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Comparing Indian Health Service Sites to Rural Physician Teaching Hospitals
Get PDFThis cross-sectional study compares characteristics of Indian Health Services hospitals and rural hospitals with Graduate Medical Education programs
Conditional knockout of C/EBPβ in epidermis results in dysregulated lipid biosynthesis and a defect in skin barrier function
Get PDFCCAAT/enhancer binding protein-β (C/EBPβ) is a basic leucine zipper transcription factor that is abundantly expressed in epidermal keratinocytes of skin. In the present study, C/EBPβ epidermal specific conditional knockout (CKOβ) SKH1 mice were utilized to interrogate C/EBPβ’s role in lipid biosynthesis and skin barrier integrity. RNAseq data analysis and gene set enrichment analysis of RNA isolated from the epidermis of CKOβ and K5Cre control mice revealed that deletion of C/EBPβ in epidermis resulted in an enrichment of downregulated genes in gene sets associated with lipid metabolism. Further analysis showed the majority of differentially regulated genes were downregulated in gene sets related to the metabolism/biosynthesis of ceramides, fatty acids, phospholipids, sphingolipids, and cholesterol species in CKOβ epidermis. Ingenuity Pathway Analysis predicted inhibition of multiple pathways involving lipid biosynthesis. Lipidomic analysis of epidermis using advanced chemical separations and tandem mass spectrometry identified 470 individual lipids in epidermis with 165 significantly decreased and 82 significantly increased in CKOβ epidermis. The lysophospholipids were the most decreased class of lipids, and free fatty acids and ceramides important in barrier formation were also decreased. The sphingomyelin class of lipids was the most increased. High resolution mass spectrometry for cholesterol lipids revealed several cholesterol esters were also dysregulated in CKOβ epidermis. Finally, we assessed the functional consequences of the loss C/EBPβ on epidermal barrier function and found that basal permeability barrier function as measured by transepidermal water loss (TEWL) was impaired, with an approximate doubling of TEWL in CKOβ mice. These results indicate that C/EBPβ is a is a major regulator of the epidermal lipidome and the deletion of C/EBPβ in epidermis leads to a defect in skin barrier function
Correction: Ssengonzi et al. Inhibitor of DNA Binding Protein 2 (ID2) Mediates the Anti-Proliferative and Pro-Differentiation Effects of Insulin-like Growth Factor-1 (IGF-1). Life 2024, 14, 1663
Get PDFCorrection to: Inhibitor of DNA Binding Protein 2 (ID2) Mediates the Anti-Proliferative and Pro-Differentiation Effects of Insulin-like Growth Factor-1 (IGF-1)
The relationship between family environments growing up and behavioral health among LGBTQ+ adults: The mediating role of internalized homonegativity
Get PDFPurpose Disparities in the behavioral health outcomes for lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) adults—such as depression, anxiety, and alcohol use—are often attributed to experiences of discrimination, victimization, and lack of supportive environments, including hetero- and cis-normative family settings. Yet, how family environments in childhood influence LGBTQ+ adults’ behavioral health and internalized homonegativity has not been extensively examined. Methods This study utilized a U.S. national dataset of LGBTQ+ adults (N = 499). Data were collected in November 2020 using an online survey. A series of multivariate ordinary least squares regression models and Sobel tests were performed. Results Results showed that as homophobic messages from family increased, levels of depression (β = .19, p < .001), anxiety (β = .17, p < .001), and internalized homonegativity (β = .13, p < .01) increased. As the conservatism level in families increased, levels of alcohol use (β = .11, p < .05), and internalized homonegativity (β = .15, p < .01) increased. In the mediation analysis, internalized homonegativity was found to partially mediate the relationship between homophobic messages from family and depression (z = 3.35, p < .001), homophobic messages and anxiety (z = 3.09, p < .01), and conservatism in family and alcohol use (z = 2.80, p < 0.01). Internalized homonegativity also fully mediated the relationship between homophobic messages and alcohol use (z = 2.66, p < 0.01), conservatism in family and depression (z = 3.76, p < 0.001), and conservatism in family and anxiety (z = 3.45, p < 0.001). Conclusion Study findings underscore the importance of inclusive climates within a family and internalized homonegativity as a mediator for LGBTQ+ individuals’ behavioral health. Implications for intervention and future research are discussed
Advice for New Stepparents From the Perspective of Stepchildren Who Experienced Stepfamily Formation During Adolescence
Get PDFStepfamilies are increasingly common and advancing research focused on the relational and interactional dynamics between stepparents and adolescents , particularly from the perspective of stepchildren, remains urgent. The current study employed qualitative methods to explore specific advice for new stepparents from stepchildren who experienced stepfamily formation during adolescence. Maximum variation sampling yielded a socio-demographically diverse sample of 18 emerging-adult participants who acquired and spent time living with a stepparent as they progressed through adolescence. Reflexive thematic analysis yielded the following six themes, reflecting detailed advice for new stepparents of adolescent stepchildren: prepare for the role, be real, be patient, don’t force it, carefully integrate (with six subthemes), and prioritize the adolescent (with three subthemes). The participants’ insights largely cohere with and augment extant literature, showcasing a holistic and comprehensive view of stepfamily issues and potential strategies to prevent or mitigate them. Practical implications and suggestions for future research are discussed
Navigating the value proposition of artificial intelligence in cardiovascular disease prevention
Get PDFArtificial intelligence (AI) is reshaping healthcare, influencing everything from administrative workflows to direct patient care. It holds promise in addressing the leading cause of death in the United States and a significant driver of costs – cardiovascular disease (CVD). Traditional reimbursement models are slow to incorporate AI. This article explores alternative financial incentives for AI in CVD prevention in fee-for-service (FFS) and value-based care models across four domains – risk prediction, diagnostics, imaging, clinical decision support, and administrative strategies – where AI may provide indirect revenue generation, cost savings, and efficiency gains. Under FFS, AI can enhance revenue by driving appropriate healthcare utilization, improving billing accuracy, and streamlining administrative workflows. In value-based models, AI aligns with incentives to prevent disease progression, reduce hospitalizations, and optimize shared savings. While AI-powered tools offer a compelling financial value proposition in cardiovascular prevention, their real-world adoption and impact will depend on successful clinical validation and seamless integration into existing workflows. The future of AI in cardiovascular care depends on a shift in reimbursement models, regulatory adaptation, and continued evidence generation demonstrating cost-effectiveness and improved outcomes. As healthcare transitions toward value-based care, AI has the potential to be a catalyst for better prevention and long-term cost savings, but only if its business case is strategically developed and implemented
Drug Overdose Mortality Disparities by Sex, Age, and Race/Ethnicity in North Carolina, 2014-2022
Get PDFBackground: Drug overdose mortality, particularly among vulnerable demographic subgroups, is a persisting public health issue. We aimed to examine and describe disparities in drug overdose mortality in three sub-populations in North Carolina (NC) by age, sex, and race and ethnicity.
Methods: We examined age, sex, and race and ethnicity-based inequities in drug overdose mortality rates in three NC sub-populations: patients of a large integrated healthcare delivery system; individuals enrolled in Medicaid; and individuals with insurance through a large, statewide, private health insurance provider. We estimated standardized mortality ratios (SMRs) stratified by sex, age group, and race and ethnicity to compare the health system, Medicaid, and private insurance populations to the NC general population. We calculated SMRs for all drug overdose, opioid overdoses, and polydrug overdoses (those involving multiple drugs), identifying overdose types using the International Classification of Disease Code, version 10 (IC-D10).
Results: Males had higher age-adjusted overdose mortality rates and SMRs than females in the NC general population and all three sub-populations. In the NC general population, health system population, and private insurance population, the 25 to 34 year-old age group had the highest sex-adjusted overdose mortality rate, while this rate was highest among 45 to 54 year-olds in the Medicaid population. Particularly elevated all drug overdose mortality was observed among Medicaid enrollees aged 45 to 54 years (SMR: 4.66, 95% CI: 4.60, 4.72) and 55 to 64 years (SMR: 4.92, 95% CI: 4.84, 4.99), as well as among health system patients aged 12 to 24 years (SMR: 4.27, 95% CI: 4.15, 4.39). For all populations, White individuals had the highest sex- and age-adjusted overdose mortality rates and SMRs.
Conclusions: These findings highlight overdose mortality disparities across demographic subgroups in healthcare and insurance populations in NC, suggesting a need for tailored overdose prevention strategies
“We have a lot of battles to fight”: The experiences of older, Black, same-gender-loving women during the COVID-19 pandemic
Get PDFPrevious studies show mental and physical health inequities have been exacerbated by the COVID-19 pandemic, but few use an intersectional lens to identify the assets and unmet needs of groups that are multiply marginalized by their social categories. This study explores how older, Black, same-gender-loving women discussed their experiences during the COVID-19 pandemic with a focus on health. Sixteen focus groups were conducted between July and December 2020 with 4–8 participants each (N = 102) from across the U.S. Content analysis revealed insight into the determinants of health among older, Black, same-gender-loving women, impacts of the pandemic, and how participants were able to maintain their health. Participants’ experiences with healthcare were most prominently shaped by their intersectional social categories, as they faced complex systems of oppression rooted in heterosexism, racism, sexism, and ageism. We found discrimination to be the most prominent determinant of health, manifesting through various barriers and a lack of access to providers of preferred social categories. The complex trauma experienced during the Trump Administration, COVID-19 lockdowns, and racial unrest after the murder of George Floyd had generally negative impacts on daily life, relationships, and mental health. However, these were mitigated for some through positive internal and external coping strategies, including online resource use, mutual aid, and telehealth experiences. As evidenced by these experiences, future research and interventions need to adopt an intersectional lens and center multiply marginalized groups to mitigate future harms and promote health equity
The Development, Evolution, and Maintenance of Structural Racism for the Study of Health Inequities: An Expanded Framework for Asian, Black, Hispanic, Indigenous, and White Americans
Get PDFEvaluating the relationship between structural racism and health inequity is conceptually and empirically complex. This critical review of policies and events extends a previously published framework for understanding structural racism in health research across ethnoracial groups from 1400 to present. We apply this framework for Asian, Black or African American, Hispanic/Latinx, Native Hawaiian/Pacific Islander, and White groups and reflect on, compare, and contrast the overarching patterns within and across groups. Our findings illustrate the utility of our framework as a tool for conceptualizing and operationalizing structural racism in future health research. We suggest that health scholars can advance the field by: (1) recognizing multiple, reinforcing domains of structural racism; (2) expanding research beyond a Black-White binary to include other ethnoracial groups; (3) emphasizing the role of time and its different manifestations as exposure across the life course and cohorts; (4) highlighting the implications of collective resistance and agency as alternatives to deficit models; and (5) disaggregating data, whenever possible, to avoid rendering smaller ethnoracial groups invisible
Investigating the suitability of dichotomous responses for the Water Insecurity Experiences (WISE) Scales using nationally representative data from 39 countries
Get PDFThe Water Insecurity Experiences (WISE) Scales have been validated to comparably measure water insecurity globally. The scales consist of 12 items that can be administered in approximately 3 minutes. There is interest in developing more rapid versions of the tools for when time is limited. One alternative is to use a subset of 4 items, which has been validated, but has some drawbacks. Here we investigate another alternative: dichotomous (yes/no) response options instead of the original four levels of frequency-based (polytomous) responses. We used nationally representative data from 39 countries to simulate dichotomized responses by collapsing the four levels of frequency (never, rarely, sometimes, often/always) into yes/no. We first explored if “rarely” is meaningful in the gradation of water insecurity, as experiences that occur “rarely” may not be affirmed with dichotomous response options. We tested item-by-item if “rarely” responses predicted dissatisfaction with water quality using logistic regression and found that they were associated with higher odds of dissatisfaction with water quality. As such, some meaningful nuance may be lost if “rare” experiences are not affirmed as “yes”. We then compared the predictive accuracy of WISE scores using simulated dichotomous responses compared to those calculated using polytomous responses. Based on receiver-operator-characteristic (ROC) curves and regression models, scores calculated using dichotomized responses had good predictive accuracy. Scores calculated using the abbreviated 4-item version were similarly accurate. Finally, we examined whether levels of water insecurity, as calculated from the original responses, could be classified using dichotomized responses. Using ROC curves, we found that this approach was effective, offering an advantage over the 4-item scales. While polytomous response options provide more detailed information, dichotomous responses offer the potential advantage of a quicker alternative for measuring water insecurity