UNASSIGNED: Individuals from minoritized racial and ethnic backgrounds experience pernicious and pervasive health disparities that have emerged, in part, from clinician bias.
UNASSIGNED: We used a natural language processing approach to examine whether linguistic markers in electronic health record (EHR) notes differ based on the race and ethnicity of the patient. To validate this methodological approach, we also assessed the extent to which clinicians perceive linguistic markers to be indicative of bias.
UNASSIGNED: In this cross-sectional study, we extracted EHR notes for patients who were aged 18 years or older; had more than 5 years of diabetes diagnosis codes; and received care between 2006 and 2014 from family physicians, general internists, or endocrinologists practicing in an urban, academic network of clinics. The race and ethnicity of patients were defined as White non-Hispanic, Black non-Hispanic, or Hispanic or Latino. We hypothesized that Sentiment Analysis and Social Cognition Engine (SEANCE) components (ie, negative adjectives, positive adjectives, joy words, fear and disgust words, politics words, respect words, trust verbs, and well-being words) and mean word count would be indicators of bias if racial differences emerged. We performed linear mixed effects analyses to examine the relationship between the outcomes of interest (the SEANCE components and word count) and patient race and ethnicity, controlling for patient age. To validate this approach, we asked clinicians to indicate the extent to which they thought variation in the use of SEANCE language domains for different racial and ethnic groups was reflective of bias in EHR notes.
UNASSIGNED: We examined EHR notes (n=12,905) of Black non-Hispanic, White non-Hispanic, and Hispanic or Latino patients (n=1562), who were seen by 281 physicians. A total of 27 clinicians participated in the validation study. In terms of bias, participants rated negative adjectives as 8.63 (SD 2.06), fear and disgust words as 8.11 (SD 2.15), and positive adjectives as 7.93 (SD 2.46) on a scale of 1 to 10, with 10 being extremely indicative of bias. Notes for Black non-Hispanic patients contained significantly more negative adjectives (coefficient 0.07, SE 0.02) and significantly more fear and disgust words (coefficient 0.007, SE 0.002) than those for White non-Hispanic patients. The notes for Hispanic or Latino patients included significantly fewer positive adjectives (coefficient -0.02, SE 0.007), trust verbs (coefficient -0.009, SE 0.004), and joy words (coefficient -0.03, SE 0.01) than those for White non-Hispanic patients.
UNASSIGNED: This approach may enable physicians and researchers to identify and mitigate bias in medical interactions, with the goal of reducing health disparities stemming from bias.

BACKGROUND: The global prevalence of type 2 diabetes mellitus (T2DM) is increasing. T2DM is associated with alterations of the gut microbiota, which can be affected by age, illness, and genetics. Previous studies revealed that there are discriminating microbiota compositions between the Dai and the Han populations. However, the specific gut microbiota differences between the two populations have not been elucidated.
OBJECTIVE: To compare the gut microbiota differences in subjects with and without T2DM in the Dai and Han populations.
METHODS: A total of 35 subjects of the Han population (including 15 healthy children, 8 adult healthy controls, and 12 adult T2DM patients) and 32 subjects of the Dai population (including 10 healthy children, 10 adult healthy controls, and 12 adult T2DM patients) were enrolled in this study. Fasting venous blood samples were collected from all the subjects for biochemical analysis. Fecal samples were collected from all the subjects for DNA extraction and 16S rRNA sequencing, which was followed by analyses of the gut microbiota composition.
RESULTS: No significant difference in alpha diversity was observed between healthy children and adults. The diversity of gut microbiota was decreased in T2DM patients compared to the healthy adults in both the Dai and Han populations. There was a significant difference in gut microbiota between healthy children and healthy adults in the Han population with an increased abundance of Bacteroidetes and decreased Firmicutes in children. However, this difference was less in the Dai population. Significant increases in Bacteroidetes in the Han population and Proteobacteria in the Dai population and decreases in Firmicutes in both the Han and Dai population were observed in T2DM patients compared to healthy adults. Linear discriminant analysis Effect Size analysis also showed that the gut microbiota was different between the Han and Dai populations in heathy children, adults, and T2DM patients. Four bacteria were consistently increased and two consistently decreased in the Han population compared to the Dai population.
CONCLUSIONS: Differences in gut microbiota were found between the Han and Dai populations. A significant increase in Bacteroidetes was related to the occurrence of T2DM in the Han population, while a significant increase in Proteobacteria was related to the occurrence of T2DM in the Dai population.

Little is known about the long-term trends in ethnic differences in cardiovascular health (CVH) in China in recent years. This study aimed to investigate ethnic differences in CVH and identify long-term trends in China.
This survey was based on the physical examination data of Tacheng Prefecture in China from 2016 to 2020, and included 1,947,938 physical examination participants aged over 20 years for analysis. The American Heart Association (AHA) criteria were used to evaluate the clinical CVH of the subjects. The time trends from 2016 to 2020 were assessed using a weighted linear regression model stratified by ethnicity. The ethnic groups included Han, Kazakh, Hui, Mongolian, Uyghur, among others. The mean ideal clinical cardiovascular score was highest in Hui and lowest in Uyghur. The scores increased from 5.99 (5.95-6.03) to 6.11 (6.08-6.14) in Kazakh males and from 6.05 (5.99-6.11) to 6.11 (6.06-6.16) in Hui males among participants (Plinear trend < 0.001). The scores for the other groups declined significantly from 2016 to 2020(Plinear trend ＜ 0.05). In the sensitivity analysis, the trend remained unchanged after calculating the body mass index (BMI) cut-off for China.
Clinical CVH differences still exist among different ethnic groups, with a decline in CVH from 2016 to 2020 in all except Kazakh and Hui males. This may indicate a higher incidence and poorer prognosis of cardiovascular disease in the future and can provide guidelines for improving CVH.

BACKGROUND: Sarcopenia is an age-related decline in skeletal muscle mass, which depends on an assessment of muscle strength and muscle mass. The diagnostic definition of sarcopenia varies by region.
OBJECTIVE: To determine the optimal diagnostic criteria for sarcopenia in a plateau population. Cut off values for the components of diagnostic algorithms for sarcopenia in plateau populations should consider altitude.
METHODS: One hundred and fifty subjects aged > 60 years attending a tertiary comprehensive hospital in the city of Xining (elevation: 2260 m) between October and December 2018 were enrolled. Handgrip strength, muscle mass, and physical performance were measured. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, Beijing criteria, and Lasha criteria.
RESULTS: Across diagnostic criteria, there were significant differences in the prevalence of sarcopenia in the overall population and stratified by gender. The prevalence of sarcopenia measured by the AWGS 2019 or Lasha criteria was significantly higher in female compared to male subjects. In males, the prevalence of sarcopenia measured by the Beijing criteria was significantly higher in subjects who identified as Han compared to Minority. In females, there were no significant differences in the prevalence of sarcopenia by ethnicity according to any criteria.
CONCLUSIONS: The Lasha criteria provided a lower prevalence of sarcopenia (males, 8.7%; females, 22.41%; overall, 14%) and were able to differentiate between males and females. The Lasha criteria are likely most appropriate for detection of sarcopenia in this plateau population. We recommend the Lasha criteria for detection of sarcopenia in Xining.

Through the study of death characteristics and trend prediction, it is hoped that key populations, regions and seasons can be identified, thereby providing evidence support for the efficient prevention and control management of unintentional injury deaths.
We collected information on 8630 unintentional deaths of children under age 5 from local surveillance systems, analyzed by chi-square test and predicted by the seasonal ARIMA model.
About 33.1% of child deaths were under the age of 1, 60.5% were boys, 37.6% were in urban areas, 2.6% were among ethnic Tibetans, 6.8% were among ethnic Yi, and 46.6% died inside houses. The top three of total deaths were accidental drowning (35.0%), accidental suffocation (32.7%) and traffic accident (15.5%). The ratio of males to females in traffic accidents (1.28:1) and poisoning (1.30:1) deaths was relatively lower than accidental falls (1.62:1) and drowning (1.85:1). The causes of death ratio in rural and urban areas were: drowning (1.83:1), poisoning (1.75:1), suffocation (1.62:1), traffic (1.41:1), and falling (1.24:1). Children\'s deaths of ethnic minority groups of Tibetan and Yi increased year by year (χ2=75.261, P< 0.001). Tibetan and Yi groups had the most deaths in summer, and Han in winter (χ2=29.093, P< 0.001). Accidental suffocation accounted for 78.2 percent of the total unintentional deaths of children under age 1. And drowning accounted for only 2.4 percent. The model SERIMA (1, 1, 2) (2, 0, 0) [12] is suitable for describing and predicting unintentional injury deaths of children under age 5.
We should combine death surveillance with qualitative investigation or in-depth quantitative investigation to further analyze unintentional injury deaths in children.

To provide us with some evidence to develop more targeted stroke intervention strategies, improve the health awareness of stroke among children, and advocate the health promotion campaign of \"small hands holding big hands\" among parents and children, we have conducted a health education program on stroke among primary school students in Dali.
This study has applied stratified random cluster sampling in Dali of Yunnan, China. We compared the improvement of students\' knowledge of stroke before and after our health education program in primary school students of Dali in October 2020. Data were collected through 3 rounds of survey by using the same questionnaire.
There were 215 participants aged 7-8 years old sampled in the first phase of the study and 145 participants in the follow-up study. The knowledge of stroke among the participants was relatively low in the pre-intervention survey. After the health education, all the indicators on stroke knowledge were improved. The correct rates in stroke definition, sequelae, and \"1-2-0\" identification were increased from 0 to 66.05%, to 53.95% and 64.19%, respectively, in both pre-intervention and post-intervention surveys. The correct rate of stroke knowledge was about 4.83-92.41% 3 months after the intervention. The mean score of the questionnaire was 4.25 ± 0.19 in the pre-intervention survey, and that was 15.85 ±0.27 in the post-intervention one. The mean score was 14.02 ± 0.28 post-3-month test. The score in the 3-month survey after the intervention was 11.55% lower than that in the post-intervention score.
The effect of stroke-related knowledge in the health education program for children is improved significantly and this can last for 3 months but it also had attenuation. We should repeat pertinent health education among students.

UNASSIGNED: We aimed to investigate the demographic situation relating to people with hearing loss in Xinjiang, the largest province in China. The situation may vary between regions and races.
UNASSIGNED: We conducted a population-based demographic study. We analyzed data obtained from 3931 people with hearing impairments (i.e., from the Han or Uyghur ethnic groups) including children and adults. We accounted for the survey design and sampling size in order to ensure that estimates were regionally representative. Basic characteristics were determined, and an ethnic distribution analysis was conducted based on age group, level of educational, marital status, and level of disability.
UNASSIGNED: Of the 3931 participants, 2228 (56.68%) were male and 1703 (43.32%) were female. The mean age of the participants was 46.02 (±19.46) years. Most of the participants (26.20%) were in the 45-59 yr age group. Illiterate people constituted the largest group (34.19%) in the Uyghur population, while a substantial proportion of participants of Han nationality had obtained a junior education (28.98%). The number of unmarried people in both ethnic groups accounted for the highest proportion (more than 70%). Grade 3 was the highest grade observed in the Uyghur population (32.35%), while Grade 1 hearing impairments were the most prevalent in the Han population (28.28%).
UNASSIGNED: The difference in basic characteristics between participants of Uyghur and Han ethnicity revealed that different provinces should set different prevention and control targets. Different policy measures should be taken to allocate medical resources and provide rehabilitation services to assist people with hearing impairments in Xinjiang, China.

The status of children\'s early motor skills play an important role during childhood and across lifetime. This study described FMS proficiency among boys (n = 189) and girls (n = 179) kindergarten children from 3 to 6 years old (4.4 s 0.7, mean ± SD) in northwest China. The differences in FMS proficiency of boys and girls from different environments, ethnic groups were analyzed respectively.
TGMD-3 was used to assess FMS. FMS mastery level was defined according to the correct performance of all criteria over two trials. The correlation between BMI and FMS and the interaction of environmental and ethnic on FMS were analyzed. The general linear model was used to evaluate the differences of boys and girls among environment groups (urban/suburban/county), and ethnic groups (Han/Hui/Tibetan) on the FMS subsets respectively.
FMS proficiency was assessed in 368 3- to 6-year-old children (n = 156 urban, n = 101 suburban, n = 111 county)/(n = 208 Han, n = 107 Hui, n = 53 Tibetan). Overall, the highest skill performance was the run, with 86% achieving mastery level, and the poorest performance was the FH strike, at only 19%. Correlation between BMI and FMS is minimal. According to TGMD-3 scores, there was no significant difference between boys and girls in total FMS (p = 0.38). In terms of locomotor skills, boys performed better than girls in the hop, skip and slide (p < 0.05). County children performed significantly difference than urban and suburban children. Some skills performed less proficiently, (boys in 6 of 13 skills: run, HJ, slide, TH strike, FH strike and kick; girls in 4 of 13 skills: run, slide, TH strike and kick) and some skills performed more proficiently (boys in dribble; girls in hop and dribble). Tibetan children performed significantly difference than Han and Hui children. Some skills performed less proficiently, (boys in 6 of 13 skills: run, HJ, slide, TH strike, FH strike and kick; girls in TH strike) and some skills performed more proficiently (boys and girls were all in dribble).
Children in northwest China showed certain characteristics in FMS, the county/Tibetan boys and girls performed poorer than others in ability to execute particular process characteristics of some skills and performed more outstanding in other skills. It suggests that a certain group population may need specific focus on interventions to improve their FMS level.

We aimed to evaluate the effects of different ethnicities and potential environmental exposure on the prevalence of thyroid autoimmune status and hypothyroid status.
The data were obtained from two cross-sectional studies.
2105 participants in Shanghai (Han) and 772 participants in Yunnan Honghe Prefecture (Han, Yi, Miao and Hani), aged 18-75 were enrolled.
Participants underwent several checkups, including urinary iodine concentration, blood lead (BPb) and blood cadmium (BCd), thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyroid stimulating hormone (TSH) as well as thyroid ultrasonography (US). Thyroid autoimmune status was defined as: antithyroid antibody positive (ATA+): TPOAb + or TgAb+; and ATA + and US+: TPOAb + or TgAb + together with characteristic US features.
The standardised prevalence of thyroid autoimmune positivity in Yunnan were higher than those in Shanghai (TPOAb+: 13.56% vs 8.27%, p<0.001; TgAb+: 9.28% vs 7.09%, p=0.045; ATA+: 16.96% vs 11.10%, p<0.001; ATA + and US+: 8.96% vs 6.64%, p=0.036). For urinary iodine-to-creatinine ratio (UI/Cr), compared with the level of 100.00-199.99 µg/g, the level of ≥300.00 µg/g had a 1.5-fold risk for ATA + and US+ (OR 1.455, p=0.041). The levels of 200.00-299.99 µg/g and ≥300.00 µg/g were positively associated with hypothyroid status (OR 1.509, p=0.002 and OR 1.338, p=0.043). Compared with the first quartiles, the fourth quartiles of BPb were positively associated with TPOAb+: (OR 1.637, p=0.006), ATA+ (OR 1.435, p=0.025), ATA + and US+ (OR 1.641, p=0.013), hypothyroid status (OR 1.467, p=0.013) and TSH levels (B 0.092, p=0.021). The fourth quartile of BCd was positively associated with the prevalence of ATA+ (OR 1.427, p=0.036).
Higher levels of UI/Cr, BPb and BCd may be associated with thyroid autoimmunity and hypothyroid status.

BACKGROUND: Hepatitis B is a potentially life-threatening liver infection caused by hepatitis B virus (HBV) and China has the largest disease burden. We aim to understand the ethnic disparities in HBV infection among the married reproductive-age couples planning for pregnancy in Yunnan, a multiethnic province in Southwest China, to increase the health equities within the hepatitis response in China.
METHODS: A population-based cross-sectional study was performed. Couples aged 20-49 years in rural Yunnan were enrolled through the National Free Preconception Health Examination Project from Jan 2014 to Dec 2019. HBsAg-positive couples were defined as couples in which one or both were HBsAg-positive, and HBsAg- and HBeAg-positive couples were defined as couples in which one or both were HBsAg- and HBeAg-positive. The HBV prevalence of positive couples was estimated by ethnicity. Multivariate logistic regression analyses were used to assess the association between ethnicity and HBsAg status.
RESULTS: Overall, 63,513 of 1,060,643 couples (5.99%, 95% CI, 5.94%-6.03%) were HBsAg-positive, and 15,898 of 63,513 HBsAg-positive couples (25.03%, 95% CI 24.69%-25.37%) were HBsAg- and HBeAg-positive couples in rural Yunnan. The highest prevalence of HBsAg-positive couples was in the Miao and Miao ethnicity (12.04%) and Zhuang and Zhuang ethnicity (9.76%), and the risk of HBV infection of wives/husbands in these ethnic groups was significantly higher than that in the Han and Han ethnicity. Additionally, the HBsAg prevalence in wives/husbands has increased with the positive status of HBsAg and HBeAg of their spouses.
CONCLUSIONS: The HBV prevalence in reproductive-age couples was intermediate (6% of 1 million couples) in rural Yunnan, China, with the highest in the Miao and Zhuang ethnicities. There are still large ethnic disparities in HBV infection in China. Therefore, China should make great efforts, especially giving priority to ethnic minorities and taking positive couples as an important unit of care, to equitably eliminate the HBV intrafamilial transmission.