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Jul 2026 DOI 10.14302/issn.2471-7061.jcrc-26-6320
R. Chao ChunCorresponding author
Background The incidence of early-onset colorectal cancer (eoCRC), diagnosed at age <50 years, is increasing in the United States. Prior studies using national and state cancer databases have observed higher eoCRC mortality after diagnosis among non-Hispanic Black (NHB) patients. These studies, however, often did not account for insurance status, access to care, and comorbidity burden, which may contribute to the observed disparities. We examined the associations between race and ethnicity and neighborhood-level socioeconomic status (measured by the neighborhood deprivation index (NDI)) and survival among persons with eoCRC in a large integrated healthcare delivery system whose racially/ethnically diverse members have standardized access to care. Methods We included Kaiser Permanente Southern California (KPSC) members diagnosedwith eoCRC (age 15-49 years) between 2009-2020 and followed them through 12/31/2023. Patients with <12 months of prior KPSC membership, an unspecific CRC site, or other/unknown race/ethnicity were excluded. Bivariate and multivariable Cox models were used to estimate hazard ratios (HRs) for the associations between race/ethnicity and NDI and all-cause and CRC-specific mortality. Multivariable models were adjusted for age at diagnosis, sex, Charlson comorbidity score, obesity, stage at diagnosis, cancer site, and histologic subtype. Subgroup analyses were conducted by stage at diagnosis (localized vs. advanced). Results Of 1,695 eoCRC cases included, we observed 465 deaths (among those with known cause, 417 (90.3%) were CRC-specific). The mean follow-up time was 6.8 years. In the adjusted models, NHB and non-Hispanic Asian/Pacific Islander (NH API) patients, but not Hispanic patients, had significantly higher all-cause mortality (HR=1.62, 95% CI: 1.14-2.29; HR=1.44 (1.08-1.93), respectively) compared with non-Hispanic White (NHW) patients. In the subgroup analyses, race and ethnicity were not associated with all-cause mortality among patients with localized disease. However, among patients diagnosed with advanced disease, NHB patients had a significantly higher risk of all-cause mortality compared with NHW patients (HR=1.54, 95% CI: 1.07-2.22, p=0.02). Similar findings were observed for CRC-specific mortality, overall and by cancer stage. NDI was not significantly associated with all-cause or CRC-specific mortality. Conclusions In this insured population, NHB race and ethnicity were associated with increased risk of CRC-specific mortality among those diagnosed with advanced stage eoCRC. However, the number of NHB patients diagnosed at distant stages was small. Therefore, future research is needed to confirm these findings and better understand potential survival disparities.
May 2023 DOI 10.14302/issn.2691-5014.jphn-23-4555
Kathryn DohertyCorresponding author
Severe ascorbic acid (Vitamin C) deficiency, commonly known as “scurvy,” continues to be a problem in malnourished populations across the world but is relatively rare in the United States. Early features of this condition include general weakness, fatigue, and aching limbs. An extremely rare and late feature of this condition is subgaleal hemorrhage. Scurvy has such a low prevalence in First World countries that it is often misdiagnosed or not diagnosed at all. The subject in this case report presented acutely and is one of few to involve a subgaleal hemorrhage to be documented in medical literature to date. Laboratory studies and clinical improvement through treatment established the diagnosis. Ascorbic acid deficiency should be considered when evaluating children with poor nutrition despite socioeconomic status, living conditions, or access to health care. This case also reminds us that neurodivergent children are a vulnerable population and more research will need to be conducted to determine just how detrimental the pandemic has been to patients with ongoing problems who were lost to follow up.
Mar 2017
Vélez Ortiz DanielCorresponding author
School of Social Work, Michigan State University
The objective of this study was to examine differences between Latino and White older adults in attitudes toward suicide and physician-assisted suicide in chronic pain scenarios. We used a cross sectional study design at four outpatient care sites in San Antonio, Texas. The study sample included 204 subjects (106 Whites and 98 Latinos), 60 years of age and older, with Mini Mental State Examination scores of 24 or higher. No statistically significant between ethnic group differences in attitudes toward suicide or physician-assisted suicide in chronic pain scenarios were found. However, separate analyses by ethnic group showed that the factors associated with these attitudes differed between ethnic groups, with attitudes among Whites significantly and negatively associated with religiosity and those among Latinos significantly and positively associated with depression, while acculturation was significantly and negatively associated with attitudes toward physician-assisted suicide in chronic pain scenarios. This study’s findings suggest that depression and acculturation among Latino elders and religion among White elders are determinant factors of these attitudes in chronic pain, end-of-life scenarios. Further research is needed with more heterogeneous study samples, including Latino subgroups (e.g. Mexican Americans, Puerto Ricans, Cubans) and more diverse ethnic groups in terms of socioeconomic status and educational level characteristics.
Jan 2017 DOI 10.14302/issn.2379-7835.ijn-16-1408
Bukusuba JohnCorresponding author
School of Food Technology, Nutrition and Bio-engineering, Makerere University, Kampala, Uganda
Despite the agreed global and national stunting reduction targets, Uganda has made very little progress. Understanding context-specific risk factors for stunted growth is therefore pertinent to designing programs to address the problem. A cross-sectional study was conducted in 32 randomly selected villages in Buhweju district, Southwest Uganda. Data entry, cleaning and analysis were carried out using Statistical Package for Social Sciences (SPSS) version 21. A regression analysis was conducted to examine the associations between potential risk factors and stunted growth. The survey covered 256 households and anthropometric measurements were taken for 221 children aged 6–59 months. The majority of the households (66%) in the district were food insecure and had a low socioeconomic status (84%). The prevalence of stunting in Buhweju district was 51%, which is significantly higher than the regional and national averages. Only 28% of the children were exclusively breastfed in the first 6 months of life, and only 10% of them received the minimum acceptable diet (MAD). The findings of this study demonstrate that reductions in stunted growth at national or regional levels has not necessarily translated into similar trends in rural areas of Uganda. The notable contributors to stunting in these areas include morbidity, sub-optimal infant and young child feeding (IYCF) practices, low consumption of animal-source foods, food insecurity, lack of access to high-quality drinking water, sanitation and hygiene (WASH) facilities and poverty. Increased investment in both nutrition specific and sensitive interventions is therefore crucial to address these risk factors.