Hispanic health in the USA: a scoping review of the literature

Hispanics are the largest minority group in the USA. They contribute to the economy, cultural diversity, and health of the nation. Assessing their health status and health needs is key to inform health policy formulation and program implementation. To this end, we conducted a scoping review of the literature and national statistics on Hispanic health in the USA using a modified social-ecological framework that includes social determinants of health, health disparities, risk factors, and health services, as they shape the leading causes of morbidity and mortality. These social, environmental, and biological forces have modified the epidemiologic profile of Hispanics in the USA, with cancer being the leading cause of mortality, followed by cardiovascular diseases and unintentional injuries. Implementation of the Affordable Care Act has resulted in improved access to health services for Hispanics, but challenges remain due to limited cultural sensitivity, health literacy, and a shortage of Hispanic health care providers. Acculturation barriers and underinsured or uninsured status remain as major obstacles to health care access. Advantageous health outcomes from the “Hispanic Mortality Paradox” and the “Latina Birth Outcomes Paradox” persist, but health gains may be offset in the future by increasing rates of obesity and diabetes. Recommendations focus on the adoption of the Health in All Policies framework, expanding access to health care, developing cultural sensitivity in the health care workforce, and generating and disseminating research findings on Hispanic health

Cyanobacterial ultrastructure in light of genomic sequence data

International audienceCyanobacteria are physiologically and morphologically diverse photosynthetic microbes that play major roles in the carbon and nitrogen cycles of the biosphere. Recently, they have gained attention as potential platforms for the production of biofuels and other renewable chemicals. Many cyanobacteria were characterized morphologically prior to the advent of genome sequencing. Here, we catalog cyanobacterial ultrastructure within the context of genomic sequence information, including high-magnification transmission electron micrographs that represent the diversity in cyanobacterial morphology. We place the image data in the context of tabulated protein domains-which are the structural, functional, and evolutionary units of proteins-from the 126 cyanobacterial genomes comprising the CyanoGEBA dataset. In particular, we identify the correspondence between ultrastructure and the occurrence of genes encoding protein domains related to the formation of cyanobacterial inclusions. This compilation of images and genome-level domain occurrence will prove useful for a variety of analyses of cyanobacterial sequence data and provides a guidebook to morphological features

ANALYSIS OF SAFETY IN MARALIXIBAT-TREATED PARTICIPANTS WITH PROGRESSIVE FAMILIAL INTRAHEPATIC CHOLESTASIS: DATA FROM THE MARCH TRIAL

Background: Maralixibat (MRX) is a novel, minimally absorbed, orally-administered inhibitor of the ileal bile acid transporter (IBAT) that interrupts the enterohepatic circulation of bile acids to improve cholestatic pruritus. MARCH, a 26-week randomized Phase 3 study, is the largest and most genetically inclusive clinical trial of Progressive Familial Intrahepatic Cholestasis (PFIC) to date, and achieved primary and key secondary endpoints of reduction in cholestatic pruritus, serum bile acids (sBA), improved bilirubin, and growth. Here, we provide a detailed analysis of safety data observed in the study. Methods: Treatment-emergent adverse events (TEAEs) and laboratory data from MARCH were analyzed. Results: 93 PFIC patients were randomized to MRX 570 µg/kg twice daily (n=47) or placebo (PBO; n=46). Median (min, max) treatment exposure was 183 (10, 203) days. TEAEs included diarrhea (57.4% vs 19.6%), and abdominal pain (25.5% vs 13%) for MRX vs PBO, respectively. Diarrhea was mostly grade 1, transient, with a median duration of 5.5 days; there were no severe or serious events. One patient with mild diarrhea discontinued therapy. Abdominal pain was also mostly mild and transient and, in nearly all instances, was concurrent with diarrhea. There were no clinically meaningful changes observed in either group from baseline in transaminase levels. Transaminase AEs were observed in 17% and 6.5% of MRX and PBO patients, respectively. Among the 8 MRX patients with transaminase elevations, 6 had resolution of the elevation without drug interruption; 2 patients had ongoing stable elevation even after drug interruption (n=1) or dose reduction (n=1) and both ultimately resumed prior maximum dose. No patients discontinued MRX due to transaminase elevation. Bilirubin increase was less common in MRX vs PBO (14.9% vs 19.6%). FSV deficiency, which was reported as an AE, was also less common in MRX vs PBO (27.7% vs 34.8%). Fractures were seen in 6.4% of MRX and in 0% of PBO; none were considered related as all had clear alternative causes for fracture, including pre-existing vitamin D deficiency which was stable or improved on MRX. Serious AEs were reported in 10.6% of MRX and 6.5% of PBO patients; none were deemed related (except 1 event of mild bilirubin increase in MRX); all resolved without any dose modifications. Conclusions: The MARCH study is the largest PFIC study conducted across PFIC types. MRX was well tolerated, with GI effects being the most frequent event but generally mild and self-limiting. FSV deficiency and bilirubin increase were more frequently seen in the PBO grou

Growth Inhibition and Compensation in Response to Neonatal Hypoxia in Rats

BackgroundHypoxia is an important disease mechanism in prematurity, childhood asthma and obesity. In children, hypoxia results in chronic inflammation.MethodsWe investigated the effects of hypoxia (Hx) (12% O2) during postnatal day 2 to 20 in rats. Control groups were normoxic (Nc), and normoxic growth restricted (14 pup liters) (Gr).ResultsHypoxia decreased growth similar Gr. Hx increased plasma TNFα and IL-6 and decreased IGF-I and VEGF. Hypoxia resulted in right ventricular (RV) hypertrophy but disproportionate decrements in limb skeletal muscle (SM) growth. miR206 was depressed in the hypertrophied RV of Hx rats while increased in growth retarded SM. Hx resulted in a decreased RV mRNA for myostatin but had no effect on SM myostatin. The mRNA for hypoxia sensitive factors such as HIFα was depressed in the RV of Hx rats suggesting negative feedback.ConclusionThe results indicate that Hx induces a proinflammatory state that depresses growth regulating mechanisms and that tissues critical for survival, such as the heart, can escape from this general regulatory program to sustain life. This study identifies accessible biomarkers for evaluating the impact of interventions designed to mitigate the long-term deleterious consequences of hypoxia that all too often occur in babies born prematurely