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Introduction: In Hawaiʻi, there are 367,000 Native Hawaiian and Pacific Islanders. Native Hawaiians experience health disparities in a variety of conditions, including stroke, diabetes, and cancer. Ethnic minorities are underrepresented among physicians; this lack of physician-patient racial concordance may contribute to the disparities, as recent studies suggest that racial discordance resulted in poorer healthcare quality. This study aims to assess the current status of neurological health disparities in the Native Hawaiian population in Hawaiʻi, with a focus on identifying neurologist ethnic representation, neurological diseases, and healthcare-related challenges disproportionately affecting Native Hawaiians. Methods: An anonymous survey on physician’s attitudes and practice was emailed to all neurologists in the Hawaiʻi Neurological Society from February 2019 to June 2019. Findings: Twenty-three full responses and one partial response was received. No participants self-identified as Native Hawaiian nor did they know of any Native Hawaiian neurologists in Hawaiʻi, yet all who completed the survey reported treating Native Hawaiians in their practice (n = 23), which identifies a gap in Native Hawaiian representation in the field of neurology in Hawaiʻi. In addition, majority of participants perceived that Native Hawaiians are disproportionately affected by neurological diseases and have difficulty accessing neurology services and obtaining quality care. Conclusions: Future focus on creating opportunities to improve racially discordant physician-patient relationships and to increase Native Hawaiian representation in neurology may help narrow the gap in health disparities experienced by Native Hawaiians.

ObjectiveHeyde’s syndrome (HS), a rare condition characterised by a unique relationship between severe aortic stenosis and angiodysplasia, is often diagnosed late increasing the risk for a prolonged hospital course and mortality in the elderly. The leading hypothesis explaining the aetiology of HS is acquired von Willebrand syndrome (AVWS) but not all studies support this claim. While individual cases of HS have been reported, here we present the first systematic review of case reports and focus on the prevalence of AVWS.DesignA systematic search was conducted through PubMed/MEDLINE, CINAHL-EBSCO, Web of Science and Google Scholar since inception. The resulting articles were screened by two independent reviewers based on inclusion criteria that the article must be a case report/series or a letter to the editor in English describing HS in an adult patient.ResultsSeventy-four articles encompassing 77 cases met the inclusion criteria. The average age was 74.3±9.3 years old with a slight female predominance. The small intestine, especially the jejunum, was the most common location for bleeding origin. Capsule endoscopy and double balloon enteroscopy were superior at identifying bleeding sources than colonoscopy (p=0.0027 and p=0.0095, respectively) and oesophagogastroduodenoscopy (p=0.0006 and p=0.0036, respectively). The mean duration from symptom onset to diagnosis/treatment of HS was 23.8±39 months. Only 27/77 cases provided evidence for AVWS. Surgical and transcutaneous aortic valve replacement (AVR) were superior at preventing rebleeding than non-AVR modalities (pConclusionFurther research is warranted for a stronger understanding and increased awareness of HS, which may hasten diagnosis and optimal management.

Summary Regular physical activity improves physical and mental health. Here we found that the effect of physical activity extends to the next generation. Voluntary wheel running of dams, from postpartum day 2 to weaning, increased the social dominance and reproductive success, but not the physical/metabolic health, of their otherwise sedentary offspring. The individual's own physical activity did not improve dominance status. Maternal exercise did not disrupt maternal care or the maternal and offspring microbiota. Rather, the development of dominance behavior in the offspring of running mothers could be explained by the reduction of LIF, CXCL1, and CXCL2 cytokines in breast milk. These data reveal a cytokine-mediated lactocrine pathway that responds to the mother's postpartum physical activity and programs offspring social dominance. As dominance behaviors are highly relevant to the individual's survival and reproduction, lactocrine programming could be an evolutionary mechanism by which a mother promotes the social rank of her offspring., Graphical Abstract, Highlights • Maternal postpartum wheel running enhances male offspring social dominance • Maternal postpartum running promotes offspring reproductive fitness • Maternal postpartum running has no effect on maternal care and gut microbiota • Maternal running programs offspring social dominance via specific milk cytokines, Biological Sciences; Behavioral Neuroscience; Immunology