Office of Minority Health

This work embodies over 30 years of research, and this publication is incredibly moving for me because it was created in collaboration with Sebastiano Tusa, Aldina Cutroni Tusa, Maurizio Tosi, and Vincenzo Tusa, who have always been dear to my heart. Great Masters not only in their profession but also in their lives, for whom respect was a priority because they were all linked by deep friendships. The area’s history, spanning at least 12,000 years and linked to the extensive and continuous humanization of the land, required special attention, but now it seems that every piece has been placed in the right place within the panorama of Sicilian antiquity. The Upper Paleolithic and Mesolithic periods (10,000-8,000 BC) held the greatest surprises, revealing an unexpected humanization of this hinterland in several locations, even remote ones. It was the period of hunting and gathering, and prehistoric man likely found ideal conditions for better survival in this area. Groups of hunter-gatherers pushed towards this hinterland which reached its peak with the transition to the Neolithic, and therefore with the advent of agriculture and livestock farming. Another established fact is that the two major historical entities of the territory, Corleone and Montagna Vecchia, should not be separated, because one is consequential to the other, but always within a single Chora, of which Montagna Vecchia constituted the natural stronghold inhabited during external incursions by other peoples colonizing Sicily. The latest discoveries have confirmed this fact, which was achieved by traversing inaccessible areas and crossing an often impenetrable nature that has also put our physical safety to the test. However, the result achieved is amply rewarding, as the vast amount of data collected now allows us to have a “scientific historical” and, above all, a clearer view of the evolution of Montagna Vecchia/Corleone. To achieve this goal, we long ago abandoned the study of sources, especially literary ones, which are highly unreliable and riddled with errors. For example, ArabSicilian sources provide us with unrealistic distances in Arabic miles between the cities in this area, while those (Scuderi, Tusa, & Vintaloro, 1997; Vintaloro, 2020)1 from the 17th to 20th centuries merely represented a “competition” to see who had the most important ancient city and to whom a name was attributed, a name rarely found today. This was merely a desire for parochialism that has unfortunately diverted methodical and scientific study of the area. Archaeological research in this area, conducted using rigorous scientific methods, only began in 1991. Unfortunately, Corleone enjoys a reputation that will not be easy to shake: land of the Mafia. Indeed, in the 1950s and 1960s, the Superintendencies expanded into the interior of Sicily with their research, but no one ever wanted to delve deeper into the Corleone area, where a terrible Mafia war was raging at the time. A simple glance at an archaeological map of Sicily prior to 1991 reveals a lack of knowledge about this area. Thanks also to Ferdinando Maurici, a renowned medievalist, for his scientific collaboration in reconstructing the region’s history during a particular period, presentday Corleone arose. We hope this work will stimulate further research, providing the necessary depth to support our conclusions and placing this area in its proper rank among Sicilian archaeological sites.

Abstract Abstract Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in patients with heart failure (HF) but underlying mechanisms remain incompletely understood. Cardiac magnetic resonance (CMR) is key in evaluating cardiac structure and function, enabling accurate assessment of reverse remodeling. Aim of this systematic review and meta-analysis was to assess the effects of SGLT2i on cardiac remodeling evaluated by CMR changes. Methods We conducted a systematic review and meta-analysis of studies assessing changes in CMR parameters in patients treated with SGLT2i (PROSPERO registration: CRD42024574302). Databases were searched through April 30, 2025. Random-effects models were used to pool mean changes in left and right ventricular volumes, mass, function, stroke volume, global longitudinal strain, left atrial volume, and tissue characterization indices. Meta-regression and sensitivity analyses were performed to evaluate potential sources of heterogeneity. Results Twenty-one studies and 1008 patients were included. Treatment with SGLT2i was associated with significant reductions in left ventricular (LV) end-diastolic volume (−7.1 mL; 95% CI: −13.0 to −1.2, p=0.023, Figure 1) and left ventricular mass (−4.2 g; 95% CI: −7.9 to −0.6, p=0.027, Figure 2). No significant change was noted in other CMR parameters. A subgroup analysis in patients with reduced LV ejection fraction showed improvement in LV stroke volume. Meta-regression revealed no significant effect of age, male sex or diabetes prevalence on pooled estimates. Conclusions SGLT2i are associated with favorable reverse remodeling effects as assessed by CMR, including reductions in LV end-diastolic volume and mass.Figure 1 Figure 2

In professional development (PD), who the learners are becomes a central feature that influences not only their learning, but also that of those around them. Participant identities, expectations, and teaching philosophies all influence the success of PD. In 2019, Zagallo and colleagues developed a set of personas to characterize how instructors show up in these settings. We are expanding on this prior study to include instructors from diverse institution types participating in a different PD context. To validate the existing personas and generate potential new personas, we followed Zagallo's stepwise procedure that included the collection of multiple types of data (interview transcripts, PD observations, meeting observations) over a 2-y period, qualitative analysis and triangulation of data, creation of skeletons that could be further developed into personas, description and refinement of skeletons into personas, and validation of the personas. Themes from the original study were also captured in this study: knowledge of students, teaching values, approaches to innovations, and perceived barriers. Four personas from the original paper were refined, and two new personas (Riley the Rookie and Ash the Advocate) were identified; both arose from institutional contexts not present in the prior research.

BackgroundChildren’s eating behaviors influence weight, but the relationships among children’s eating behaviors, caregiver feeding styles, and modifying maternal and child factors remain unclear.ObjectivesThis study aimed to examine the associations between 1) child eating behaviors and body mass index (BMI) z-scores, and 2) caregiver feeding style and child eating behaviors.MethodsData from 290 Hispanic mother–child dyads (children aged 3–9 y) in the Hispanic Community Health Study/Study of Latinos Family Lifestyle Outcomes Research cohort were analyzed cross-sectionally. Child eating behaviors, caregiver feeding styles, and child BMI z-scores were assessed. Linear regression examined: 1) child eating behaviors and BMI z-scores, and 2) caregiver feeding styles and child eating behaviors. Models adjusted for maternal marital status, prepregnancy BMI, child health, Supplemental Nutrition Assistance Program status, poverty level, and study site.ResultsHigher child food responsiveness [β = 0.16; 95% confidence interval (CI): 0.01, 0.32] and enjoyment of food (β = 0.18; 95% CI: 0.02, 0.33) were associated with higher BMI z-scores, while greater satiety responsiveness (β = −0.23; 95% CI: −0.42, −0.04) was associated with lower BMI z-score. Authoritarian feeding style was associated with a lower enjoyment of food (β = −0.72; 95% CI: −1.06, −0.38), greater food fussiness (β = 0.42; 95% CI: 0.09, 0.76), greater satiety responsiveness (β = 0.57; 95% CI: 0.31, 0.84), and greater slowness in eating (β = 0.44; 95% CI: 0.13, 0.76). An indulgent feeding style was associated with a lower desire to drink (β = −0.52; 95% CI: −0.90, −0.13), lower satiety responsiveness (β = −0.36; 95% CI: −0.65, −0.10), and lower emotional undereating (β = −0.55, 95% CI: −0.84, −0.25). An uninvolved feeding style was associated with lower emotional undereating (β = −0.63; 95% CI: −0.97, −0.29).ConclusionsChild food approach behaviors correlate with higher BMI. Findings on caregiver feeding styles and child eating behaviors show complex, sometimes unexpected patterns, highlighting the need for further interdisciplinary research.

This study aims to evaluate the strengths, opportunities, and facilitators in the implementation of the National Policy for Comprehensive Men’s Health Care (PNAISH) in Brazil in response to user demands. A mixed-method approach was applied to residents across Brazil between April and July 2024 through a web survey using a semi-structured questionnaire addressing sociodemographic characteristics, engagement, and critiques of the PNAISH. The qualitative analysis employed the Collective Subject Discourse method. A total of 144 individuals participated, primarily young cisgender men, with 80.5% holding postgraduate degrees and 75.7% engaged in male health initiatives. Progress has been observed in the implementation of the PNAISH, particularly in primary care, yet challenges persist regarding policy dissemination and managerial involvement. Most respondents (77.8%) recognized strengths and facilitators in PNAISH, with 43.8% reporting its implementation at both state and municipal levels. Qualitative narratives revealed that participants perceive PNAISH as a strategic opportunity not only to engage men in preventive care but also to foster reflection on masculinities, self-care, and health promotion. Many highlighted that the policy helps to overcome cultural stigmas that traditionally distance men from health services, especially through educational actions and intersectoral strategies. While the policy has advanced access and male participation in health services, structural barriers and limited visibility still constrain its broader impact and effective engagement.

To examine whether geographic driving distance to substance use disorder (SUD) treatment varies by racial/ethnic concentration of residents in urban and rural communities. We conducted a cross-sectional analysis at the ZIP Code Tabulation Area (ZCTA) level using data from the Substance Abuse and Mental Health Service Administration (SAMHSA) 2021 Behavioral Health Treatment Services Locator. We conducted logistic regressions to examine rural-urban differences in driving distances to SUD treatment facilities among ZCTAs with a high relative concentration of a single racial/ethnic group. Urban ZCTAs with a high concentration of Black or Hispanic residents had greater odds of having a SUD treatment facility (odds ratio [OR] = 2.39, confidence interval [CI] [2.04, 2.81] and OR = 2.20, CI [1.86, 2.61], respectively), while ZCTAs with a high concentration of White and American Indian/Alaska Natives (AI/AN) communities had lower odds (OR = 0.26, CI [0.23, 0.30] and OR = 0.55, CI [0.47, 0.63], respectively), compared to all other ZCTAs. SUD treatment facilities, which have historically faced heavy stigmatization, are more likely to be placed in communities with a high concentration of Black and Hispanic residents. Consequently, White ZCTAs were less likely to have a SUD treatment facility nearby than other communities. This is important evidence to explore in determining whether stigmatization may play a role in treatment availability.

Subjective cognitive decline (SCD) may be an early indicator of Alzheimer disease and related dementias (ADRD), yet its association with plasma biomarkers remains unclear among middle-aged and older adults (aged 50-86 years). To examine associations between plasma biomarkers of amyloid, tau, neuroaxonal damage, and glial activation with SCD in a heterogeneous cohort of Hispanic and/or Latino adults. This cross-sectional study used survey-weighted data from the Study of Latinos-Investigation of Neurocognitive Aging, an ancillary study of the Hispanic Community Health Study/Study of Latinos. Participants were aged 50 to 86 years and resided in 4 major US cities. Data were collected from 2016 to 2018 and analyzed between December 2024 and June 2025. Plasma biomarkers included amyloid-beta (Aβ42/40), phosphorylated tau-181 (ptau-181), neurofilament light chain (NfL), and glial fibrillary acidic protein (GFAP), quantified using Simoa (Quanterix HD-X) and log-transformed (ln) to reduce skewness. SCD was assessed using the short-form Everyday Cognition Scale (ECog-12), evaluating global-, executive-, and memory-related SCD, and a single-item cognitive concerns question. Survey-weighted linear and logistic regression models tested associations between biomarkers and SCD, adjusting for demographic, cardiovascular, kidney, and APOE genotype covariates. Among 5712 adults (mean [SD] age, 63.47 (8.15) years; unweighted 3663 [53.92%] female), higher ln(ptau-181) was associated with ECog-12 memory (unstandardized β = 0.088; 95% CI, 0.005-0.170). Higher ln(NfL) levels were associated with greater ECog-12 global (unstandardized β = 0.169; 95% CI, 0.074-0.265), executive (unstandardized β = 0.182; 95% CI, 0.087-0.277), and memory (unstandardized β = 0.156; 95% CI, 0.065-0.248) domains. Higher ln(GFAP) levels were associated with greater ECog-12 global (unstandardized β = 0.109; 95% CI, 0.019-0.198) and executive (unstandardized β = 0.121; 95% CI, 0.031-0.211) domains. Ln(Aβ42/40) was not associated with SCD domains. Cognitive concerns significantly modified the associations between ln(NfL) and ECog-12 domains, with more pronounced associations among those reporting cognitive concerns. No biomarkers were associated with the single-item cognitive concerns score. In this study of middle-aged and older Hispanic and/or Latino adults, plasma biomarkers of p-tau181, NfL, and GFAP, but not Aβ42/40, were associated with greater SCD. These findings underscore their potential utility in early ADRD detection strategies.