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Share on Pinterest Fly View Productions/Getty ImagesAround 60 million women in the US have cardiovascular disease (CVD).Women from racial and ethnic minority groups are at greater risk of CVD death.A new American Heart Association (AHA) statement emphasizes that doctors must also consider social determinants of health when screening for CVD.These include factors such as discrimination, environment, and language barriers.

An estimated 60 million women in the US (equal to 44% of the population) live with some form of cardiovascular disease (CVD).

Additionally, 1 in 5 deaths among women stems from CVD with those from racial and ethnic minorities at greater risk.

Traditional contributing factors, such as obesity, smoking, diabetes, and high cholesterol, are frequently considered by doctors when assessing a patients CVD risk.

However, a new scientific statement from the American Heart Association (AHA), published in its journal Circulation, highlighted that medical professionals must look beyond these when monitoring and treating CVD in women, especially those from underrepresented groups.

In comparison to other women, Black women in the US (including African American and Afro Caribbean) have the highest rate of heart disease, stated Dr. Heather M. Johnson,a preventive cardiologist at Boca Raton Regional Hospital, part of Baptist Health South Florida, who was not involved with the report.

The AHA researchers stated that nontraditionalsocio-economic factors such as discrimination and environment must be considered if the gap in CVD treatment and survival between whites and racial and ethnic groups is to be reduced.

Many of these are often overlooked but can significantly affect health risks, care, and outcomes.

Understanding both traditional and nontraditional risk factors are important to prevent heart disease, but also to support the early diagnosis and treatment of heart disease in women, Johnson told Healthline. How bias, discrimination, and racism can affect your health

In the statement, the researchers said: Behavioral and environmental factors and social determinants of health disproportionately affect women of underrepresented races and ethnicities.

These factors result in a higher prevalence of CVD and significant challenges in the diagnosis and treatment of cardiovascular conditions, they added.

Five social determinants of health were emphasized in the AHAs statement. But what are they and how do they influence CVD?Discrimination

The AHA noted that discriminatory barriers faced by ethnic communities lead to high levels of stress. This, in turn, contributes to CVD issues such as inflammation and hypertension.

Research also highlights that minority groups can encounter racial bias and stereotyping from white healthcare providers which may lead to patients having their concerns dismissed or receiving poorer care.

Studies show this is often due to the activation of stereotypes that influence clinical judgment, said Heather Orom, PhD, associate professor of community health and health behavior at the University at Buffalo.

Furthermore, when actions are perceived as racially motivated or discriminatory, this can put a wedge between provider and patient and create an environment of mistrust, said Dr. Deborah L. Crabbe, a professor of medicine at the Temple Heart and Vascular Institute at Lewis Katz School of Medicine.

As a result, she told Healthline, patients may not follow through with care recommendations and may even seek other providers, perhaps delaying care for their medical condition.Language barriers

Understanding medical terms and phrasing can be tricky enough for patients at the best of times. However, things are complicated further when the doctor and patient dont share the same first language.

Language barriers can reduce patients satisfaction with their care, care quality, and safety, explained Orom.

Furthermore, she told Healthline, such barriers can hinder the doctor-patient relationship, prevent patients from advocating for themselves, and inhibit the doctor from understanding the full complexity of a patients condition and their life circumstances. Environment

The AHA statement revealed that environmental factors, such as air pollution, high long-term arsenic exposure, and cadmium and lead exposure, have been linked to CVD.

Studies show minority groups are more likely to live in areas with more air pollution and closer proximity to toxic waste and other hazards.

For decades, polluting industries, waste facilities, and other sources of exposure, such as highways systems, have been more likely to be placed in neighborhoods of color, Orom revealed. This stems from the fact these communities have had less political and economic clout. Assimilation to a different culture

The AHA statement didnt expressly state how acculturation or assimilation to a different culture can impact CVD.

However, this is an important factor for CVD that often is missed, stated Dr. Yu-Ming Ni, a cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center.

For instance, he shared with Healthline that older studies of Japanese individuals showed those who traveled to Hawaii and then to the continental U.S. had higher CVD rates than their peers who stayed in Japan.Healthcare access

It was noted in the AHA statement that there is evidence that SDOH factors experienced in youth, such as inability to access healthcare or inability to afford care, may affect heart health into adulthood and contribute to CVD risk factors and outcomes in adulthood.

Research shows that Black, Hispanic, Asian-American, and Native individuals are less likely to have health insurance.

But healthcare access isnt only about insurance, said Crabbe. For example, [it also] includes geographic access to a particular health care service.

Orom concurred, stating there is a typically lack of high-quality healthcare facilities in neighborhoods where people of color have historically lived.

Other social burdens can limit access, too. For example, United States Census Bureau data shows that ethnic minority groups are generally poorer compared to white populations. Poverty can prevent individuals from purchasing necessary medications, for example.

Finally, Michele Horan, a registered nurse and COO of Healthy Alliance, shared that other daily stressors such as care responsibilities and the potential of eviction can reduce the capacity of underserved communities to access healthcare.

In most cases, these urgent situations are prioritized over ones health and well-being, Horan told Healthline. Addressing life challenges, in my experience, will almost always surpass healthcare, accessible or not. What to discuss with your doctor

If you think youre at higher risk of CVD, its crucial to ensure your doctor is aware of your concerns and potential risk profile.

Ni said discussing with your doctor means they can be more aggressive with screening.

For example, doctors might choose to test for disease states with no symptoms earlier than usual if the fear is that someone has a higher risk due to the environment they live in, he explained.

Tests and screenings generally vary depending on the patient and their history.

Its recommended that everyone understands their individual risk for heart disease and has a preventive heart health evaluation, Johnson said.

This assessment, she explained, includes a detailed discussion of their traditional and nontraditional risk factors for heart disease.

According to Johnson, further preventative screening tests are also possible and include:Electrocardiogram (EKG or ECG)Coronary artery calcium scan (also known as a calcium score)Special cholesterol tests What can healthcare professionals do to help?

According to the AHA researchers, culturally sensitive, peer-led community and healthcare professional education is a necessary step in CVD prevention.

Language barriers can be overcome by providing translators or simply using language apps, such as Google Translate. Studies show that using such app in healthcare settings can significantly improve both doctor and patient satisfaction.

Horan said healthcare providers need to screen patients from minority groups in a culturally competent and sensitive way.

Identifying barriers and the root cause behind them with a proactive lens is often the only way to effectively coordinate care in a manner that addresses their patients full spectrum of needs, she asserted.

Education is vital for both medical professionals and patients, said Crabbe.

Healthcare organizations can provide training and education to staff regarding the challenges that minorities and women face in receiving healthcare, she noted.

Meanwhile, Crabbe continued, opportunities to provide education to improve the health literacy of minorities and women could help improve patient acceptance of healthcare recommendations, and thus compliance.

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Politics

David Lammy blames ‘human error’ for release of migrant sex offender – as confirms independent investigation

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David Lammy blames 'human error' for release of migrant sex offender - as confirms independent investigation

David Lammy has confirmed there will be an independent investigation into the accidental release of a migrant jailed for sex offences, as he blamed “human error” for the incident.

The deputy prime minister and justice secretary told MPs he was “livid” on behalf of Hadush Kebatu’s victims and he would be deported back to Ethiopia “as quickly as possible”.

Politics latest: Epping MP calls on Lammy to commit to closing the Bell Hotel

Kebatu, who was found guilty in September of sexually assaulting a 14-year-old girl and a woman in Epping, was freed in error from HMP Chelmsford in Essex on Friday instead of being handed over to immigration officials for deportation.

Migrant sex offender found and arrested after manhunt
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Migrant sex offender found and arrested after manhunt

His accidental release sparked widespread alarm and a manhunt that resulted in him being found and arrested by the Metropolitan Police in the Finsbury Park area of London at around 8.30am on Sunday.

The incident has sparked questions over how the man, whose crimes sparked protests in Epping over the use of asylum hotels, was able to be freed.

Addressing MPs in the House of Commons, Mr Lammy said the mistake should not have happened as he sought to lay part of the blame on to the Conservatives over the state of the prison system over the past 14 years.

He said “there must and there will be accountability” for the mistaken release of Kebatu from prison.

“I’ve been clear from the outset that a mistake of this nature is unacceptable,” he said.

“We must get to the bottom of what happened and take immediate action to try and prevent similar releases in error to protect the public from harm.”

Mr Lammy said he ordered an “urgent review” into the checks that take place when an offender is released from prison, and new safeguards have been added that amount to the “strongest release checks that have ever been in place”.

The justice secretary said the investigation would be led by former Metropolitan Police deputy commissioner Dame Lynne Owens, who also used to lead the National Crime Agency.

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Witness describes confusion outside prison

He also said the investigation would have the same status as high-profile probes into other prison incidents, including the attack on three prison officers at HMP Franklin in April of this year and the escape of Daniel Khalife from HMP Wandsworth in 2023.

‘Calamity Lammy’

Shadow justice secretary Robert Jenrick referred to a report by Sky News which detailed how a witness present at the prison observed Kebatu appearing “confused” upon his release.

The witness said Kebatu had in fact tried to go back into the prison several times, but was instead guided to Chelmsford station, where he caught a train to London.

Mr Jenrick claimed the case was proof “the only illegal migrants this government are stopping are those that actually want to leave the UK”.

“Dear oh dear,” he said. “Where to begin? This justice secretary could not deport the only small boat migrant who wanted – no – who tried to be deported.

“Having been mistakenly released, Hadush Kebatu came back to prison asking to be deported not once, not twice, but five times, but he was turned away.”

He went on: “The only illegal migrants this government are stopping are those that actually want to leave the UK.

“His officials, briefing the press, called it the mother of all – yeah, they’re not wrong, are they?”

Read more:
Reform UK’s Zia Yusuf defends MP accused of ‘racism’

A colossal repair job is desperately needed after Kebatu debacle

Mr Jenrick, who served as immigration minister under the previous Conservative government, branded his opposite number “calamity Lammy”.

“It’s a national embarrassment and today the justice secretary feigns anger at what happened.”

Continuing with his attack, Mr Jenrick asked Mr Lammy whether he would resign if Kebatu was not deported “by the end of the week” – to which he received no reply.

But asked later by an MP whether he was considering his position, Mr Lammy replied: “A ridiculous question, the answer is no.”

The new checks announced by Mr Lammy on Monday involve five pages of instructions and require more senior prison staff to sign off a release, according to documents obtained by Sky News.

The instructions are effective from Monday.

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Sports

Passan: 18 innings, 11 runs, a walk-off homer — and an epic Game 3

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Passan: 18 innings, 11 runs, a walk-off homer -- and an epic Game 3

LOS ANGELES — The game that had everything ended at 11:50 p.m. PT on Monday. For the previous 6 hours, 39 minutes, Game 3 of the World Series played out like a fantastical dreamscape of baseball, filled with tension and drama and madness. It was a game unlikely any before, never to be repeated again, and when the 18th inning ended and the Los Angeles Dodgers had beaten the Toronto Blue Jays 6-5, it was, in a way, a relief, because holding your breath for hours on end is not a sustainable way to live.

Such is the price we pay for an affair like Game 3. The Dodgers and Blue Jays competed at an exceptional level in the longest game in World Series history by innings and second-longest by time. They punched and counterpunched, emptied their benches and bullpens. They executed with wizardry and found pieces of themselves they didn’t know existed. And in the 18th inning, it was Freddie Freeman, already the hero of last year’s World Series, who deposited a center-cut sinker from Brendon Little over the center-field fence 406 feet away.

There have been 703 games played in the 121-year history of the World Series. While there are certainly competitors, this one launched itself into the upper echelon, undoubtedly elite, and left the 52,654 fans at Dodger Stadium as giddy as they were almost seven years to the day earlier, when the only other 18-inning game in World Series history ended the same way: with a Dodgers walk-off homer.

The heroes were plentiful, and in the aftermath of the lunacy, one of them stood in the Dodgers’ clubhouse, still trying to process what happened. Will Klein, the last man out of the Dodgers’ bullpen, a reliever who had topped out this year at two innings and 30 pitches, threw four innings of one-hit ball and struck out five on 72 pitches. The last of them, an 86 mph curveball, induced a swing and miss from Tyler Heineman and a scream from Klein, who understood what had been asked of him and knew he’d delivered.

Games don’t become classics without efforts like Klein’s — and he had an admirer who wanted to acknowledge that. Into the Dodgers’ clubhouse strode Sandy Koufax, his eminence of Dodgers pitching, who, at 89 years old, looked no worse for the wear at 12:48 a.m. Koufax walked up to Klein, stuck out his hand, looked him in the eyes and said: “Nice going.”

This was that kind of game, the one that forges bonds between a Hall of Famer and a man with 22.2 career major league innings who didn’t make the Dodgers’ roster in any of the previous three rounds of the postseason. The kind of game that prompted Klein to unlock his phone just to see how many messages he had, only for him to scroll … and keep scrolling … and keep scrolling to the point he just stopped. The kind of game that made Klein marvel to a friend in the clubhouse: “Seventy-two. Can you believe it?”

Game 3 was anarchy, a funhouse mirror of a ballgame, everything out of order. Shohei Ohtani‘s magnificence is never in question, but to see a baseball player reach nine times, something that had been done only twice in big league history — never in the postseason and not since 1942 — still registered as incredible, his magnitude lording over the game from beginning to end. He led off the game for the Dodgers with a double. He homered his next time up. He doubled again. He homered once more, his second of the game, his eighth of the postseason, to tie the game at 5 and unleash the chaos to come.

At that point, Blue Jays manager John Schneider had seen enough. In the ninth inning, Ohtani became the first hitter intentionally walked with the bases empty in the ninth inning or later of a postseason game. The next three times he came to the plate — twice with the bases empty — Schneider held up four fingers and gladly gave Ohtani a free pass. In the 17th, with a runner on first, the Blue Jays opted to pitch to him — and Brendon Little promptly deposited four balls nowhere near the strike zone. (Schneider said after the game to expect more tiptoeing around Ohtani in the days to come.)

Schneider’s decision-making earlier in the game, in which he tried to scratch across runs by substituting in a cadre of pinch runners, left the Blue Jays’ lineup compromised for most of the second half of the game. Against a Dodgers bullpen that had been a sieve for most of the postseason, Toronto managed just one run in 13⅓ innings. Los Angeles used 10 pitchers — including Clayton Kershaw, the future Hall of Famer. Kershaw came on in the 13th with the bases loaded, ground through a nine-pitch at-bat against Nathan Lukes and induced a dribbler to second base that Tommy Edman scooped with his glove to Freeman.

Memorable moments abounded over the game that featured 615 pitches, the most in a postseason game since MLB began tracking pitches in 1988. In the 14th, Will Smith lofted a fly ball to center field and dropped his bat, thinking it was a game winner. The ball died on the warning track. Teoscar Hernández, who, like Ohtani, had four hits, did the same in the 16th. It wound up in a glove, too.

By that point, Klein had arrived and set about pulling a modern-day Nathan Eovaldi, who went 97 pitches over the final six innings of the 2018 marathon. In Klein’s final inning, Yoshinobu Yamamoto — who had thrown a 105-pitch complete game two days prior — was warming up in the bullpen. Klein walked two batters. Dodgers manager Dave Roberts could have easily gone to Yamamoto. He stuck with Klein.

Klein just did it, because he had to, and that, as much as anything, is the lesson of an evening like Game 3, when a great game — which this was for the first dozen or so innings — evolves into something different altogether. Game 3 was a test. Of endurance and will — or, as it were, Will.

“You just got to either do it or you don’t,” said Dodgers reliever Justin Wrobleski, who spent time with Klein at AAA this season. “You go out there and you’re like, ‘I know what has to be done here and let’s see what I got.’ I like moments like that because it’s a test of your character. More than that, it’s a test of everything else.”

Klein passed. And Freeman, of course, is the valedictorian of such moments, one of the clutch kings of his generation. He had struggled much of the postseason, entering the game with only one RBI in the Dodgers’ previous dozen playoff games. His first two in this World Series had looked a far cry from his performance last year, when, nursing a number of injuries, he hit a walk-off grand slam in Game 1 and won series MVP. It wasn’t just the lack of production. He wasn’t hitting the ball particularly hard, either.

On the final pitch, he finally did. This is the kind of thing that happens in 18-inning games. They are uncomfortable and scary and can end with the crack of a bat. It is terrifying. It is beautiful. It is everything.

Those lucky enough to bear witness will never forget it, either. They squirmed and flinched and closed their eyes and prayed and squealed and cringed and, in the end, saw 31 hits and 37 runners left on base and 19 pitchers and one particularly majestic swing that, 10 minutes shy of Monday turning into Tuesday, ended one of the best World Series games ever — and gave the Dodgers a 2-1 advantage in this year’s series.

Klein isn’t sure how his arm will feel by the time he returns to the ballpark Tuesday for Game 4. Typically, he said, he’s a Day 2 guy, the soreness not coming until the second day after an outing. After being lavished with praise from his teammates and thanked by Sandy Koufax and written into the annals of Dodgers history, though, tomorrow and the next day wasn’t of much concern.

“I feel great right now,” he said, and with good reason. He was the winning pitcher, the stopper, the MVP of the night every bit as much as Freeman and Ohtani, and the adrenaline rush numbed whatever pain will eventually arrive. That’s for another day. This was everything — and more.

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Sports

Dodgers win WS classic on Freeman’s HR in 18th

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Dodgers win WS classic on Freeman's HR in 18th

LOS ANGELES — Freddie Freeman homered leading off the bottom of the 18th inning, Shohei Ohtani went deep twice in another record-setting performance and the Los Angeles Dodgers outlasted the Toronto Blue Jays 6-5 in Game 3 on Monday night to win a World Series classic.

The defending champion Dodgers took a 2-1 Series lead, and they still have a chance to win the title at home — something they haven’t done since 1963.

Freeman connected off left-hander Brendon Little, sending a 406-foot drive to straightaway center field to finally end a game that lasted 6 hours, 39 minutes, and matched the longest by innings in postseason history.

The only other Series contest to go 18 innings was Game 3 at Dodger Stadium seven years ago. Freeman’s current teammate, Max Muncy, won that one with a homer against the Boston Red Sox.

It was Freeman’s second World Series walk-off homer in two years. The star first baseman hit the first game-ending grand slam in Series history to win Game 1 last season against the New York Yankees.

Will Klein, the last reliever left in the Dodgers’ bullpen, got the biggest win of his career. He allowed one hit over four shutout innings and threw 72 pitches — twice as many as his previous high in the majors.

As the hours crept by, Vladimir Guerrero Jr. munched on an apple at the dugout railing. A staffer brought a fruit tray into the dugout, and the Toronto slugger helped himself to another piece.

Most of the 52,654 fans who stuck around were on their feet deep into the night — including 89-year-old Hall of Famer Sandy Koufax — and only sat in between innings.

Will Smith flied out to the left-center fence leading off the bottom of the 14th. Long drives by Freeman and teammate Teoscar Hernandez also died on the warning track with the temperature dropping in Chavez Ravine as the evening grew late.

Ohtani’s second solo homer tied it 5-all in the seventh. The two-way superstar also doubled twice to became the second player with four extra-base hits in a World Series game. Frank Isbell had four doubles for the Chicago White Sox in Game 5 against the Chicago Cubs in 1906.

After getting four hits in the first seven innings, Ohtani drew five consecutive walks — four intentional. That made him the first major leaguer in 83 years to reach base safely nine times in a game. Nobody else has even done it seven times in a postseason game.

“What matters the most is we won,” Ohtani said through his interpreter. “And what I accomplished today is in the context of this game, and what matters the most is we flip the page and play the next game.”

Freeman’s latest clutch homer cleared the fence just over 17 hours before Ohtani will make his first World Series start on the mound when he pitches in Game 4 on Tuesday night.

“I want to go to sleep as soon as possible so I can get ready,” a smiling Ohtani said.

The Associated Press contributed to this report.

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