Racial and ethnic determinants of psoriatic arthritis phenotypes and disease activity.

OBJECTIVE: Individuals of racially and ethnically diverse backgrounds are underrepresented in psoriatic arthritis (PsA) research/clinical trials, despite evidence that their disease presentation, severity and course may be distinct. Here we aim to describe how race, ethnicity and other socioeconomic factors inform disease characteristics in PsA. METHODS: 817 consecutive patients with PsA from a large, diverse metropolitan area, were enrolled in an observational, longitudinal registry. Demographics, medical history, medication use, and psoriatic disease phenotype and activity were all recorded and analyzed. RESULTS: The population was 77.4% non-Hispanic White, 2.2% Black, 7.1% Asian, and 9.9% identified as other races or multiracial, and 11.8% identified as Hispanic. Hispanic and non-White individuals had higher tender joint counts (p= 0.033) with similar swollen joint counts (p= 0.308) and medication use (p= 0.171). They also had high rates of radiographic axial disease. Hispanic individuals were significantly more likely to have higher tender joint counts (p= 0.029), higher RAPID3 scores (p= 0.004), and moderate-severe psoriasis (p= 0.010) compared with non-Hispanic White individuals. CONCLUSION: In this diverse cohort, 22.6% of patients identified as underrepresented racial and/or ethnic groups, mostly Asian or Hispanic. Despite similar swollen joint counts and medication use, non-white individuals have higher tender joint counts compared with white individuals. Phenotypically, they also were more likely to have radiographic axial involvement. These findings may reflect differences in PsA presentation, experience and outcomes in individuals of various racial and ethnic groups, which need to be taken into consideration in clinical care and research design.

Perceived Teacher Enthusiasm and Professional Commitment: The Mediating Role of Boredom and Learning Engagement.

Introduction: Some students in current society do not pursue careers related to their majors after graduation, which may be the result of low professional commitment of college students, and the teaching enthusiasm of college teachers presented in the classroom may influence students' professional commitment. This study considered the effect of teacher enthusiasm on students' emotional state of boredom during class and its effect on students' engagement in learning. This correlational study aims to explore the relationship between perceived teacher enthusiasm and professional commitment as mediated by class-related boredom and learning engagement. Methods: This study is a correlational design and adopts regression analysis. The respondents were college students (n=358; 68% female, 22% male) of different grades and majors from universities in Wenzhou, China. Questionnaires about perceived teacher enthusiasm, professional commitment, class-related boredom and learning engagement were adopted to measure the study variables. Results: The results reveal that although there is no significant direct influence between perceived teacher enthusiasm and professional commitment, perceived teacher enthusiasm affects students' professional commitment through students' class-related boredom and learning engagement, and there is an indirect and statistically significant correlation between them. Conclusion: This study provides insight into the facilitative effect of teachers' increased enthusiasm on students' professional commitment and how this facilitative effect is triggered through the mediating role of class related boredom and learning engagement. Future research should explore the theoretical and teaching significance and how to guide and enhance students' professional commitment.

Mixed and nonvaccine high risk HPV types are associated with higher mortality in Black women with cervical cancer.

We studied the incidence of HPV genotypes in mostly Black women with cervical carcinoma and correlated histopathologic tumor characteristics, immune markers and clinical data with survival. Disease-free survival (DFS) and overall survival (OS) were recorded for 60 months post-diagnosis. Fifty four of the 60 (90%) patients were Black and 36 (60%) were < 55 years of age. Of the 40 patients with typeable HPV genotypes, 10 (25%) had 16/18 HPV genotypes, 30 (75%) had one of the non-16/18 HPV genotypes, and 20 (50%) had one of the 7 genotypes (35, 39, 51, 53, 56, 59 and 68) that are not included in the nonavalent vaccine. Mixed HPV infections (≥ 2 types) were found in 11/40 (27.5%) patients. Patients infected with non-16/18 genotypes, including the most common genotype, HPV 35, had significantly shorter DFS and OS. PD-L1 (p = 0.003), MMR expression (p = 0.01), clinical stage (p = 0.048), histologic grade (p = 0.015) and mixed HPV infection (p = 0.026) were independent predictors of DFS. A remarkably high proportion of cervical cancer cells in our patients expressed PD-L1 which opens the possibility of the use of immune checkpoint inhibitors to treat these cancers. Exclusion of the common HPV genotypes from the vaccine exacerbates mortality from cervical cancer in underserved Black patients.