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Frontiers in Immunology 2022Immune-mediated skin conditions (IMSCs) are a diverse group of autoimmune diseases associated with significant disease burden. Atopic dermatitis and psoriasis are among... (Review)
Review
Immune-mediated skin conditions (IMSCs) are a diverse group of autoimmune diseases associated with significant disease burden. Atopic dermatitis and psoriasis are among the most common IMSCs in the United States and have disproportionate impact on racial and ethnic minorities. African American patients are more likely to develop atopic dermatitis compared to their European American counterparts; and despite lower prevalence of psoriasis among this group, African American patients can suffer from more extensive disease involvement, significant post-inflammatory changes, and a decreased quality of life. While recent studies have been focused on understanding the heterogeneity underlying disease mechanisms and genetic factors at play, little emphasis has been put on the effect of psychosocial or psychological stress on immune pathways, and how these factors contribute to differences in clinical severity, prevalence, and treatment response across ethnic groups. In this review, we explore the heterogeneity of atopic dermatitis and psoriasis between African American and European American patients by summarizing epidemiological studies, addressing potential molecular and environmental factors, with a focus on the intersection between stress and inflammatory pathways.
Topics: Dermatitis, Atopic; Ethnicity; Humans; Psoriasis; Quality of Life; Skin Diseases; United States
PubMed: 35572606
DOI: 10.3389/fimmu.2022.845655 -
Blood Advances Jan 2024Idecabtagene vicleucel (ide-cel) was the first chimeric antigen receptor T-cell therapy to gain US Food and Drug Administration approval for patients with...
Idecabtagene vicleucel (ide-cel) was the first chimeric antigen receptor T-cell therapy to gain US Food and Drug Administration approval for patients with relapsed/refractory multiple myeloma (RRMM). The clinical outcomes of standard of care (SOC) ide-cel in racially and ethnically diverse populations have been understudied. This study pooled data from 207 patients with RRMM (28% patients of racial and ethnic minority groups) treated with SOC ide-cel across 11 institutions to examine racial and ethnic differences in the incidence of toxicities and adverse events, response to ide-cel, and survival. This study included 22 (11%) Hispanic, 36 (17%) non-Hispanic Black, and 149 (72%) non-Hispanic White patients with RRMM. Compared with Hispanic and non-Hispanic White patients, non-Hispanic Black patients had higher median levels of C-reactive protein (1.0, 0.8, and 3.5 mg/dL, respectively; P = .02) and baseline ferritin (362.0 vs 307.0 vs 680.5, respectively; P = .08) and were more likely to develop cytokine release syndrome (77%, 85%, and 97%, respectively; P = .04). Although best overall response rate was lower among Hispanic patients (59%) than among non-Hispanic Black (86%) and White patients (86%; P = .01), there were no racial and ethnic differences in progression-free or overall survival. We provide, to our knowledge, the first and largest investigation of clinical outcomes of SOC ide-cel by race and ethnicity. Despite differences in safety and response to ide-cel, our findings encourage the use of ide-cel in all patients with RRMM. These findings should be confirmed in larger samples of diverse patients with RRMM, with longer follow-up time.
Topics: United States; Humans; Multiple Myeloma; Immunotherapy, Adoptive; Ethnicity; Minority Groups; Neoplasms, Plasma Cell
PubMed: 37855718
DOI: 10.1182/bloodadvances.2023010894 -
PLoS Medicine Dec 2022Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress... (Review)
Review
BACKGROUND
Evidence regarding the presence and persistence of ethnic inequalities in mental healthcare is well established. The reasons for these inequalities and lack of progress in diminishing them are less understood. This meta-ethnography aims to provide a new conceptual understanding of how ethnic inequalities are created and sustained; this is essential to develop effective interventions. Specifically, we sought to understand why people from ethnic minority groups are underrepresented in primary care mental health service provision and overrepresented in crisis pathways and detention.
METHODS AND FINDINGS
Following eMERGe guidelines for meta-ethnographies, we searched OpenGrey, Kings Fund, CINAHL, Medline, PsycINFO, and Social Care Online databases for qualitative articles published from database inception until October 2, 2022, using broad categories of search terms relating to "ethnicity AND (mental illness/mental health/emotional distress) AND (help-seeking/service utilisation/experience/perception/view)." We included all conceptually rich articles that used qualitative methods of data collection and analysis and excluded non-UK studies and those that focused solely on causation of mental illness. Our patient, public, and practitioner lived experience advisory group provided feedback and input on key stages of the project including search terms, research questions, data analysis, and dissemination. A total of 14,142 articles were identified; 66 met the inclusion criteria. We used reciprocal, refutational, and line of argument analytical approaches to identify convergence and divergence between studies. The synthesis showed that current models of statutory mental healthcare are experienced as a major barrier to the delivery of person-centred care to those in ethnic minority groups due to the perceived dominance of monocultural and reductionist frameworks of assessment and treatment (described as "medical" and "Eurocentric") and direct experiences of racist practice. The lack of socially oriented and holistic frameworks of knowledge and understanding in medical training and services is experienced as epistemic injustice, particularly among those who attribute their mental illness to experiences of migration, systemic racism, and complex trauma. Fear of harm, concerns about treatment suitability, and negative experiences with health providers such as racist care and medical neglect/injury contribute to avoidance of, and disengagement from, mainstream healthcare. The lack of progress in tackling ethnic inequalities is attributed to failures in coproduction and insufficient adoption of existing recommendations within services. Study limitations include insufficient recording of participant characteristics relating to generational status and social class in primary studies, which prevented exploration of these intersections.
CONCLUSIONS
In this study, we found that the delivery of safe and equitable person-centred care requires a model of mental health that is responsive to the lived experiences of people in ethnic minority groups. For the people considered in this review, this requires better alignment of mental health services with social and anti-racist models of care. Our findings suggest that intersections related to experiences of racism, migration, religion, and complex trauma might be more relevant than crude ethnic group classifications. Strategies to tackle ethnic inequalities in mental healthcare require an evaluation of individual, systemic, and structural obstacles to authentic and meaningful coproduction and implementation of existing community recommendations in services.
Topics: Humans; Ethnicity; Minority Groups; Delivery of Health Care; Anthropology, Cultural; Mental Health Services; United Kingdom
PubMed: 36512523
DOI: 10.1371/journal.pmed.1004139 -
Lancet (London, England) Mar 2021With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by...
With more than 1·2 million people living with HIV in the USA, a complex epidemic across the large and diverse country, and a fragmented health-care system marked by widening health disparities, the US HIV epidemic requires sustained scientific and public health attention. The epidemic has been stubbornly persistent; high incidence densities have been sustained over decades and the epidemic is increasingly concentrated among racial, ethnic, and sexual and gender minority communities. This fact remains true despite extraordinary scientific advances in prevention, treatment, and care-advances that have been led, to a substantial degree, by US-supported science and researchers. In this watershed year of 2021 and in the face of the COVID-19 pandemic, it is clear that the USA will not meet the stated goals of the National HIV/AIDS Strategy, particularly those goals relating to reductions in new infections, decreases in morbidity, and reductions in HIV stigma. The six papers in the Lancet Series on HIV in the USA have each examined the underlying causes of these challenges and laid out paths forward for an invigorated, sustained, and more equitable response to the US HIV epidemic than has been seen to date. The sciences of HIV surveillance, prevention, treatment, and implementation all suggest that the visionary goals of the Ending the HIV Epidemic initiative in the USA might be achievable. However, fundamental barriers and challenges need to be addressed and the research effort sustained if we are to succeed.
Topics: Epidemics; Epidemiological Monitoring; Ethnicity; HIV Infections; Health Plan Implementation; Health Status Disparities; Humans; Minority Groups; Public Health Administration; Racial Groups; Sexual and Gender Minorities; Social Stigma
PubMed: 33617770
DOI: 10.1016/S0140-6736(21)00390-1 -
Inflammatory Bowel Diseases Jun 2023Observational studies have described racial differences in inflammatory bowel disease (IBD) genetics, clinical manifestations, and outcomes. Whether race impacts... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Observational studies have described racial differences in inflammatory bowel disease (IBD) genetics, clinical manifestations, and outcomes. Whether race impacts response to biologics in IBD is unclear. We conducted a post hoc analysis of phase 2 and 3 randomized clinical trials in ulcerative colitis to evaluate the effect of race on response to golimumab.
METHODS
We analyzed pooled individual-level data from induction and maintenance trials of golimumab through the Yale Open Data Access Project. The primary outcome was clinical response. Secondary outcomes were clinical remission and endoscopic healing. Multivariable logistic regression was performed comparing White vs racial minority groups (Asian, Black, or other race), adjusting for potential confounders.
RESULTS
There were 1006 participants in the induction (18% racial minority) and 783 participants in the maintenance (17% racial minority) trials. Compared with White participants, participants from racial minority groups had significantly lower clinical response (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.28-0.66), clinical remission (aOR, 0.41; 95% CI, 0.22-0.77), and endoscopic healing (aOR, 0.48; 95% CI, 0.31-0.74) at week 6. Participants from racial minority groups also had significantly lower clinical remission (aOR, 0.46; 95% CI, 0.28-0.74) and endoscopic healing (aOR, 0.63; 95% CI, 0.41-0.96) at week 30. There were no racial differences in placebo response rates.
CONCLUSIONS
Ulcerative colitis participants from racial minority groups were less likely to achieve clinical response, clinical remission, and endoscopic healing with golimumab compared with White participants in induction and maintenance trials. Further studies are needed to understand the impact of race on therapeutic response in IBD.
Topics: Humans; Antibodies, Monoclonal; Colitis, Ulcerative; Inflammatory Bowel Diseases; Remission Induction
PubMed: 35913121
DOI: 10.1093/ibd/izac161 -
Brain, Behavior, and Immunity Oct 2020Exposure to discrimination or unfair treatment has emerged as an important risk factor for illness and disease that disproportionately affects racial and ethnic... (Review)
Review
Exposure to discrimination or unfair treatment has emerged as an important risk factor for illness and disease that disproportionately affects racial and ethnic minorities. Discriminatory experiences may operate like other stressors in that they activate physiological responses that adversely affect the maintenance of homeostasis. Research suggests that inflammation plays a critical role in the pathophysiology of stress-related diseases. Recent findings on discrimination and inflammation are discussed. We highlight limitations in the current evidence and provide recommendations for future studies that seek to examine the association between discrimination and inflammation.
Topics: Ethnicity; Humans; Inflammation; Minority Groups; Racial Groups; Risk Factors
PubMed: 32688027
DOI: 10.1016/j.bbi.2020.07.017 -
Disaster Medicine and Public Health... May 2022Coronavirus disease 2019 (COVID-19) has placed massive socio-psychological, health, and economic burdens including deaths on countless lives; however, it has... (Review)
Review
Coronavirus disease 2019 (COVID-19) has placed massive socio-psychological, health, and economic burdens including deaths on countless lives; however, it has disproportionally impacted certain populations. Co-occurring Social Determinants of Health (SDoH) disparities and other underlying determinants have exacerbated the COVID-19 pandemic. This literature review sought to (1) examine literature focused on SDoH and COVID-19 outcomes ie, infectivity, hospitalization, and death rates among marginalized communities; and (2) identify SDoH disparities associated with COVID-19 outcomes. We searched electronic databases for studies published from October 2019 to October 2021. Studies that were selected were those intersecting SDoH indicators and COVID-19 outcomes and were conducted in the United States. Our review underscored the disproportionate vulnerabilities and adverse outcomes from COVID-19 that have impacted racial/ethnic minority communities and other disadvantaged groups (ie, senior citizens, and displaced/homeless individuals). COVID-19 outcomes were associated with SDoH indicators, ie, race/ethnicity, poverty, median income level, housing density, housing insecurity, health-care access, occupation, transportation/commuting patterns, education, air quality, food insecurity, old age, etc. Our review concluded with recommendations and a call to action to integrate SDoH indicators along with relevant health data when implementing intelligent solutions and intervention strategies to pandemic response/recovery among vulnerable populations.
Topics: Humans; United States; COVID-19; Ethnicity; Pandemics; Social Determinants of Health; Minority Groups
PubMed: 35492024
DOI: 10.1017/dmp.2022.104 -
International Journal of Environmental... Jan 2022This study set out to answer the question 'Which kinds of agency do refugees perform when dealing with mental health problems of themselves and their children?'. Aiming...
This study set out to answer the question 'Which kinds of agency do refugees perform when dealing with mental health problems of themselves and their children?'. Aiming to gain more insight in why it seems harder for refugee parents and minors than for the native population to talk to health professionals about their mental health and wellbeing, we combined two theoretical notions of agency to investigate a broad spectrum of informants' behaviour. We conducted 25 interviews with 30 refugees from 8 countries (Syria, Yemen, Iran, Afghanistan, Armenia, Eritrea, Turkish Kurdistan, Vietnam), whose Dutch residence permit varied from 26 years to less than one year. Data were analysed through open and axial coding, followed by pattern analyses. Although sometimes refugees seek (mental) healthcare, at other times they show agency by doing 'nothing' or by deliberately using distracting activities to deal with severe stress. Making use of resources available to them, oftentimes refugees show agency in ways that are less visible to healthcare professionals, by surviving, showing resilience, and suffering. In these cases, we think healthcare for refugees should intervene in a non-medical way, e.g., by supporting them to obtain resources that help refugees to (re)gain agency.
Topics: Child; Delivery of Health Care; Humans; Mental Health; Minors; Refugees; Syria
PubMed: 35055628
DOI: 10.3390/ijerph19020806 -
Journal of Behavioral Medicine Oct 2020Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for... (Review)
Review
Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.
Topics: Bisexuality; Female; Humans; Male; Minority Groups; Sexual Behavior; Sexual and Gender Minorities; Social Stigma; Stress, Psychological
PubMed: 31863268
DOI: 10.1007/s10865-019-00120-6 -
JHEP Reports : Innovation in Hepatology Apr 2023Pegylated interferon alpha (pegIFNα) is commonly used for the treatment of people infected with HDV. However, its mode of action in HDV-infected cells remains elusive...
BACKGROUND & AIMS
Pegylated interferon alpha (pegIFNα) is commonly used for the treatment of people infected with HDV. However, its mode of action in HDV-infected cells remains elusive and only a minority of people respond to pegIFNα therapy. Herein, we aimed to assess the responsiveness of three different cloned HDV strains to pegIFNα We used a previously cloned HDV genotype 1 strain (dubbed HDV-1a) that appeared insensitive to interferon-α , a new HDV strain (HDV-1p) we isolated from an individual achieving later sustained response to IFNα therapy, and one phylogenetically distant genotype 3 strain (HDV-3).
METHODS
PegIFNα was administered to human liver chimeric mice infected with HBV and the different HDV strains or to HBV/HDV infected human hepatocytes isolated from chimeric mice. Virological parameters and host responses were analysed by qPCR, sequencing, immunoblotting, RNA hybridisation and immunofluorescence staining.
RESULTS
PegIFNα treatment efficiently reduced HDV RNA viraemia (∼2-log) and intrahepatic HDV markers both in mice infected with HBV/HDV-1p and HBV/HDV-3. In contrast, HDV parameters remained unaffected by pegIFNα treatment both in mice (up to 9 weeks) and in isolated cells infected with HBV/HDV-1a. Notably, HBV viraemia was efficiently lowered (∼2-log) and human interferon-stimulated genes similarly induced in all three HBV/HDV-infected mouse groups receiving pegIFNα. Genome sequencing revealed highly conserved ribozyme and L-hepatitis D antigen post-translational modification sites among all three isolates.
CONCLUSIONS
Our comparative study indicates the ability of pegIFNα to lower HDV loads in stably infected human hepatocytes and the existence of complex virus-specific determinants of IFNα responsiveness.
IMPACT AND IMPLICATIONS
Understanding factors counteracting HDV infections is paramount to develop curative therapies. We compared the responsiveness of three different cloned HDV strains to pegylated interferon alpha in chronically infected mice. The different responsiveness of these HDV isolates to treatment highlights a previously underestimated heterogeneity among HDV strains.
PubMed: 36908749
DOI: 10.1016/j.jhepr.2023.100673