Tag: ethnicity

Categories : Emergency Medicine Obstetrics & GynaecologyTags :

Sharp Spike Seen in Emergency Visits for Life Threatening Pregnancy Complication

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Findings suggest significant increase in emergency department utilisation for hypertensive disorders of pregnancy over 14 year span

Photo by Camilo Jimenez on Unsplash

Hypertensive disorders of pregnancy, the second leading cause of maternal deaths worldwide, may be sending a significantly higher number of pregnant people to the emergency department. Between 2006 and 2020, researchers found a surge in emergency visits and admissions for the condition that causes serious maternal and neonatal complications and accounts for 6.3% of all pregnancy-related deaths in the United States.

The study, which appears in JAMA Network Open, also suggests greater emergency utilisation for the disease among underrepresented racial and ethnic groups. 

“Hypertensive disorders of pregnancy often develop suddenly, even in healthy women, and symptoms may appear without warning and progress rapidly,” said senior author Erica Marsh, MD, professor of obstetrics and gynaecology at the University of Michigan Medical School and chief of the division of reproductive endocrinology and infertility at U-M Health Von Voigtlander Women’s Hospital, of Michigan Medicine.

“Ideally, this risk would be detected during prenatal care and lead to early intervention. Our study indicates more people turning to the emergency department, which may reflect a higher prevalence of the condition or an increased awareness for prompt assessment and treatment.”

Hypertensive disorders of pregnancy, which could include preeclampsia, gestational hypertension, and eclampsia, are serious complications that involve elevated blood pressure. 

The American College of Obstetricians and Gynecologists recommends management of severe blood pressure in pregnancy within 30 to 60 minutes of diagnosis to prevent complications such as stroke, myocardial ischaemia, seizure, placental abruption, and maternal and neonatal mortality.

Disparities in ED reliance, disease severity

Researchers analysed nationally representative data, finding a 76% increase in emergency encounters related to the condition over the 14-year span, up from 31  623 to 55  893, and nearly 1.5 times as many ED admissions – up from 17 338 to 43 563.

Concerns about costs, time constraints, misconceptions about the necessity of early care or barriers to accessing prenatal care may be possible factors for the increase, authors say.

“The disparities in reliance on emergency rooms for this disease may imply limited access to timely outpatient care or other health system barriers,” said lead author Courtney Townsel, MD, MSc, who was at Michigan Medicine at the time of the study and is now at the University of Maryland.

Black, Hispanic, and Asian or Pacific Islander groups were also more likely to both utilise emergency care and be admitted to the hospital for hypertensive disorders of pregnancy.

“The disproportionate rate of admissions among certain racial and ethnic groups suggests worse disease severity by the time people seek care,” Townsel said.

“Racial differences in emergency care utilisation for hypertensive disorders of pregnancy underscore the ongoing racial disparities in US maternal morbidity and mortality and highlight a critical need for accessible, culturally competent community-level interventions for all.”

Original written by Beata Mostafavi. Republished under a Creative Commons Licence.

Source: Michigan Medicine – University of Michigan

 

Categories : Medical Research & TechnologyTags :

New Effort to Improve Diversity in Clinical Trials

On By ModernMedia
Source: CC0 Creative Commons

Columbia University and Pfizer Inc. have established the Columbia-Pfizer Clinical Trials Diversity Initiative, which aims to reduce health disparities by increasing the number of minorities in clinical trials and making clinical researchers more diverse.

In the United States, 12% of the population is Black and 18% is Hispanic or Latino but in 2020, only 8% were Black and 11% were Hispanic among the 32 000 patients who participated in clinical trials that led to FDA approval of new drugs. For example, a review of clinical trials between 1999 and 2015 for cystic fibrosis only had a representation of 2.0% for Latinos, 1.0% for Black individuals, and 0.1% for Asians.

“People of different ethnicities can have different responses to the same medicine or treatment, so a lack of diversity among clinical trial participants means doctors cannot know if the treatment will be effective in all the patients they treat,” said Anil K Rustgi, MD, Interim Executive Vice President and Dean of the Faculties of Health Sciences and Medicine at Columbia University and director of the Herbert Irving Comprehensive Cancer Center. “Increasing diversity in trials will improve the treatment of patients from underrepresented groups and is a moral imperative as well as a fundamental medical issue.”

Rod MacKenzie, PhD, Executive Vice President and Chief Development Officer at Pfizer, said, “Diversity of representation in clinical trials is a matter of equity, which is a core Pfizer value. We are deeply committed to ensuring our clinical trials reflect the diversity of the communities like New York in which they are conducted. We look forward to working with Columbia University both to offer any willing individual, regardless of background, the opportunity to participate in and contribute to clinical research, and to expand the roster of diverse clinical researchers who are helping us conduct studies.”

Pfizer will provide a three-year, $10 million grant to Columbia to help establish and expand the Initiative, which will improve the diversity of participants in clinical trials by looking at the barriers that prevent participation by marginalised individuals. The Initiative will expand Columbia’s Community Health Workers Program network to connect with underserved populations and create culturally sensitive engagement tools. The efforts will include researching new ways to increase the accessibility of clinical trials through telemedicine, wearable technology, and home visits.

The Initiative also aims to improve diversity among clinical research faculty and staff. Columbia will help build an additional pipeline of diverse clinical investigators through a new National Diversity Clinical Trials Leadership Program to increase the number of faculty and staff from underrepresented groups as well.

“A diverse research staff not only helps to improve trust in clinical trials among participants from underserved groups but improves the entire clinical trial enterprise by bringing different questions, experience, and perspective to the table,” Dr Rustgi said.

Source: Columbia University Irving Medical Center

Categories : COVID General InterestTags :

Doctor Receives Forbes Magazine Honour for COVID Discovery

On By ModernMedia
Photo by Karolina Grabowska from Pexels

One of the first doctors to warn of COVID’s disproportionate effect  on ethnic minorities has been named on the Forbes 30 Under 30 list.

Dr Daniel Pan in Leicester, UK, was part of a group to treat the first cases in the city and noticed some of the sickest patients were minority ethnic.

The Forbes 30 Under 30 list celebrates young innovators in their respective fields, such as science and healthcare.

Dr Pan, who is a clinical fellow at the National Institute for Health Research (NIHR) at the University of Leicester, said: “It’s a great honour and I think the best thing about it is it helps advertise the research we’ve been doing, because it’s important work.”

He was one of the first to treat COVID patients in Leicester, and noticed the differences among the patients.

Dr Pan said: “Leicester has a very multi-ethnic diverse population so when the pandemic first hit the UK, I was working on the clinical wards.

“It became immediately clear to myself and my colleagues that a lot of these patients were from ethnic minority backgrounds – especially the ones who were very sick.

“We probably noticed that slightly earlier than a lot of other places, for example Italy, and we felt a need to get that out there.”

As part of a group of researchers led by Dr Manish Pareek, he contributed to work that demonstrated that COVID’s disproportionate impact on UK ethnic minority groups was largely a result of a greater risk of being infected, due to societal and health inequalities.

NIHR Leicester Biomedical Research Centre director Professor Melanie Davies remarked that Dr Pan had made a “significant contribution to research efforts”, adding he had “a bright future in clinical research ahead of him”.

He is now working alongside his colleagues on a face mask that could determine whether the wearer has COVID, and possibly how infectious they are.

Dr Pan said: “We can probably find out when a person is most infectious, because we can find the time of day and the period of their illness where they breathe out the most virus.

“If it’s effective it can be rolled out, for example, everyone in A&E could wear a mask while they’re waiting to see a doctor and those who are mask positive can then go into isolation bays.”

Source: BBC News

Categories : GeneticsTags :

Refining the Genetic Heritage of South Africans for Better Medicine

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A new study from Wits University challenges the idea that all South-Eastern-Bantu speaking groups are a single genetic group.

The South-Eastern-Bantu (SEB) language family includes isiZulu, isiXhosa, siSwati, Xitsonga, Tshivenda, Sepedi, Sesotho and Setswana. Almost 80% of South Africans speak one of these as their first language and their origins can be traced to West-Central Africa farmers whose descendants over the past two millennia southwards, finally reaching Southern Africa.

Since then, settling and population movements and interaction with Khoe and San communities, as other SEB speakers, ultimately resulted in distinct Southern African languages such as isiZulu, isiXhosa and Sesotho. But despite these linguistic differences, these groups of people are treated as one group in genetic studies.

Genetic disease studies rely on understanding the genetic diversity of population. If two genetically distinct populations are treated as one, errors could occur when finding disease genes, especially for complex diseases like hypertension and diabetes.

Dr Dhriti Sengupta  and Dr  Ananyo Choudhury in the Sydney Brenner Institute for Molecular Bioscience (SBIMB) at Wits University were joint lead authors of the paper published in Nature Communications. 

“South Eastern Bantu-speakers have a clear linguistic division – they speak more than nine distinct languages – and their geography is clear: some of the groups are found more frequently in the north, some in central, and some in southern Africa. Yet despite these characteristics, the SEB groups have so far been treated as a single genetic entity,” said Dr Choudhury.

The study found that SEB speaking groups are too different to be treated as a single genetic unit.

“So if you are treating say, Tsonga and Xhosa, as the same population – as was often done until now – you might get a completely wrong gene implicated for a disease,” said Sengupta.

The study aimed to find out whether the SEB speakers are indeed a single genetic entity or if they have enough genetic differences to be grouped into smaller units.

Genetic data from more than 5000 participants speaking eight different southern African languages were generated and analysed. Participants were recruited from research sites in Gauteng, Mpumalanga, and Limpopo province.

The study detected major variations in genetic contribution from the Khoe and San into SEB speaking groups; some groups have received a lot of genetic influx from Khoe and San people, while others have had a very little genetic exchange with these groups.

This variation ranged on average from about 2% in Tsonga to more than 20% in Xhosa and Tswana, suggesting that  SEB speaking groups are too different to be treated as a single genetic unit.

“The study showed that there could be substantial errors in disease gene discovery and disease risk estimation if the differences between South-Eastern-Bantu speaking groups are not taken into consideration,” said Dr Sengupta.

The genetic data also show major differences in the history of these groups over the last 1000 years, with genetic exchanges occurring at different points in time. These genetic differences are distinctive enough to affect the outcomes of biomedical genetic research.

Dr Sengupta cautioned that ethnolinguistic identities are complex and broad conclusions extrapolated should not from the findings regarding genetic differences.

“Although genetic data showed differences [separation] between groups, there was also a substantial amount of overlap [similarity]. So while findings regarding differences could have huge value from a research perspective, they should not be generalised,” she said.

A common approach to identify if a genetic variant causes or predisposes a disease is to compare occurrence of many genetic variants in individuals with a disease (eg, hypertension or diabetes) against healthy individuals. If there is a difference in frequency in a variant between two sets, the genetic variant is assumed to be perhaps linked to the disease.

“However, this approach depends entirely on the underlying assumption that the two groups consist of genetically similar individuals. One of the major highlights of our study is the observation that Bantu-speakers from two geographic regions – or two ethnolinguistic groups – cannot be treated as if they are the same when it comes to disease genetic studies,” said Dr Choudhury.

Future studies, especially those testing a small number of variants, need to be more nuanced and have balanced ethnolinguistic and geographic representation, he said.

Professor Michèle Ramsay, director of the SBIMB and corresponding author of the study, says: “The in-depth analysis of several large African genetic datasets has just begun. We look forward to mining these datasets to provide new insights into key population histories and the genetics of complex diseases in Africa”.

Source: Wits University

Journal reference: Sengupta, D., et al. (2021) Genetic substructure and complex demographic history of South African Bantu speakers. Nature Communications.doi.org/10.1038/s41467-021-22207-y.

Categories : Cardiovascular DiseaseTags :

Black Barbershops with Pharmacist-led Care can Combat Hypertension

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Black and white image of a black man getting a haircut at a barbershop. Credit: BariKive from Pexels.

Black barbershops with pharmacist-led blood pressure (BP) care for their clients, have been shown to be cost effective, with the high initial costs offsetting reduced cardiovascular events later in life.

The study cost simulations were based on the original  Los Angeles Barbershop Blood Pressure Study (LABBPS). In that study, intervention consisted of a trial with men being assigned either to barbershops where barbers encouraged patrons to meet with pharmacists who prescribed drug therapy under an agreement with the participants’ doctors, with the control group being men assigned to barbershops where the barbers only promoted lifestyle modification and physician visits. This intervention resulted in a mean BP drop of 27.0mmHg compared to the control group which fell by 9.3mmHg.

In a 1-year intervention based on costs for the LABBPS, on average, $2356 more per participant than the controls and was associated with a gain of 0.06 quality-adjusted life years (QALYs) over a 10-year horizon, according to Brandon Bellows, PharmD, MS, of Columbia University in New York City, and colleagues.

Thus, in computer simulations,  the LABBPS intervention was associated with 10-year projected total healthcare costs averaging $42 717 per QALY gained, reported the researchers.

“One concern raised as a potential barrier to widespread LABBPS implementation is the specialty training of clinical pharmacists. In this analysis, the cost of specialty training and certification was included; the results suggest that long-term health benefits and avoided healthcare costs of the LABBPS offset these upfront training costs,” the researchers wrote.

The team reported that the cost effectiveness of the intervention could be increased under various various scenarios:

  • Only using generic drugs: $17 162 per QALY gained
  • Shortening intervention to 26 weeks: $18 300 per QALY gained
  • Implementing optimal savings from less time spent on intervention tasks, lower equipment costs, only using generics, and no participant incentive costs: intervention becomes dominant (both less expensive and more effective than control)

However, if pharmacists were less likely to intensify antihypertensive medications when systolic BP was ≥ 150 mm Hg, or if pharmacists took longer to get to the barbershops, the cost of the LABBPS intervention would exceed $50 000 per QALY gained.

“Hypertension care delivered by clinical pharmacists in Black barbershops is a highly cost-effective way to improve BP control in Black men,” the authors concluded.  

The LABBPS has received praise for demonstrating that Black men with uncontrolled hypertension had better BP control after 6 months with barbershop visits by specialty pharmacists than with regular physician visits. Extending the intervention to 1 year did not change the results.

Researchers previously reported that a telemedicine component could bring down cost and maintain efficiency of the LABBPS program.

“Hypertension prevalence remains higher among non-Hispanic Black men than in any other racial or ethnic group in the US. Hypertension awareness and treatment have plateaued in the US since 2010, and Black men continue to have worse BP control and higher hypertension-related cardiovascular disease mortality rates compared with other groups,” the investigators wrote.

The researchers assumed that after the one-year intervention period, processes of hypertension care management returned to standard care, which was a major limitation of the study.

“These findings may also be somewhat limited in scope as a healthcare sector perspective was used, which only considers direct healthcare costs, rather than a societal perspective, which may include indirect costs such as improvements in productivity,” noted Bellows and co-authors. “Finally, cost-effectiveness estimated for the LABBPS may not be generalizable to other U.S. communities, as it was specific to Los Angeles County and was driven in part by the high underlying risk of cardiovascular disease in Black men.”

Source: MedPage Today

Journal information: Bryant KB, et al “Cost-effectiveness of hypertension treatment by pharmacists in black barbershops” Circulation 2021; DOI: 10.1161/CIRCULATIONAHA.120.051683.

Categories : Cancer General Interest PaediatricsTags :

Donated Afro Hair Wigs Now Possible Thanks to UK Girl

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A silhouetted woman with afro hair reading a book by a window. Photo by Thought Catalog from Pexels

A British girl who was told her afro hair was too delicate to donate for wig-making prompted a new wig-making approach to use it, BBC News reports.

When eleven year old Carly Gorton wanted to donate her afro hair to the Little Princess Trust charity, which makes natural hair wigs for children who have lost theirs from cancer treatment and other causes, she was initially frustrated as the charity said the hair was too delicate. Undeterred, Carly had urged the charity to rethink, which it did.

Following research and a trial to make them possible, the charity described the new wigs as a “historic breakthrough”.

“It’s really beautiful,” said Carly, of one of the new wigs.

A BMJ study showed that wigs positively impact psychological wellbeing for people with alopecia, attributed to increasing their confidence of going out in public and the perception of fewer comments about hair loss.

At a special school assembly, Carly’s mother Anna Mudeka then cut her daughter’s hair and it was donated for use in the first new wigs to be worn by other children.

Phil Brace, The Little Princess Trust’s chief executive, said Carly’s “determination” to donate her hair had pushed them to find a solution.

The charity worked with the 120-year-old London company Raoul to develop a wefting method to weave and tie the donated locks.

Carly’s mother, Anna Mudeka, said: “History has been made and we are so proud of Carly.

“Through her sheer determination and everyone pulling together to hear her voice, children of black and mixed heritage can now donate their hair to the Little Princess Trust.”

Ms Mudeka, of Southburgh, added that children needing wigs through illness could now receive a wig “true to their heritage”.

Carly and her mother’s campaign had created a “fundamental change in wig manufacturing”, said Mr Brace. “The commitment and work that has gone on has shown just what is possible when groups of people get together and bring different skills to find a solution.”

Source: BBC News

Categories : GeneticsTags :

African Genetic Data Needed to Complete the DNA Picture

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A $4.5 billion initiative to gather genomic data from African populations has been put forward to help fill the gaps in understanding the human genome.

Genome Wide Assay Studies (GWAS) have yielded a huge amount of insight into genetic associations with disease and roles in bodily function, transforming medicine. But the picture is still incomplete, and there are large gaps remaining.

While the genomes of Europeans and Americans has been well mapped, the genomes of Africans remain virtually a blank state despite having far more genetic diversity than any other region. Genome mapping has come a long way in the two decades since the first genome was sequenced, falling in cost from $3 billion to around $1000.

“Most genomic research on the African continent over the last two decades has largely been driven by agendas defined more by European and American investigators,” Ambroise Wonkam, a medical genetics professor and deputy dean of research at the University of Cape Town’s Faculty of Health Sciences, told AFP.

“The Three Million African Genomes (3MAG) project would require sequencing individuals carefully selected across Africa to cover ethnolinguistic, regional and other groups,” Prof Wonkam said. A similar study to map the genomes of 100 000 Asian people is underway. 

The continent’s enormous genetic diversity no doubt holds a great number of surprises and important discoveries. Making his case in a comment in Nature, Prof Wonkam said that having access to such a diverse database would make it much easier to track down mutations.

“The aim is to capture the full scope of Africa’s genetic variation—for the benefit of all human populations and to ensure equitable access to genetic medicine.”

For example, a variant of the PCSK9 gene that is correlated with dyslipidaemia only came to light because it was 200 times more common in African Americans than Europeans.

Citing another example, Prof Wonkam said, “The inclusions of even a small number of black Americans in control cohorts probably would have prevented the misclassification of benign variants as causing cardiomyopathy.”

The relatively few GWAS of African populations that have been done also revealed a genetic susceptibility to type-2 diabetes that had previously gone unreported, and up to half of African populations have a gene variant associated with severe side effects to the HIV drug efavirenz.

When the genomes of 910 people of African descent were sequenced, it revealed large gaps in the ‘reference genome’ used by researchers around the world, Jesse Gillis, a researcher at the Stanley Institute for Cognitive Genomics in New York, noted in a study in BMC.

“Approximately 10 percent of DNA sequences—some 300 million base pairs—from these genomes were ‘missing’,” he stated.

Prof Wonkam has said that the study should mostly be funded by African governments, but international organisations should help foot the bill too. 

Source: Medical Xpress

Journal information: Comment: Sequence three million genomes across Africa, Nature (2021). DOI: 10.1038/d41586-021-00313-7 , www.nature.com/articles/d41586-021-00313-7