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INTRODUCTION Imaging biomarkers are fundamental in diagnosing neurodegenerative diseases, but their use in FTD remains limited. This study examines PET biomarkers in Argentine bvFTD patients. METHODS We studied a cohort of bvFTD patients (n = 20) and controls (n = 21) with three different PET radiotracers (18F‐FDG, 11C‐PiB, and 18F‐AV1451). RESULTS In bvFTD patients, 18F‐FDG PET showed significant hypometabolism in frontotemporal regions, along with hypermetabolism in the precentral gyrus, compared to normal controls. 11C‐PIB did not reveal a pattern typical of Alzheimer's disease, yet increased uptake was notably observed in the precentral region. We found 18F‐AV1451 uptake in frontal lobe, parietal, precuneus, cuneus, posterior cingulum, highly significant in bvFTD with respect to NCs. DISCUSSION PET biomarkers are a crucial tool in diverse real‐world clinical scenarios. However, their utility in revealing questions about the underlying pathology in FTD is still limited. Highlights First bvFTD study using 18F‐FDG, 11C‐PIB, and 18F‐AV1451 PET in a Latin American cohort. Frontotemporal hypometabolism with compensatory precentral hypermetabolism due to amyloid. Amyloid deposits observed in the precentral gyrus without an Alzheimer's‐like pattern. 18F‐AV1451 shows limitations in specificity for bvFTD pathology. Study provides new insights into PET biomarker utility for bvFTD clinical assessment.

While South Americans are underrepresented in human genomic diversity studies, Brazil has been a classical model for population genetics studies on admixture. We present the results of the EPIGEN Brazil Initiative, the most comprehensive up-to-date genomic analysis of any Latin-American population. A population-based genome-wide analysis of 6,487 individuals was performed in the context of worldwide genomic diversity to elucidate how ancestry, kinship, and inbreeding interact in three populations with different histories from the Northeast (African ancestry: 50%), Southeast, and South (both with European ancestry >70%) of Brazil. We showed that ancestry-positive assortative mating permeated Brazilian history. We traced European ancestry in the Southeast/South to a wider European/Middle Eastern region with respect to the Northeast, where ancestry seems restricted to Iberia. By developing an approximate Bayesian computation framework, we infer more recent European immigration to the Southeast/South than to the Northeast. Also, the observed low Native-American ancestry (6–8%) was mostly introduced in different regions of Brazil soon after the European Conquest. We broadened our understanding of the African diaspora, the major destination of which was Brazil, by revealing that Brazilians display two within-Africa ancestry components: one associated with non-Bantu/western Africans (more evident in the Northeast and African Americans) and one associated with Bantu/eastern Africans (more present in the Southeast/South). Furthermore, the whole-genome analysis of 30 individuals (42-fold deep coverage) shows that continental admixture rather than local post-Columbian history is the main and complex determinant of the individual amount of deleterious genotypes.

Background Hispanics living in the USA may have unrecognized potential birthplace and lifestyle influences on the gut microbiome. We report a cross-sectional analysis of 1674 participants from four centers of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), aged 18 to 74 years old at recruitment. Results Amplicon sequencing of 16S rRNA gene V4 and fungal ITS1 fragments from self-collected stool samples indicate that the host microbiome is determined by sociodemographic and migration-related variables. Those who relocate from Latin America to the USA at an early age have reductions in Prevotella to Bacteroides ratios that persist across the life course. Shannon index of alpha diversity in fungi and bacteria is low in those who relocate to the USA in early life. In contrast, those who relocate to the USA during adulthood, over 45 years old, have high bacterial and fungal diversity and high Prevotella to Bacteroides ratios, compared to USA-born and childhood arrivals. Low bacterial diversity is associated in turn with obesity. Contrasting with prior studies, our study of the Latino population shows increasing Prevotella to Bacteroides ratio with greater obesity. Taxa within Acidaminococcus, Megasphaera, Ruminococcaceae, Coriobacteriaceae, Clostridiales, Christensenellaceae, YS2 (Cyanobacteria), and Victivallaceae are significantly associated with both obesity and earlier exposure to the USA, while Oscillospira and Anaerotruncus show paradoxical associations with both obesity and late-life introduction to the USA. Conclusions Our analysis of the gut microbiome of Latinos demonstrates unique features that might be responsible for health disparities affecting Hispanics living in the USA.

Telehealth (care delivered by phone or video) comprises a substantial proportion of cardiology care delivered in the Veterans Health Administration (VHA). Little is known about how factors specific to patients, clinicians, and facilities contribute to variation in cardiology telehealth use. The aim of this study is to estimate the relative extent to which patient-, clinician-, and facility-level factors affect cardiology telehealth use in VHA. This was a retrospective, nation-wide cohort study of veterans' use of VHA cardiology telehealth care during the first 2 years of the COVID-19 pandemic (March 11, 2020, to March 10, 2022). We constructed multilevel, multivariable, logistic regression models of patient-level cardiology telehealth use (telephone or video-based care). Models included random effects for the patient, the patient's main cardiology provider, and the patient's primary facility (ie, VHA medical center) for specialty care and fixed effects for patient sociodemographic and clinical characteristics. Our analytic cohort comprised 223,809 veterans with 989,271 encounters among 2235 unique clinicians. The veterans' average age was 70.2 years, and 3.4% (n=7616) were women. Of the 989,271 encounters, 4.2% (n=41,480) were video based and 34.3% (n=338,834) were phone based. Adjusted odds of telehealth use were slightly higher for women versus men (adjusted odds ratio [AOR] 1.08, 95% CI 1.05-1.10), individuals identifying as Hispanic or Latino versus not Hispanic or Latino (AOR 1.46, 95% CI 1.43-1.49), and those with medium and long drive times versus short drive time (AOR 1.11, 95% CI 1.10-1.12 and AOR 1.09, 95% CI 1.07-1.10, respectively). Further, 40.5% of the variation in a veteran's likelihood of using cardiology telehealth care was found at the patient level, 30.8% at the clinician level, and 7% at the facility level. The largest share of the attributable variability in VHA cardiology telehealth use in this cohort was explained by the patient, followed closely by the clinician. Little variability was attributed to the primary facility through which the veteran received their cardiology care. These results suggest that policy solutions intended to improve equity of cardiology telehealth care use in VHA may be most impactful when directed at patients and clinicians.

Background Examining the neuropathology of the oldest‐old has significantly advanced our understanding of the multiple etiologies in very late life. Most studies, however, have included mostly White decedents with limited ethnoracial diversity. Our goal was to characterize neuropathology in a cohort of ethnically and racially diverse oldest‐old decedents. Method The LifeAfter90 study is an ongoing cohort study of Kaiser Permanente Northern California members, aged 90+ with targeted recruitment of individuals across different racial/ethnic groups with no prior diagnosis of dementia in their medical record. Interviews and cognitive assessments occur approximately every 6 months. Brain donation was available to all interested consenting participants. Neuropathology was assessed using National Alzheimer's Coordinating Center Neuropathology forms and NIA‐AA guidelines for diagnoses. Result As of January 2025, 390 participants (34%) had enrolled in autopsy (22% Asian, 20% African American, 18% Latino, 9% Multiracial/Other, and 33% White). Of the 390 participants, 124 had died and neuropathological evaluations completed. The mean age of death was 95 years (range 90‐105), 75 (60%) were female, 21 Asian, 15 Black, 23 Latino, 61 White, and 1 Native American (Table 1). At final clinical exam, 43 participants had dementia (35%), 29 had cognitive impairment without dementia (23%), and 52 had normal cognition (41%). Alzheimer disease (AD) and vascular neuropathologies were the most frequent (Table 2). 79% of participants had at least low likelihood of AD and all but one had neurofibrillary tangles (NFT). However, the most severe level of AD, NFT, and plaques were infrequent. For vascular pathologies, 73% had moderate/severe arteriolosclerosis, 42% moderate/severe atherosclerosis, and 23% 1+ microinfarct. Neurodegenerative pathologies other than AD were less common: 32% had Lewy bodies (6 cases having diffuse type), 24% LATE‐NC, and 4 cases hippocampal sclerosis. Frequencies of other pathologies are shown within the Figure. Cognitive status was associated with the presence of AD neuropathologies, but not other neuropathological changes. Conclusion This ethnoracially diverse cohort of oldest‐old individuals reveal numerous brain pathologies are present with advanced age, with AD and select vascular pathologies being the most common. This shows that as in younger cohorts, AD neuropathologies are an important driver of cognitive impairment.

Objectives. To assess whether Latino patients receiving care in community-based health centers (CHCs) in US states that expanded Medicaid eligibility regardless of immigration status to adults 50 years and older had greater insurance coverage after the eligibility amendment compared with states that did not expand eligibility. Methods. We performed a retrospective cohort study, using electronic health record data from 40 602 nonpregnant CHC patients aged 50 to 64 years living in states that expanded eligibility (OR, CA) or that did not (AK, CT, IN, MN, MT, NC, NJ, OH, WA) with a visit in both 2018-2019 (before policy change) and 2021-2023 (after policy change). Results. Among Spanish-preferring Latinas, the overall Medicaid-insured difference-in-difference estimate across all 3years after the amendment was positively moderate (average treatment effect on treated [ATT] = +7.04; 95% confidence interval [Cl] = 0.10, 13.98); however, this effect was greatest in the third year after the amendment (ATT = 421.82; 95% Cl = 14.04, 29.59), and this was accompanied by a substantial drop in third year uninsured visit rates (ATT = -15.45; 95% Cl = -24.77, -6.13). We observed the same pattern for Spanish-preferring Latinos. Conclusions. The findings suggest that expanding Medicaid eligibility regardless of immigration status improved access to health insurance for some Latino communities. (Am J Public Health. 2025;115(6): 900-909.

BACKGROUND Effect of apolipoprotein E (APOE) on Alzheimer's disease and related dementias (ADRD) risk is heterogeneous across populations, with scarce data on Hispanics/Latinos. METHODS APOE genotype was studied in 12,221 Hispanics/Latinos (per cohort and via metanalysis): Caribbean‐Hispanics, Mexicans, Mexican‐Americans, and Peruvians/Bolivians. A subsample had longitudinal assessment and plasma p‐tau. We tested the modifying effects of global and local ancestries. Results were replicated in an independent Peruvian cohort and brain samples. RESULTS APOE ε4 effect was strongest in Peruvians/Bolivians (odds ratio [OR] = 6.13, 95% confidence interval [CI] = 2.71–13.83), followed by Mexicans (OR = 4.31, 95% CI = 1.58–11.74), Mexican‐Americans (OR = 3.06, 95% CI = 2.04–4.59), and Caribbean‐Hispanics (OR = 2.22, 95% CI = 1.99–2.48). Meta‐analyses showed OR = 2.32 (95% CI = 2.09–2.57) and OR = 0.81 (95% CI = 0.68–0.97) for the ε4 and ε2 allele, respectively. The APOE ε4 effect was replicated independently in Peruvians (OR = 5.06, 95% CI = 2.48–10.70). ε4 carriers displayed higher ADRD conversions and p‐tau levels. Global and local ancestries did not modify ADRD risk, and they were associated with Braak stage. DISCUSSION APOE shows a heterogeneous effect on ADRD risk in our Hispanics/Latinos sample, the largest to date. Highlights The apolipoprotein E (APOE) ε4 effect is stronger in Peruvians/Bolivians than in other Hispanic/Latino groups. The strong APOE effect size in Peruvians and Bolivians was replicated in a second independent Peruvian cohort. Meta‐analysis for ε4 and ε2 confirmed a significant association with Alzheimer's disease and related dementias (ADRD). Global and local ancestry do not modify the association between APOE genotype and ADRD.

Background Examining the neuropathology of the oldest‐old has significantly advanced our understanding of the multiple etiologies in very late life. Most studies have included exclusively White decedents with limited ethnoracial diversity. Our goal was to characterize neuropathology in a cohort of ethnically and racially diverse oldest‐old decedents. Method The LifeAfter90 study is an ongoing cohort study of Kaiser Permanente Northern California members, aged 90+ with targeted recruitment of individuals across different racial/ethnic groups with no prior diagnosis of dementia in their medical record. Interviews and cognitive assessments occur approximately every 6 months. Brain donation was available to all interested consenting participants. Neuropathology was assessed using National Alzheimer’s Coordinating Center Neuropathology forms and NIA‐AA guidelines diagnoses. Result As of January 2024, 340 participants (39%) have enrolled in autopsy (22% Asian, 18% African American, 17% Latino, 9% Multiracial/Other, and 34% White). Of the 340 participants, 91 had died and neuropathological evaluations were completed. The mean age of death was 95 years (range 90‐105), 51 (56%) were female, 12 Asian, 10 Black, 16 Latino, 44 White, and 8 Multiracial/Other. At final clinical exam, 25 participants had dementia (28%), 24 had cognitive impairment no dementia (CIND, 42%), and 41 had normal cognition (45%) (Table 1). Alzheimer disease (AD) and vascular pathologies were the most frequent findings (Figure & Table 2). Nineteen percent of participants did not have AD, one lacked neurofibrillary tangles (NFT). The most severe distributions/densities of NFTs and plaques were infrequent, with high likelihood of AD in only four participants. For vascular pathologies, 54% had moderate/severe white matter rarefaction and 76% had moderate/severe arteriolosclerosis. Thirty‐three percent had Lewy bodies, with six cases having diffuse type. Two cases had hippocampal sclerosis. One case had pathologic evidence of progressive supranuclear palsy and had dementia at last diagnosis. Conclusion This ethnoracially diverse cohort of over 90 oldest‐old individuals reveal numerous brain pathologies are present with advanced age, with AD and select vascular pathologies being the most common. This confirms previous findings that with increases in cognitive impairment there is increasing pathology severity especially for AD pathologies.

The objective of this analysis was to describe individual and structural-level factors associated with pre-exposure prophylaxis (PrEP) use among a sample of sexual and gender minorities (SGM) at risk for HIV recruited using limited interaction strategies. SGM (N = 3330), ages 15–34, without HIV enrolled in a nationwide limited interaction cohort study from 2017 to 2020. A baseline cross-sectional single-survey design examined individual and structural-level correlates of PrEP lifetime use and current use using logistic regression. PrEP lifetime use and current use were reported by 31.2% and 23.9%, respectively, of SGM with PrEP data (n = 3077). PrEP use outcomes (lifetime or current use) in cisgender MSM were associated with being over age 18, Black or other race, Hispanic/Latina/x/o ethnicity, being gay, being out to one’s healthcare provider, having health insurance, being a college graduate, and having a greater number of PrEP peers. PrEP use outcomes (lifetime use or current use) in transgender/non-binary participants were associated with being over age 24, being Latinx, being transgender vs. non-binary, being assigned male at birth, being out to their healthcare provider, living in the western or northeastern United States, and having more peers on PrEP. More work is needed to address lower PrEP uptake in SGM under 18 and those whose sex risk may be more dynamic (e.g., non-binary, pansexual/queer, and bisexual SGM) and such strategies should consider utilizing peers to provide information and ameliorate structural barriers.

Purpose To determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors. Methods SLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual. Results 901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, p<0.001 (OR 2.62, 95% CI 1.31 to 5.24, p=0.006 for severe and OR 1.91, 95% CI 1.28 to 2.83, p=0.001for mild-moderate). Conclusions The number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors.