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Despite longstanding concerns about environmental injustice in Louisiana’s industrialized communities, including the area known as Cancer Alley, there is a lack of environmental health research in this state. This research gap has direct consequences for residents of industrialized neighborhoods because state regulators have cited a lack of evidence for adverse health outcomes when making industrial permitting decisions. We investigated how cancer incidence relates to cancer risk from toxic air pollution, race, poverty, and occupation across Louisiana census tracts, while controlling for parish-level smoking and obesity rates, using linear regression and Akaike information criterion model selection. We used the most recent cancer data from the Louisiana Tumor Registry (2008–2017), estimates of race, poverty, and occupation from the US Census Bureau’s American Community Survey (2011–2015), and estimated cancer risk due to point sources from the US Environmental Protection Agency’s 2005 National Air Toxics Assessment (accounting for cancer latency). Because race and poverty were strongly correlated ( r = 0.69, P < 0.0001), we included them in separate, analogous models. Results indicated that higher estimated cancer risk from air toxics was associated with higher cancer incidence through an interaction with poverty or race. Further analysis revealed that the tracts with the highest (i.e. top quartile) proportions of impoverished residents (or Black residents) were driving the association between toxic air pollution and cancer incidence. These findings may be explained by well-established disparities that result in greater exposure/susceptibility to air toxics in Black or impoverished neighborhoods. Regardless, our analysis provides evidence of a statewide link between cancer rates and carcinogenic air pollution in marginalized communities and suggests that toxic air pollution is a contributing factor to Louisiana’s cancer burden. These findings are consistent with the firsthand knowledge of Louisiana residents from predominantly Black, impoverished, and industrialized neighborhoods who have long maintained that their communities are overburdened with cancer.

In this randomized, controlled, phase 3 trial of tafamidis for transthyretin amyloid cardiomyopathy, tafamidis was associated with lower all-cause mortality and lower rates of cardiovascular-related hospitalizations and decline in functional capacity and quality of life.

PurposeTo assess discrepancies in current imaging recommendations for hematuria among North American societies: American College of Radiology (ACR), American Urological Association (AUA), and Canadian Urological Association (CUA).MethodsThe latest available ACR Appropriateness Recommendations, AUA guidelines, and CUA guidelines were reviewed. AUA and CUA guidelines imaging recommendations by variants and level of appropriateness were converted to match the style of ACR. Imaging recommendations including modality, anatomy, and requirement for contrast were recorded.ResultsClinical variants included microhematuria without risk factors, microhematuria with risk factors, gross hematuria, and microhematuria during pregnancy. CUA recommends ultrasound kidneys as the first-line imaging study in the first 3 variants; pregnancy is not explicitly addressed. For hematuria without risk factors, ACR does not routinely recommend imaging, while AUA recommends shared decision-making to decide repeat urinalysis versus cystoscopy with ultrasound kidneys. For hematuria with risk factors and gross hematuria, ACR recommends CT urography; MR urography can also be considered in gross hematuria. AUA further stratifies intermediate- and high-risk patients, for which ultrasound kidneys and CT urography are recommended, respectively. For pregnancy, ACR and AUA both recommend ultrasound kidneys, though AUA additionally recommends consideration of CT or MR urography after delivery.ConclusionThere is no universally agreed upon algorithm for diagnostic evaluation. Discrepancies centered on the role of upper tract imaging with ultrasound versus CT. Prospective studies and/or repeat simulation studies that apply newly updated guidelines are needed to further clarify the role of imaging, particularly for patients with microhematuria with no and intermediate risk factors.

Background Approximately 13–19% of postpartum women experience postpartum depression and a majority report at least some stress during the postpartum phase. Traditional interventions such as psychotherapy and antidepressant medications are often not feasible or desirable. The purpose of this study was to examine two low cost, brief, accessible interventions designed to prevent postpartum depression and perceived stress among women at high risk. Methods Participants ( n  = 450) who were on average four weeks postpartum, had a history of depression before pregnancy, and exercised less than 60 min per week were randomly assigned to one of the following three conditions: (1) 6-month telephone-based exercise intervention; (2) 6-month telephone-based wellness/support intervention (e.g., healthy eating, sleep, and perceived stress); or (3) usual care. Results Overall, 2.4% of participants met criteria for depression at 6 months and 3.6% at 9 months with no differences between groups. At 6 months following randomization, median symptoms of depression were significantly lower among wellness participants compared to usual care participants (b = − 1.00, SE = 0.46, p  = .03). Perceived stress at 6 months post-randomization was significantly lower among exercise vs. usual care participants (b = − 2.00, SE = .98, p  = .04) and exercise vs. wellness participants (b = − 2.20, SE = 1.11, p = .04). Conclusions The wellness intervention was efficacious for preventing symptoms of depression; however, postpartum depression that met the diagnostic criteria was surprisingly low in all conditions among this at risk sample of postpartum women. Exercise interventions may have a protective effect on perceived stress among women at risk for postpartum depression. Practitioners should consider integrating exercise and wellness interventions into postpartum care. Trial registration Clinical Trials Number: NCT01883479 (06/21/2013).

In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial, tafamidis significantly reduced all-cause mortality and cardiovascular-related hospitalizations in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). ATTR-CM is associated with a significant burden of disease; further analysis of patient-reported quality of life will provide additional data on the efficacy of tafamidis. In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial, 441 adult patients with ATTR-CM were randomized (2:1:2) to tafamidis 80 mg, tafamidis 20 mg, or placebo for 30 months, with pooled tafamidis (80 mg and 20 mg) compared with placebo. Change in Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) domain scores, EQ-5D-3L scores, and patient global assessment, were prespecified exploratory end points. A greater proportion of patients improved KCCQ-OS score at month 30 with tafamidis (41.8%) versus placebo (21.4%). Tafamidis significantly reduced the decline in all 4 KCCQ-OS domains (p <0.0001 for all), and in EQ-5D-3L utility (0.09 [confidence interval 0.05 to 0.12]; p <0.0001) and EQ visual analog scale (9.11 [confidence interval 5.39 to 12.83]; p <0.0001) scores at month 30 versus placebo. A larger proportion of tafamidis-treated patients reported their patient global assessment improved at month 30 (42.3% vs 23.8% with placebo). In conclusion, tafamidis effectively reduced the decline in patient-reported outcomes, providing further insight into its efficacy in health-related quality of life in patients with ATTR-CM.

In the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), tafamidis significantly reduced mortality and cardiovascular (CV)-related hospitalizations compared with placebo in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). This analysis aimed to assess the causes of CV-related death and hospitalization in ATTR-ACT to provide further insight into the progression of ATTR-CM and efficacy of tafamidis. ATTR-ACT was an international, double-blind, placebo-controlled, and randomized study. Patients with hereditary or wild-type ATTR-CM were randomized to tafamidis (n = 264) or placebo (n = 177) for 30 months. The independent Endpoint Adjudication Committee determined whether certain investigator-reported events met the definition of disease-related efficacy endpoints using predefined criteria. Cause-specific reasons for CV-related deaths (heart failure [HF], arrhythmia, myocardial infarction, sudden death, stroke, and other CV causes) and hospitalizations (HF, arrhythmia, myocardial infarction, transient ischemic attack/stroke, and other CV causes) were assessed. Total CV-related deaths was 53 (20.1%) with tafamidis and 50 (28.2%) with placebo, with HF (15.5% tafamidis, 22.6% placebo), followed by sudden death (2.7% tafamidis, 5.1% placebo), the most common causes. The number of patients with a CV-related hospitalization was 138 (52.3%) with tafamidis and 107 (60.5%) with placebo; with HF the most common cause (43.2% tafamidis, 50.3% placebo). All predefined causes of CV-related death or hospitalization were less frequent with tafamidis than placebo. In conclusion, these data provide further insight into CV disease progression in patients with ATTR-CM, with HF the most common adjudicated cause of CV-related hospitalization or death in ATTR-ACT. Clinical trial registration ClinicalTrials.gov: NCT01994889.

Using an intersectional framework, this paper analyzes the behavioral and interactional responses to anti-gay religious teachings among young Black gay men. Drawing on 26 semi-structured interviews and 18 months of ethnographic observation data, I highlight the role non-religious youth development organizations play in the negotiation of contradictory religious and sexual identities among young Black gay men. My findings illuminate new patterns in the understanding of personal narrative reconciliation while simultaneously highlighting new directions for research in the roles that youth-led spaces play in socialization practices. While previous research on religion and sexuality has relied primarily on interview data, this study uses ethnographic data to supplement interviews with youth to further elucidate the community building and collective negotiations of religious teachings. Ultimately, I argue that these young Black gay men work collaboratively to repurpose religious messaging in order to justify their sexualities; to reinforce positive behaviors and explain everyday occurrences with religious exclamations (e.g., call and response, shouting); and to create new religious communities.

During the COVID-19 pandemic, the increase in demand for protective equipment caused a global shortage and homemade barrier face coverings were recommended as alternatives. However, filtration performances of homemade face coverings have not been fully evaluated. Test methods in the ASTM standard (F3502-21) were used to evaluate filtration efficiencies (FE) and breathability (pressure drop, Δp) of face coverings and home fabric materials commonly used during the pandemic. Submicron particulates FE was measured by particle transmission through face covering samples using a Condensation Particle Counter equipped with differential mobility analyzer and electronic manometer. Flow resistance of 0.1 μm-diameter fluorescent nanoparticles in droplets was determined by measuring fluorescence intensity of residual collected at the reverse side of samples. The size-dependent FE (3–94%) and Δp (0.8–72 mmH2O) varied considerably among fabrics. Of the 16 mask types, 31.25% and 81.25% met the minimum FE and breathability standards in the ASTM F3502-21, respectively. Overall performance (qF) was highest for velcro masks (max qF = 3.36, min qF = 2.80) and lowest for Dutch wax print fabrics (max qF = 0.12, min qF = 0.03). Most of the samples resisted the flow of 0.1 µm-diameter nanoparticles in droplets. Low flow resistance was observed in bandana, neck gaiter, t-shirt I, tank top and bedspread fabrics. GSM and fabric finishing seems to affect performance. Low performances can be improved by selecting optimum-performance fabrics in the design and manufacture of barrier face coverings.Face coverings protect both the wearer and others against severe acute respiratory diseases.Shortage of personal protective equipment resulted in the use of homemade face coverings.Standardized test revealed filtration efficiency and breathability that varied among fabric samples.Tested materials and multiple layers are recommended for use in alternative face coverings production.

Posttraumatic stress disorder (PTSD) and cannabis use disorder (CUD) are commonly comorbid and are associated with many negative public health outcomes. One plausible explanation for this comorbidity comes from a self-medication framework, which suggests people use cannabis to cope with PTSD symptoms. Despite theoretical and empirical evidence for PTSD-related cannabis use to cope, no measure of this construct exists. We sought to address this gap by developing and validating a novel measure of PTSD-specific cannabis self-medication, which we have termed the Trauma-Related Cannabis Use to Cope (TRCU) questionnaire. The psychometric properties of the TRCU and how it relates to relevant constructs were examined among a diverse sample of 345 trauma-exposed undergraduate cannabis users (  = 22.19,  = 6.45; 46.7% White; 79.7% woman-identifying) using structural equation modelling in Mplus. Study findings indicate that the TRCU is a more precise and targeted measure of cannabis use to cope with PTSD symptomology, as compared to existing measures of cannabis coping motives. Furthermore, our data support the use of the TRCU as a four-factor scale, assessing cannabis use to cope with the four PTSD symptom clusters ( (164) = 257.83,  < .001; CFI = .969; TLI = .965; RMSEA = .041). We also found strong evidence supporting the construct and criterion validity of the TRCU, specifically in relation to PTSD symptoms, cannabis use, and cannabis-related issues and dependence. Results support the use of the TRCU in future self-medication research and as a clinically useful screening tool for identifying individuals with PTSD who are at risk for developing CUD.