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20 pages, 1442 KB  
Systematic Review
Short-Chain Fatty Acids and Colorectal Cancer: A Systematic Review and Integrative Bayesian Meta-Analysis of Microbiome–Metabolome Interactions and Intervention Efficacy
by Yingge He, Ke Peng, Junze Tan, Yonghui Hao, Shiyan Zhang, Changqing Gao and Liqi Li
Nutrients 2025, 17(22), 3552; https://doi.org/10.3390/nu17223552 - 14 Nov 2025
Viewed by 505
Abstract
Objective: Existing studies on short-chain fatty acids (SCFAs) and colorectal cancer (CRC) yield contradictory conclusions and are limited to single ethnic groups or sample types. This study aimed to (1) quantify associations between total SCFAs/subtypes (acetate, propionate, butyrate) and CRC/advanced colorectal adenoma [...] Read more.
Objective: Existing studies on short-chain fatty acids (SCFAs) and colorectal cancer (CRC) yield contradictory conclusions and are limited to single ethnic groups or sample types. This study aimed to (1) quantify associations between total SCFAs/subtypes (acetate, propionate, butyrate) and CRC/advanced colorectal adenoma (A-CRA) risks; (2) identify modifiers (ethnicity, sample type, intervention); and (3) clarify SCFA–gut microbiota interaction mechanisms via integrative Bayesian meta-analysis and multi-ancestry data integration. Methods: We systematically searched PubMed, Embase, Cochrane Library, and Web of Science (inception to September 2025) using keywords: “Short-chain fatty acids”, “SCFAs”, “Colorectal cancer”, “CRC”, “Gut microbiota”, “Dietary fiber”, and “High-amylose maize starch butyrate”. Eligible studies included 14 peer-reviewed original studies (7 observational, cohort/case–control/cross-sectional; 7 RCTs) covering Europeans, Asians, and African Americans. Inclusion criteria: Quantitative SCFA data (total/≥3 subtypes), clear ethnic grouping, reported CRC/A-CRA risks or intervention outcomes. Exclusion criteria: Reviews, animal/in vitro studies, incomplete data, low-quality studies (Newcastle–Ottawa Scale [NOS] <6 for observational; high Cochrane risk for RCTs), or limited populations (single gender/rare genetics). A Bayesian hierarchical random-effects model quantified effect sizes (Odds Ratio [OR]/Mean Difference [MD], 95% credible intervals [CrI]), with heterogeneity analyzed via multi-ancestry stratification, intervention efficacy, and microbiota interaction analyses (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] 2020; International Prospective Register of Systematic Reviews [PROSPERO]: CRD420251157250). Results: Total SCFAs were negatively associated with CRC (OR = 0.78, 95% CrI: 0.65–0.92) and A-CRA (OR = 0.72, 95% CrI: 0.59–0.87), with butyrate showing the strongest protective effect (CRC: OR = 0.63, 95% CrI: 0.51–0.77). Ethnic heterogeneity was significant: Europeans had the strongest protection (OR = 0.71), Asians had weaker protection (OR = 0.86), and African Americans had the lowest fecal SCFA levels and the highest CRC risk. Fecal SCFAs showed a stronger CRC association than serum/plasma SCFAs (OR = 0.73 vs. 0.85). High-Amylose Maize Starch Butyrate (HAMSB) outperformed traditional fiber in increasing fecal butyrate (MD = 4.2 mmol/L vs. 2.8 mmol/L), and high butyrate-producing bacteria (Clostridium, Roseburia) enhanced SCFA protection (OR = 0.52 in high-abundance groups). Conclusions: SCFAs (especially butyrate) protect against CRC and precancerous lesions, with effects modulated by ethnicity, sample type, and gut microbiota. High-Amylose Maize Starch Butyrate is a priority intervention for high-risk populations (e.g., familial adenomatous polyposis, FAP), and differentiated strategies are needed: 25–30 g/d dietary fiber for Europeans, 20–25 g/d for Asians, and probiotics (Clostridium) for African Americans. Future Perspectives: Expand data on underrepresented groups (African Americans, Latinos), unify SCFA detection methods, and conduct long-term RCTs to validate intervention efficacy and “genetics-microbiota-metabolism” crosstalk—critical for CRC precision prevention. Full article
(This article belongs to the Section Lipids)
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26 pages, 597 KB  
Systematic Review
Psychosocial Determinants of Behavioral Health in Latinx Americans Nationwide: A Systematic Review Highlighting Cultural Strength Factors
by Amy L. Ai, Zhe Yang, Michaé D. Cain and Thomas Knobel
Int. J. Environ. Res. Public Health 2025, 22(11), 1715; https://doi.org/10.3390/ijerph22111715 - 13 Nov 2025
Viewed by 257
Abstract
Objectives: Latinx Americans represent the largest ethnic minority group (nearly 19% of the U.S. population). Their behavioral health has received increasing attention as they exhibit elevated prevalence rates of anxiety (ANX), depression (DEP), and substance use disorders (SUDs). The National Latino and Asian [...] Read more.
Objectives: Latinx Americans represent the largest ethnic minority group (nearly 19% of the U.S. population). Their behavioral health has received increasing attention as they exhibit elevated prevalence rates of anxiety (ANX), depression (DEP), and substance use disorders (SUDs). The National Latino and Asian American Study (NLAAS) is the first national population-based mental health study of Latinx Americans and is the most comprehensive resource for understanding their behavioral health. This systematic review aims to synthesize peer-reviewed publications using the NLAAS dataset to identify psychosocial determinants of the three key outcomes. Method: We followed PRISMA to search for English peer-reviewed articles published in EBSCO, Embase, PsycINFO, Web of Science, and PubMed. Inclusion criteria were as follows: (1) Latinx in the NLAAS database; (2) ANX, DEP, or SUD; (3) risk or protective factors; and (4) peer-reviewed publications in English. Search terms such as Latino, Latina, anxiety, depressive symptoms, substance abuse, and NLAAS were used to search for relevant articles. Two authors screened the articles independently and extracted data from each study. Results: Thirty-two studies published between 2007 and 2024 were included in our final review. Among them, 12 studies investigated ANX, and 17 studies examined DEP and SUD, respectively. Sixteen studies assessed protective factors. Ten articles assessed multiple key outcomes. All risk factors were grouped into three categories: Trauma and negative relationships (e.g., childhood maltreatment, negative family relationship, traumatic life experience), acculturation- and immigration-related factors (e.g., nativity, acculturation experience, English proficiency, discrimination), and sociodemographic and social participation factors (e.g., gender, education, income level). Protective factors such as family cohesion, religious activity, gender, and education were also identified. Conclusion: This first systematic review provided comprehensive NLAAS findings on multifaceted cultural, social, and intrapersonal factors that were either negatively or positively associated with three behavioral health outcomes within the U.S. Latinx population. Potential mechanisms by which risk and protective factors influence their mental health, as well as limitations of this review, were discussed. Findings of this review can inform culturally responsive prevention strategies and interventions to reduce behavioral health disparities and to improve mental health outcomes among Latinx Americans. Full article
(This article belongs to the Section Behavioral and Mental Health)
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11 pages, 270 KB  
Article
Validity and Reliability of a Bilingual Healthcare Discrimination Scale Among Churchgoing Latino Adults in Los Angeles
by Daniel F. López-Cevallos, Mariana Pinto-Alvarez, Karen R. Flórez and Kathryn P. Derose
Behav. Sci. 2025, 15(11), 1514; https://doi.org/10.3390/bs15111514 - 7 Nov 2025
Viewed by 272
Abstract
Healthcare discrimination is an important barrier to accessing services among Latino populations in the United States. However, few validated scales have been developed to systematically examine this issue. In this study, we evaluated the validity and reliability of a bilingual healthcare discrimination scale [...] Read more.
Healthcare discrimination is an important barrier to accessing services among Latino populations in the United States. However, few validated scales have been developed to systematically examine this issue. In this study, we evaluated the validity and reliability of a bilingual healthcare discrimination scale in a sample of churchgoing Latino adults in Los Angeles, California. The study sample included 336 participants (foreign-born: 250; US-born: 86) who attended 12 Catholic churches in Los Angeles. Psychometric testing of the 7-item healthcare discrimination (HCD) scale included internal consistency; split-half reliability; convergent, discriminant, and predictive validity; and confirmatory factor analyses. The HCD had relatively high internal consistency (full sample Cronbach’s α = 0.92; foreign-born: 0.91; US-born: 0.92) and showed good convergent and discriminant validity, as it was moderately correlated with the depression scale (full sample r = 0.28, p < 0.001) and weakly correlated with the acculturation scale (full sample r = 0.15, p = 0.008). Confirmatory factor analyses yielded further support for a one-factor solution. Our study finds that the HCD is a valid and reliable scale for use among churchgoing Latino adult populations in the United States. Future studies should examine the psychometric properties of the HCD among Latinos of diverse backgrounds, geographic locations, religious beliefs, and languages. Full article
(This article belongs to the Section Health Psychology)
20 pages, 543 KB  
Article
Pulse Consumption and Metabolic Syndrome: Findings from the Hispanic Community Health Study/Study of Latinos
by Juliana Teruel Camargo, Gabriela Recinos, Amanda S. Hinerman, Chelsea Duong, Erik J. Rodriquez, Jordan J. Juarez, Amanda C. McClain, Sarah K. Alver, Martha L. Daviglus, Linda Van Horn and Eliseo J. Pérez-Stable
Nutrients 2025, 17(21), 3392; https://doi.org/10.3390/nu17213392 - 29 Oct 2025
Viewed by 323
Abstract
Background/Objectives: Metabolic syndrome affects half of middle-aged (ages 45–64) Hispanic or Latino (Latino) adults. Pulses, fiber-rich plant proteins common in Latino diets (e.g., dry beans and lentils), may mitigate metabolic syndrome. We evaluated the association between pulse intake and metabolic syndrome. Methods [...] Read more.
Background/Objectives: Metabolic syndrome affects half of middle-aged (ages 45–64) Hispanic or Latino (Latino) adults. Pulses, fiber-rich plant proteins common in Latino diets (e.g., dry beans and lentils), may mitigate metabolic syndrome. We evaluated the association between pulse intake and metabolic syndrome. Methods: We analyzed data from 6,958 adults aged ≥ 50 in the Hispanic Community Health Study/Study of Latinos (2008–2011) Visit 1. Pulse intake was assessed using two 24 h dietary recalls and categorized into no, low (<1/2 cup), moderate (≥1/2 to 3/4 cup), and high pulse (>3/4 cup) daily intake groups. Metabolic syndrome was defined by criteria including blood pressure ≥130/85 mmHg or medication use, triglycerides ≥150 mg/dL or medication use, high-density lipoprotein cholesterol (men <40 mg/dL and women <50 mg/dL), and waist circumference (men ≥102 cm and women ≥88 cm). We used multivariate logistic regression models with predicted probability proportions to assess the association adjusted for sociodemographic factors, acculturation, diet quality, energy intake, and physical activity. Results: Of the 6,958 participants, 53.1% had metabolic syndrome and 53.4% had a moderate or high pulse intake. Pulse intake varied, where 19.4% had a high intake, 33.9% had a moderate intake, 12.5% had a low intake, and 34.2% had no intake. Moderate (predicted marginal = 0.52, 95% confidence interval [CI] = 0.49, 0.55) and high (predicted marginal = 0.49, 95%CI = 0.45, 0.53) intakes were associated with a lower prevalence of metabolic syndrome. Conclusions: Among Latino adults ≥50 years old, a moderate or high pulse intake was associated with a lower prevalence of metabolic syndrome. Increasing the pulse intake in the population may be linked to reduced metabolic syndrome. Full article
(This article belongs to the Section Nutrition and Public Health)
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18 pages, 3692 KB  
Article
Artificial Intelligence-Guided Molecular Determinants of PI3K Pathway Alterations in Early-Onset Colorectal Cancer Among High-Risk Groups Receiving FOLFOX
by Fernando C. Diaz, Brigette Waldrup, Francisco G. Carranza, Sophia Manjarrez and Enrique Velazquez-Villarreal
Biomedicines 2025, 13(11), 2630; https://doi.org/10.3390/biomedicines13112630 - 27 Oct 2025
Viewed by 430
Abstract
Background: Early-onset colorectal cancer (EOCRC), defined as diagnosis before the age of 50, is rising rapidly and disproportionately affects high-risk populations, particularly Hispanic/Latino (H/L) individuals, who experience the steepest increases in incidence and mortality. While prevention and screening strategies have curbed late-onset [...] Read more.
Background: Early-onset colorectal cancer (EOCRC), defined as diagnosis before the age of 50, is rising rapidly and disproportionately affects high-risk populations, particularly Hispanic/Latino (H/L) individuals, who experience the steepest increases in incidence and mortality. While prevention and screening strategies have curbed late-onset CRC rates, EOCRC remains outside standard screening guidelines and is projected to become the leading cause of cancer-related death in individuals aged 20–49 by 2030. FOLFOX (folinic acid, fluorouracil, and oxaliplatin) is a standard first-line therapy for microsatellite stable (MSS) CRC lacking actionable driver mutations; however, its efficacy and genomic impact in EOCRC, particularly in underrepresented groups, remain poorly understood. The phosphatidylinositol 3-kinase (PI3K) pathway regulates cell growth, survival, and metabolism, and its alterations have been implicated in therapeutic resistance and adverse outcomes. Yet, the prevalence, clinical relevance, and treatment-specific associations of PI3K pathway alterations in EOCRC remain underexplored. Methods: We analyzed somatic mutation and clinical data from 2515 CRC patients (266 H/L and 2249 Non-Hispanic White [NHW]) across publicly available genomic datasets. Patients were stratified by age at diagnosis (EOCRC < 50 vs. LOCRC ≥ 50), ancestry (H/L vs. NHW), and FOLFOX treatment status. PI3K pathway alterations—including mutations in PIK3CA, PTEN, AKT isoforms, and regulatory genes—were identified using curated pathway definitions. Mutation prevalence was compared across groups using Fisher’s exact or chi-squared tests. AI-HOPE-PI3K, a conversational AI platform, was deployed to automate cohort construction, stratify subgroups, and perform post hoc survival analysis. Results: PI3K pathway alterations were observed across all demographic groups. In EO NHW patients treated with FOLFOX, Kaplan–Meier analysis revealed significantly reduced overall survival among those with PI3K pathway alterations (n = 124) compared with their unaltered counterparts (n = 251; p = 0.0008), identifying alterations as a candidate prognostic biomarker in this subgroup. AI-guided subgroup interrogation further highlighted mutation-specific signals: INPP4B and RPTOR emerged as exploratory candidates in EO H/L patients but did not show significant treatment- or ancestry-specific enrichment upon confirmatory testing. Similarly, ancestry-stratified analysis of PIK3R2 mutations revealed comparable rates in EO H/L (1.37%) and EO NHW (1.6%) FOLFOX-treated patients (p = 1.0). Across ancestry and age groups, mutational landscape analysis revealed diverse molecular events—including missense, nonsense, splice-site, frameshift, and in-frame deletions—underscoring the heterogeneity of PI3K pathway dysregulation. Conclusions: This study identifies PI3K pathway alterations as a potential prognostic marker of poor survival in EO NHW patients receiving FOLFOX and uncovers ancestry- and treatment-specific mutational differences in high-risk CRC populations. By integrating clinical, molecular, and treatment variables, the AI-HOPE and AI-HOPE-PI3K platforms enabled rapid, reproducible, and fine-grained analysis of complex datasets. These findings underscore the need for ancestry-informed molecular profiling to optimize therapeutic strategies and highlight AI-guided interrogation as a powerful tool for advancing precision oncology in underrepresented and disproportionately affected CRC populations. Full article
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14 pages, 516 KB  
Article
Mental and Behavioral Health Disparities Among Pain-Reliever Misusers: A Cross-Sectional Analysis by Race and Ethnicity
by James P. D’Etienne, Sam Abduganiev, Ryan Warrior and Hao Wang
Healthcare 2025, 13(21), 2674; https://doi.org/10.3390/healthcare13212674 - 23 Oct 2025
Viewed by 259
Abstract
Objectives: The misuse of pain relievers has been linked to mental and behavioral disorders. This study aims to determine the associations between pain-reliever misuse, severe psychological distress (SPD), suicidal ideation, and difficulties in performing daily activities. Additionally, it seeks to identify the [...] Read more.
Objectives: The misuse of pain relievers has been linked to mental and behavioral disorders. This study aims to determine the associations between pain-reliever misuse, severe psychological distress (SPD), suicidal ideation, and difficulties in performing daily activities. Additionally, it seeks to identify the socio-demographic factors associated with pain-reliever misuse across different racial and ethnic groups. Methods: This cross-sectional study utilizes data from the 2022 United States National Survey on Drug Use and Health (NSDUH). Participants were categorized into four groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic/Latino (Hispanic), and Other (American Indian, Alaska Native, Asian, Native Hawaiian or other Pacific Islanders, and two or more races) groups. Comparisons were made between individuals regarding pain-reliever misuse, socio-demographic characteristics, SPD, suicidal thoughts, and World Health Organization Disability Assessment Schedule (WHODAS) scores, using Rao–Scott Chi-square tests. Stepwise multivariable logistic regression analyses were conducted to identify socio-demographic factors associated with pain-reliever misuse. Results: The study included 45,451 participants, with 27,551 (62.00 wt%) identified as NHW, 5186 (11.98 wt%) as NHB, 7795 (17.15 wt%) as Hispanic, and 4919 (8.87 wt%) as other racial and ethnic groups. The rate of pain-reliever misuse was 2.90% among NHWs, 3.40% among NHBs, 3.61% among Hispanics, and 2.05% among individuals of other races and ethnicities (p = 0.043). Among those who misused pain relievers, a significantly higher proportion experienced SPD (36.00% vs. 14.05%), suicidal thoughts (15.51% vs. 4.91%), and difficulties in performing daily activities (73.77% vs. 52.84%) compared to those who did not misuse pain relievers (p < 0.001). Socio-demographic factors associated with a lower risk of misuse included being female (AOR = 0.80, 95% CI 0.67–0.95, p = 0.013), being employed (AOR = 0.66, 95% CI 0.48–0.90, p = 0.010), and having a college or higher education (AOR = 0.54, 95% CI 0.37–0.79, p = 0.002). Conclusions: The prevalence of pain-reliever misuse varies across racial and ethnic groups, with Hispanic individuals demonstrating the highest rates of misuse. Pain-reliever misuse is strongly associated with SPD, suicidal thoughts, and impaired daily functioning. Socio-demographic factors are crucial in predicting the likelihood of pain-reliever misuse. These findings highlight the importance of culturally tailored prevention strategies and public health policies aimed at mitigating misuse, especially among vulnerable populations. Full article
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24 pages, 5198 KB  
Article
Artificial Intelligence-Enhanced Precision Medicine Reveals Prognostic Impact of TGF-Beta Pathway Alterations in FOLFOX-Treated Early-Onset Colorectal Cancer Among Disproportionately Affected Populations
by Fernando C. Diaz, Brigette Waldrup, Francisco G. Carranza, Sophia Manjarrez and Enrique Velazquez-Villarreal
Int. J. Mol. Sci. 2025, 26(18), 9067; https://doi.org/10.3390/ijms26189067 - 17 Sep 2025
Viewed by 682
Abstract
Early-onset colorectal cancer (EOCRC; <50 years) incidence is increasing most rapidly among Hispanic/Latino (H/L) populations. While the transforming growth factor–beta (TGF-β) pathway influences colorectal cancer (CRC) progression, its prognostic role in FOLFOX-treated EOCRC, particularly in H/L patients, is unclear. We analyzed 2515 CRC [...] Read more.
Early-onset colorectal cancer (EOCRC; <50 years) incidence is increasing most rapidly among Hispanic/Latino (H/L) populations. While the transforming growth factor–beta (TGF-β) pathway influences colorectal cancer (CRC) progression, its prognostic role in FOLFOX-treated EOCRC, particularly in H/L patients, is unclear. We analyzed 2515 CRC cases (H/L = 266; NHW = 2249) stratified by ancestry, age at onset, and FOLFOX treatment using Fisher’s exact, chi-square, and Kaplan–Meier analyses. We then applied AI-HOPE and AI-HOPE-TGFβ, conversational artificial intelligence (AI) platforms that integrate clinical, genomic, and treatment data, to perform complex, natural language-driven queries requiring multi-parameter integration. TGF-β pathway alterations occurred in 28–39% of H/L and 23–31% of NHW patients, with SMAD4 being the predominant driver. BMPR1A mutations were enriched in FOLFOX-treated EO H/L patients (5.5% vs. 1.1% EO NHW; p = 0.0272), while late-onset NHW non-FOLFOX cases had higher SMAD2/TGFBR2 mutation rates. In FOLFOX-treated EO H/L patients, TGF-β pathway alterations predicted poorer survival (p = 0.029); no survival impact was seen in other groups. SMAD4 mutations were less frequent in EO H/L than in EO NHW receiving FOLFOX (2.74% vs. 13.87%; p = 0.013). TGF-β pathway alterations may serve as ancestry- and treatment-specific biomarkers of poor prognosis in FOLFOX-treated EO H/L CRC. AI-enabled integration accelerated biomarker discovery, supporting precision medicine. Full article
(This article belongs to the Special Issue Molecular Diagnosis and Treatment of Colorectal Cancer)
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19 pages, 2631 KB  
Article
AI-HOPE-TP53: A Conversational Artificial Intelligence Agent for Pathway-Centric Analysis of TP53-Driven Molecular Alterations in Early-Onset Colorectal Cancer
by Ei-Wen Yang, Brigette Waldrup and Enrique Velazquez-Villarreal
Cancers 2025, 17(17), 2865; https://doi.org/10.3390/cancers17172865 - 31 Aug 2025
Cited by 1 | Viewed by 1089
Abstract
Background/Objectives: The incidence of early onset colorectal cancer (EOCRC) is increasing globally, particularly among underrepresented populations such as Hispanic/Latino individuals. TP53 is among the most frequently mutated pathways in CRC; however, its role in EOCRC, especially in relation to disparities and treatment outcomes, [...] Read more.
Background/Objectives: The incidence of early onset colorectal cancer (EOCRC) is increasing globally, particularly among underrepresented populations such as Hispanic/Latino individuals. TP53 is among the most frequently mutated pathways in CRC; however, its role in EOCRC, especially in relation to disparities and treatment outcomes, remains poorly defined. We developed AI-HOPE-TP53, a novel conversational AI agent, to enable a real-time, disparity-aware analysis of TP53 pathway alterations in EOCRC. Methods: AI-HOPE-TP53 integrates a fine-tuned biomedical large language model (LLaMA 3) with harmonized datasets from cBioPortal (TCGA, MSK-IMPACT, AACR Project GENIE). Natural language queries are translated into workflows for mutation profiling, Kaplan–Meier survival analysis, and odds ratio estimation across clinical and demographic subgroups. Results: The platform replicated known genotype–phenotype associations, including elevated TP53 mutation frequency in EOCRC and poorer prognosis in TP53-mutated tumors. Significant findings included a survival benefit for patients with early-onset TP53-mutant CRC treated with FOLFOX (p = 0.0149). Additional exploratory analyses showed a trend toward higher prevalence of TP53 pathway alterations in Hispanic/Latino EOCRC patients (OR = 2.13, p = 0.084) and identified sex-based disparities in treatment, with women being less likely than men to receive FOLFOX (OR = 0.845, p = 0.0138). Conclusions: AI-HOPE-TP53, developed in this study and made publicly available, is the first conversational AI platform tailored for pathway-specific and disparity-aware EOCRC research. By integrating clinical, genomic, and demographic data through natural language interaction, hypothesis generation and equity-focused analyses are enabled, with significant potential to advance precision oncology. Full article
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26 pages, 5308 KB  
Article
Precision Oncology Insights into WNT Pathway Alterations in FOLFOX-Treated Early-Onset Colorectal Cancer in High-Risk Populations
by Fernando C. Diaz, Brigette Waldrup, Francisco G. Carranza, Sophia Manjarrez and Enrique Velazquez-Villarreal
Cancers 2025, 17(17), 2833; https://doi.org/10.3390/cancers17172833 - 29 Aug 2025
Viewed by 932
Abstract
Background/Objectives: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is rising rapidly and disproportionately affects Hispanic/Latino (H/L) populations. While FOLFOX is a standard first-line chemotherapy, its impact on tumor genomics in EOCRC remains poorly understood. Given the central role of WNT [...] Read more.
Background/Objectives: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is rising rapidly and disproportionately affects Hispanic/Latino (H/L) populations. While FOLFOX is a standard first-line chemotherapy, its impact on tumor genomics in EOCRC remains poorly understood. Given the central role of WNT signaling in colorectal cancer (CRC), we aimed to characterize WNT pathway alterations in EOCRC across diverse populations and assess their associations with FOLFOX treatment and clinical outcomes. Methods: Somatic mutation data from 2515 CRC patients (266 H/L, 2249 Non-Hispanic White [NHW]) were analyzed. Patients were stratified by age (EOCRC vs. late-onset colorectal cancer), ancestry (H/L vs. NHW), and FOLFOX treatment status. Mutation frequencies in WNT pathway genes were compared, and Kaplan–Meier analysis evaluated overall survival. Results: WNT pathway alterations were pervasive across groups, with APC mutations dominating. Notably, non-canonical WNT mutations (e.g., CTNNB1, RNF43) were significantly less frequent in FOLFOX-treated H/L EOCRC patients compared to untreated individuals, suggesting potential chemotherapy-driven selection. In NHW patients, FOLFOX treatment was associated with reduced mutation frequencies across multiple WNT regulators, which correlated with improved overall survival. Conclusions: Our findings reveal that WNT pathway dysregulation in EOCRC is shaped by ancestry, treatment status, and age. FOLFOX appears to reduce specific WNT alterations in H/L patients and broader WNT disruptions in NHW patients, with survival benefits observed primarily in the latter. These results underscore ancestry-specific molecular responses to chemotherapy and the need for precision oncology strategies tailored to high-risk populations. Full article
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18 pages, 1835 KB  
Systematic Review
Humanized and Community-Based Nursing for Geriatric Care: Impact, Clinical Contributions, and Implementation Barriers
by Viviana Margarita Espinel-Jara, María Ximena Tapia-Paguay, Amparo Paola Tito-Pineda, Eva Consuelo López-Aguilar and Eloy Fernández-Cusimamani
Nurs. Rep. 2025, 15(8), 302; https://doi.org/10.3390/nursrep15080302 - 18 Aug 2025
Cited by 1 | Viewed by 3227
Abstract
Background: As global populations age, the demand for effective and compassionate geriatric care has intensified. Humanized nursing emphasizes empathy and person-centered care, while community-based nursing builds on local resources and networks to support health and well-being. Together, these approaches offer promising strategies [...] Read more.
Background: As global populations age, the demand for effective and compassionate geriatric care has intensified. Humanized nursing emphasizes empathy and person-centered care, while community-based nursing builds on local resources and networks to support health and well-being. Together, these approaches offer promising strategies for improving care for older adults. This integrative review explores the evolution, clinical contributions, and implementation barriers of these models. Methods: A comprehensive literature search was performed using PubMed, CINAHL, Scopus, and Web of Science, targeting peer-reviewed studies, including qualitative and quantitative studies published between 2010 and 2025, that involved adults aged 60 years and older. Inclusion criteria emphasized humanized and community-based nursing interventions while excluding non-nursing and pediatric-focused studies. Quality appraisal was performed using CASP and JBI checklists, and data were thematically synthesized. Results: Evidence indicates that these care models significantly improve functional independence and psychosocial well-being and reduce hospital readmissions. For instance, community-based care in Taiwan improved activities of daily living in dementia patients by 15%, while U.S.-based programs reduced depressive symptoms by 30% among Latino older adults. Interdisciplinary, nurse-led interventions in South Korea and Puerto Rico showed a 22% reduction in readmissions and an 85% increase in care access. Despite these benefits, numerous barriers hinder widespread implementation, including workforce shortages, inadequate funding, fragmented healthcare systems, cultural resistance, digital literacy challenges, and policy constraints, particularly in low-resource settings such as the Philippines and Nepal. Conclusions: These findings underscore the transformative potential of humanized and community-based nursing while highlighting the need for targeted strategies such as task-shifting, inclusive technologies, and policy reform to advance equitable, sustainable geriatric care globally. Full article
(This article belongs to the Section Nursing Care for Older People)
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17 pages, 807 KB  
Review
Racial and Gender Disparities in Clinical Trial Representation for Age-Related Macular Degeneration Treatments: A Scoping Review
by Amirmohammad Shafiee, Taylor Juran, Iza Zabaneh, Deepkumar Patel and Karen Allison
J. Clin. Transl. Ophthalmol. 2025, 3(3), 16; https://doi.org/10.3390/jcto3030016 - 13 Aug 2025
Viewed by 1178
Abstract
Background/Objective: Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the primary treatment for neovascular AMD. This study aimed to assess racial, ethnic, and gender representation in U.S.-based randomized controlled trials (RCTs) [...] Read more.
Background/Objective: Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the primary treatment for neovascular AMD. This study aimed to assess racial, ethnic, and gender representation in U.S.-based randomized controlled trials (RCTs) of anti-VEGF therapies. Methods: A systematic PubMed search identified 19 eligible RCTs. Titles and abstracts were screened, and demographic data were independently extracted and cross-verified. Chi-squared analysis was used to evaluate disparities in participant representation. Risk of bias was assessed using the ROBIS checklist. Results: Among 8003 participants across 19 trials, 92.3% were Caucasian. Asian, African American, Hispanic/Latino, and American Indian participants collectively comprised just over 5%. This underrepresentation of non-Caucasian groups was statistically significant (p < 0.01, df = 4) and not associated with study sponsorship. Gender analysis showed 59% female and 41% male participation, which was not statistically significant (p = 0.83, df = 1). Conclusions: Non-Caucasian populations remain significantly underrepresented in anti-VEGF RCTs for AMD. This raises concerns about the generalizability of trial findings to diverse populations. Future clinical trials must prioritize inclusive recruitment to ensure equitable, evidence-based care for all patients. Full article
(This article belongs to the Special Issue Retinal Diseases: Recent Advances in Diagnosis and Treatment)
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24 pages, 3643 KB  
Article
Inequality in Housing Payment Insecurity Across the United States During the COVID-19 Pandemic: Who Was Affected and Where?
by Xinba Li and Chuanrong Zhang
J. Risk Financial Manag. 2025, 18(8), 445; https://doi.org/10.3390/jrfm18080445 - 10 Aug 2025
Viewed by 1518
Abstract
Widespread job losses and economic disruptions during the COVID-19 pandemic led to significant housing payment insecurity, disproportionately affecting various demographic groups and regions across the United States (US). While previous studies have explored the pandemic’s impact on housing insecurity, they all focused on [...] Read more.
Widespread job losses and economic disruptions during the COVID-19 pandemic led to significant housing payment insecurity, disproportionately affecting various demographic groups and regions across the United States (US). While previous studies have explored the pandemic’s impact on housing insecurity, they all focused on specific periods, populations or areas. No study has yet provided a comprehensive analysis of inequality in housing insecurity throughout the pandemic, particularly in terms of spatial disparities. Our study addresses this gap by analyzing individual-level and aggregated data from the Household Pulse Survey (HPS) (N = 2,062,005). The findings reveal heightened vulnerability among individuals aged 40–54, those with lower education and income, Black and Hispanic/Latino populations, women, households with children, individuals who experienced job loss, the divorced, and larger households. Renters experienced greater housing insecurity than homeowners. A hotspot analysis identified the southeastern US as a region of acute housing insecurity, revealing that insecurity cannot be solely measured by affordability. The regression results show that poverty is the main reason for differences in housing insecurity across places, and rent burden is also important. The geographically weighted regression (GWR) model shows stronger coefficients in southern states, highlighting that poverty and rent burden are particularly influential factors in these areas. This study shows the multifaceted nature of housing insecurity, calling for targeted group or location policy interventions. Full article
(This article belongs to the Section Financial Markets)
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13 pages, 259 KB  
Article
Excessive Daytime Sleepiness and Associated Cardiometabolic Factors in Latino Individuals of Mexican Ancestry at High Risk of Type 2 Diabetes: An El Banco Biobank Cross-Sectional Study
by Ludovica Verde, Dawn K. Coletta, Yann C. Klimentidis, Linsday N. Kohler, Lisa Soltani, Oscar D. Parra, Sairam Parthasarathy, Lawrence J. Mandarino and Giovanna Muscogiuri
Nutrients 2025, 17(15), 2476; https://doi.org/10.3390/nu17152476 - 29 Jul 2025
Viewed by 723
Abstract
Background/Objectives: Latinos, particularly those of Mexican ancestry, experience high rates of type 2 diabetes and sleep disturbances, exacerbating adverse health outcomes. This study aimed to examine the prevalence of excessive daytime sleepiness and its associations with diet, cardiometabolic risk factors, and glycemic [...] Read more.
Background/Objectives: Latinos, particularly those of Mexican ancestry, experience high rates of type 2 diabetes and sleep disturbances, exacerbating adverse health outcomes. This study aimed to examine the prevalence of excessive daytime sleepiness and its associations with diet, cardiometabolic risk factors, and glycemic control in this population. Methods: This cross-sectional study utilized data from the El Banco por Salud biobank, including 1685 participants (aged 52.6 ± 14.5 years, BMI: 32.4 ± 7.0 kg/m2) recruited from Federally Qualified Community Health Centers. Excessive daytime sleepiness was assessed using the Epworth Sleepiness Scale, while dietary information was obtained via the Brief Dietary Assessment Tool for Hispanics. Primary outcomes included cardiometabolic risk factors and glycated hemoglobin (HbA1c) levels. Results: Excessive daytime sleepiness (Epworth Sleepiness Scale > 10) was present in 22.0% of participants and was associated with higher BMI (p < 0.001), larger waist circumference (p = 0.002), poorer diet quality, increased dyslipidemia (p = 0.036), and elevated HbA1c (p = 0.007). Linear regression analyses confirmed that excessive daytime sleepiness was significantly associated with higher HbA1c levels, both in unadjusted (R2 = 0.011; p < 0.001) and adjusted for demographic, anthropometric, and socioeconomic factors (R2 = 0.107; p = 0.004) models. Conclusions: Excessive daytime sleepiness among Latinos of Mexican ancestry is associated with unhealthy dietary patterns and poor glycemic control, highlighting the need for targeted interventions addressing sleep and dietary habits in this vulnerable population. Full article
(This article belongs to the Special Issue The Diabetes Diet: Making a Healthy Eating Plan)
20 pages, 1153 KB  
Article
Economic Attitudes and Financial Decisions Among Welfare Recipients: Considerations for Workforce Policy
by Jorge N. Zumaeta
J. Risk Financial Manag. 2025, 18(8), 407; https://doi.org/10.3390/jrfm18080407 - 22 Jul 2025
Viewed by 566
Abstract
This study investigates economic decision-making behaviors among welfare recipients in Miami, Florida, by leveraging well-established experimental protocols: the Guessing Game, the Prudence Measurement Task, the Risk Aversion Task, and the Stag Hunt Game. For this purpose, our study defines financial decisions as the [...] Read more.
This study investigates economic decision-making behaviors among welfare recipients in Miami, Florida, by leveraging well-established experimental protocols: the Guessing Game, the Prudence Measurement Task, the Risk Aversion Task, and the Stag Hunt Game. For this purpose, our study defines financial decisions as the underlying individual preferences that serve as validated proxies for savings behavior, debt management, job-search intensity, and participation in cooperative finance. A central objective is to compare the behavior of welfare recipients to that of undergraduate students, a cohort typically used in experimental economics research. The analysis reveals significant differences between the two groups in strategic thinking and coordination, particularly across ethnic and gender lines. Non-Hispanic/Latino participants in Miami displayed significantly higher average guesses in the Guessing Game compared to their counterparts in Tucson, indicating potential discrepancies in the depth of strategic reasoning. Additionally, female participants in Tucson exhibited higher levels of coordination in the Stag Hunt Game compared to females in Miami, suggesting variance in cooperative behavior between these groups. Despite these findings, regression models demonstrate that location, gender, and ethnicity collectively account for only a small fraction of the observed variance, as evidenced by low R2 values and substantial mean squared errors across all games. These results suggest that individual heterogeneity, rather than broad demographic variables, may be more influential in shaping economic decisions. This study underscores the complexity of generalizing findings from traditional student samples to more diverse populations, highlighting the need for further investigation into the socioeconomic factors that drive financial decision-making. Full article
(This article belongs to the Special Issue Behavioral Influences on Financial Decisions)
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16 pages, 284 KB  
Article
Suicidal Ideation in U.S. Adolescents Exposed to Neighborhood Violence
by Silviya Nikolova, Eusebius Small and Benjamin Sesay
Adolescents 2025, 5(3), 31; https://doi.org/10.3390/adolescents5030031 - 7 Jul 2025
Cited by 1 | Viewed by 2038
Abstract
Background: Suicidal ideation among adolescents remains a major public health challenge. Exposure to neighborhood violence is associated with increased risk of mental health distress and school-related vulnerabilities. This study investigates the predictors of suicidal ideation among U.S. adolescents who have witnessed neighborhood violence. [...] Read more.
Background: Suicidal ideation among adolescents remains a major public health challenge. Exposure to neighborhood violence is associated with increased risk of mental health distress and school-related vulnerabilities. This study investigates the predictors of suicidal ideation among U.S. adolescents who have witnessed neighborhood violence. Methods: Data were drawn from the 2023 Youth Risk Behavior Survey (YRBS), a nationally representative survey of high school students in the United States. A subsample of 3495 adolescents who reported witnessing neighborhood violence was analyzed. Key variables included sociodemographic characteristics, mental health symptoms, perceived school safety, and experiences of victimization. Multivariable logistic regression was used to identify factors associated with suicidal ideation, defined as seriously considering suicide in the past year. Analyses were conducted using Jamovi (version 2.6), with statistical significance set at p < 0.05. Results: The prevalence of suicidal ideation in the sample was 34.2%. Bisexual adolescents had significantly higher odds of suicidal ideation compared to heterosexual peers (OR = 2.34, p < 0.001). Depressive symptoms were the strongest predictor (OR = 7.51, p < 0.001). Both perceived lack of safety at school and differences in ethnic and population backgrounds were significant. Black and Hispanic/Latino adolescents had lower odds compared to White peers. Conclusions: Findings highlight sexual identity, depressive symptoms, school safety concerns, and ethnic and population background differences as key correlates of suicidal ideation. Culturally responsive, trauma-informed interventions are urgently needed for youth exposed to community violence. Full article
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