Publications by authors named "Keith Norris"

350 Publications

Diagnosis, Education, and Care of Patients with -Associated Nephropathy: A Delphi Consensus and Systematic Review.

J Am Soc Nephrol 2021 Apr 14. Epub 2021 Apr 14.

Department of Bioethics and Humanities, University of Washington, Seattle, Washington.

Background: variants contribute to the markedly higher incidence of ESKD in Blacks compared with Whites. Genetic testing for these variants in patients with African ancestry who have nephropathy is uncommon, and no specific treatment or management protocol for -associated nephropathy currently exists.

Methods: A multidisciplinary, racially diverse group of 14 experts and patient advocates participated in a Delphi consensus process to establish practical guidance for clinicians caring for patients who may have -associated nephropathy. Consensus group members took part in three anonymous voting rounds to develop consensus statements relating to the following: () counseling, genotyping, and diagnosis; () disease awareness and education; and () a vision for management of -associated nephropathy in a future when treatment is available. A systematic literature search of the MEDLINE and Embase databases was conducted to identify relevant evidence published from January 1, 2009 to July 14, 2020.

Results: The consensus group agreed on 55 consensus statements covering such topics as demographic and clinical factors that suggest a patient has -associated nephropathy, as well as key considerations for counseling, testing, and diagnosis in current clinical practice. They achieved consensus on the need to increase awareness among key stakeholders of racial health disparities in kidney disease and of -associated nephropathy and on features of a successful education program to raise awareness among the patient community. The group also highlighted the unmet need for a specific treatment and agreed on best practice for management of these patients should a treatment become available.

Conclusions: A multidisciplinary group of experts and patient advocates defined consensus-based guidance on the care of patients who may have -associated nephropathy.
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http://dx.doi.org/10.1681/ASN.2020101399DOI Listing
April 2021

Prevalence and predictors of obesity-related cancers among racial/ethnic groups with metabolic syndrome.

PLoS One 2021 7;16(4):e0249188. Epub 2021 Apr 7.

UCLA Division of General Internal Medicine and Health Services Research, Los Angeles, California, United States of America.

Background: Obesity-related cancer (ORC) is associated with higher amounts of body fat, which could increase the risk of developing cardiovascular disease (CVD). A significant factor associated with CVD is metabolic syndrome (MetS), and MetS prevalence differs by race/ethnicity. The purpose of this study was to compare the prevalence and predictors of ORCs by race/ethnicity among adults (>18) with MetS.

Methods: This was a retrospective, cross-sectional study using data from the 1999-2014 National Health and Nutrition Examination Survey (NHANES). A chi-square test was performed to determine differences in ORC prevalence between non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic participants with MetS. A multivariate logistic regression was used to evaluate predictors (race, sex, income, insurance, education, marital status, and smoking status) of ORC among adults with MetS.

Results: Of the 1,554 adults, the prevalence of ORC was 30.6% among NHWs, 51.3% in NHBs, and 54.1% in Hispanics (p = <0.001). Females were 6.27 times more likely to have an ORC compared to males (95% CI = 4.95-14.11). Compared to NHWs, NHBs were 2.1 times more likely to have an ORC (95% CI = 1.40-3.38); and Hispanics were 2.5 times more likely (95% CI = 1.39-4.77). For every 1-year unit increase in age, the odds of ORC increased by 3% (95% CI = 1.00-1.05).

Conclusions: Among NHANES participants with MetS, the prevalence of ORCs was significantly higher in NHBs and Hispanics, females, and older adults with MetS. Future studies, by race/ethnicity, are warranted on mortality risk of persons with MetS and ORC.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249188PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8026066PMC
April 2021

Racial Disparities in Potentially Avoidable Hospitalizations During the COVID-19 Pandemic.

Am J Prev Med 2021 Mar 19. Epub 2021 Mar 19.

Division of Geriatric Medicine, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California; Greater Los Angeles VA Healthcare System Geriatrics Research Education and Clinical Center (GRECC), Los Angeles, California.

Introduction: Potentially avoidable hospitalizations are disproportionately experienced by racial and ethnic minorities and expose these groups to unnecessary iatrogenic harm (including the risk of nosocomial COVID-19) and undue financial burden. In working toward an overarching goal of eliminating racial and ethnic health disparities, it is important to understand whether and to what extent potentially avoidable hospitalizations have changed by race and ethnicity during the COVID-19 pandemic.

Methods: This single-center pre-post study included patients admitted to any UCLA Health hospital for an ambulatory care-sensitive condition between March-August 2019 (prepandemic period) and March-August 2020 (postpandemic period). Investigators measured the change in the number of potentially avoidable hospitalizations (defined per the Agency for Healthcare Research and Quality guidelines) stratified by race and ethnicity and calculated the 95% CIs for these hospitalizations using a cluster bootstrap procedure.

Results: Between March 1, 2020 and August 31, 2020, 347 of 4,838 hospitalizations (7.2%) were potentially avoidable, compared with 557 of 6,248 (8.9%) during the same 6-month period in 2019. Potentially avoidable hospitalizations decreased by 50.3% (95% CI=41.2, 60.9) among non-Hispanic Whites but only by 8.0% (95% CI= -16.2, 39.9) among African Americans (50.3% vs 8.0%, p=0.015).

Conclusions: Racial disparities in potentially avoidable hospitalizations increased during the COVID-19 pandemic at a large urban health system. Given that the prepandemic rates of potentially avoidable hospitalizations were already higher among racial and ethnic minorities, especially among African Americans, this finding should cause alarm and lead to further exploration of the complex factors contributing to these disparities.
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http://dx.doi.org/10.1016/j.amepre.2021.01.036DOI Listing
March 2021

Choice of Intensive Lifestyle Change and/or Metformin after Shared Decision Making for Diabetes Prevention: Results from the Prediabetes Informed Decisions and Education (PRIDE) Study.

Med Decis Making 2021 Apr 3:272989X211001279. Epub 2021 Apr 3.

David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Introduction: While the Diabetes Prevention Program Study demonstrated that intensive lifestyle change and metformin both reduce type 2 diabetes incidence, there are little data on patient preferences in real-world, clinical settings.

Methods: The Prediabetes Informed Decisions and Education (PRIDE) study was a cluster-randomized trial of shared decision making (SDM) for diabetes prevention. In PRIDE, pharmacists engaged patients with prediabetes in SDM using a decision aid with information about both evidence-based options. We recorded which diabetes prevention option(s) participants chose after the SDM visit. We also evaluated logistic regression models examining predictors of choosing intensive lifestyle change ± metformin, compared to metformin or usual care, and predictors of choosing metformin ± intensive lifestyle change, compared to intensive lifestyle change or usual care.

Results: Among PRIDE participants ( = 515), 55% chose intensive lifestyle change, 8.5% chose metformin, 15% chose both options, and 21.6% declined both options. Women (odds ratio [OR] = 1.60, = 0.023) had higher odds than men of choosing intensive lifestyle change. Patients >60 years old (OR = 0.50, = 0.028) had lower odds than patients <50 years old of choosing metformin. Participants with higher body mass index (BMI) had higher odds of choosing intensive lifestyle change (OR = 1.07 per BMI unit increase, = 0.005) v. other options and choosing metformin (OR = 1.06 per BMI unit increase, = 0.008) v. other options.

Conclusions: Patients with prediabetes are making choices for diabetes prevention that generally align with recommendations and expected benefits from the published literature. Our results are important for policy makers and clinicians, as well as program planners developing systemwide approaches for diabetes prevention.
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http://dx.doi.org/10.1177/0272989X211001279DOI Listing
April 2021

Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy.

Am J Nephrol 2021 22;52(2):98-107. Epub 2021 Mar 22.

Nephrology Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA,

Background: The global epidemiology of end-stage kidney disease (ESKD) reflects each nation's unique genetic, environmental, lifestyle, and sociodemographic characteristics. The response to ESKD, particularly regarding kidney replacement therapy (KRT), depends on local disease burden, culture, and socioeconomics. Here, we explore geographic variation and global trends in ESKD incidence and prevalence and examine variations in KRT modality, practice patterns, and mortality. We conclude with a discussion on disparities in access to KRT and strategies to reduce ESKD global burden and to improve access to treatment in low- and middle-income countries (LMICs).

Summary: From 2003 to 2016, incidence rates of treated ESKD were relatively stable in many higher income countries but rose substantially predominantly in East and Southeast Asia. The prevalence of treated ESKD has increased worldwide, likely due to improving ESKD survival, population demographic shifts, higher prevalence of ESKD risk factors, and increasing KRT access in countries with growing economies. Unadjusted 5-year survival of ESKD patients on KRT was 41% in the USA, 48% in Europe, and 60% in Japan. Dialysis is the predominant KRT in most countries, with hemodialysis being the most common modality. Variations in dialysis practice patterns account for some of the differences in survival outcomes globally. Worldwide, there is a greater prevalence of KRT at higher income levels, and the number of people who die prematurely because of lack of KRT access is estimated at up to 3 times higher than the number who receive treatment. Key Messages: Many people worldwide in need of KRT as a life-sustaining treatment do not receive it, mostly in LMICs where health care resources are severely limited. This large treatment gap demands a focus on population-based prevention strategies and development of affordable and cost-effective KRT. Achieving global equity in KRT access will require concerted efforts in advocating effective public policy, health care delivery, workforce capacity, education, research, and support from the government, private sector, nongovernmental, and professional organizations.
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http://dx.doi.org/10.1159/000514550DOI Listing
March 2021

Nomenclature in nephrology: preserving 'renal' and 'nephro' in the glossary of kidney health and disease.

J Nephrol 2021 Mar 13. Epub 2021 Mar 13.

Guy's & Saint Thomas' Hospital, London, UK.

A recently published nomenclature by a "Kidney Disease Improving Global Outcomes" (KDIGO) Consensus Conference suggested that the word "kidney" should be used in medical writings instead of "renal" or "nephro" when referring to kidney disease and kidney health. Whereas the decade-old move to use "kidney" more frequently should be supported when communicating with the public-at-large, such as the World Kidney Day, or in English speaking countries in communications with patients, care-partners, and non-medical persons, our point of view is that "renal" or "nephro" should not be removed from scientific and technical writings. Instead, the terms can coexist and be used in their relevant contexts. Cardiologists use "heart" and "cardio" as appropriate such as "heart failure" and "cardiac care units" and have not replaced "cardiovascular" with "heartvessel", for instance. Likewise, in nephrology, we consider that "chronic kidney disease" and "continuous renal replacement therapy" should coexist. We suggest that in scientific writings and technical communications, the words "renal" and "nephro" and their derivatives are more appropriate and should be freely used without any pressure by medical journals to compel patients, care-partners, healthcare providers, researchers and other stakeholders to change their selected words and terminologies. We call to embrace the terms "kidney", "renal" and "nephro" as they are used in different contexts and ask that scientific and medical journals not impose terminology restrictions for kidney disease and kidney health. The choice should be at the discretion of the authors, in the different contexts including in scientific journals.
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http://dx.doi.org/10.1007/s40620-021-01011-3DOI Listing
March 2021

Time to Repair the Effects of Racism on Kidney Health Inequity.

Am J Kidney Dis 2021 Feb 24. Epub 2021 Feb 24.

Center for Community and Population Health Improvement, Clinical and Translational Science Institute, Duke University School of Medicine, Durham, NC; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, NC.

Kidney disease continues to manifest stark U.S. racial inequities, revealing the entrenchment of racism and bias within multiple facets of society including in our institutions, practices, norms, and beliefs. In this perspective, we synthesize theory and evidence to describe why an understanding of race and racism is integral to kidney care, providing examples of how kidney health disparities manifest interpersonal and structural racism. We then describe racialized medicine and color-blind approaches as well as their pitfalls, offering in their place suggestions to embed anti-racism and equity lens into our practice. We propose examples of how we can enhance kidney health equity by enhancing our structural competency, equity-focused race consciousness, and by centering investigation and solutions around the needs of the most marginalized. To achieve equitable outcomes for all, our medical institutions must embed anti-racism and equity into all aspects of advocacy, policy, patient/community engagement, educational efforts, and clinical care processes. Organizations engaged in kidney care should commit to promoting structural equity and eliminating potential sources of bias across referral practices, guidelines, research agendas, and in clinical care. Kidney care providers should reaffirm our commitment to structurally competent patient care and educational endeavors in which empathy and continuous self-education about social drivers of health and inequity, racism, and bias are integral. We envision a future in which kidney health equity is a reality for all. Through bold collective and sustained investment, we can achieve this critical goal.
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http://dx.doi.org/10.1053/j.ajkd.2021.01.010DOI Listing
February 2021

The Role of Place in Disparities Affecting Black Men Receiving Hemodialysis.

Kidney Int Rep 2021 Feb 20;6(2):357-365. Epub 2020 Oct 20.

Division of General Internal Medicine and Nephrology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.

Introduction: Black men are over-represented in the end stage kidney disease population and are at disproportionate risk of unfavorable outcomes. There is a paucity of investigation to elucidate the mediators of this risk. This study attempts to identify residential community attributes as a possible contributor.

Methods: A post-hoc analysis of prospectively collected data from a cohort of Black men enrolled in the US Dialysis Outcomes and Practice Patterns Study (DOPPS), 2010--2015, linked to the American Community Survey, by dialysis facility zip codes was undertaken. The exposure variable was the dialysis facility community composition as defined by percent Black residents. Negative binomial regression was used to estimate incidence rate ratio (IRR) of hospitalization (first outcome) for Black men in crude and adjusted models. Similarly, Cox proportional hazards modeling was used to estimate mortality (second outcome) for Black men by type of community.

Results: A total of 702 Black men receiving chronic hemodialysis were included in the study. Black men receiving hemodialysis in communities with greater proportions of Black residents had lower Charlson scores and fewer comorbidities, but a higher rate of hypertension. They had equivalent adherence to dialysis treatments, but a lower rate of arteriovenous fistula use and fewer dialysis minutes prescribed. Black men receiving dialysis in communities with a greater proportion of Black residents (per 10% increase) had higher adjusted hospitalization rates (IRR 1.09, 95% confidence interval [CI] 1.00-1.19) and mortality (hazard ratio [HR] 1.29, 95% CI 1.05-1.59).

Conclusions: This study supports the unique role of residential community as a risk factor for Black men with end stage kidney disease, showing higher hospitalization and mortality in those treating in Black versus non-Black communities, despite equivalent adherence and fewer comorbidities.
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http://dx.doi.org/10.1016/j.ekir.2020.10.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879205PMC
February 2021

Church Attendance and Mobility Limitation Among Black and White Men With Prostate Cancer.

Am J Mens Health 2021 Jan-Feb;15(1):1557988321993560

Program for Research on Faith, Justice, and Health, Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA.

Prostate cancer is a significant impediment that can reduce physical functional status. Mobility is fundamental for quality of life and church attendance to be associated with improved physical functioning. Few studies have examined how religious participation have implications for mobility limitation among men in general and among prostate cancer survivors in particular. The purpose of this study was to assess the association between church attendance and mobility limitation among Black and White prostate cancer patients and survivors. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 804 Black and White men with complete information on the primary outcome and predictor variables. Mobility limitation was the primary outcome variable, and church attendance was the main independent variable. The analytic sample was almost equally divided between Black ( = 382) and White men ( = 422). The proportion of Black men reporting mobility limitation (30.09%) more than doubled the corresponding percentage for White men (14.7%). Black men had a higher proportion of individuals who reported weekly church attendance (49.2% vs. 45.0%). Fully adjusted modified Poisson regression models produced results indicating that respondents attending church weekly had a lower mobility limitation prevalence (PR = 0.56, 95% CI [0.39, 0.81]) than those never attending church. Results from this study contribute to the body of evidence asserting the health benefits of church attendance. These findings suggest that health providers should consider how religion and spirituality can present opportunities for improved outcomes in prostate cancer patients and survivors.
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http://dx.doi.org/10.1177/1557988321993560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883168PMC
February 2021

Social Determinants of Kidney Health: Focus on Poverty.

Clin J Am Soc Nephrol 2021 Jan 13. Epub 2021 Jan 13.

Department of Health Systems and Population Health Sciences, University of Houston, Houston, Texas.

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http://dx.doi.org/10.2215/CJN.12710820DOI Listing
January 2021

Reflections on the Importance of Community-Partnered Research Strategies for Health Equity in the Era of COVID-19.

J Health Care Poor Underserved 2020 ;31(4):1515-1519

Objective: In the face of coronavirus disease 2019 (COVID-19) physical distancing mandates, community-engaged research (CER) faces new vulnerabilities in the equitable inclusion of communities within research partnerships aiming to address these very inequities.

Methods: We convened a series of virtual meetings with our CER partnership to discuss the current state of activities and to identify considerations for remote community engagement. We outlined and expanded recommendations through iterative, partnered discussions to inform protections against new CER susceptibilities.

Results: This article presents CER recommendations in translational COVID-19 research for health equity, including increasing accessibility for remote engagement, promoting opportunities for bi-directional knowledge exchange, committing to a community-centered workforce, and leveraging novel opportunities within community-academic partnerships.

Conclusion: Researchers conducting CER face an opportunity to reimagine community engagement remotely for partnered resilience to ensure the voices of the most affected are appropriately and inclusively integrated into all aspects of decision-making within the COVID-19 research, practice, and policymaking continuum.
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http://dx.doi.org/10.1353/hpu.2020.0112DOI Listing
January 2021

The Association Between Depressive Symptoms and Accumulation of Stress Among Black Men in the Health and Retirement Study.

Innov Aging 2020 29;4(5):igaa047. Epub 2020 Sep 29.

Brown School at Washington University in St. Louis, Missouri.

Background And Objectives: Among the multiple factors posited to drive the health inequities that black men experience, the fundamental role of stress in the production of poor health is a key component. Allostatic load (AL) is considered to be a byproduct of stressors related to cumulative disadvantage. Exposure to chronic stress is associated with poorer mental health including depressive symptoms. Few studies have investigated how AL contributes to depressive symptoms among black men. The purpose of the cross-sectional study was to examine the association between AL and depressive symptoms among middle- to old age black men.

Research Design And Methods: This project used the 2010 and 2012 wave of the Health and Retirement Study enhanced face-to-face interview that included a biomarker assessment and psychosocial questionnaire. Depressive symptoms, assessed by the endorsement of 3 or more symptoms on the Center for Epidemiological Studies-Depression 8-item scale, was the outcome variable. The main independent variable, AL, score was calculated by summing the number values that were in the high range for that particular biomarker value scores ranging from 0 to 7. black men whose AL score was 3 or greater were considered to be in the high AL group. Modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (CIs).

Results: There was a larger proportion of black men in the high AL group who reported depressive symptoms (30.0% vs. 20.0%) compared with black men in the low AL group. After adjusting for age, education, income, drinking, and smoking status, the prevalence of reporting 3 or more depressive symptoms was statistically significant among black men in the high AL group (PR = 1.61 [95% CI: 1.20-2.17]) than black men in the low AL group.

Discussion And Implications: Exposure to chronic stress is related to reporting 3 or more depressive symptoms among black men after controlling for potential confounders. Improving the social and economic conditions for which black men work, play, and pray is key to reducing stress, thereby potentially leading to the reporting of fewer depressive symptoms.
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http://dx.doi.org/10.1093/geroni/igaa047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7737789PMC
September 2020

Removal of Race From Estimates of Kidney Function: First, Do No Harm.

JAMA 2021 01;325(2):135-137

Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina.

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http://dx.doi.org/10.1001/jama.2020.23373DOI Listing
January 2021

The quest for cardiovascular disease risk prediction models in patients with nondialysis chronic kidney disease.

Curr Opin Nephrol Hypertens 2021 Jan;30(1):38-46

Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, University of California Irvine, Orange.

Purpose Of Review: Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). However, traditional CVD risk prediction equations do not work well in patients with CKD, and inclusion of kidney disease metrics such as albuminuria and estimated glomerular filtration rate have a modest to no benefit in improving prediction.

Recent Findings: As CKD progresses, the strength of traditional CVD risk factors in predicting clinical outcomes weakens. A pooled cohort equation used for CVD risk prediction is a useful tool for guiding clinicians on management of patients with CVD risk, but these equations do not calibrate well in patients with CKD, although a number of studies have developed modifications of the traditional equations to improve risk prediction. The reason for the poor calibration may be related to the fact that as CKD progresses, associations of traditional risk factors such as BMI, lipids and blood pressure with CVD outcomes are attenuated or reverse, and other risk factors may become more important.

Summary: Large national cohorts such as the US Veteran cohort with many patients with evolving CKD may be useful resources for the developing CVD prediction models; however, additional considerations are needed for the unique composition of patients receiving care in these healthcare systems, including those with multiple comorbidities, as well as mental health issues, homelessness, posttraumatic stress disorders, frailty, malnutrition and polypharmacy. Machine learning over conventional risk prediction models may be better suited to handle the complexity needed for these CVD prediction models.
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http://dx.doi.org/10.1097/MNH.0000000000000672DOI Listing
January 2021

Beyond the 405 and the 5: Geographic variations and factors associated with SARS-CoV-2 positivity rates in Los Angeles County.

Clin Infect Dis 2020 Nov 3. Epub 2020 Nov 3.

Division of Infectious Diseases, David GeffenSchool of Medicine, UCLA.

Objectives: To highlight geographic differences and the socio-structural determinants of SARS-CoV-2 test positivity within Los Angeles County (LAC).

Methods: A geographic information system was used to integrate, map, and analyze SARS-CoV-2 testing data reported by LAC DPH, and data from the American Community Survey. Structural determinants included race/ethnicity, poverty, insurance status, education, population and household density. We examined which factors were associated with positivity rates, using a 5% test positivity threshold, with spatial analysis and spatial regression.

Results: Between 1 March and 30 June 2020 there were 843,440 SARS-CoV-2 tests and 86,383 diagnoses reported, for an overall positivity rate of 10.2% within the study area. Communities with high proportions of Latino/a residents, those living below the federal poverty line and with high household densities had higher crude positivity rates. Age- adjusted diagnosis rates were significantly associated with the proportion of Latino/as, individuals living below the poverty line, population, and household density.

Conclusions: There are significant local variations in test positivity within LAC and several socio-structural determinants contribute to ongoing disparities. Public health interventions, beyond shelter in place, are needed to address and target such disparities.
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http://dx.doi.org/10.1093/cid/ciaa1692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665433PMC
November 2020

COVID-19, health disparities and the US election.

EClinicalMedicine 2020 Nov 27;28:100617. Epub 2020 Oct 27.

Charles R Drew University of Medicine and Science, Los Angeles, CA, USA.

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http://dx.doi.org/10.1016/j.eclinm.2020.100617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591228PMC
November 2020

Baseline Characteristics of the 2015-2019 First Year Student Cohorts of the NIH Building Infrastructure Leading to Diversity (BUILD) Program.

Ethn Dis 2020 24;30(4):681-692. Epub 2020 Sep 24.

BUILD Coordination & Evaluation Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Objective: The biomedical/behavioral sciences lag in the recruitment and advancement of students from historically underrepresented backgrounds. In 2014 the NIH created the Diversity Program Consortium (DPC), a prospective, multi-site study comprising 10 Building Infrastructure Leading to Diversity (BUILD) institutional grantees, the National Research Mentoring Network (NRMN) and a Coordination and Evaluation Center (CEC). This article describes baseline characteristics of four incoming, first-year student cohorts at the primary BUILD institutions who completed the Higher Education Research Institute, The Freshmen Survey between 2015-2019. These freshmen are the primary student cohorts for longitudinal analyses comparing outcomes of BUILD program participants and non-participants.

Design: Baseline description of first-year students entering college at BUILD institutions during 2015-2019.

Setting: Ten colleges/universities that each received <$7.5mil/yr in NIH Research Project Grants and have high proportions of low-income students.

Participants: First-year undergraduate students who participated in BUILD-sponsored activities and a sample of non-BUILD students at the same BUILD institutions. A total of 32,963 first-year students were enrolled in the project; 64% were female, 18% Hispanic/Latinx, 19% African American/Black, 2% American Indian/Alaska Native and Native Hawaiian/Pacific Islander, 17% Asian, and 29% White. Twenty-seven percent were from families with an income <$30,000/yr and 25% were their family's first generation in college.

Planned Outcomes: Primary student outcomes to be evaluated over time include undergraduate biomedical degree completion, entry into/completion of a graduate biomedical degree program, and evidence of excelling in biomedical research and scholarship.

Conclusions: The DPC national evaluation has identified a large, longitudinal cohort of students with many from groups historically underrepresented in the biomedical sciences that will inform institutional/national policy level initiatives to help diversify the biomedical workforce.
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http://dx.doi.org/10.18865/ed.30.4.681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518523PMC
September 2020

Race and Ethnicity Predict Bone Markers and Fracture in Pediatric Patients With Chronic Kidney Disease.

J Bone Miner Res 2021 Feb 23;36(2):298-304. Epub 2020 Oct 23.

Department of Pediatrics, Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.

Studies in healthy children have shown racial-ethnic differences in bone markers and bone outcomes including fractures. At present, limited studies have evaluated the impact of race and ethnicity on bone markers and fractures within the pediatric chronic kidney disease (CKD) population. In a cohort study of 762 children between the ages of 1.5 years and 18 years, with CKD stages 1 to 4 from the CKD in children (CKiD) cohort, the relationship between racial-ethnic group and bone markers (parathyroid hormone [PTH], 25-hydroxyvitamin D [25-OHD], 1,25-dihydroxyvitamin D [1,25(OH) D], and C-terminal fibroblast growth factor [FGF23]) was determined using linear mixed models. Additionally, logistic regression was used to evaluate racial-ethnic differences in prevalent fracture upon study entry. Black race was associated with 23% higher PTH levels (confidence interval [CI], 2.5% to 47.7%; p = .03), 33.1% lower 25-OHD levels (CI, -39.7% to -25.7%; p < .0001), and no difference in C-terminal FGF23 or 1,25(OH) D levels when compared to whites. Hispanic ethnicity was associated with 15.9% lower C-terminal FGF23 levels (CI, -28.3% to -1.5%; p = .03) and 13.8% lower 25-OHD levels (CI, -22.2% to -4.5%; p = .005) when compared to whites. Black and Hispanic children had 74% (odds ratio [OR] 0.26; CI, 0.14 to 0.49; p = .001) and 66% (OR 0.34; CI, 0.17 to 0.65; p < .0001) lower odds of any fracture than white children at study entry, respectively. Race and ethnicity are associated with differences in bone markers and despite lower 25-OHD levels, both black and Hispanic children with CKD reported a lower prevalent fracture history than white children. The current findings in the CKD population are similar to racial-ethnic differences described in healthy children. Additional studies are needed to better understand how these differences might impact the management of pediatric CKD-MBD. © 2020 American Society for Bone and Mineral Research (ASBMR).
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http://dx.doi.org/10.1002/jbmr.4182DOI Listing
February 2021

How Clinically Relevant Is C-Reactive Protein for Blacks with Metabolic Syndrome to Predict Microalbuminuria?

Metab Syndr Relat Disord 2021 02 3;19(1):39-47. Epub 2020 Sep 3.

Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.

The metabolic syndrome (MetS) is associated with elevated urinary albumin (UA) excretion and C-reactive protein (CRP). However, potential differences in CRP levels on the association between individual components of the MetS and microalbuminuria (MA; 30-300 μg/mL) and/or UA (0-300 μg/mL) by race/ethnicity is unknown. We analyzed National Health and Nutrition Examination Surveys (NHANES) data, (1999-2010) for adults (≥20 years of age) with the MetS ( = 5700). The Sobel-Goodman mediation test examined the influence of CRP on the association between individual MetS components and both MA and UA by race/ethnicity. We applied machine learning models to predict UA. CRP mediated the association between waist circumference (WC) and MA in Whites and Hispanics but not in Blacks. However, in general, the proportion of the total effect of MetS components on UA, mediated by CRP, was: 11% for high-density lipoprotein cholesterol (HDL-C) and 40% for WC ( < 0.001). In contrast to MA, the mediation effect of CRP for WC and UA was highest for Blacks (94%) compared with Whites (55%) or Hispanics (18%),  < 0.05. The prediction of an elevated UA concentration was increased in Blacks (∼51%) with the MetS when CRP was added to the random forest model. CRP mediates the association between UA and both HDL-C and WC in Whites and Blacks and between UA and WC in Hispanics. Moreover, the machine learning approach suggests that the incorporation of CRP may improve model prediction of UA in Blacks. These findings may favor screening for CRP in persons with the MetS, particularly in Blacks.
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http://dx.doi.org/10.1089/met.2019.0121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891189PMC
February 2021

Interventions Incorporating Therapeutic Alliance to Improve Hemodialysis Treatment Adherence in Black Patients with End-Stage Kidney Disease (ESKD) in the United States: A Systematic Review.

Patient Prefer Adherence 2020 17;14:1435-1444. Epub 2020 Aug 17.

Vanderbilt Center for Kidney Disease, Nashville, TN, USA.

Background: In the US, Blacks with end-stage kidney disease (ESKD) have a four-fold higher prevalence rate of hemodialysis treatment and higher subsequent rates of hemodialysis treatment nonadherence and hospitalization compared to their White peers. Nonadherence to prescribed dialysis therapy is an underestimated life-threatening behavior, because of its association with increased morbidity and mortality. Few studies have specified and systematically evaluated targeted methods of increasing hemodialysis treatment adherence among Black hemodialysis patients with added focus on therapeutic alliance, a rewarding patient-centered relationship between patients and providers, based on common goals and objectives. This review seeks to evaluate the state of the science to determine the salience of a therapeutic alliance for the development of effective interventions positively impacting hemodialysis treatment adherence among Black patients.

Methods: Medline (via PubMed), Embase (OvidSP), Cumulative Index of Nursing and Allied Health Literature (CINAHL; EBSCOhost), and PsycInfo (ProQuest) databases were used to search for abstracts with the keywords "dialysis", "therapeutic alliance", and "treatment adherence and compliance", including all underlying index terms and alternative variations of terms, in order to cover the entire scope of the field. Only randomized clinical trials and pre/postintervention studies published in the previous 10 years (2009-2019) and including a proportion of Black patients >25% were included for review.

Results: Only three intervention studies met these criteria, for a total aggregated sample of 130 - mean age 58.1 years and 53% female. None of these studies was composed exclusively of Black patients (range 62%-91.3%), nor did they present data specifically for Blacks. Despite the lack of robust data informing strategies to improve hemodialysis adherence among Blacks with ESRD, a limited number of intervention studies have reported positive effects on hemodialysis attendance.

Discussion/conclusion: Further research is warranted to fill this significant gap in our understanding of theoretically based, therapeutic alliance-enhanced, and culturally tailored hemodialysis treatment-adherence interventions among Blacks.
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http://dx.doi.org/10.2147/PPA.S260684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443008PMC
August 2020

The association of race and COVID-19 mortality.

EClinicalMedicine 2020 Aug 15;25:100455. Epub 2020 Jul 15.

Department of Epidemiology and Population Health and Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx NY, United States.

Background: COVID-19 mortality disproportionately affects the Black population in the United States (US). To explore this association a cohort study was undertaken.

Methods: We assembled a cohort of 505,992 patients receiving ambulatory care at Bronx Montefiore Health System (BMHS) between 1/1/18 and 1/1/20 to evaluate the relative risk of hospitalization and death in two time-periods, the pre-COVID time-period (1/1/20-2/15/20) and COVID time-period (3/1/20-4/15/20). COVID testing, hospitalization and mortality were determined with the Black and Hispanic patient population compared separately to the White population using logistic modeling. Evaluation of the interaction of pre-COVID and COVID time periods and race, with respect to mortality was completed.

Findings: A total of 9,286/505,992 (1.8%) patients were hospitalized during either or both pre-COVID or COVID periods. Compared to Whites the relative risk of hospitalization of Black patients did not increase in the COVID period (p for interaction=0.12). In the pre- COVID period, compared to Whites, the odds of death for Blacks and Hispanics adjusted for comorbidity was statistically equivalent. In the COVID period compared to Whites the adjusted odds of death for Blacks was 1.6 (95% CI 1.2-2.0,  = 0.001). There was a significant increase in Black mortality risk from pre-COVID to COVID periods (p for interaction=0.02). Adjustment for relevant clinical and social indices attenuated but did not fully explain the observed difference in Black mortality.

Interpretation: The BMHS COVID experience demonstrates that Blacks do have a higher mortality with COVID incompletely explained by age, multiple reported comorbidities and available metrics of sociodemographic disparity.

Funding: N/A.
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http://dx.doi.org/10.1016/j.eclinm.2020.100455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361093PMC
August 2020

Applying Community-Partnered Participatory Research Approaches to Develop COVID-19 Solutions.

Ethn Dis 2020 9;30(3):433-436. Epub 2020 Jul 9.

Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.

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http://dx.doi.org/10.18865/ed.30.3.433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360174PMC
August 2020

Socioeconomic Factors and Racial and Ethnic Differences in the Initiation of Home Dialysis.

Kidney Med 2020 Mar-Apr;2(2):105-115. Epub 2020 Feb 11.

Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Rationale & Objective: Home dialysis has been underused in the United States, especially among minority groups. We investigated whether adjustment for socioeconomic factors would attenuate racial/ethnic differences in the initiation of home dialysis.

Study Design: Retrospective observational cohort study.

Setting & Population: Adult patients in the US Renal Data System who initiated dialysis on day 1 with either in-center hemodialysis (HD), home HD (HHD), or peritoneal dialysis (PD) from 2005 to 2013.

Predictor: Race/ethnicity: non-Hispanic white, Hispanic, black, or Asian.

Outcome: Initiating dialysis with PD versus in-center HD and HHD versus in-center HD for each minority group compared with non-Hispanic whites.

Analytical Approach: Odds ratios and 95% CIs estimated by logistic regression.

Results: Of 523,526 patients, 55% were white, 28% were black, 13% were Hispanic, and 4% were Asian; 8% started dialysis on PD, and 0.1%, on HHD. In unadjusted analyses, blacks and Hispanics were 30% and 19% less likely and Asians were 31% more likely to start on PD than whites. The differences narrowed when fully adjusted for demographic, medical, and socioeconomic factors. Adjustment for socioeconomic factors reduced these differences between white and black, Hispanic, and Asian patients by 13%, 28%, and 1%, respectively. Blacks were just as likely and Hispanics and Asians were less likely to start on HHD than whites. This did not change appreciably when fully adjusted for demographic, medical, and socioeconomic factors.

Limitations: No data for physician and patient preferences or modality education.

Conclusions: Black and Hispanic patients are less likely to start on PD than white patients, attributable partly, though not completely, to socioeconomic factors. Hispanics and Asians are less likely to start on HHD than whites. This was materially unaffected by socioeconomic factors. More research is needed to determine whether urgent-start PD programs and transitional care units in socioeconomically disadvantaged areas might reduce these disparities and increase home dialysis use among all groups.
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http://dx.doi.org/10.1016/j.xkme.2019.11.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380374PMC
February 2020

The Impact of Race and Ethnicity Upon Health-Related Quality of Life and Mortality in Dialysis Patients.

Kidney Med 2019 Sep-Oct;1(5):253-262. Epub 2019 Sep 5.

Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA.

Rationale & Objective: Health-related quality of life (HRQoL) has been recognized as a strong predictor of mortality among hemodialysis patients. However, differences in the association of HRQoL with survival across diverse racial/ethnic groups have not been well studied in this population.

Study Design: Observational cohort study.

Setting & Participants: We examined the relationship between HRQoL and mortality in a prospective cohort of racially/ethnically diverse hemodialysis patients recruited from 18 outpatient dialysis units during 2011 to 2016.

Exposure: Using the 36-Item Short Form Health Survey (SF-36) administered every 6 months, HRQoL was ascertained by 36 questions summarized as 2 Physical and Mental Component and 8 subscale scores.

Outcome: All-cause mortality.

Analytical Approach: Associations of time-varying SF-36 scores with mortality were estimated using Cox models in the overall cohort and within racial/ethnic subgroups.

Results: Among 753 hemodialysis patients who met eligibility criteria, expanded case-mix analyses showed that the lowest quartiles of time-varying Physical and Mental Component scores were associated with higher mortality in the overall cohort (reference: highest quartile): adjusted HRs, 2.30 (95% CI, 1.53-3.47) and 1.54 (95% CI, 1.05-2.25), respectively. In analyses stratified by race/ethnicity, the lowest quartile of Physical Component scores was significantly associated with higher mortality across all groups: adjusted HRs, 2.64 (95% CI, 1.31-5.29), 1.84 (95% CI, 1.01-3.38), and 3.18 (95% CI, 1.13-8.91) for Hispanic, African American, and other race/ethnicity patients, respectively. The lowest quartile of time-varying physical functioning, role limitations due to physical health, role limitations due to emotional problems, social functioning, and pain subscale scores were associated with higher mortality in the overall cohort and particularly in Hispanics and blacks.

Limitations: Residual confounding cannot be excluded.

Conclusions: Lower SF-36 Physical Component and subscale scores were associated with higher mortality in hemodialysis patients, including those of minority background. Further studies are needed to determine whether interventions that augment physical health might improve the survival of these diverse populations.
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http://dx.doi.org/10.1016/j.xkme.2019.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380436PMC
September 2019

Impact of Malnutrition in Patients With Infective Endocarditis.

Nutr Clin Pract 2021 Apr 23;36(2):472-479. Epub 2020 Jul 23.

Department of Internal Medicine, Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.

Background: Effects of malnutrition on patients with infective endocarditis (IE) have not been fully studied. Because malnutrition is associated with poor health, we hypothesized that among patients with IE, those with malnutrition would have more negative in-hospital outcomes.

Methods: The National Inpatient Sample was used to identify adults ≥18 years old with IE. We compared outcomes of in-hospital mortality, morbidity, valvular interventions, and utilization of resources between individuals with and without malnutrition.

Results: 11,939 adults ≥18 years were hospitalized with IE, 2035 had a secondary diagnosis for malnutrition. There were no significant differences in age (mean age ± SEM: 55.6 ± 1.0 vs 54.3 ± 0.4 years, P = .21) or sex (female: 36.7%; 743/2,035 vs 37.5%; 3,717/9,904, P = .69) in patients with and without malnutrition. Patients with malnutrition had more comorbidities (Charlson comorbidity score ≥3: 36%; 732/2,035 vs 30.7%; 3,040/9,904, P = .04). Despite similar adjusted in-hospital mortality (adjusted odds ratio [aOR], 1.4; 95% CI, 0.8-1.5; P = .23), malnourished patients were more likely to develop sepsis (aOR, 1.7; 95% CI, 1.2-2.4; P < .01) and had higher odds of mitral-valve (aOR, 1.7; 95% CI, 1.2-2.4; P < .01) repairs/replacements. Patients with malnutrition also had increased lengths of stay (adjusted mean difference [aMD], 4.7 days; 95% CI, 2.9-6.5 days; P < .01) and hospital charges (aMD, $36,052; 95% CI, $14,935-$57,168; P < .01).

Conclusions: Patients with malnutrition and IE are at risk for high morbidity, valvular repairs/replacements, and use of hospital resources.
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http://dx.doi.org/10.1002/ncp.10557DOI Listing
April 2021

Community Racial Composition and Hospitalization Among Patients Receiving In-Center Hemodialysis.

Am J Kidney Dis 2020 12 13;76(6):754-764. Epub 2020 Jul 13.

Division of General Internal Medicine, UCLA/David Geffen School of Medicine, Los Angeles, CA; Division of Nephrology, UCLA/David Geffen School of Medicine, Los Angeles, CA.

Rationale & Objective: Community racial composition has been shown to be associated with mortality in patients receiving maintenenance dialysis. It is unclear whether living in communities with predominantly Black residents is also associated with risk for hospitalization among patients receiving hemodialysis.

Study Design: Retrospective analysis of prospectively collected data from a cohort of patients receiving hemodialysis.

Setting & Participants: 4,567 patients treated in 154 dialysis facilities located in 127 unique zip codes and enrolled in US Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4 to 5 (2010-2015).

Exposure: Tertile of percentage of Black residents within zip code of patients' dialysis facility, defined through a link to the American Community Survey.

Outcome: Rate of hospitalizations during the study period.

Analytic Approach: Associations of patient-, facility-, and community-level variables with community's percentage of Black residents were assessed using analysis of variance, Kruskal-Wallis, or χ/Fisher exact tests. Negative binomial regression was used to estimate the incidence rate ratio for hospitalizations between these communities, with and without adjustment for potential confounding variables.

Results: Mean age of study patients was 62.7 years. 53% were White, 27% were Black, and 45% were women. Median and threshold percentages of Black residents in zip codes in which dialysis facilities were located were 34.2% and≥14.4% for tertile 3 and 1.0% and≤1.8% for tertile 1, respectively. Compared with those in tertile 1 facilities, patients in tertile 3 facilities were more likely to be younger, be Black, live in urban communities with lower socioeconomic status, have a catheter as vascular access, and have fewer comorbid conditions. Patients dialyzing in communities with the highest tertile of Black residents experienced a higher adjusted rate of hospitalization (adjusted incidence rate ratio, 1.32; 95% CI, 1.12-1.56) compared with those treated in communities within the lowest tertile.

Limitations: Potential residual confounding.

Conclusions: The risk for hospitalization for patients receiving maintenance dialysis is higher among those treated in communities with a higher percentage of Black residents after adjustment for dialysis care, patient demographics, and comorbid conditions. Understanding the cause of this association should be a priority of future investigation.
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http://dx.doi.org/10.1053/j.ajkd.2020.05.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844565PMC
December 2020

Serum albumin is incrementally associated with increased mortality across varying levels of kidney function.

Nutrition 2020 Nov - Dec;79-80:110818. Epub 2020 Mar 20.

Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California; Tibor Rubin Veterans Affairs Medical Center, Long Beach, California. Electronic address:

Objectives: Serum albumin (sAlb) may be a strong predictor of longevity in the general population and in chronic kidney disease. This study aimed to determine the relationship between sAlb concentrations and mortality risk independent of kidney function.

Methods: This was a retrospective cohort study of 31 274 adults from the 1999-2010 National Health and Nutrition Examination Survey. The estimated glomerular filtration rate (eGFR) was examined as both a confounder and modifier of the association of sAlb with mortality risk. We examined the association of sAlb (categorized as <3.8, 3.8 to <4.0, 4.0 to <4.2, 4.2 to <4.4, 4.4 to <4.6, 4.6 to <4.8, and ≥4.8 g/dL) with mortality using Cox models. Subsequently, we conducted spline analyses to estimate the association of sAlb with all-cause mortality across varying eGFR levels.

Results: In unadjusted analyses, participants with incrementally lower sAlb concentrations of <4.6 g/dL had an increasingly higher mortality risk compared with those with sAlb levels ranging from 4.6 to <4.8 g/dL (reference), whereas those with higher sAlb levels of ≥4.8 g/dL had a lower mortality risk (hazard ratios [95% confidence interval]: 3.88 [3.26-4.62], 3.59 [3.01-4.27], 2.79 [2.37-3.29], 2.10 [1.79-2.48], 1.72 [1.45-2.03], and 0.71 [0.55-0.92] for sAlb concentrations of <3.8, 3.8 to <4.0, 4.0 to <4.2, 4.2 to <4.4, 4.4 to <4.6, and ≥4.8 g/dL, respectively). Adjusted analyses showed similar findings, although the association of higher sAlb levels of ≥4.8 g/dL with better survival was attenuated to the null. Spline analyses showed that participants with sAlb levels of <4.6 g/dL had higher mortality across all concentrations of eGFR, ranging from 30 to 120 mL/min/1.73 m (reference: sAlb ≥ 4.6 g/dL).

Conclusions: Among a nationally representative U.S. cohort, a graded association was observed between lower sAlb concentrations and higher death risk, which was robust across varying levels of kidney function.
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http://dx.doi.org/10.1016/j.nut.2020.110818DOI Listing
March 2020

Religious Service Attendance and Despair Among Health Professionals-A Catalyst for New Avenues of Inquiry.

JAMA Psychiatry 2020 07;77(7):670-671

Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

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http://dx.doi.org/10.1001/jamapsychiatry.2020.0173DOI Listing
July 2020

Writing Accountability Groups Are a Tool for Academic Success: The Obesity Health Disparities PRIDE Program.

Ethn Dis 2020 23;30(2):295-304. Epub 2020 Apr 23.

Center for Research on Men's Health and Center for Medicine, Health, and Society, Vanderbilt University, Nashville, TN.

Introduction: The current hypercompetitive extramural funding environment in the United States emphasizes the critical need for effective research training programs that focus not only on grantsmanship, but on skill development across the full range of research activities, culminating in writing research results for publication. Using Writing Accountability Groups (WAG), the National Heart, Lung, and Blood Institute (NHLBI) funded Obesity Health Disparities (OHD) PRIDE is one of the few research training and mentoring programs that places an equal focus on scientific writing and grant writing. This article reports on the utility of WAGs for OHD PRIDE mentees.

Method: Participants included 14 of 26 individuals who were fellows in the OHD PRIDE research training and mentoring program. A typical WAG has between four and eight members who meet for one hour each week over a 10-week period and commit a priori to attend at least 70% of the sessions. Summary statistics were produced to characterize number of peer-reviewed publications, grants, years in academic rank, and category of current academic rank, barriers to frequency of writing, and duration of writing. Results from pre- and post-WAG surveys were compared to determine the overall impact of the WAG. The study period discussed in this article took place between January and December 2017 and included data from three 10-week cycles beginning in February, May, and September.

Results: Fifty-three percent of OHD PRIDE participants successfully completed at least one 10-week WAG cycle. The WAGs did not have a statistically significant impact on either the frequency of writing or the duration of writing. However, the majority of the participants who successfully completed at least one WAG cycle reported that they either maintained or increased their frequency or duration of writing.

Conclusion: By providing a structured approach to developing and/or enhancing a practice of consistent writing, time management skills, and collaborative relationships, the WAG has promise for enhancing scientific writing skills for many trainees and early-career faculty. Longer term follow-up is needed to more fully assess the potential impact of WAGs.
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http://dx.doi.org/10.18865/ed.30.2.295DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186058PMC
March 2021

Correction to: The influence of race in older adults with infective endocarditis.

BMC Infect Dis 2020 Mar 24;20(1):243. Epub 2020 Mar 24.

Department of Internal Medicine, Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.

After publication of the original article [1], there is a duplicate "35.322" in the section "Study outcomes": Secondary outcomes included combined aortic valve repairs or replacements (ICD-9 35.11, 35.22, 35.22), […]". This should be read "(ICD-9 35.11, 35.21, 35.22)", instead.
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http://dx.doi.org/10.1186/s12879-020-04970-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092465PMC
March 2020