Search Results (1,785)

Background: Endometrioid ovarian carcinoma is a subtype of epithelial ovarian carcinoma and is the second most common type of malignant ovarian neoplasm. Studies investigating delayed treatment of ovarian cancer have identified significant impacts on overall survival rates. This study utilizes the Surveillance, Epidemiology, and End Results (SEER) database to identify cases of endometrioid ovarian carcinomas and factors associated with delays in time to treatment (TTT) greater than one month. Methods: The SEER database was queried to identify females with biopsy-confirmed cases of ovarian endometrioid carcinoma from 2010 to 2015. Chi-square tests, two-sided Fisher’s exact tests, and multivariable binary logistic regressions were completed using SPSS version 29.0.2. Statistical significance was confirmed when p < 0.05. Results: A total of 11,235 relevant patients were identified within the SEER database. A majority were Non-Hispanic White (69.2%), aged 50–59 (30.1%), had an annual income of $75,000+ (58.9%), resided in urban communities (90.0%), and were diagnosed with AJCC stage 1 disease (62.0%). When investigating treatment, 94.9% of patients received treatment within 1 month of diagnosis, while 5.1% experienced a delay of over 1 month before starting treatment. Multivariable binary logistic regression analysis demonstrated that American Indian and Alaksa Native (AIAN) patients independently experienced a +376% increased likelihood of treatment delays exceeding 1 month (aOR 4.76; 95% CI 1.32–17.08; p = 0.017). Patients diagnosed at AJCC stage III (aOR 1.88; 95% CI: 1.22–2.91; p = 0.004) or stage IV (aOR: 4.50; 95% CI: 2.75–7.38; p < 0.001) additionally had +88% and +350% higher odds of treatment delays greater than 1 month, respectively. Conclusions: AIAN patients and those presenting with later stage disease for endometrioid ovarian carcinoma face significantly longer TTT, indicating disparities in timely care. Our findings demonstrate an urgent need for targeted interventions to address systemic barriers contributing to delayed treatment in these populations. Full article

Since the 1980s, several studies have reported a decline in all-White neighborhoods and a rising number of racially mixed neighborhoods, including what have been called multiethnic “global” neighborhoods. Previous research has shown that these changes between 1980 and 2010 partly reflected the rapidly rising shares of Hispanics and Asians in urban areas. However, they also showed that there had been a substantial change in the pattern of settlement, resulting in many transitions to greater diversity than could have been expected from this demographic shift. We update their analysis to 2020, comparing transitions in the 1980–2000 period to those in 2000–2020, to test whether the earlier observed trends have continued, intensified, or weakened. We also quantify the impact of residential changes on the numbers of persons in each racial/ethnic group who live in each type of neighborhood. Full article

Background: Latina mothers in the United States report lower rates of breastfeeding initiation and exclusivity than their non-Hispanic counterparts. Lower rates of breastfeeding in infancy may lead to a higher rate of excess weight in childhood and adverse health conditions. Breastfeeding disparities in Latina women have been previously correlated with socio-cultural factors such as acculturation, education, income, nativity, and marital status. This study examines whether socio-cultural factors are associated with breastfeeding behaviors in Latina mothers in Nevada. Methods: Participants were Latina mothers [n = 214] over 18 years of age, with a child 2–5 years old. A logistic regression was conducted to assess the associations between acculturation, age, marital status, education, and nativity with breastfeeding. Results: Mothers who were married/living with their partner had 2.3 greater odds (95% CI = 1.08, 4.73; p-value < 0.05) of breastfeeding than the mothers who were not in a relationship, and mothers who were born outside the US had 4 times greater odds of breastfeeding than mothers who were born in the US (95% CI = 1.178, 13.514; p-value < 0.05). No significant association was found for acculturation (OR = 1.13; 95% CI = 0.74, 1.7; p-value = > 0.05), maternal age (OR = 1.01; 95%; CI = 0.96, 1.07; p-value = > 0.05) and education (OR = 0.81; 95% CI = 0.37, 1.8; p-value = > 0.5). Conclusions: These findings suggest that a romantic partner may be supportive of breastfeeding, and foreign-born mothers may retain their cultural norm of breastfeeding. These results can be applied to develop a culturally tailored intervention to promote breastfeeding behavior. Full article

Background: Parenting styles are associated with various health outcomes among children, such as fruit and vegetable consumption, physical activity, and emotional well-being. Previous literature suggests that responsive parenting styles are associated with improved mental health outcomes. This study examines the association between an adult’s responsive parenting style and the psychosocial outcomes of emotion regulation and loneliness among children. Methods: Using data from the U.S. National Cancer Institute’s Family Life, Activity, Sun, Health, and Eating (FLASHE) cross-sectional survey, this secondary data analysis study seeks to understand how perceived parental responsiveness is associated with adolescents’ emotional health outcomes from the perspective of the adolescent. The sample consisted of 12- to 17-year-olds (n = ~1560), mostly female (50.2%) and non-Hispanic White (63.7%), with a mean age of 14.48 years (SD = 1.61). Results: Through multivariable regression, we found that perceived parental responsiveness negatively predicted adolescent emotion suppression (β = −0.29, p < 0.001), even after controlling for sex, age, race/ethnicity, parental marital status, parental education level, parent’s time spent at work, and the number of kids in the household (β = −0.29, p < 0.001). We also found that perceived parental responsiveness was the strongest predictor for adolescent loneliness (β = −0.27, p < 0.001), even when controlling for sex, age, race/ethnicity, parental marital status, parental education level, parent’s time spent at work, and the number of kids in the household (β = −0.28, p < 0.001). Conclusions: These results suggest that implementing interventions targeting parental responsiveness may be beneficial to improving adolescents’ emotional well-being. Full article

Background/Objectives: Chronic medical conditions are comorbid with psychological disorders, often attributed to the weight of managing persistent demands associated with debilitating illness. Lifestyle adjustments, physical pain, and costs of health care can impose impairment of functioning, exacerbated by the onset of a chronic disease. While cause-and-effect directionality is difficult to ascertain, it is widely assumed that psychological stress can exacerbate the ability of patients to manage chronic medical conditions. Methods: The current study examined a novel model comprising five psychological factors which might explain variations in patients’ level of adherence, satisfaction, and quality of life. The sample consisted primarily of 124 low-income, female Hispanic patients, who were patients diagnosed with rheumatic and endocrine medical diagnoses. Results: Psychological distress and the lingering psychological effects of the COVID-19 pandemic were negatively associated with patient adherence, satisfaction, and quality of life, and that patients’ reports of the working alliances with their doctors moderated (i.e., significantly lessened) the negative association between the lingering impact of the COVID-19 pandemic and their satisfaction with care. Patients’ self-efficacy, resilience, and working alliance were all positively and significantly associated with adherence, satisfaction, and QOL. The association between working alliance and satisfaction represents a very large effect (r = 0.77, p < 0.001). Path analysis found a direct effect between psychological distress (stand. est. = 0.28, p = 0.05) and treatment adherence and a direct effect between COVID-19 impact and adherence (stand. est. = −0.19, p = 0.05). Conclusions: This study provides evidence of the role that both psychological stress and psychological strengths play in the experience of receiving medical care for low-income patients with rheumatic and endocrine conditions. Psychological stress inhibits adherence, and the physician–patient working alliance moderates the negative correlation between COVID impact and treatment satisfaction. Full article

Disparities in primary care access among Medicaid enrollees may be driven by differences in provider acceptance of Medicaid, yet the extent to which primary care provider (PCP) panels reflect the racial and ethnic diversity of local Medicaid populations is unknown. Objectives: To quantify the alignment between the racial/ethnic composition of PCP Medicaid panels and the underlying Medicaid population in their service areas. Methods: We conducted a cross-sectional analysis of 2019 Transformed Medicaid Statistical Information System Analytic Files from 44 states focusing on non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic enrollees. We calculated a panel representation ratio (PRR) for each PCP (physicians, nurse practitioners, and physician associates) as the proportion of a racial/ethnic group in their panel divided by that group’s proportion in the county Medicaid population. PRRs > 1 indicate overrepresentation; PRRs < 1, underrepresentation. Analyses were stratified by provider specialty, rurality, and Health Professional Shortage Area (HPSA) status. Results: The study sample included 372,320 PCPs from the following professions: nurse practitioners (NPs) and physician associates (PAs), along with physicians from the following specialties: family physicians (FPs), internal medicine physicians (IM), obstetrician gynecologists (ObGyn), and pediatricians (Peds). In the full sample, PRR was 1.28 for NHW enrollees, but less than one for NHB (0.98) and Hispanic (0.82) enrollees. Across provider specialties and professions, NHW enrollees were overrepresented in both rural and urban areas. In rural areas, NHB enrollees were overrepresented, but Hispanic enrollees remained underrepresented regardless of Health Professional Shortage Area (HPSA) status. In urban areas, both NHB and Hispanic enrollees were underrepresented in provider panels. Conclusions: Medicaid PCP panels do not reflect the racial/ethnic diversity of local Medicaid populations, particularly for NHB and Hispanic enrollees in urban settings. Efforts to improve equitable access to primary care must address these disparities in provider panel composition. Full article

Background/Objective: Alcohol consumption has been linked to alterations in gut microbiota and insulin resistance. The alcohol dehydrogenase 1B (ADH1B) gene plays a crucial role in alcohol catabolism, where rs1229984 variant carriers (CT/TT) catabolize ethanol at an 80-fold faster rate than non-carriers (CC). This study investigates the relationships between ADH1B gene rs1229984 mutation, alcohol consumption, gut microbiota, and insulin resistance. Methods: We performed cross-sectional analysis on fecal metagenomic sequencing data from diabetes-free participants in a longitudinal cohort of the Hispanic Community Health Study/Study of Latinos. We used Analysis of Composition of Microbiomes to identify gut microbial species associated with alcohol consumption in non-carriers (n = 1399) and carriers (n = 193). We constructed genotype-specific gut microbiome scores (GMSs) based on the identified species associated with alcohol consumption to examine how gut microbiota may influence the relationship between alcohol consumption and insulin resistance across ADH1B genotypes. Insulin resistance was defined as Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) > 2.5. Results: Distinct microbial species associated with alcohol consumption were identified in non-carriers (54 species) and carriers (16 species). In non-carriers, the genotype-specific GMS modified the relationship between alcohol consumption and insulin resistance (P_interaction = 0.011). The odds ratios (OR) for insulin resistance with increasing alcohol consumption levels across low, moderate, and high tertiles of GMS were 0.75 (95%CI 0.58–0.96), 0.82 (0.67–1), and 1.13 (0.93–1.39), respectively. We identified that individual alcohol-related species, such as Prevotella copri, Ruminococcus callidus, and Erysipelatoclostridium ramosum, modified the relationship between alcohol consumption and insulin resistance in non-carriers. Conclusions: This study suggests that the ADH1B gene rs1229984 mutation is associated with gut microbiota profiles altered by alcohol consumption. Our findings also suggest a potential role of gut microbiota in the protective association between alcohol consumption and insulin resistance in the ADH1B variant non-carriers. Full article

The existing literature suggests that exposure to Per- and Polyfluoroalkyl Substances (PFAS) can increase Papillary Thyroid Cancer (PTC) risk by interfering with thyroid hormone signaling, leading to hormonal imbalances that promote carcinogenesis. In addition, significant disparities exist in environmental exposure. However, ecological evidence of these associations has not been established within a statewide database of cancer outcomes. Therefore, this study investigated the relationship between socioeconomic conditions, environmental PFAS exposure, and PTC incidence in Florida using the state’s cancer registry. Data on facilities potentially releasing PFAS and ZIP codes with known PFAS drinking water contamination were retrieved from the EPA’s PFAS Analytic Tool. Proximity to PFAS sites and age-adjusted incidence by patient race/ethnicity were calculated by census tract. Lower socioeconomic status was associated with greater exposure to environmental PFAS. Census tracts with closer proximity to PFAS sites were more likely to have public water systems with PFAS contamination. Lastly, residential proximity to PFAS sites was positively associated with age-adjusted PTC incidence in Non-Hispanic Whites and Hispanics. These results demonstrate disparities in environmental exposure and suggest that exposure to PFAS may be an important factor for PTC risk at the population level and should be considered in the development of public health policies. Full article

Background/Objective: Pediatric obesity negatively impacts metabolic and musculoskeletal health, particularly muscle quality and function. Ultrasound-derived measures like muscle thickness and echo intensity, combined with body composition data, provide a more comprehensive assessment of muscle status in this population. The purpose of our study was to examine the relationship between anthropometric measurements, muscle strength, and bioelectrical impedance estimations with ultrasound-derived indicators such as subcutaneous fat and quadriceps femoris thickness, as well as muscle quality, through EI. Methods: This cross-sectional study included Hispanic children aged 6 to under 18 years with overweight or obesity (BMI ≥ 85th percentile per CDC standards). Participants were recruited consecutively from outpatient visits. All eligible children were invited for a standardized nutritional assessment, and those who consented were included. Results: The study included 294 children and adolescents (153 boys, 141 girls) with overweight or obesity, showing significant sex differences in anthropometric and body composition variables. Girls had higher intramuscular adipose tissue (IMAT) (p < 0.001), while boys had more lean and musculoskeletal mass. Body fat percentage was significantly correlated with muscle echo intensity (EI corrected: R² = 0.264, p < 0.001; EI uncorrected: R² = 0.242, p < 0.001) and with IMAT (R² = 0.268, p < 0.001). These associations were stronger in girls. Linear models identified body fat and BMI percentile as key predictors of muscle quality indicators (p < 0.001). Conclusions: This study found that higher body fat in children and adolescents with overweight or obesity is linked to poorer muscle quality, and especially increased echo intensity and intramuscular fat. Ultrasound proves useful for early, non-invasive detection of musculoskeletal changes, emphasizing the need to assess both muscle size and quality. Full article

Background and Clinical Significance: This case report highlights the rare but potentially sight-threatening presentation of corneal ulcers associated with methamphetamine abuse. Identifying the signs of illicit drug use is critical, as ocular complications may be overlooked without proper social history or lab confirmation. Case Presentation: A 48-year-old Hispanic male presented with progressive bilateral vision loss over four weeks, describing his condition as “blind vision.” Two weeks earlier, he had visited the emergency room after a fall caused by impaired vision and was prescribed insulin, metronidazole, and fluoroquinolone drops. At ophthalmology follow-up, visual acuity was 20/400 OD and 20/800 OS. Examination revealed bilateral stromal corneal ulcers with infiltrates. Notable systemic signs—pockmarks, poor dentition, thin body habitus, and jittery behavior—raised suspicion for methamphetamine use. He was treated with bandage contact lenses, dehydrated amniotic membranes, and a steroid-antibiotic combination drop. Conclusions: This case underscores the importance of recognizing physical signs of methamphetamine abuse, even in the absence of disclosed history. Emergency room laboratory testing confirmed methamphetamine use. Awareness of drug-induced ocular effects allows for appropriate patient education, timely intervention, and referral to addiction services. Patients should be warned that continued drug use may result in irreversible vision loss. Full article

Certain environmental exposures are associated with COVID-19 incidence and mortality. To determine whether environmental context is associated with other COVID-19 experiences, we used data from the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Study data (n = 1785; three survey waves 2020–2022 for adults in the United States). Environmental context was assessed using self-reported climate stress and county-level air pollution, greenness, toxic release inventory site, and heatwave data. Self-reported COVID-19 experiences included willingness to vaccinate, health impacts, receiving assistance for COVID-19, and provisioning assistance for COVID-19. Self-reported climate stress in 2020 or 2021 was associated with increased COVID-19 vaccination willingness by 2022 (odds ratio [OR] = 2.35; 95% confidence interval [CI] = 1.47, 3.76), even after adjusting for political affiliation (OR = 1.79; 95% CI = 1.09, 2.93). Self-reported climate stress in 2020 was also associated with increased likelihood of receiving COVID-19 assistance by 2021 (OR = 1.89; 95% CI = 1.29, 2.78). County-level exposures (i.e., less greenness, more toxic release inventory sites, and more heatwaves) were associated with increased vaccination willingness. Air pollution exposure in 2020 was positively associated with the likelihood of provisioning COVID-19 assistance in 2020 (OR = 1.16 per µg/m³; 95% CI = 1.02, 1.32). Associations between certain environmental exposures and certain COVID-19 outcomes were stronger among those who identify as a race/ethnicity other than non-Hispanic White and among those who reported experiencing discrimination; however, these trends were not consistent. A latent variable representing a summary construct for environmental context was associated with COVID-19 vaccination willingness. Our results suggest that intersectional equity issues affecting the likelihood of exposure to adverse environmental conditions are also associated with health-related outcomes. Full article

Hispanic breast cancer survivors reported worse quality of life, and fatalism is considered one of the mediators for this disparity. This study aimed to identify the factors associated with fatalism within a diverse Hispanic population. Hispanic origin was self-reported, and the Multidimensional Fatalism Measure questionnaire, a validated tool that measures fatalism across multiple dimensions, was used to assess fatalism. A total of 390 women, consisting of 210 Puerto Ricans, 34 Colombians, 29 Dominicans, 25 Cubans, 24 Venezuelans, 22 Mexicans, and 46 individuals of other Hispanic backgrounds, completed the fatalism assessment. The mean fatalism score was 16.4 (95% CI = 15.8–17.0), characterized by a high internal locus of control and strong religious beliefs, along with moderate beliefs in luck and a low external locus of control. The higher fatalism scores were reported in Dominican, Mexican, and Venezuelan groups, while Colombians reported the lowest score. Multivariable analysis showed that Colombians (β = −4.0), individuals with higher household incomes (β = −2.3 for USD 20,000–USD 75,000, β = −2.4 for ≥75,000), higher education levels (β = −1.9), and those using English more frequently at home (β = −2.0) reported lower fatalism compared to their reference group. To enhance the quality of life for these survivors, culturally tailored interventions should focus on improving perceived control and mitigating fatalism. Full article

Background/Objective: Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the primary treatment for neovascular AMD. This study aimed to assess racial, ethnic, and gender representation in U.S.-based randomized controlled trials (RCTs) of anti-VEGF therapies. Methods: A systematic PubMed search identified 19 eligible RCTs. Titles and abstracts were screened, and demographic data were independently extracted and cross-verified. Chi-squared analysis was used to evaluate disparities in participant representation. Risk of bias was assessed using the ROBIS checklist. Results: Among 8003 participants across 19 trials, 92.3% were Caucasian. Asian, African American, Hispanic/Latino, and American Indian participants collectively comprised just over 5%. This underrepresentation of non-Caucasian groups was statistically significant (p < 0.01, df = 4) and not associated with study sponsorship. Gender analysis showed 59% female and 41% male participation, which was not statistically significant (p = 0.83, df = 1). Conclusions: Non-Caucasian populations remain significantly underrepresented in anti-VEGF RCTs for AMD. This raises concerns about the generalizability of trial findings to diverse populations. Future clinical trials must prioritize inclusive recruitment to ensure equitable, evidence-based care for all patients. Full article

Background: Hispanic college students face high stress, which may increase their risk for chronic stress-related health issues. Effective and accessible stress management strategies for this population remain limited. Objective: This pilot study filled a gap by studying the effects of psychological stress on diet and physical activity habits and evaluating the impact of moderate-intensity physical exercise (MIPE) and yoga interventions on chronic psychological stress and acute stress responses among Hispanic college students. Methods: A total of 18 Hispanic college students participated in a 6-week intervention consisting of either MIPE or yoga, conducted twice weekly. Anthropometric measurements and lifestyle data were collected at both pre- and post-intervention timepoints. Psychological stress was evaluated using the Perceived Stress Scale-10 (PSS-10), morning salivary cortisol concentrations, and the Trier Social Stress Test (TSST). Results: Before the intervention, both perceived stress scores and morning salivary cortisol concentrations were positively correlated with the frequency of sweetened beverage intake and negatively correlated with attitudes toward exercise. Psychological stress was not significantly reduced after MIPE or yoga interventions. The salivary cortisol response to TSST was significantly improved after the yoga intervention. Conclusions: Although this pilot exploratory study suggests that short-term yoga may have beneficial effects in managing acute stress response in Hispanic college students, the efficacy of the interventions needs to be tested and replicated in a fully powered trial. Full article

Background: Premature atherosclerosis (PreAS) is generally defined as a disease affecting those under the age of 50 and has an outsized impact on quality-adjusted life years. We sought to better understand what individuals are at the highest risk for PreAS by examining differences in demographics and comorbidities compared to traditional atherosclerosis (TradAS). Study Design: An Institutional Review Board (IRB) approved retrospective study was conducted using retrospective data from a large regional health system. Patients who received a diagnosis of cerebrovascular disease (CeVD), coronary artery disease (CAD) or peripheral arterial disease (PAD) between 2012 and 2023 were included. Results: The review identified 136,328 patients in which 17,008 or 13% presented with PreAS (diagnosed from age 18 up to, and including, age 50). Rates of comorbidities were as follows (PreAs/TradAS): hypertension 63%/86%, diabetes 29%/35%. hyperlipidemia 45%/67%, chronic kidney disease 15%/26%, tobacco use 52%/60% and substance use 25%/9%. Differences in race, ethnicity and gender were as follows (PreAS/TradAS): White 59%/80%, Black 22%/10% and Latinx 17%/6%; male 51%/55%, and female 49%/45%. Conclusions: Patients with PreAS had lower rates of diseases that typically progress with aging, including hypertension, hyperlipidemia, chronic kidney disease, and diabetes. Tobacco use was less prevalent in the PreAS group and there was a significantly higher rate of illicit substance use in the PreAS population. Race and ethnicity were notably different with Black and Hispanic patients representing a significantly larger proportion of those with PreAS relative to TradAS. Our findings suggest risk factors beyond those classically described may play key roles in causing patients to develop PreAS. Full article