites (ps < 0.05). Vitamin D3 supplementations increase serum levels of C18Cer and C18SM in a dose-response fashion among overweight/obese African Americans.


Asunto(s)
Afroamericanos , Calcifediol/sangre , Colecalciferol/administración & dosificación , Glicoesfingolípidos Neutros/metabolismo , Obesidad/metabolismo , Adulto , Afroamericanos/etnología , Colecalciferol/metabolismo , Suplementos Dietéticos , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Masculino , Obesidad/etnología , Sobrepeso/etnología , Sobrepeso/metabolismo
5.
Medicine (Baltimore) ; 99(14): e19505, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32243366

RESUMEN

Chronic hepatitis C virus (HCV) infection disproportionately affects African-Americans (AAs) and is a major contributor to liver failure and mortality. Genetic factors may not be the only cause in outcome disparity. We retrospectively investigated whether genetic host factors, viral genotypes, and treatment compliance in AA patients impacted the efficacy and the sustained virological response (SVR) rate of the interferon (IFN)-based treatment regimen. The medical chart review included 76 African-American patients (age ranging from 26 to 76) with varying levels of hepatitis condition. Fifty-seven (75%) of them had a clinically verifiable HCV infection and were followed by a hepatologist for 2 years at Howard University Hospital in Washington, DC. Both comprehensive metabolic profile and complete blood count analyses were performed. Among the 57 patients whose viral and IL28B genotypes were determined, sixty-eight percent (68%) were infected with viral genotype 1 and 71% harbored the CT allele of the IL28B gene. Among the 12 patients who completed treatment with IFN-based dual or triple therapy, 58% had achieved SVR 12 weeks following completion of treatment; 33% had a partial response with under 6000 viral count after 16 weeks of treatment; and there was one patient with viral genotype 1a and CT allele who did not respond to the medications. The results of this study prove that the PEG IFN-based regimen was effective in treating HCV-infected AA patients despite the current availability of new direct-acting antivirals. The major obstacles contributing to a low reduction in HCV infection and outcome in the AA community were avoidance or lack of treatment or compliance; contraindications, medication side effects, non-adherence, and payer eligibility restrictions.


Asunto(s)
Afroamericanos , Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Alelos , Antivirales/administración & dosificación , Índice de Masa Corporal , Femenino , Genotipo , Hepatitis C Crónica/genética , Humanos , Interferones/genética , Pruebas de Función Hepática , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Sexuales , Respuesta Virológica Sostenida , Carga Viral
6.
Am Surg ; 86(3): 213-219, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223800

RESUMEN

Grady Memorial Hospital is a pillar of public medical and surgical care in the Southeast. The evolution of this institution, both in its physical structure as well as its approach to patient care, mirrors the cultural and social changes that have occurred in the American South. Grady Memorial Hospital opened its doors in 1892 built in the heart of Atlanta's black community. With its separate and unequal facilities and services for black and white patients, the concept of "the Gradies" was born. Virtually, every aspect of care at Grady continued to be segregated by race until the mid-20th century. In 1958, the opening of the "New Grady" further cemented this legacy of the separate "Gradies," with patients segregated by hospital wing. By the 1960s, civil rights activists brought change to Atlanta. The Atlanta Student Movement, with the support of Dr. Martin Luther King Jr., led protests outside of Grady, and a series of judicial and legislative rulings integrated medical boards and public hospitals. Eventually, the desegregation of Grady occurred with a quiet memo that belied years of struggle: on June 1, 1965, a memo from hospital superintendent Bill Pinkston read "All phases of the hospital are on a non-racial basis, effective today." The future of Grady is deeply rooted in its past, and Grady's mission is unchanged from its inception in 1892: "It will nurse the poor and rich alike and will be an asylum for black and white."


Asunto(s)
Derechos Civiles/historia , Desegregación/historia , Desegregación/legislación & jurisprudencia , Afroamericanos/estadística & datos numéricos , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Georgia , Hispanoamericanos/estadística & datos numéricos , Historia del Siglo XX , Hospitales Públicos/historia , Humanos
7.
Am Surg ; 86(3): 237-244, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223804

RESUMEN

Racial and gender disparities in end-of-life decision-making practices have not been well described in surgical patients. We performed an eight-year retrospective analysis of surgical patients within the Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. ICU patients with documented admission code status, and death or ICU discharge code status, respectively, were included. Logistic regression analysis was performed to assess change in code status. Of 468,000 ICU patients, 97,968 (20.9%) were surgical, 63,567 (95%) survived, and 3,343 (5%) died during their hospitalization. Of those, 50,915 (80.1%) and 2,625 (78.5%) had complete code status data on admission and discharge or death, respectively. Women were less likely than men to remain full code at ICU discharge and death (n = 20,940, 95.6% and n = 141, 11.9% vs n = 29,320, 97.4% and n = 233, 16.3%, P < 0.001). Compared with whites, blacks and other minorities had a 0.46 odds (95% confidence interval [CI]: 0.33-0.64, P < 0.001) and 0.54 odds (95% CI: 0.34-0.85, P = 0.01) of changing from full code status before death, respectively. Before ICU discharge, blacks and other minorities had a 0.56 odds of changing from full code status when compared with whites (95% CI: 0.40-0.79, P < 0.001 vs 95% CI: 0.36-0.87, P = 0.01, respectively). Women were more likely to be discharged or die after a change in code status from full code (odds ratio 1.27, 95% CI: 1.06-1.07, P < 0.001; odds ratio 1.39, 95% CI: 1.09-1.79, P = 0.009). Men and minorities are more likely to be discharged from the ICU or die with a full code status designation.


Asunto(s)
Reanimación Cardiopulmonar/mortalidad , Mortalidad Hospitalaria/tendencias , Unidades de Cuidados Intensivos/estadística & datos numéricos , Grupos Minoritarios , Evaluación de Resultado en la Atención de Salud , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Causas de Muerte , Toma de Decisiones Clínicas , Intervalos de Confianza , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Bases de Datos Factuales , Femenino , Encuestas de Atención de la Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Admisión del Paciente , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores Sexuales , Procedimientos Quirúrgicos Operativos
9.
Am J Surg ; 219(4): 546-551, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32147021

RESUMEN

BACKGROUND: Surgeons from under-represented backgrounds are less likely to receive academic tenure and obtain leadership positions. Our objective was to query the curriculum vitaes (CVs) of SBAS leadership to develop a benchmarking tool to promote and guide careers in academic surgery. METHODS: CVs from academic leaders were reviewed for academic productivity at early career stages-the first 5-and 10-years. Variables queried: peer-reviewed publications, grant funding, surgical societal involvement, invited lectureships and visiting professorships. RESULTS: Of 20 CVs, 41 leadership positions including 13 SBAS Presidents were identified. At 5- and 10-years, respectively, the academic productivity increased: 20.6 and 52.3 publications; 4.7 and 9.7 grants; 18 and 42.6 lectures/professorships. CONCLUSION: The CV benchmarking tool may be a useful framework for aspiring academic surgeons to track their progress relative to successful SBAS members. Creative strategies like these, paired with faculty mentorship and sponsorship are necessary to improve the ethnic diversity in academic surgery.


Asunto(s)
Movilidad Laboral , Docentes Médicos/estadística & datos numéricos , Cirujanos/estadística & datos numéricos , Personal Administrativo/tendencias , Afroamericanos , Benchmarking , Diversidad Cultural , Humanos , Liderazgo , Edición/tendencias , Apoyo a la Investigación como Asunto/tendencias , Sociedades Médicas , Estados Unidos
11.
Am J Hum Genet ; 106(4): 496-512, 2020 04 02.
Artículo en Inglés | MEDLINE | ID: mdl-32220292

RESUMEN

Most existing expression quantitative trait locus (eQTL) mapping studies have been focused on individuals of European ancestry and are underrepresented in other populations including populations with African ancestry. Lack of large-scale well-powered eQTL mapping studies in populations with African ancestry can both impede the dissemination of eQTL mapping results that would otherwise benefit individuals with African ancestry and hinder the comparable analysis for understanding how gene regulation is shaped through evolution. We fill this critical knowledge gap by performing a large-scale in-depth eQTL mapping study on 1,032 African Americans (AA) and 801 European Americans (EA) in the GENOA cohort. We identified a total of 354,931 eSNPs in AA and 371,309 eSNPs in EA, with 112,316 eSNPs overlapped between the two. We found that eQTL harboring genes (eGenes) are enriched in metabolic pathways and tend to have higher SNP heritability compared to non-eGenes. We found that eGenes that are common in the two populations tend to be less conserved than eGenes that are unique to one population, which are less conserved than non-eGenes. Through conditional analysis, we found that eGenes in AA tend to harbor more independent eQTLs than eGenes in EA, suggesting potentially diverse genetic architecture underlying expression variation in the two populations. Finally, the large sample sizes in GENOA allow us to construct accurate expression prediction models in both AA and EA, facilitating powerful transcriptome-wide association studies. Overall, our results represent an important step toward revealing the genetic architecture underlying expression variation in African Americans.


Asunto(s)
Afroamericanos/genética , Grupo de Ascendencia Continental Europea/genética , Regulación de la Expresión Génica/genética , Sitios de Carácter Cuantitativo/genética , Mapeo Cromosómico/métodos , Estudios de Cohortes , Femenino , Predisposición Genética a la Enfermedad/genética , Estudio de Asociación del Genoma Completo/métodos , Humanos , Masculino , Polimorfismo de Nucleótido Simple/genética , Transcriptoma/genética
13.
Medicine (Baltimore) ; 99(11): e19140, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32176039

RESUMEN

Treatment of hepatitis C virus (HCV) infection for patients with human immunodeficiency virus (HIV) has improved with direct acting antivirals. However, outcomes among Black persons treated with ledipasvir/sofosbuvir (LDV/SOF) may be inferior to non-Blacks. We assessed responses to LDV/SOF in a cohort of Black HIV/HCV coinfected persons.Retrospective chart reviews were conducted for Black, genotype 1 (GT1), HIV/HCV coinfected patients treated with LDV/SOF at 3 hospitals in Newark, NJ between January 2014 and July 2016. Data collected included demographics, HCV treatment history, treatment duration, and response.One hundred seventeen HIV/HCV coinfected Black patients started treatment with LDV/SOF but 5 had no follow-up data and 5 prematurely discontinued treatment (1 due to side effects). We included 107 HIV/HCV coinfected patients who completed LDV/SOF at all 3 sites. The study population was 65% male, median age 58 years, 26% had cirrhosis, and 78% had GT1a. Thirty-one percent were treatment experienced but none with prior NS5a treatment. At baseline, median CD4 count was 680 cells/mm, HIV viral load (VL) was <40 copies/mL in 94% and median HCV VL was 2,257,403 IU/mL. Twenty-nine percent of patients changed antiretroviral treatment before LDV/SOF treatment due to drug interactions. Six, 89, and 12 patients completed 8, 12, and 24 weeks of LDV/SOF, respectively. Overall sustained virologic response rate was 93% with 7 relapses.In this real-world cohort of Black, GT1, HIV/HCV coinfected patients, LDV/SOF had high sustained virologic response 12 weeks post completion of treatment rate of 93%. This data supports the overall high efficacy of LDV/SOF in a historically difficult-to-treat patient population.


Asunto(s)
Antivirales/uso terapéutico , Bencimidazoles/uso terapéutico , Coinfección/tratamiento farmacológico , Fluorenos/uso terapéutico , Infecciones por VIH/complicaciones , Hepacivirus/efectos de los fármacos , Hepatitis C/complicaciones , Uridina Monofosfato/análogos & derivados , Afroamericanos/estadística & datos numéricos , Antivirales/administración & dosificación , Bencimidazoles/administración & dosificación , Coinfección/virología , Femenino , Fluorenos/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Hepatitis C/tratamiento farmacológico , Hepatitis C/virología , Humanos , Masculino , Persona de Mediana Edad , New Jersey , Estudios Retrospectivos , Resultado del Tratamiento , Uridina Monofosfato/administración & dosificación , Uridina Monofosfato/uso terapéutico
14.
Nephrol Nurs J ; 47(1): 53-65, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32083437

RESUMEN

Understanding African-American families' experiences with treatment for kidney failure is necessary for informing the delivery of family-centered care and the design of appropriate interventions. This qualitative study explored treatment-related questions, concerns, and family impacts among African-American family members of patients with pre-kidney failure and kidney failure. Thirty-five family members participated in focus groups stratified by patients' treatment experiences (pre-kidney failure, in-center hemodialysis, peritoneal dialysis, awaiting living-donor kidney transplantation, or post-transplantation). Family members raised questions and concerns about the psychological, lifestyle, and practical aspects of treatment. Similarly, discussions about family impacts emphasized psychosocial effects, lifestyle consequences, and the provision and receipt of support. Efforts to address these questions, concerns, and perceived family impacts through additional research, early and tailored education, and supportive interventions are needed.


Asunto(s)
Afroamericanos/psicología , Actitud Frente a la Salud/etnología , Familia/etnología , Insuficiencia Renal/etnología , Insuficiencia Renal/terapia , Familia/psicología , Humanos
15.
Medicine (Baltimore) ; 99(6): e18820, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32028392

RESUMEN

Cross-sectional studies indicate that the fat mass and obesity-associated (FTO) rs9939609 gene variant is associated with metabolic syndrome (MetS) primarily in European ancestry. However, the association is not fully elucidated in African Americans.We hypothesized that rs9939609 (AT = moderate-risk carriers or AA = high-risk carriers compared to TT = low-risk carriers) is associated with MetS and its component risk factors over time; and that its association is ancestry-specific. A secondary hypothesis was that higher levels of physical activity can decrease the deleterious effect of rs9939609 at higher body mass index (BMI).Atherosclerosis Risk in Communities study repeated measures data from 4 visits (1987-1998) were obtained from the database of Genotypes and Phenotypes for 10,358 participants (8170 Whites and 2188 African Americans) aged 45 to 64 years at baseline. Guidelines for elevated blood pressure by the American College of Cardiology and American Heart Association Task Force were updated within the MetS criteria. Risk ratios (RR) and 95% confidence intervals from generalized estimating equations assessed population-average risks.MetS was present among 3479 (42.6%) Whites and 1098 (50.2%) African Americans at baseline, and 50.3% Whites and 57% African Americans over 11-years of follow-up. Among MetS component risk factors, high waist circumference was most prevalent among White AT (RR = 1.07; 1.06-1.09) and AA (RR = 1.12; 1.10-1.14) higher-risk carriers. High triglycerides were elevated among African American AA high-risk carriers (RR = 1.11; 1.02-1.21) compared to TT low-risk carriers. Over time, White AT-and AA higher-risk carriers had 1.07 and 1.08-fold increase (P < .0001) in MetS risk. Physical activity had independent protective effects on MetS among both races (P < .05). White AA high-risk carriers with normal BMI and low vs high physical activity had higher MetS risk (RR = 1.69; 1.25-2.30 and RR = 0.68;0.53-0.87, respectively). In rs9939609 × BMI× physical activity interaction, White A-allele high-risk carriers had lower MetS risk (RR = 0.68; 0.53-0.87). Among Whites, physical activity can lessen the effect of rs9939609 and high BMI on risk for MetS.


Asunto(s)
Dioxigenasa FTO Dependiente de Alfa-Cetoglutarato/genética , Predisposición Genética a la Enfermedad , Síndrome Metabólico/genética , Afroamericanos , Anciano , Índice de Masa Corporal , Bases de Datos Factuales , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Estudios Longitudinales , Masculino , Síndrome Metabólico/etiología , Persona de Mediana Edad , Obesidad , Factores de Riesgo , Estados Unidos
16.
BMC Infect Dis ; 20(1): 144, 2020 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-32059635

RESUMEN

BACKGROUND: The southeastern US is an epicenter for incident HIV in the US with high prevalence of human papillomavirus (HPV) co-infections. However, epidemiologies of HPV-associated clinical conditions (CC) among people living with HIV-1 infection (PLWH) are not fully known. METHODS: Electronic medical records (EMR) of PLWH attending one of the leading HIV clinics in the southeastern US between 2006 and 2018 were reviewed and analyzed. The retrospective study was nested within the University of Alabama at Birmingham HIV clinical cohort, which has electronically collected over 7000 PLWH's clinical and sociobehavioral data since 1999. Incidence rates of HPV-related CC including anogenital warts, penile, anal, cervical, and vaginal/vulvar low- and high-grade squamous intraepithelial lesions (LSIL and HSIL) were estimated per 10,000 person years. Joinpoint regressions were performed to examine temporal changes in the trends of incident CC. All rates and trends were stratified by gender and race. RESULTS: Of the 4484 PLWH included in the study (3429 men, 1031 women, and 24 transgender), we observed 1038 patients with HPV-related CC. The median nadir CD4 count (cells/uL) was higher in the HPV-condition free group than the case groups (P < 0.0001). Anogenital warts, anal LSIL, HSIL, and cancer were more likely to be diagnosed among HIV-infected men than women. White men presented more frequently with anal LSIL and anal and penile cancers than black men (P < 0.03). White women were also more likely to be diagnosed with cervical HSIL (P = 0.023) and cancer (P = 0.037) than black women. CONCLUSIONS: There were significant differences between gender and race with incidence of HPV-related CC among HIV patients. EMR-based studies provide insights on understudied HPV-related anogenital conditions in PLWH; however, large-scale studies in other regions are needed to generalize current findings and draw public health attention to co-infection induced non-AIDS defining comorbidities among PLWH.


Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por Papillomavirus/epidemiología , Adulto , Afroamericanos/estadística & datos numéricos , Canal Anal/virología , Recuento de Linfocito CD4 , Estudios de Cohortes , Comorbilidad , Condiloma Acuminado/epidemiología , Condiloma Acuminado/virología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Infecciones por VIH/patología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infecciones por Papillomavirus/patología , Prevalencia , Estudios Retrospectivos , Sudeste de Estados Unidos/epidemiología
17.
PLoS One ; 15(2): e0229002, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32059045

RESUMEN

BACKGROUND: Although protective associations between dietary antioxidants and pregnancy outcomes have been reported, randomized controlled trials of supplementation have been almost uniformly negative. A possible explanation is that supplementation during pregnancy may be too late to have a beneficial effect. Therefore, we examined the relationship between antioxidant levels prior to pregnancy and birth outcomes. METHODS AND FINDINGS: Serum carotenoids and tocopherols were assayed in fasting specimens at 1985-86 (baseline) and 1992-1993 (year 7) from 1,215 participants in Coronary Artery Risk Development in Young Adults (CARDIA) study. An interviewer-administered quantitative food-frequency questionnaire assessed dietary intake of antioxidants. Pregnancy outcome was self-reported at exams every 2 to 5 years. Linear and logistic regression modeling was used to assess relationships of low birthweight (LBW; <2,500 g), continuous infant birthweight, preterm birth (PTB; <37 weeks) and length of gestation with antioxidant levels adjusted for confounders, as well as interactions with age and race. RESULTS: In adjusted models, lycopene was associated with higher odds of LBW (adjusted odds ratio for top quartile, 2.15, 95% confidence interval 1.14, 3.92) and shorter gestational age (adjusted beta coefficient -0.50 weeks). Dietary intake of antioxidants was associated with lower birthweight, while supplement use of vitamin C was associated with higher gestational age (0.41 weeks, 0.01, 0.81). CONCLUSIONS: Higher preconception antioxidant levels are not associated with better birth outcomes.


Asunto(s)
Afroamericanos , Antioxidantes/metabolismo , Ácido Ascórbico/sangre , Carotenoides/sangre , Grupo de Ascendencia Continental Europea , Edad Gestacional , Nacimiento Prematuro/sangre , Adolescente , Adulto , Femenino , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Embarazo , Adulto Joven
18.
Health Qual Life Outcomes ; 18(1): 38, 2020 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087734

RESUMEN

BACKGROUND: Area-level socioeconomic characteristics have been shown to be related to health status and mortality however, little is known about the association between residential community characteristics in relation to postpartum women's health. METHODS: Data from the longitudinal, multi-site Community Child Health Network (CCHN) study were used. Postpartum women (n = 2510), aged 18-40 were recruited from 2008 to 2012 within a month of delivery. Socioeconomic data was used to create deprivation indices. Census data were analysed using principal components analysis (PCA) and logistic regression to assess the association between deprivation indices (DIs) and various health indicators. RESULTS: PCA resulted in two unique DIs that accounted for 67.5% of the total variance of the combined all-site area deprivation. The first DI was comprised of variables representing a high percentage of Hispanic or Latina, foreign-born individuals, dense households (more than one person per room of residence), with less than a high-school education, and who spent more than 30% of their income on housing costs. The second DI was comprised of a high percentage of African-Americans, single mothers, and high levels of unemployment. In a multivariate logistic regression model, using the quartiles of each DI, women who reside in the geographic area of Q4-Q2 of the second DI, were almost twice as likely to have more than three adverse health conditions compared to those who resided in the least deprived areas. (Q2vs.Q1:OR = 2.09,P = 0.001,Q3vs.Q1:OR = 1.89,P = 0.006,Q4vs.Q1:OR = 1.95,P = 0.004 respectively). CONCLUSIONS: Our results support the utility of examining deprivation indices as predictors of maternal postpartum health.


Asunto(s)
Pobreza/psicología , Calidad de Vida , Características de la Residencia , Salud de la Mujer/etnología , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Niño , Femenino , Hispanoamericanos/estadística & datos numéricos , Humanos , Modelos Logísticos , Estudios Longitudinales , Periodo Posparto , Pobreza/estadística & datos numéricos , Adulto Joven
19.
PLoS Genet ; 16(2): e1008641, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32059012

RESUMEN

Men of predominantly African Ancestry (AA) have higher prostate cancer (CaP) incidence and worse survival than men of predominantly European Ancestry (EA). While socioeconomic factors drive this disparity, genomic factors may also contribute to differences in the incidence and mortality rates. To compare the prevalence of prostate tumor genomic alterations and transcriptomic profiles by patient genetic ancestry, we evaluated genomic profiles from The Cancer Genome Atlas (TCGA) CaP cohort (n = 498). Patient global and local genetic ancestry were estimated by computational algorithms using genotyping data; 414 (83.1%) were EA, 61 (12.2%) were AA, 11 (2.2%) were East Asian Ancestry (EAA), 10 (2.0%) were Native American (NA), and 2 (0.4%) were other ancestry. Genetic ancestry was highly concordant with self-identified race/ethnicity. Subsequent analyses were limited to 61 AA and 414 EA cases. Significant differences were observed by ancestry in the frequency of SPOP mutations (20.3% AA vs. 10.0% EA; p = 5.6×10-03), TMPRSS2-ERG fusions (29.3% AA vs. 39.6% EA; p = 4.4×10-02), and PTEN deletions/losses (11.5% AA vs. 30.2% EA; p = 3.5×10-03). Differentially expressed genes (DEGs) between AAs and EAs showed significant enrichment for prostate eQTL target genes (p = 8.09×10-48). Enrichment of highly expressed DEGs for immune-related pathways was observed in AAs, and for PTEN/PI3K signaling in EAs. Nearly one-third of DEGs (31.3%) were long non-coding RNAs (DE-lncRNAs). The proportion of DE-lncRNAs with higher expression in AAs greatly exceeded that with lower expression in AAs (p = 1.2×10-125). Both ChIP-seq and RNA-seq data suggested a stronger regulatory role for AR signaling pathways in DE-lncRNAs vs. non-DE-lncRNAs. CaP-related oncogenic lncRNAs, such as PVT1, PCAT1 and PCAT10/CTBP1-AS, were found to be more highly expressed in AAs. We report substantial heterogeneity in the prostate tumor genome and transcriptome between EA and AA. These differences may be biological contributors to racial disparities in CaP incidence and outcomes.


Asunto(s)
Afroamericanos/genética , Biomarcadores de Tumor/genética , Grupo de Ascendencia Continental Europea/genética , Disparidades en el Estado de Salud , Neoplasias de la Próstata/genética , Biomarcadores de Tumor/metabolismo , Secuenciación de Inmunoprecipitación de Cromatina , Estudios de Cohortes , Regulación Neoplásica de la Expresión Génica , Genoma Humano/genética , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Mutación , Proteínas Nucleares/genética , Proteínas de Fusión Oncogénica/genética , Fosfohidrolasa PTEN/genética , Neoplasias de la Próstata/epidemiología , ARN Largo no Codificante/metabolismo , RNA-Seq , Receptores Androgénicos/genética , Proteínas Represoras/genética , Transcriptoma/genética
20.
Pediatrics ; 145(3)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32060140

RESUMEN

BACKGROUND: Hepatitis C virus (HCV) prevalence doubled among pregnant women from 2009 to 2014, reaching 3.4 per 1000 births nationwide. Infants exposed to HCV may acquire HCV by vertical transmission. National guidelines recommend that infants exposed to HCV be tested; however, it is unclear if these recommendations are being followed. Our objectives were to determine if infants exposed to HCV were tested and to determine hospital- and patient-level factors associated with differences in testing. METHODS: In this retrospective cohort study of infants exposed to HCV who were enrolled in the Tennessee Medicaid program, we used vital statistics-linked administrative data for infants born between January 1, 2005, and December 31, 2014. Infants were followed until 2 years old. Multilevel logistic regression was used to assess the association of HCV testing and hospital- and patient-level characteristics. RESULTS: Only 23% of 4072 infants exposed to HCV were tested. Infants whose mothers were white versus African American (96.6% vs 3.1%; P <.001), used tobacco (78% vs 70%; P <.001), and had HIV (1.3% vs 0.4%; P = .002) were more likely to be tested. Infants exposed to HCV who had a higher median of well-child visits (7 vs 6; P <.001) were more likely to be tested. After accounting for maternal and infant characteristics and health care use patterns, African American infants were less likely to undergo general testing (adjusted odds ratio 0.32; 95% confidence interval, 0.13-0.78). CONCLUSIONS: Testing occurred in <1 in 4 infants exposed to HCV and less frequently among African American infants. Public health systems need to be bolstered to ensure that infants exposed to HCV are tested for seroconversion.


Asunto(s)
Hepatitis C/diagnóstico , Hepatitis C/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Tamizaje Neonatal , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Afroamericanos/estadística & datos numéricos , Preescolar , Estudios de Cohortes , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Intercambio Materno-Fetal , Medicaid , Visita a Consultorio Médico/estadística & datos numéricos , Embarazo , Estudios Retrospectivos , Fumar/epidemiología , Tennessee/epidemiología , Estados Unidos , Adulto Joven
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