Search Results (756)

Background: Suicide remains a leading cause of death in the United States, with more than 49,000 fatalities in 2023. Rural counties consistently face higher suicide mortality rates than urban areas, reflecting deep-seated mental health inequities. Methods: This study analyzes 39 U.S. states with suicide mortality rates exceeding the national average, as defined by the Centers for Disease Control and Prevention (CDC) (>14.1 per 100,000), to examine rural–urban disparities and their intersectional demographic factors. Age-adjusted mortality data (2019–2023) from HDPulse were analyzed using IBM SPSS Statistics, version 31.0. Counties were classified by USDA Rural–Urban Continuum Codes and stratified by region, sex, age, and race. Subgroup differences were tested using a two-way ANOVA (p < 0.01). Results: Rural suicide rates were significantly higher than urban rates (28.69 vs. 20.20 per 100,000; p < 0.001). The West reported the highest mortality and widest rural–urban gap (38.23 vs. 24.83), while the Northeast had the lowest. Men had higher rates than women, particularly in rural settings (37.12 vs. 11.77). The largest rural–urban gap occurred among young adults (20–39 years). American Indian/Alaska Native populations experienced the highest rates (rural: 58.73; urban: 35.15). The literature review highlighted limited healthcare access, social stigma, substance use, and economic hardship as variables commonly associated with rural–urban differences in suicide mortality. Conclusions: Suicide mortality is markedly elevated in rural America across all subgroups, with the greatest risks among young adults, men, and American Indian/Alaska Native populations. Tailored prevention strategies and expanded mental health infrastructure are critical for high-burden states. Full article

Glutathione-S-Transferase T1 (GSTT1) and M1 (GSTM1) are key enzymes involved in phase II detoxification. Null genotypes resulting from gene deletions are known to cause a complete loss of enzymatic activity and have been associated with altered xenobiotic metabolism in previous studies. Although genotype frequencies vary across ethnic groups, data from non-European populations, particularly Andean populations, remain limited. In this cross-sectional study, the frequency of GSTM1 and GSTT1 null genotypes was determined in 206 individuals from Cusco and Junín. Genotyping was performed by PCR using genomic DNA extracted from peripheral blood. The frequency of the GSTM1 null genotype was 49.51%, whereas that of GSTT1 was 25.24%. Combined genotype analysis showed that 63.11% of participants carried at least one null genotype and 11.65% carried both null variants. No significant differences were observed between Cusco and Junín. Compared with previously reported data, these frequencies were similar to those observed in Peruvian coastal and several South American populations. At the intercontinental level, frequencies were comparable to Europe, the Middle East, and Asia but differed from Sub-Saharan Africa and Native American populations. This first molecular characterization of GSTM1 and GSTT1 null genotypes in Andean populations provides a population-specific genetic baseline for pharmacogenetics and precision medicine research in high-altitude settings. Full article

Background: Adjuvant radiation therapy for breast cancer improves survival but may expose thoracic organs to low-dose radiation, increasing the risk of second primary lung cancer (SPLC). Racial and ethnic disparities and social factors influencing SPLC risk remain underexplored. Objectives: We quantified racial and ethnic differences in SPLC incidence and survival among radiotherapy-treated breast cancer survivors and assessed the potential protective role of marital status. Methods: Using SEER-17 (2000–2022), we identified patients with first primary breast cancer receiving radiotherapy, excluding those who died within two months. Standardized incidence ratios (SIRs) assessed observed versus expected SPLC cases by race and ethnicity and marital status, and five-year overall survival (OS) after SPLC and mean age at death were calculated. Racial categories included White, Black, Asian or Pacific Islander (API), and American Indian or Alaska Native (AI/AN); ethnicity was categorized as Hispanic or non-Hispanic. Results: Among 558,493 patients, 6674 developed SPLC (1.19%). Risk varied significantly by race (p < 0.05). AI/AN patients had the highest overall risk (SIR 1.82), particularly 12–59 months and ≥120 months post-treatment. Black (SIR 1.21) and API (SIR 1.23) survivors had sustained elevated risk, while White survivors showed no overall increase (SIR 0.96) and Hispanic survivors had lower risk (SIR 0.72). Married individuals had 12% lower SPLC incidence (SIR 0.88). Five-year overall survival after SPLC was 28.0%, with significant variation by race and ethnicity (p = 0.002). API (32.2%) and AI/AN (32.5%) patients had the highest survival, followed by White (28.0%) and Black patients (25.6%). Married patients had higher five-year survival (31.8% vs. 25.0%) and older mean age at death (64.3 vs. 48.6 years) compared to unmarried patients. Conclusions: SPLC risk and prognosis after breast radiotherapy differ by race, ethnicity, and marital status. These findings highlight the importance of context-aware survivorship counseling and support the consideration of personalized lung cancer screening for breast cancer survivors. Full article

Background: In the Americas, the number of people living with diabetes is expected to rise from 92 million in 2024 to 120 million by 2050. Indigenous populations may experience distinct biological, environmental, and sociocultural risk factors; however, they are often treated as a homogeneous group in epidemiological research, and consolidated evidence on diabetes prevalence across diverse Indigenous populations remains limited. This scoping review examines the prevalence of diabetes among Indigenous populations in the Americas. Methods: Following PRISMA-ScR guidelines, we conducted a systematic scoping review of population-based studies reporting the prevalence of diabetes among Indigenous adult populations in the Americas. Searches were performed in PubMed and Scopus. Collected data included study location, Indigenous group, population characteristics, diagnostic criteria, and test used and reported prevalence estimates. Results: Sixty documents encompassing 73 studies met the inclusion criteria, representing 45,503 individuals from 16 countries between 1975 and 2025. The total number of ethnic groups represented was 111, and 12 studies did not identify a specific ethnic group. Fasting blood glucose (FBG) was the most frequently used diagnostic method, followed by the oral glucose tolerance test (OGTT). Estimates of the prevalence of diabetes varied widely across populations, regions, and time periods. Five studies—from Brazil, Chile, Colombia, Mexico, and Paraguay—did not identify any cases of diabetes. Among studies reporting cases, prevalence ranged from 1 to 70% in North America, 5 to 14% in Central America, and 1 to 29% in South America. Conclusions: The prevalence of diabetes among Indigenous populations varied widely across the region, with substantially higher estimates reported in North America than in Central and South America. The decline in published studies in recent years suggests reduced research attention to this topic. The marked heterogeneity identified in this review underscores the need for standardized measurement approaches to support population-specific strategies aligned with personalized care and precision public health. Full article

Freshwater bivalves influence ecosystem functioning by transferring pelagic material to the benthos through filtration and biodeposition, yet quantitative multiscale evidence remains scarce for South American lakes. We assessed the role of the native mussel Diplodon chilensis in Laguna Chica de San Pedro (southern Chile) by integrating laboratory measurements, seasonal in situ mesocosm experiments, and lake-scale estimates. Individual filtration rates were quantified under contrasting temperature and phytoplankton biomass conditions, while field experiments evaluated mussel effects on sediment biogeochemistry and zoobenthic assemblages. Filtration increased strongly with temperature, whereas food availability exerted a detectable effect only at lower temperatures. Live mussels consistently enhanced sediment organic matter and total nitrogen, while total phosphorus responses were weak and variable. Macroinvertebrate richness and abundance increased in association with mussel presence, whereas meiofaunal responses were weaker and inconsistent. When scaled to the lake level using bathymetric population distribution and seasonal deposition rates, D. chilensis accounted for substantial annual fluxes of organic matter and nitrogen to surface sediments, largely driven by shallow and intermediate depths. These results demonstrate that native freshwater mussels mediate a persistent downward component of benthic–pelagic coupling in clear-water temperate lakes of southern South America. Full article

Background: Early-onset colorectal cancer (EOCRC), defined as diagnosis before age 50, is increasing despite declining colorectal cancer (CRC) rates among older adults. Emerging evidence suggests widening racial and ethnic disparities. We aimed to characterize long-term EOCRC incidence and mortality trends across racial and ethnic groups in the United States with comparisons by tumor subtype. Methods: We conducted a population-based analysis using United States Cancer Statistics data (2001–2021) for EOCRC incidence and National Center for Health Statistics data (2000–2022) for mortality. Analyses were stratified by race/ethnicity and histology. Trends were quantified using average annual percent change (AAPC) with 95% confidence intervals (Cis). Results: Among 474,601 early-onset adenocarcinoma (EO-ADC) cases, incidence increased in all racial and ethnic groups except Non-Hispanic Black individuals, in whom incidence declined (AAPC = −0.35%, 95% CI −0.63 to −0.08; p = 0.01). The steepest incidence increases occurred among American Indian/Alaska Native (AIAN; AAPC = 3.39%, 95% CI 2.70–4.15), Hispanic (AAPC = 0.94%, 95% CI 0.61–1.30), and Asian/Pacific Islander populations (AAPC = 0.64%, 95% CI 0.37–0.95; all p < 0.001). EOCRC mortality increased among AIAN (AAPC = 2.67%, 95% CI 1.26–4.26; p = 0.001) and Hispanic populations (AAPC = 0.81%, 95% CI 0.39–1.27; p < 0.001), but declined among Black individuals (AAPC = −1.08%, 95% CI −1.29 to −0.77; p < 0.001). Neuroendocrine tumors increased more rapidly than adenocarcinomas across all groups. Conclusions: EOCRC incidence and mortality are rising most rapidly among AIAN and Hispanic populations. Distinct incidence trajectories of colorectal neuroendocrine tumors compared with adenocarcinomas highlight the importance of histology-specific analyses for accurate epidemiologic interpretation. Full article

Tallgrass prairie ecosystems in North America sustain globally important plant and animal biodiversity while providing ecosystem services, including biomass production, forage for livestock, and carbon sequestration. Land use change has left less than 1% of North American prairies intact, and opportunities are needed for their restoration. There has been increasing interest in the establishment of prairies on degraded former minelands, where significant challenges exist in reestablishing historic vegetation communities. We examined how the productivity and diversity of mineland prairies were influenced by varying restoration treatments that had been applied nearly a decade previously. We utilized an existing prairie research plot network established using seed mixes containing from one to seven different species and differing fertilization and tillage treatments. We calibrated a non-destructive method to assess prairie biomass and used it to assess the productivity and diversity across 312 research plots. The results showed that, with the exception of C4 grasses, few originally seeded species were present. Significant differences in species richness existed as a function of the interacting effects of seed mix type and fertilization treatment. Unfertilized plots generally had a higher species richness, particularly where larger numbers of species were included in the mixes. Prairie biomass was significantly greater in seed mixes containing big bluestem (Andropogon gerardii) and was also significantly related to Shannon diversity. Our results suggest that the establishment of (Andropogon gerardii) is fundamental to maximizing the diversity and productivity of mineland prairies, especially in the absence of follow-up management. The results also suggest that caution should be exercised when considering the use of fertilizer, as this may reduce the diversity of native species by favoring competitive non-native species such as some C3 grasses. Full article

Humans tend to mark their presence and thus their lands by naming charismatic places such as mountains, canyons, rivers, and lakes. Toponyms is the term for marking places with names. In doing so, cultural groups claim the lands and the recognition of their presence through names in their language and behaviors reflecting their culture. When other cultures occupy these lands, they similarly mark them with their own place names, thus replacing earlier names and evidence of occupation. A conflict of toponyms occurs when one cultural group uses their power to maintain a superior attachment to the land. This chapter uses six toponym ethnographic studies to understand the origins of debates between Native American and settler colonial peoples in North American. Research findings from these studies define both the importance of toponyms to cultural groups and possible resolution of heritage conflicts. All studies have been reviewed and approved for public use for place interpretations, visitor education, and culturally appropriate management by funding agencies and participating Native American tribes and Pueblos. Full article

This paper describes Alaska Native youth-identified community strengths that support young people’s well-being. Youth from three rural Alaska communities were engaged by the research team in digital storytelling and photovoice to explore their perspectives on what their communities were already undertaking to support youth. Each youth participant was then invited to complete an interview, which was then transcribed, coded, and qualitatively analyzed by the research team leads. The community strengths described by young people align with several community-level protective factors identified in a parent study as associated with reduced risk of youth suicide. Findings illustrate that protective communities help young people build and maintain supportive relationships with community members, family, and peers, and promote their connection to their culture, including by providing opportunities to learn their language, history, and culture; to be out on the land hunting and fishing; and to practice traditional ceremonies and spirituality. Communities implementing initiatives that support these factors may protect young people from youth suicide. Full article

Background: The term immigrant health paradox describes how immigrants often have better health outcomes than their American-born counterparts. While existing literature treats this phenomenon as broadly generalizable, emerging research indicates that its expression varies across cultural and migration contexts. Understanding how the immigrant health paradox may appear across specific ethnic groups requires research that maps variation rather than assumes uniformity. Objectives: This study seeks to describe patterns, explore variation by nativity, and identify factors associated with well-being among the Vietnamese population in the United States (US). By focusing on descriptive trends and contextual influences, the study aims to generate new insights into how the paradox may manifest—or diverge—in the Vietnamese context. Methods: We conducted an online survey asking participants about their depressive disorders, physical and mental health status, demographics, socioeconomic status, social networks, and experiences with daily discrimination. Descriptive statistics were used to describe the study sample. Linear regression and ordinal logistic regression were performed to explore the relationships. Results: In this exploratory analysis, we did not observe indications of the Vietnamese immigrant health paradox. Material factors, especially perceptions of financial needs, as well as psychological factors, were somewhat associated with how Vietnamese people living in the US assess their health. Conclusions: The absence of the Vietnamese immigrant health paradox in the US underscores the need for nuanced health models that reflect diversity within immigrant groups. Their experiences reveal how migration histories, structural barriers, and racialization shape health outcomes in ways that differ from expectations. Full article

Background: Congenital anomalies are influenced by genetic and environmental factors. While interventions including folic acid supplementation have reduced neural tube defects, data on modifiable socio-demographic risk factors remain limited. Aim: This study aimed to assess variation in the prevalence of selected congenital anomalies across the United States according to socio-demographic factors. Methods: A population-based analysis was conducted using CDC-WONDER natality data from 2016 to 2023. Included anomalies were anencephaly, spina bifida, cyanotic heart disease, diaphragmatic hernia, omphalocele, gastroschisis, limb reduction, cleft lip/palate, Down syndrome, chromosomal disorders, and hypospadias. Associations with maternal age, BMI, race, tobacco use, diabetes, and fertility treatments were analyzed. Prevalence rates were calculated per 1000 live births. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated. Joinpoint regression was used to assess annual percent changes (APCs), with p < 0.05 considered significant. Results: Among 3,482,944 singleton live births in 2023, the overall prevalence of the selected congenital anomalies was 3.3 per 1000. Compared to Caucasian mothers, risk was lower in Asian (RR 0.57; 95% CI: 0.52–0.63) and Black (RR 0.81; 95% CI: 0.76–0.85) infants and higher in American Indian/Alaska Native infants. Significant risk factors included pre-pregnancy diabetes (RR 2.41; 95% CI: 2.16–2.69), maternal age > 45 (RR 2.95; 95% CI: 2.36–3.69), and tobacco use (RR 1.78; 95% CI: 1.64–1.94). A significant decline in prevalence was observed from 2016 to 2023 (APC: −0.6%; 95% CI: −1.1 to −0.2; p = 0.006). Conclusions: Significant disparities and modifiable maternal risk factors were associated with the prevalence of selected congenital anomalies in the U.S. from 2016 to 2023. A modest statistically significant decline in overall prevalence was observed during the study period, supporting the importance of continued national surveillance and targeted preconception and prenatal interventions to reduce risk and address inequities. Full article

Background: Liver transplantation (LT) is the definitive treatment for end-stage liver disease, yet racial and ethnic disparities persist across the LT continuum. This study investigated the patient-level and system-level barriers to LT and evaluated racial disparities in access and outcomes. Methods: We conducted a retrospective cohort study (2012–2022) at Banner University Medical Center, Phoenix, analyzing adult LT-referred, evaluated, waitlisted, and transplanted patients. Primary outcomes included mortality and LT barriers, assessed using competing-risk and Cox regression analyses. Results: Among 2877 LT-referred patients, 61% were Non-Hispanic White (NHW), 26% Hispanic, 8.8% Native American/Alaska Native (NA/AN), 3% Black, and 1% Asian. Compared with NHW patients, lower rates of LT evaluation and listing were observed among NA/AN (39% and 53%) and Hispanic patients (56% and 63%) versus NHW patients (51% and 64%). Patient-level financial barriers were more common among NA/AN (15.5%) and Hispanic (19.81%) individuals. Waitlist mortality was significantly higher for NA/AN (sub-distribution hazard ratio [SHR]: 5.26; p < 0.01) and Hispanic (SHR: 2.92, p < 0.02) patients than for NHW patients, whereas graft survival did not differ significantly by race. Conclusions: Marked racial and ethnic disparities exist in LT access and waitlist mortality, particularly among NA/AN and Hispanic patients. Targeted interventions addressing financial and systemic barriers are critical to ensuring equitable LT access and improving transplant outcomes. Full article

The objective of this research was to optimize a technological package for the biosorption of heavy metals in water, using agricultural waste activated with lemon juice, as a sustainable development alternative. Heavy metals such as lead, cadmium, copper, and chromium were characterized in two stages (field and laboratory conditions) using the American Public Health Association (APHA) method, and morphological characterization was performed using electron scanning techniques. Cocoa pod husk (CPH) and banana stem (BS) waste was collected with the informed consent of the native communities to obtain charcoal activated with lemon juice (LJ). In addition, a portable filter was designed that could be adapted to the native communities. The efficiency and validation of the filter were also calculated in the field. Statistical analysis was performed using Student’s t-test and Pearson’s correlation. The results show a significant reduction in lead from 0.209 mg/L to 0.02 mg/L. With regard to morphological characterization, more compact structures were observed after activation with BS, favoring the absorption of heavy metals. The correlations were positive for copper and lead (1.000), evidently due to the alteration of anthropic factors. The efficiency of the cocoa filter reached 87.48% and that of the banana stem reached 88.77%. For the cadmium, copper, and chromium parameters, the values obtained were within the maximum permissible limit (LMP). The validation of the filters showed that 80% of the population agrees with using the filters and hopes for their large-scale implementation. These findings represent a new alternative for native communities and a solution to the problem of heavy metals in drinking water. Full article

Tularemia is a well-known zoonotic disease around the world, with particularly high rates in certain geographic areas of the U.S. Though the disease is regularly reported, it is classified as a rare condition owing to the relatively low number of cases detected annually. Interestingly, however, the number of cases in the U.S. has shown a positive upward trend through time. The aim of this study was to summarize, interpret, compare, and contextualize temporal trends in tularemia epidemiology at the national scale within the U.S. utilizing long-term data sets encompassing the 23-year span from 2000 to 2022. We used two secondary data sets: (1) case data reports from the National Notifiable Disease Surveillance System (NNDSS) of the Centers for Disease Control and Prevention (CDC) and (2) the National Inpatient Sample (NIS) of hospitalization discharge records. In addition to investigating patterns, we were interested in the utility of using hospital discharge records as a means of indirect epidemiological surveillance of this rare disease. Both data sets highlight the high variability in annual cases through time but underscore the highest risk of disease among patients classified as White and male, as well as the extraordinarily high rates among American Indian/Alaska Native populations, particularly those with pulmonary tularemia disease. Descriptive epidemiological summaries and statistical comparisons are provided across the time series for sex, age, ethnoracial identity, and geography; hospitalization characteristics are also described. Our desire to use case rates from hospitalization records as a surrogate for CDC case incidence rates did not provide the desired precision, though hospital discharge records do provide valuable and useful information necessary to estimate general high-risk groups for tularemia through time. Full article

Apolipoprotein B (APOB) is a key structural component of atherogenic lipoproteins and one of the principal genes implicated in familial hypercholesterolemia (FH). However, APOB genetic variation remains poorly characterized in Latin American and admixed populations. In this study, we performed a descriptive analysis of APOB variants in 60 Ecuadorian mestizo patients with inherited cardiac conditions using next-generation sequencing (NGS) and genetic ancestry inference. A total of 227 APOB variants were identified, the majority of which were classified as benign (n = 220) or likely benign (n = 3) according to ACMG criteria, while three variants were classified as variants of uncertain significance (VUS). The most frequently observed variants included rs1042034, rs679899, rs676210, and rs1367117. Comparative allele-frequency analyses using ALFA and PAGE Latin American reference datasets demonstrated that the APOB variant frequencies observed in the cohort were comparable to those reported in other Latin American populations, reflecting the admixed genetic background of Ecuadorian mestizos, predominantly of Native American and European ancestry. No pathogenic APOB variants were detected. Although lipid measurements were not available and genotype–phenotype associations could not be assessed, this study provides the first comprehensive overview of APOB variation in Ecuadorian mestizo individuals. These findings expand population-specific genomic data for an underrepresented group and underscore the importance of regional reference datasets for accurate variant interpretation in admixed populations. Full article