Health Disparities among Latinx Communities: Issues of Access to Information, Interpreters, and Bilingual Providers

Health Disparities among Latinx Communities: Issues of Access to Information, Interpreters, and Bilingual Providers Shea Wenzler, Depts. of Psychology and Political Science, Roma Kankaria, Sydney Welles, and Anubhav Thapaliya, with Dr. Indira Sultanić, School of World Studies Members of the Latinx community in Richmond and the United States face challenges in obtaining equitable health care access because of socioeconomic and systematic barriers within the healthcare system. This analysis conducted by the Collective Corazón—a VCU student organization that addresses Latinx healthy equity through service and advocacy—examines the underlying causes of Latinx health disparities. Special emphasis is placed on access to just, equitable, and ethical care, information, qualified interpreters, and bilingual healthcare providers—with the objective of proposing viable solutions to alleviate health disparities. This study found that while the U.S. Census Bureau identifies the Latinx population as the fastest growing demographic in the country, the group’s average income and educational attainment fall below the national average, causing increased amounts of stress and thus contributing to poor mental and physical health outcomes. The health disparities created by these socioeconomic factors are further exacerbated by discrimination by healthcare workers and language barriers that result from a lack of qualified interpreters and bilingual providers. This situation creates a cultural divide in which Latinx individuals who are less comfortable speaking English are more likely to turn to alternative forms of support, such as religious and community institutions. This study contends that increasing physician and interpreter training, designing and delivering culturally specific eHealth and Telehealth tools, connecting language access to patient safety and quality of care, and encouraging connections with community leaders are ways to lessen the challenges faced by Latinx individuals in healthcare.https://scholarscompass.vcu.edu/uresposters/1335/thumbnail.jp

The transcription factor Nfe2l2a is required for development of hematopoietic stem cells in the zebrafish embryo

Hematopoietic Stem Cells (HSCs) are the self-renewing population of cells that generate all erythrocytes and leukocytes over the lifetime of a vertebrate organism. HSCs are also the therapeutic units of curative bone marrow transplants used in the treatment of blood malignancies and in gene therapy for genetic blood disorders. In all vertebrate embryos, HSCs originate from the floor of the embryonic dorsal aorta during the endothelial to hematopoietic transition. Nascent HSCs will bud into the blood vessel and be carried to maturation sites by the embryonic blood flow. Despite the curative potential of HSC transplants in blood disorders, this approach is limited by low numbers of immunologically compatible HSCs for transplantation. A major objective is to generate unlimited numbers of patient matched HSCs from patient derived induced pluripotent stem cells (iPSCs) to alleviate this challenge to therapy, however it has not yet been possible to generate HSCs from iPSCs. This is likely because key developmental signals remain unknown. This makes the study of HSC development in the vertebrate embryo a key area of biomedical study. Previous work has suggested glucose metabolism generates reactive oxygen species (ROS) which are needed for HSC development. Nfe2l2a is a transcription factor and master regulator of the cellular antioxidant response and is activated by increased levels of ROS in the cell. Nfe2l2a has been previously indicated as a regulator of ROS mediated cytokine signaling in adult HSCs. Additionally, nfe2l2a is expressed in the embryonic vasculature of zebrafish embryos, which is the origin of HSCs. We sought to determine whether nfe2l2a is required for the development of HSCs in the zebrafish embryo. The zebrafish pre-clinical animal model serves as an appropriate model due to evolutionary conservation of hematopoiesis between the zebrafish and humans. We examined the expression of the conserved hematopoietic markers runx1, cmyb, and rag1 in embryos injected with an antisense morpholino oligonucleotide which disrupts nfe2l2a mRNA translation. We observed a significant reduction in the expression of these markers, indicative of impaired HSC development. Since normal patterning of the embryonic dorsal aorta is required for HSC development, the embryonic vasculature of nfe2l2a morphants was also examined for expression of key marker genes, which indicated normal patterning of these tissues. Interestingly, examination of fli1:EGFP transgenic embryos injected with nfe2l2a morpholino revealed arterio-venous malformations which are indicative of defects in the segregation of the dorsal aorta and cardinal vein. Overall, our work has revealed that nfe2l2a activity is required for the development of HSCs in the zebrafish embryo, possibly by controlling segregation of the dorsal aorta and cardinal vein blood vessels during development. Future experiments will be aimed at determining how nfe2l2a regulates this process.https://scholarscompass.vcu.edu/uresposters/1400/thumbnail.jp

Health Disparities in Afro-Latinx Populations: Chronic Health Diseases, Linguistic and Cultural Competency, and Inequities and Barriers in Richmond, Virginia

Afro-Latinx individuals face health disparities that differ from those faced by white Latinx individuals. This literature review was conducted by the Collective Corazón—a VCU student organization, mentored by Dr. Indira Sultanić, that addresses Latinx health equity through service and advocacy—in order to examine the underlying causes of Afro-Latinx health disparities. Skin color is a predictor of health, life expectancy, and quality of life for many Latinx individuals. On average, Afro-Latinx individuals in particular have less access to education, fewer financial freedoms, and poorer health outcomes. The Afro-Latinx community also describes higher rates of discrimination compared to white Latinx individuals. As a result, Afro-Latinx individuals suffer from higher rates of chronic illness, stress, anxiety, and depression. Furthermore, due to a lower average socioeconomic status and decreased education access that many Afro-Latinx individuals face, the prevalence and incidence of chronic diseases, such as type 2 diabetes, are higher for such populations when compared to national averages. Additionally, COVID-19 has exacerbated inequities and unequal access to resources; chronic comorbidities that Afro-Latinx individuals have are also predictors of poor COVID-19 outcomes. In Richmond in particular, another barrier that affects the health of many Afro-Latinx populations is the lack of access to healthcare services and/or insurance. This review argues that increasing cultural competency and racial equity trainings in healthcare systems, addressing social determinants of health, and encouraging connections with community leaders are ways to reduce health disparities that Afro-Latinx individuals face.https://scholarscompass.vcu.edu/uresposters/1407/thumbnail.jp

Deoxyribose phosphate aldolase is required for development of hematopoietic stem cells in the zebrafish embryo

Hematopoietic stem cells (HSCs) are an integral part of modern biomedical research because they are precursors to all blood cell lineages in vertebrates. Further understanding of hematopoietic development will allow for improvements in the success of therapeutic bone marrow transplantation; which is a crucial treatment in management of both malignant and non-malignant blood disorders. Although HSC transplantation is curative for many blood disorders, finding compatible donors is difficult due to a need for immunologic compatibility. Consequently, recent research efforts have been directed towards generating HSCs for the patient, from the patient themselves through the directed differentiation of induced pluripotent stem cells (iPSCs). To achieve this overarching goal, it is imperative to have a thorough understanding of genetics and molecular signals involved in the specification, determination, and differentiation of HSCs during embryonic development so that this process can be replicated using patient derived cells. In all vertebrates, hemogenic endothelium cells, located in the dorsal aorta floor, are the origin of HSCs. Hemogenic endothelial must undergo an endothelial to hematopoietic transition to become HSCs. Oxidative stress, as a result of glycolysis, is required for this transition and to generate proliferating, quiescent, and differentiating HSCs. Deoxyribose phosphate aldolase (Dera) is an enzyme that is involved in controlling the development of stress granules in cells that are under stress. These stress granules are thought to play an important role in mediating the stress response in cells. Dera is expressed in the embryonic vasculature early in zebrafish development – at the time when HSCs first develop. Trunk expression is present in the intermediate cell mass at 18 hours post fertilization (hpf) and in the pronephric ducts, vasculature, and neural crest. Publicly available RNA sequencing data suggests that dera might be somewhat enriched in the hemogenic endothelium. In this study, we knocked down Dera expression in zebrafish embryos by antisense morpholino oligonucleotide and examined expression of the conserved hematopoietic markers: runx1, cmyb and rag1. We found a significant reduction in the expression of these markers, indicating defective HSC development in dera morphant embryos. We further examined the expression of markers of embryonic vasculature development in morphant embryos and found expression to be normal suggesting that defective HSC development was not a result of abnormal vascular patterning. We also conducted drug treatments with cycloheximide and sodium arsenite, at varying concentrations, to determine if embryos are more sensitive to stress in the absence of Dera. In conclusion, normal HSC development requires dera where its role is likely to moderate the cellular stress response to keep it within physiological levels that are required for HSC development.https://scholarscompass.vcu.edu/uresposters/1401/thumbnail.jp