Search Results (1,584)

Clozapine, a second-generation antipsychotic known for its effectiveness in treating resistant schizophrenia, is often linked with serious hematological side effects, particularly neutropenia and agranulocytosis. This review investigates the underlying pathophysiological mechanisms of clozapine-induced neutropenia (CIN) and agranulocytosis (CIA), outlines associated risk factors, and evaluates current clinical management strategies. Clozapine’s pharmacological profile, marked by its antagonism of dopamine D4 and serotonin receptors, contributes to both its therapeutic advantages and hematological toxicity. Epidemiological data show a prevalence of CIN and CIA at approximately 3.8% and 0.9%, respectively, with onset typically occurring within the first six months of treatment. Key risk factors include older age, Asian and African American ethnicity, female sex, and certain genetic predispositions. The development of CIN and CIA may involve bone marrow suppression and autoimmune mechanisms, although the exact processes remain partially understood. Clinical presentation often includes nonspecific symptoms such as fever and signs of infection, necessitating regular hematological monitoring in accordance with established guidelines. Management strategies include dosage adjustments, cessation of clozapine, and the administration of granulocyte colony-stimulating factors (G-CSF). Advances in pharmacogenomics show promise for predicting susceptibility to CIN and CIA, potentially improving patient safety. This review emphasizes the importance of vigilant monitoring and personalized treatment approaches to reduce the risks associated with clozapine therapy. Full article

Background/Objectives: People are better at recognizing the faces of racial in-group members than out-group members. This own-race bias relies on pattern recognition and memory processes, which rely on hemispheric specialization. We hypothesized that handedness, a proxy for hemispheric specialization, would moderate own-race bias. Specifically, consistently handed individuals perform better on tasks that require the hemispheres to work independently, while inconsistently handed individuals perform better on tasks that require integration. This led to the hypothesis that inconsistently handed individuals would show less own-race bias, driven by an increase in accuracy. Methods: 281 participants completed the study in exchange for course credit. Of those, the sample was isolated to Caucasian (174) and African American individuals (41). Participants were shown two target faces (one Caucasian and one African American), given several distractor tasks, and then asked to identify the target faces during two sequential line-ups, each terminating when participants made an identification judgment. Results: Continuous handedness score and the match between participant race and target face race were entered into a binary logistic regression predicting correct/incorrect identifications. The overall model was statistically significant, Χ² (3, N = 430) = 11.036, p = 0.012, Nagelkerke R² = 0.038, culminating in 76% correct classifications. Analyses of the parameter estimates showed that the racial match, b = 0.53, SE = 0.23, Wald Χ² (1) = 5.217, p = 0.022, OR = 1.703 and the interaction between handedness and the racial match, b = 0.51, SE = 0.23, Wald test = 4.813, p = 0.028, OR = 1.671 significantly contributed to the model. The model indicated that the probability of identification was similar for own- or cross-race targets amongst inconsistently handed individuals. Consistently handed individuals, by contrast, showed an increase in accuracy for the own-race target and a decrease in accuracy for cross-race targets. Conclusions: Results partially supported the hypotheses. Inconsistently handed individuals did show less own-race bias. This finding, however, seemed to be driven by differences in accuracy amongst consistently handed individuals rather than a hypothesized increase in accuracy amongst inconsistently handed individuals. Underlying hemispheric specialization, as measured by proxy with handedness, may impact the own-race bias in facial recognition. Future research is required to investigate the mechanisms, however, as the directional differences were different than hypothesized. Full article

African, Caribbean, and Black (ACB) communities face increased COVID-19 morbidity and mortality, coupled with significant barriers to vaccine acceptance and uptake. Addressing these challenges requires innovative, multifaceted strategies. Peer-led interventions, grounded in critical health literacy (CHL) and critical racial literacy (CRL), and integrating collaborative equity learning processes, can enhance community capacity, empowerment, and health outcomes, contributing to long-term health equity. This paper describes and presents the evaluative outcomes of a peer-led intervention aimed at enhancing COVID-19 vaccine confidence and acceptance. The Peer-Equity Navigator (PEN) intervention consisted of a specialized training curriculum grounded in CHL and CRL. Following training, PENs undertook a 5-month practicum in community or health settings, engaging in diverse outreach and educational activities to promote vaccine literacy in ACB communities. The evaluation utilized a modified Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, using quantitative and qualitative methods to collect data. Sources of data included tracking records with community feedback, and a PEN focus group, to assess program feasibility, outreach, and effectiveness. From 16 September 2022, to 28 January 2023, eight trained PENs conducted 56+ community events, reaching over 1500 community members. Both PENs and community members reported high engagement, endorsing peer-led, community-based approaches and increased vaccine literacy. The PEN approach proves feasible, acceptable, and effective in promoting positive health behaviors among ACB communities. This intervention has clear implications for health promotion practice, policy, and research in equity-deserving communities, including immigrants and refugees, who also face multiple and intersecting barriers to health information and care. Full article

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymatic disorder, affects over 500 million people worldwide and is often linked to exercise intolerance due to oxidative stress, but its true impact on physical performance remains unclear. This study aimed to evaluate the physiological and metabolic effects of G6PD deficiency on endurance capacity. Using humanized mice carrying the African G6PD variant [V68M; N126D] (hG6PD_A−), we show that despite reduced pentose phosphate pathway activity, these mice exhibit a 10.8% increase in treadmill critical speed (CS)—suggesting enhanced endurance capacity. Multi-omics profiling across red blood cells, plasma, skeletal muscle, spleen, kidney, and liver reveals metabolic adaptations, including elevated glycolysis, fatty acid oxidation, and increased mitochondrial activity, alongside heightened oxidative phosphorylation in muscle and accelerated red blood cell turnover in the spleen and liver. These findings indicate that systemic metabolic reprogramming may offset antioxidant deficiencies, potentially conferring a performance advantage. Given that G6PD deficiency affects up to 13% of African Americans and is associated with cardiovascular health disparities, our results challenge conventional exercise restrictions and highlight the need for personalized exercise guidelines for affected individuals. Full article

Background/Objectives: Hypertension (HTN) continues to be a leading cause of death and disability in older adults, especially in the southeastern United States. A cross-sectional study was conducted to evaluate the relationships among measured, diagnosed, and treated (HTN) in community-dwelling adults participating in student-led health screenings in eastern Alabama. Methods: Between 2017 and 2019, students from health-related disciplines facilitated screenings at 23 community and independent living sites to conduct health assessments, including measuring blood pressure (BP), obtaining medical history, and evaluating current prescriptions. Statistical analyses including chi-square tests, t-tests, and backward stepwise linear regression were performed. Results: The current sample includes data from 357 adults aged 60 to 99 years (mean age 74.6 ± 8.7), who were 70.9% females, 60.8% identifying as Black/African American (BA), and 36.8% residing in rural areas. The majority of clients had a prior HTN diagnosis (71.1%) and/or currently measured HTN (78.7%). Forty-three percent of adults screened had measured, diagnosed, and pharmaceutically treated HTN, while 31% had measured but untreated HTN. Black clients had higher measured systolic and diastolic BP and were more likely to also have been diagnosed with HTN (p < 0.05 for all). Linear regression indicated that lower systolic BP was predicted by not living alone (p = 0.003), White race (p = 0.004), and previous HTN diagnosis (p = 0.012), while female gender (p = 0.079) and decreasing body mass index (p = 0.053) had marginal predictive value. Conclusions: These results indicate that awareness and screening of HTN in this population are noteworthy, though management of the disease through ongoing screening and referrals is essential to reduce disparities. Full article

Prostate Cancer (PCa) is the most commonly diagnosed cancer and the second leading cause of cancer death among men. In Louisiana (LA), Black men are disproportionately diagnosed at later stages compared to White men. This study explores environmental risk factors as potential intermediate variables linking race to cancer diagnosis stage. The Louisiana Tumor Registry data included 24,647 male patients diagnosed with PCa in LA between 2010 and 2018. Among them, 15,875 (64.40%) were Caucasian American (CA) and 8772 (35.59%) African American (AA). Mediation analysis using multiple additive regression trees (MART) identified possible intermediate variables that potentially explain the observed disparity. The study found that individual characteristics and environmental factors jointly explained 84% (95% CI: 44.1%, 94.6%) and 18.6% (95% CI: 7.3%, 53.7%) of the observed racial disparity in PCa stage at diagnosis, respectively. Individual factors included BMI (35.9%), marital status (28.5%), CDI (8.2%), female-headed households (2.3%), comorbidity (3.9%), and insurance status (6.3%). Environmental contributors included cancer risk due to air toxicity exposure (7.2%), asthma prevalence (6.6%), acetaldehyde levels (2.1%), railroad proximity (2.1%), walkability (0.3%), and ozone level (−0.1%). Environmental factors jointly played a significant role in the observed racial disparity. The factors such as air toxicity, acetaldehyde levels, and asthma prevalence highlight the need to address industrial pollutants to reduce the differences. Full article

The present study investigates how US Southerners perceive second language (L2) speech by recruiting 170 undergraduate students who spoke Southern American English to listen to recordings of four speakers (US, Bangladeshi, Chinese, and Saudi Arabian) and evaluate their attributes. The listeners were grouped based on their ethnic affiliation: African American, Anglo-American, and Asian/Hispanic/multi-racial. A random half were primed, being asked questions about whether/how other people had negatively commented on their accents. Results showed no effect of priming on speech ratings. Moreover, whilst African American and Anglo-American listeners rated L2 speakers lower than the L1 speaker in almost all aspects, Asian/Hispanic/multi-racial listeners did not. Full article

Health literacy is a critical determinant of health outcomes, yet it is often overlooked, particularly among marginalized groups. This paper explores the significance of health literacy, with a particular focus on low-income African American and Black (AA/B) men, a population that faces unique challenges due to intersecting factors such as race, gender, socioeconomic status, and educational disparities. We examine how these factors contribute to health literacy gaps, highlighting adverse effects on health outcomes for AA/B men compared to the general population. Additionally, we stress the growing importance of digital literacy in an increasingly technology-driven world. Not actively addressing digital health literacy, especially within chronic disease self-management programs (CDSMPs), further exacerbates health disparities within this group. Recommendations are provided for improving health literacy, with specific strategies to also enhance general literacy and digital literacy, among low-income AA/B men. The paper also advocates for a systematic review of the existing literature on health literacy among this group, emphasizing the need for tailored interventions that account for the unique challenges faced by low-income AA/B men. In conclusion, the paper underscores the critical need for targeted research and practical approaches to improve health literacy and ultimately health outcomes for AA/B men in the digital age, particularly through CDSMPs. Full article

Background/Objectives: Prostate cancer (PCa) is diagnosed at an earlier median age, more advanced stage, and has worse clinical outcomes in African American (AA) men compared to European Americans (EA). Methods: To investigate the role of aberrant DNA methylation in tumor-adjacent stroma (TAS), methyl binding domain sequencing (MBD-seq) was performed on AA (n = 17) and EA (n = 15) PCa patients. This was independently confirmed using the long interspersed nuclear element-1 (LINE-1) assay. Pathway analysis was performed on statistically significantly differentially methylated genes for AA and EA TAS. DNA methylation profiles of primary cultured AA and EA carcinoma-associated fibroblasts (CAFs) were compared with AA and EA TAS. AA and EA CAFs were treated with demethylating agent 5-Azacytidine (5-AzaC). Results: AA TAS exhibited higher global DNA methylation than EA TAS (p-value < 0.001). Of the 3268 differentially methylated regions identified (DMRs, p-value < 0.05), 85% (2787 DMRs) showed increased DNA methylation in AA TAS, comprising 1648 genes, of which 1379 were protein-coding genes. Based on DNA methylation levels, two AA subgroups were identified. Notably, AA patients with higher DNA methylation were predominantly those with higher Gleason scores. Pathway analysis linked methylated genes in AA TAS to several key signaling pathways (p-value < 0.05), including immune response (e.g., IL-1, IL-15, IL-7, IL-8, IL-3, and chemokine), Wnt/β-catenin, androgen, PTEN, p53, TGF-β, and circadian clock regulation. A total of 168 concordantly methylated genes were identified, with 109 genes (65%) showing increased methylation in AA CAFs and TAS (p-value < 0.05). Treatment with 5-AzaC significantly reduced DNA methylation of concordant genes in AA CAFs (p-value < 0.001). Conclusions: These findings suggest a distinct stromal methylome in AA, providing a foundation for integrating demethylating agents into standard therapies. This approach targets the tumor microenvironment, potentially addressing PCa disparities in AA men. Full article

Genetic factors play an important role in the risk of developing lung cancer, a disease that disproportionately affects African American (AA) individuals who smoke. Accumulating evidence suggests that specific ancestry-informative genetic markers are predictive of lung cancer risk in AA individuals who smoke. Although testing for, and communication of, genetic risk to patients should impact health and screening, results are mixed. The goal of this study was to evaluate the effects of genetic risk communication that also included ancestry-specific risk information among African American individuals who smoke. Using an experimental design, African American individuals who smoke (n = 166) were assigned randomly to receive hypothetical genetic test results that indicated (1) low vs. high genetic risk for lung cancer (“Risk”) and (2) European vs. African Ancestry (“Ancestry”). We hypothesized that participants who had been told that they were both at high risk for lung cancer based on genetic markers prominent in African persons at risk of lung cancer, and that they have African ancestry, would exhibit increases in cognitive (perceived lung cancer risk), emotional (cancer worry and psychological distress), and motivational (motivation to quit smoking) factors shown to predict longer-term health behavior change. Results revealed significant and moderate-to-large effects of Risk for all outcomes. There was also a significant Ancestry effect on perceived lung cancer risk: increased risk perceptions among participants who learned that they have high African genetic heritage. Path analytic modeling revealed that cognitive and emotional factors mediated the effects of both Risk and Ancestry feedback on motivation to quit smoking. Findings further highlight the importance of incorporating ancestry-specific genetic risk information into genetic counseling sessions, especially in underserved populations, as doing so may impact key cognitive, emotional, and motivational factors critical to behavior change. Full article

Throughout history, communities have struggled to build homes in places actively hostile to their presence, a challenge long faced by African descendants in the American diaspora. In cities across the U.S., including Washington, D.C., efforts have often been made to erase Black cultural identity. D.C., once a hub of Black culture, saw its urban fabric devastated during the 1968 riots following Dr. Martin Luther King Jr.’s assassination. Since then, redevelopment has been slow and, more recently, marked by gentrification, which has further displaced Black communities. Amid this context, Black architects such as Michael Marshall, FAIA, and Sean Pichon, AIA, have emerged as visionary leaders. Their work exemplifies Value-Inclusive Design and aligns with Roberto Verganti’s Design-Driven Innovation by embedding cultural relevance and community needs into development projects. These architects propose an intentional approach that centers Black identity and brings culturally meaningful businesses into urban redevelopment, shifting the paradigm of design practice in D.C. This collective case study (methodology) argues that their work represents a distinct architectural style, Black Modernism, characterized by cultural preservation, community engagement, and spatial justice. This research examines two central questions: Where does Black Modernism begin, and where does it end? How does it fit within and expand beyond the broader American Modernist architectural movement? It explores the consequences of the destruction of Black communities, the lived experiences of Black architects, and how those experiences are reflected in their designs. Additionally, the research suggests that the work of Black architects aligns with heutagogical pedagogy, which views community stakeholders not just as beneficiaries, but as educators and knowledge-holders in architectural preservation. Findings reveal that Black Modernism, therefore, is not only a design style but a method of reclaiming identity, telling untold histories, and building more inclusive cities. Full article

Background: Myocarditis is associated with increased mortality due to complications such as cardiogenic shock and arrhythmia. Trends of myocarditis-related mortality in the United States, along with demographic and regional disparities and changes during the COVID-19 pandemic, are unknown. Methods: We used the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database to extract data for myocarditis deaths from 1999 to 2023. The Joinpoint Regression Program was used to analyze long-term trends in mortality, and R Studio (version 4.4.1) was used to calculate expected and excess mortality for 2020 to 2023. Results: There were 33,016 myocarditis-related deaths from 1999 to 2023. The age-adjusted mortality rate (AAMR) of myocarditis deaths decreased by 46.08% from 7.40 (95% CI: 7.04–7.76) in 1999 to 3.99 (95% CI: 3.74–4.23) in 2019, with an APC of −2.59 (95% CI: −2.97 to −2.24). From 2019 to 2021, the AAMR increased by 46.62% to 5.85 (95% CI: 5.56–6.14) by 2021 (2019–2021 APC 22.3%*), reversing the gains of the previous two decades. By 2023, the AAMR recovered to 4.33 (95% CI: 4.09 to 4.58), though mortality was still higher than expected from pre-pandemic trends. From 2020 to 2023, there were 40.12% more deaths than expected, with 54.94% higher mortality in 2021. Briefly, 70.33% of excess myocarditis-related deaths also had COVID-19, with a peak of 76.15% of excess myocarditis deaths in 2021 being reported as involving COVID-19 infection. Significant disparities in mortality trends persisted, with males, NH Black or African Americans, and the elderly having higher mortality rates. Conclusions: Myocarditis mortality decreased in the United States from 1999 to 2019 but significantly increased during the COVID-19 pandemic years 2020 and 2021. At the height of the pandemic, COVID-19 infection contributed to almost three-quarters of excess myocarditis mortality. Significant disparities in myocarditis mortality persisted from 1999 to 2023. Full article

Hypertensive left ventricular hypertrophy (LVH) is an ominous cardiovascular sequel to chronic hypertension, marked by structural and functional alterations in the heart. Identified as a significant risk factor for adverse cardiovascular outcomes, LVH is typically detected through echocardiography and is characterized by pathological thickening of the left ventricular wall. This hypertrophy results from chronic pressure overload (increased afterload), leading to concentric remodelling, or from increased diastolic filling (preload), contributing to eccentric changes. Apoptosis, a regulated process of cell death, plays a critical role in the pathogenesis of LVH by contributing to cardiomyocyte loss and subsequent cardiac dysfunction. Given the substantial clinical implications of LVH for cardiovascular health, this review critically examines the role of cardiomyocyte apoptosis in its disease progression, evaluates the impact of pharmacological interventions, and highlights the necessity of a comprehensive, multifaceted treatment approach for the prevention and management of hypertensive LVH. Finally, we address the health disparities associated with LVH, with particular attention to the disproportionate burden faced by African Americans and other Black communities, as this remains a key priority in advancing equity in cardiovascular care. Full article

Objective: This study aimed to assess the feasibility and acceptability of a Culinary Medicine and Wellness (CMW) class among undergraduate college students attending a U.S. Minority-Serving Institution (MSI), as well as their food security, mental health status, and eating behaviors. Methods: This pre- and post-intervention study was conducted at an MSI in a Southeastern U.S. University, where students enrolled in a 15-week, three-credit CMW class equivalent to 2.5 h per week and received instruction on cooking and preparing healthy meals on a budget. The primary outcomes were acceptability and feasibility of the CMW class. Participants’ food security status, mental health status, and fruit and vegetable intake were also assessed. Program evaluation utilized thematic analysis and descriptive statistics, and trend analyses of outcomes were performed. Results: Eleven participants completed both surveys. The average age was 24 years, with 73% identifying as Black/African American. All participants were female and experienced low or very low food insecurity, and most reported moderate stress levels. All participants reported they would recommend the CMW class to others, with 73% rating it as excellent. Additionally, 82% felt they had learned valuable cooking and budgeting skills. Conclusions: The acceptability and feasibility of a CMW class among college students at an MSI suggests a promising approach to improving cooking skills, enhancing nutrition knowledge, increasing fruit and vegetable intake, and reducing stress. Full article

Introduction: Air pollution is a risk factor for a variety of cardiopulmonary diseases and is a contributing factor to cancer, diabetes, and cognitive impairment. The impact on mortality is not clearly elucidated. Objectives: The goal of this study is to determine the impact (if any) of air pollution on the 5-year mortality of patients in the American Family Cohort (AFC) dataset. Methods: The AFC dataset is derived from the American Board of Family Medicine PRIME Registry electronic health record data. It includes longitudinal information from 6.6 million unique patients from an estimated 800 primary care practices across 47 states, with 40% coming from rural areas. The Environmental Protection Agency’s Air Quality Index (AQI) measures were downloaded for the study period (2016–2022). Using the Python library pandas, the AFC and EPA datasets were merged with respect to date, time, and location. Cox Regression Models were performed on the merged dataset to determine the impact (if any) of air quality on patients’ five-year survival. In the model, AQI was handled as a time-independent (time-fixed) covariate. Results: The group with AQI > 50 had an adjusted hazard of death that was 4.02 times higher than the hazard of death in the group with AQI ≤ 50 (95% CI: 3.36, 4.82, p < 0.05). The hazard of death was 6.73 times higher in persons older than 80 years of age (95% CI: 5.47, 8.28; p < 0.05) compared to those younger than 80 years of age. Black/African American patients had a 4.27 times higher hazard of death (95%CI: 3.47, 5.26; p < 0.05) compared to other races. We also found that regional effects played a role in survival. Conclusions: Poor air quality was associated with a higher hazard of mortality, and this phenomenon was particularly pronounced in Black/African American patients and patients older than 80 years of age. Air pollution is an important social determinant of health. Public health initiatives that improve air quality are necessary to improve health outcomes. Full article