Publications

Keywords: One Health; occupational health; Total Worker Health; workplace health promotion programs.
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JHSS 2022;7(4):363-367
TECHNICAL VIEWPOINT IN MEDICAL EDUCATION
Risks associated with the citation of retracted medical literature
Authors: Jaime A. TEIXEIRA da SILVA^1*
Affiliation:
¹Independent researcher, Ikenobe 3011-2, Kagawa-ken, 761-0799, Japan. E-mail: jaimetex@yahoo.com
*Corresponding Author:
Jaime A. Teixeira da Silva, Independent researcher, Ikenobe 3011-2, Kagawa-ken, 761-0799, Japan. E-mail: jaimetex@yahoo.com

Abstract

If ever there was any field of research that carried weight within society, it would most certainly and arguably be medical research. The validity of medical research, transmitted via the medical literature and propagated as having been validated by robust peer review, tends to be associated with bibliometric platforms such as PubMed or databases such as Web of Science or Scopus. An unknown fraction of the existent medical literature is likely unreliable, either due to errors, fraud or misconduct, and in extreme cases, such papers are retracted. A general rule of thumb is that such papers should not be cited, but for several reasons, the citation of retracted medical literature is not always avoidable. This paper reflects on the citation of the medical literature, using several case studies to draw readers’ awareness to some of the issues, discussion points, and risks – bibliometric and practical – associated with the citation of retracted medical literature. The primary objective of this paper is to draw the attention of academics in the field of medicine to the risks associated with citing retracted literature.

Keywords: Citations; database credibility; fraud; misconduct; reference validation; retraction.
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JHSS 2022;7(4):368-380
VIEWPOINT IN OCCUPATIONAL HEALTH
The interplay between psychological stressors and biological hazards among healthcare workers during the COVID-19 pandemic
Authors: Paola TOMAO¹, Salvatore ZAFFINA², Reparata Rosa DI PRINZIO³, Nicoletta VONESCH^4*, Francesco CHIRICO^5#, Nicola MAGNAVITA^6#
Affiliation:
¹ Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Monte Porzio Catone (Rome), Italy. E-mail: p.tomao@inail.it. ORCID: 0000-0001-6690-0069.
² Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, Roma, Italy. E-mail: salvatore.zaffina@opbg.net.  ORCID: 0000-0002-8858-5423.
³ Occupational Medicine Unit, Bambino Gesù Children’s Hospital IRCCS, Roma, Italy. Alta scuola di economia e management dei sistemi sanitari (ALTEMS) – Università Cattolica del Sacro Cuore, Roma, Italy. E-mail: repdip@gmail.com. ORCID: 0000-0001-5956-1038.
⁴ Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Monte Porzio Catone (Rome), Italy. E-mail: n.vonesh@inail.it. ORCID: 
⁵ Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy. E-mail: francesco.chirico@unicatt.it. ORCID: 0000-0002-8737-4368.
⁶Postgraduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy. Department of Woman, Child & Public health Sciences, Fondazione Policlinico A. Gemelli IRCCS, Roma, Italy. E-mail: nicolamagnavita@gmail.com. ORCID: 0000-0002-0988-7344.
#Last co-authorship
*Corresponding Author: Nicoletta Vonesch, Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), Monte Porzio Catone (Rome), Italy. E-mail: p.tomao@inail.it.

Abstract

Despite the advent of modern technologies, biological risks still cause concern in workplaces. Healthcare workers (HCWs) are exposed to a wide range of occupational risks including biological and psychosocial ones. During the COVID-19 pandemic, HCWs experienced unprecedented levels of distress, especially due to the risk of SARS-CoV-2 contagion and the fear of spreading the virus in the work and social community. This emotional overload led to an increase in mental health disorders (e.g., anxiety, depression, and burnout) that can hinder patients’ safety and the quality of care. After outlining the international safety regulation on biological risks, we discussed the interplay between biohazard and psychosocial risk, focusing on how to prevent occupational infections in healthcare using comprehensive action strategies that aim to ensure a healthy work environment to improve, protect, and promote the health and safety of all workers.

Keywords: Healthcare workers; occupational infections; infectious diseases; biological risk assessment; biological risk management.
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JHSS 2022;7(4):381-396
SYSTEMATIC REVIEW IN IMMUNOLOGY
Associations between Interleukin-4 and COVID-19 severity: A systematic review and meta-analysis
Authors: Michal MATUSZEWSKI¹, Aanuoluwapo Adeyimika AFOLABI², Olayinka Stephen ILESANMI³, Michal PRUC⁴, Alla NAVOLOKINA⁵, Mahdi AL-JEABORY⁶, Magdalena BORKOWSKA⁷, Gabriella NUCERA⁸, Murat YILDIRIM⁹, Francesco CHIRICO^10#, Lukasz SZARPAK^11#*
Affiliation:
¹ Department of Anaesthesiology and Intensive Therapy at the Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland. E-mail: matuszewski.mike@gmail.com ORCID: 0000-0002-3467-1377.
² Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria. E-mail: afoannade@gmail.com.  ORCID: 0000-0001-9928-2252.
³ Department of Internal Medicine, Brody School of Medicine, East Carolina University, NC 27834, United States. E-mail: ileolasteve@yahoo.co.uk. ORCID: 0000-0003-0827-6442.
⁴ Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland E-mail: m.pruc@ptmk.org ORCID:0000-0002- 2140-9732. 
⁵ European School of Medicine, International European University, Kyiv, Ukraine; E-mail: allanavolokina@ieu.edu.ua. ORCID: 0000-0003-1711-6002.
⁶Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland E-mail: mmahdi@interia.pl. ORCID: 0000-0003- 4412-6409.
⁷ Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland. E-mail: mborkowska@onkologia.bialystok.pl. ORCID: 0000-0001-7858-776X.
⁸ASST Fatebenefratelli and Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy. E-mail: gabriellanucera@gmail.com. ORCID: 0000- 0003-1425-0046.
⁹Department of Psychology, Agri Ibrahim Cecen University, Turkey. E-mail: muratyildirim@agri.edu.tr. ORCID: 0000- 0003-1089-1380.
¹⁰Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy. Health Service Department, Italian State Police, Ministry of the Interior, Milan, Italy. E-mail: francesco.chirico@unicatt.it. ORCID: 0000-0002-8737-4368.
¹¹Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland. Maria Sklodowska- Curie Bialystok Oncology Center, Bialystok, Poland. Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, United States. E-mail: lukasz.szarpak@gmail.com. ORCID: 0000-0002-0973-5455.
#Last co-authorship
*Corresponding Author: Associate Professor, Lukasz Szarpak, 10 Zelaznej Bramy Square, 00-136 Warsaw, Poland. E-mail: lukasz.szarpak@gmail.com.

Abstract

Introduction: This systematic review and meta-analysis aimed to determine the correlation between
IL-4 concentrations and COVID-19 severity.
Methods: This study was designed as a systematic review and meta-analysis and was performed in accordance to the PRISMA statement. Titles, abstracts, and full texts of articles were independently reviewed by at least 2 authors. Continuous variables were compared by the mean difference (MD) with 95% confidence interval (CI).
Results: Thirty-three studies reported IL-4 levels among severe versus non-severe COVID-19 patients. Pooled analysis showed that levels of IL-4 among those groups varied and amounted to 2.72 ± 3.76 pg/mL vs 3.08 ± 4.14 pg/mL (MD = -0.26; 95%CI: -0.43 to -0.10; p = 0.002. In addition, eight studies reported levels of IL-4 among COVID-19 patients who survived vs deceased and was 2.61 ± 0.49 pg/mL vs (3.44 ± 16.4 pg/mL, respectively (MD = 0.22; 95%CI: 0.08 to 0.37; p = 0.002).
Discussion: This detailed systematic review and meta-analysis revealed that the plasma concentration of IL-4 is a potential risk factor for COVID-19 severity and mortality. Specifically, old age and male gender were associated with high IL-4 levels. Lung damage could result from the change in IL-4 concentration, thus making critical and severe COVID-19 cases at a very high risk of dying, thereby reducing their quality of life. Therefore, strategies such as using monoclonal antibodies to inhibit Th2 cytokines could be explored in developing an effective treatment regimen for COVID-19 patients.

Keywords: Interleukin-4; IL-4; COVID-19; SARS-CoV-2; COVID-19 severity.
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JHSS 2022;7(4):397-409
SYSTEMATIC REVIEW IN INFECTIOUS DISEASES
Copeptin as a marker of COVID-19 severity: A systematic review and meta-analysis
Authors: Michal MATUSZEWSKI¹, Aleksandra GASECKA², akub M ZIMODRO³, Zofia ZADOROZNA⁴, Michal PRUC⁵, Magdalena BORKOWSKA⁶, Alla NAVOLOKINA⁷, Gabriella NUCERA⁸, Murat YILDIRIM⁹, Behdin NOWROUZI-KIA¹⁰, Francesco CHIRICO^11#, Lukasz SZARPAK^11#*
Affiliation:
¹ Department of Anaesthesiology and Intensive Therapy at the Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland. E-mail: matuszewski.mike@gmail.com. ORCID: 0000-0002-3467-1377.
² 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland. E-mail: gaseckaa@gmail.com.  ORCID: 0000-0001-5083-7587.
³ 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland. E-mail: zimodro.jakub@gmail.com. ORCID: 0000-0002-2405-8982.
⁴ Students Research Club, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland. E-mail: zosia.zadorozna33@gmail.com. ORCID:0000-0002-8653-7284. 
⁵ Research Unit, Polish Society of Disaster Medicine, Warsaw, Poland E-mail: m.pruc@ptmk.org. ORCID: 0000-0002- 2140-9732.
⁶Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland; E-mail: mborkowska@onkologia.bialystok.pl. ORCID: 0000-0002-2390-8375.
⁷ European School of Medicine, International European University, Kyiv, Ukraine; E-mail: allanavolokina@ieu.edu.ua. ORCID: 0000-0003-1711-6002.
⁸ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy. E-mail: gabriellanucera@gmail.com. ORCID: 0000- 0003-1425-0046.
⁹Department of Psychology, Agri Ibrahim Cecen University, Turkey. E-mail: muratyildirim@agri.edu.tr. ORCID: 0000- 0003-1089-1380.
¹⁰Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. E-mail: behdin.nowrouzi.kia@utoronto.ca. ORCID: 0000-0002-5586-4282.
¹¹Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy. Health Service Department, Italian State Police, Ministry of the Interior, Milan, Italy. E-mail: francesco.chirico@unicatt.it. ORCID: 0000-0002-8737-4368.
¹²Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland. Maria Sklodowska- Curie Bialystok Oncology Center, Bialystok, Poland. Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, United States. E-mail: lukasz.szarpak@gmail.com. ORCID: 0000-0002-0973-5455.
#Last co-authorship
*Corresponding Author: Associate Professor, Lukasz Szarpak, 10 Zelaznej Bramy Square, 00-136 Warsaw, Poland. E-mail: lukasz.szarpak@gmail.com.

Abstract.

Introduction: Infection with SARS-CoV-2 is particularly hazardous in patients with cardiovascular
pathology, diabetes or chronic lung disease. Arginine vasopressin (AVP), an antidiuretic hormone secreted in response to hemodynamic and osmotic disturbances plays a crucial role in maintenance of cardiovascular homeostasis. Copeptin has shown promising results regarding its utility in prediction of morbidity and mortality of COVID-19. Therefore, we conducted a meta-analysis to evaluate the role of copeptin in risk stratification in COVID-19.
Methods: This study was designed as a systematic review and meta-analysis. We systematically searched the following databases: Scopus, Web of Science, PubMed, EMBASE, Cochrane Library through September 10th, 2022. Methodological quality was assessed using the Cochrane risk-of-bias tool.
Results: Pooled analysis of four trials showed that mean copeptin plasma concentrations were higher in patients with severe course of COVID-19 than in patients with non-severe course of the disease (26.64 ± 13.59 vs. 16.75 ± 6.13, respectively; MD=9.39; 95%CI: 1.38 to 17.40; I2=99%; p=0.02). Furthermore, higher copeptin concentrations in COVID-19 patients who died than in those who survived (13.25 ± 3.23 vs. 44.65 ± 26.92, respectively; MD=-31.40; 95%CI: -42.93 to -19.87; p<0.001).
Discussion: Results from the present meta-analysis revealed that increased copeptin plasma concentrations found in COVID-19 patients are associated with the severity of the disease. Copeptin may assist in early identification of COVID-19 progression and possibly in prediction of adverse outcomes, thus its use in risk stratification could be beneficial.

Keywords: Copeptin; COVID-19; meta-analysis; SARS-CoV-2; severity.
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JHSS 2022;7(4):410-421
ORIGINAL ARTICLE IN PSYCHOLOGY
Vulnerability and self-efficacy predict loneliness among the Turkish public during the COVID-19 pandemic
Authors: Murat YILDIRIM^1†, Zafer Güney ÇAĞIŞ^2†, Pietro CRESCENZO³, Giuseppe FERRARI⁴, Meghnath DHIMAL⁵, Gabriella NUCERA⁶, Lukasz SZARPAK^7*, Francesco CHIRICO^8*
Affiliation:
¹ Department of Psychology, Agri Ibrahim Cecen University, Turkey. ORCID: 0000-0003-1089-1380.
² Department of Psychology, Mersin University, Mersin, Turkey. Department of Psychology, Agri Ibrahim Cecen University,  ORCID: 0000-0001-8795-9000.
³ Department of Educational Sciences, Psychology and Communication, University of Bari “Aldo Moro”, Bari, Italy. Email: pietro.crescenzo@uniba.it. ORCID: 0000-0001-5240-315X.
⁴ SIPISS, Milan, Italy. E-mail: ferrari@sipiss.it. ORCID:0000-0003-1244- 5931. 
⁵ Research Section, Nepal Health Research Council, Kathmandu, Nepal, Email: meghdhimal@gmail.com. ORCID: 0000- 0001-7176-7821.
⁶Emergency Department, Fatebenefratelli Hospital, ASST Fatebenefratelli and Sacco, Milano, Italy, Email: gabriellanucera@gmail.com. ORCID: 0000-0003-1425-0046.
⁷ Institute of Outcomes Research, Maria Sklodowska – Curie Medical Academy, Warsaw, Poland, Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA. Email: lukasz.szarpak@gmail.com. ORCID: 0000-0002-0973-5455.
⁸Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy. Health Service
Department, Italian State Police, Ministry of the Interior, Milan, Italy. Email: francesco.chirico@unicatt.it. ORCID: 0000-0002-8737-4368.
†First co-authorship.#Last co-authorship
*Corresponding Author: Associate Professor Murat Yıldırım. Agri Ibrahim Cecen University, Department of Psychology, Faculty of Science and Letters, Erzurum Yolu 4 Km 04100, Merkez, Ağrı, Turkey. E-mail: muratyildirim@agri.edu.tr; muratyildirimphd@gmail.com

Abstract.

Introduction: The COVID-19 pandemic has caused several negative psychological effects as well as physical effects. There are numerous studies indicating that individuals have experienced high levels of loneliness during the current health crisis. However, the relationship between vulnerability and self-efficacy with loneliness has not been sufficiently discussed during the pandemic. Therefore, in the present study, we investigated the predictive effect of vulnerability and self-efficacy in loneliness among Turkish adults during the second wave of the COVID-19 pandemic in Turkey.
Methods: This study is a cross-sectional study using the snowball sampling method. The vulnerability and self-efficacy related to COVID-19 were measured with single questions, and loneliness was measured by the UCLA Loneliness scale (ULS-8). Data were analyzed using Pearson correlation and hierarchical multiple regression.
Results: The results indicated that vulnerability was negatively correlated with self-efficacy (β = – 0.36, p<0.001) and positively correlated with loneliness (β = 0.13, p<0.001). Similarly, self-efficacy was negatively correlated with loneliness (β = -0.12, p<0.001). Furthermore, the current research revealed that vulnerability positively predicted loneliness (β = 0.10, p<0.05). On the other hand, self-efficacy negatively predicted loneliness (β = -0.11, p< 0.05) after controlling for age and gender.
Discussion: The study examined the relationship between vulnerability, self-efficacy, and loneliness among Turkish adults during COVID-19, and revealed that vulnerability is a potential risk factor for loneliness, while self-efficacy is a potential protective factor for loneliness.

Keywords: COVID-19 pandemic; loneliness; vulnerability; self-efficacy.
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JHSS 2022;7(4):422-434
ORIGINAL ARTICLE IN ONCOLOGY
Perturbation of specific transcripts in peripheral blood mononuclear cells in breast cancer: A case- control pilot study
Authors: Nadia PANERA¹, Vincenzo CAMISA², Maria Rita BRAGHINI³, Emanuele COSCIA⁴, Gabriele ARNESANO⁵, Rita BRUGALETTA⁶, Teresa GIGLIOTTI⁷, Antonella CIABATTONI⁸, Gabriella NUCERA⁹, Lukasz SZARPAK¹⁰, Giuseppe D’ERMO^11§, Anna ALISI^11*§, Salvatore ZAFFINA^13*§
Affiliation:
¹ Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy. Email: nadia.panera@opbg.net. ORCID: 0000-0002-5365-3123
² 1st Occupational Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy. Email: vincenzo.camisa@opbg.net.  ORCID: 0000-0003-1935-4282.
³ 1st Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy. Email: mariarita.braghini@opbg.net. ORCID: 0000-0002-5041-2893.
⁴ Occupational Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy. Email emanuele.coscia@opbg.net. ORCID:0000-0002-9842-0649 
⁵ Post-Graduate School of Occupational Health, Department of Life Sciences and Public Health, Facoltà di Medicina e Chirurgia, Università Cattolica del Sacro Cuore, Rome, Italy. Email: gabrielearnesano93@gmail.com. ORCID: 0000-0001-8763-2761.
⁶ Occupational Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy. E-mail:rita.brugaletta@opbg.net. ORCID: 0000-0002-2970-1455.
⁷ Unit of Diagnostic Radiology, Ospedale Santo Spirito, Rome, Italy. Email: teresa.gigliotti@aslroma1.it.
⁸Department of Radiation Oncology, Ospedale San Filippo Neri, ASL Roma 1, Rome, Italy. Email: antonella.ciabattoni@aslroma1.it. ORCID: 0000-0002-3377- 4251.
⁹ASST Fatebenefratelli Sacco, Fatebenefratelli Hospital, University of Milan, Milan, Italy. E-mail: gabriellanucera@gmail.com. ORCID: 0000- 0003-1425-0046.
¹⁰Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy, Warsaw, Poland. Maria Sklodowska-Curie Bialystok Oncology Center, Bialystok, Poland. Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine Houston, Houston, TX, United States. E-mail: lukasz.szarpak@gmail.com. ORCID: 0000-0002-0973-5455.
¹¹Department of Surgery, “Pietro Valdoni”, Universitá di Roma “La Sapienza”, Rome, Italy. Email: giuseppe.dermo@uniroma1.it. ORCID: 0000-0003-4403- 140X.
¹²Unit of Molecular Genetics of Complex Phenotypes, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy. Email: anna.alisi@opbg.net ORCID: 0000-0001-7241-6329.
¹³Occupational Medicine Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy. Email: salvatore.zaffina@opbg.net. ORCID: 0000-0002-8858-5423
§ These authors equally contribute to the manuscript as last authors.
*Corresponding Author: Anna Alisi, PhD, Chief of Molecular Genetics of Complex Phenotypes Research Unit, Bambino Gesù Children’s Hospital, IRCCS, Viale S. Paolo, 15, 00146 Rome, Italy

Abstract.

Introduction: Breast cancer (BC) is the most common type of diagnosed cancer worldwide and the
leading cause of cancer death in women and it is the second most frequent cancer-causing mortality for women worldwide. Peripheral blood-based biopsy for BC could be a promising tool for risk prediction and diagnosis. In this study, we aimed to evaluate the gene expression profile of PBMCs in Italian patients with BC.
Methods: In this case-control pilot study, we isolated PBMCs from 22 BC patients and 21 healthy controls and evaluated the expression of a panel of 52 target genes related to BC or circadian rhythm by a customized TaqMan Open Array Real-Time PCR panel.
Results: Among the differentially expressed genes, 22 remained unchanged. These unchanged genes are mainly involved in cellular processes, including the circadian clock, cellular responses to stress/stimuli, the immune system, signal transduction, and metabolism. We found a total of 30 significantly de-regulated genes. In particular, 8 genes, including PARP6, IGFR1, EZH2, VEGFA, NOTCH1, CD44, BCAR1, and CD24A, resulted significantly down-regulated in patients with BC compared to Controls, while 22 genes were significantly up-regulated in BCs patients compared to Controls. We found several already reported BC-associated genes up-regulated in PBMCs of our BC patients, but FOXO3, ARNTL, and ADAM17 emerged as the most strongly up-regulated. The enrichment pathways analysis highlight that de-regulated genes are mainly involved in the regulation of gene expression and transcription, signal transduction, and immune system response.
Discussion: The results of our pilot study demonstrated that the evaluation of PBMC gene signature could be a valuable tool for primary prevention and early diagnosis of BC in several high-risk settings, thus reducing the global mortality associated with this tumour.

Keywords: Breast cancer; circadian rhythm; diagnosis; gene expression; PBMCs.
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JHSS 2022;7(4):435-446
ORIGINAL ARTICLE IN DIABETOLOGY
Diabetes Type 2 Risk Score for African Americans based on Jackson Heart Study data: A cross-sectional study
Authors: Veronica de Los Angeles HERNANDEZ-MORALES¹, Vincent L MENDY², Manoj SHARMA³, Lei ZHANG^4*, Anthony R. MAWSON^5#, Marinelle PAYTON^6#
Affiliation:
¹ School of Public Health, Jackson State University, USA Country. Email Veroji2008@gmail.com. ORCID: 0000-0002- 3419-374X.
² School of Public Health, Jackson State University, USA Country. Email Vincent.l.mendy@jsums.edu.  ORCID: 0000- 0001-9239-2723
³ Department of Social & Behavioral Health, School of Public Health, Department of Internal Medicine, University of Nevada, Las Vegas, Nevada, USA Country. Email Manoj.Sharma@unlv.edu. ORCID: 0000-0002-4624-2414.
⁴ School of Nursing, University of Mississippi Medical Center, USA Country. Email Lzhang2@umc.edu. ORCID: 0000- 0001-8838-0551
⁵ School of Public Health, Jackson State University, USA Country. Email amawsn@gmail.com. ORCID: 0000-0002-3746- 4546.
⁶School of Public Health, Jackson State University, USA Country. Email marinelle.payton@jsums.edu. ORCID: 0000- 0002-6680-4808.
*Corresponding Author: Veronica de Los Angeles Hernandez-Morales, Student, School of Public Health, Jackson State University, 1400 J R. Lynch Street, Jackson, MS 39217 Email veroji2008@gmail.com

Abstract.

Introduction: The Finnish Diabetes Risk Score (FINDRISC) has been used as a low-cost screening
tool in many European countries for the early identification of people at risk of Type 2 Diabetes (T2D). However, for African American individuals, an optimal Diabetes Risk Score has not been developed. There is a need for an African American Diabetes Risk Score (AADRSC to include exclusive characteristics for African Americans that can be an extension of FINDRISC. Hence, the objective of this study was to develop a diabetes risk score for African Americans and to assess the accuracy of the AADRSC for undiagnosed T2D, using data from the Jackson Heart Study.
Methods: A cross-sectional study was conducted in a sample population of men and women ages 20 to 95 with and without diabetes (n = 3,098) for Exam 1 of the Jackson Heart Study (JHS). Participants with chronic kidney disease were excluded. A univariate analysis was carried out for the selection of relevant risk factors associated with diabetes based on the socioecological model. The variables were identified as significant and were included in a multivariate logistic regression model. Based on the beta coefficients obtained, a risk score was made. The validity of the score was assessed in Exam 1 by comparing the AADRSC with the FINDRISC using receiver operating characteristic curves. Results: The Area Under the Curve (AUC) was 0.78 for the AADRSC and 0.72 for the FINDRISC (p=0.00012). Using the risk score cutoff value of 11 in the AADRISC to detect T2D resulted in a sensitivity of 66% and a specificity of 71%.
Discussion and Conclusion: The characteristics of the AADRSC showed that it can be used as a simple, safe, and inexpensive test to identify people at high risk of T2D in the African American population. An implication for the field of Public Health is that the AADRSC can be used in primary care for detecting people with a high risk of T2D.

Keywords: African Americans, diabetes mellitus, risk score.
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