Direct and Vicarious Racial Discrimination at Three Life Stages and Preterm Labor: Results from the African American Women's Heart & Health Study.

INTRODUCTION: Health disparities research has demonstrated a negative relationship between racial discrimination and African American women's maternal health outcomes. Yet, the relationship between racial discrimination and preterm labor, a key measure of maternal health, remains understudied. This study sought to examine the associations between preterm labor and direct and vicarious racial discrimination among African American women at three life stages: childhood, adolescence, and adulthood. METHODS: Logistic regression methods were used to analyze cross-sectional data from the African American Women's Heart & Health Study (AAWHHS; N = 173). The AAWHHS includes detailed maternal health information on a community sample of African American women residing in the San Francisco Bay Area. RESULTS: Findings indicated each unit increase in adolescent direct racial discrimination was associated with a 48% increase in the odds of preterm labor (OR: 1.480, 95% CI 1.002-2.187, p < 0.05) and each unit increase in childhood vicarious racial discrimination was associated with a 45% increase in the odds of preterm labor (OR: 1.453, 95% CI 1.010-2.092, p < 0.05) after adjusting for number of pregnancies and socioeconomic variables. DISCUSSION: This study provides evidence of an association between life-stage racial discrimination and preterm labor risk among African American women, underscoring a need to consider how both directly and vicariously experienced racial discrimination at different developmental periods impact racial disparities in birth outcomes.

Randomized Controlled Trial of a 4-Week Mindfulness Intervention among Cancer Survivors Compared to a Breathing Control.

Purpose: This randomized controlled trial (RCT: NCT02633748) examined effectiveness of an abbreviated mindfulness program on psychosocial symptoms, behaviors, and inflammation. Methods: Cancer survivors (n = 36) underwent a 4-week mindfulness intervention compared to a breathing control. Data included psychosocial questionnaires, anthropometrics, actigraphy, and blood draws. Clinic visits occurred at baseline, post-intervention, and a 3-month post-follow-up. Results: Compared to baseline, the intervention arm displayed reductions in sedentary time and perceived stress and improvements in subjective sleep quality, and daily steps at post-follow-up. Conclusions: An abbreviated mindfulness intervention in feasible in cancer survivors and signs of efficacy warrant further mindfulness studies among this population.

Traumatic carotid artery-cavernous sinus fistula treated with a covered stent. Report of two cases.

The authors describe the cases of two patients with unilateral traumatic caroticocavernous fistulas in whom a self-expanding covered stent was successfully used to obliterate the fistula after failed occlusion with detachable balloons and coils. They discuss this option as a primary therapeutic modality in cases in which detachable balloons or coils, with or without a bare stent, have failed to obliterate the fistula. The placement of a covered stent to occlude the lesion from the outset may represent a new therapeutic approach to the treatment of these lesions.

Why is microcalcification missed on mammography?

INTRODUCTION: Ductal carcinoma in situ (DCIS) is often only mammographically evident as microcalcification. Although the overall percentage of screening cases with histologically proven DCIS microcalcification is small, the clinical relevance of missing this finding is significant. The current guidelines in Australia for breast screening departments are for double reading of mammograms to reduce both perceptive and interpretative error. METHODS: This retrospective study identified patients from a state screening program with histologically proven DCIS whose mammograms showed microcalcification. The initial double reader results were documented according to the 5-point grading scale of BreastScreen Tasmania, and discrepancies between readers were noted. Mammographic factors such as breast density, lesion location, morphology, distribution, size and presence on previous imaging were assessed for significant influence on inter-reader discrepancy. Histological evidence of invasion and grade of malignancy were also analysed. RESULTS: Of 65 identified cases, 29 (45%) showed that one of the two readers had not flagged the microcalcification on the report. Analyses revealed no significant difference in reader discrepancy with any of the analysed factors including breast density, size of microcalcification or presence on previous imaging. Twenty-five of 29 (86%) cases of discrepancy were perceptive. CONCLUSION: Breast screening reading for microcalcification is poorly correlated to mammographic or histological features. The majority of errors were perceptive rather than interpretative. Double reading is advocated as standard practice to reduce perceptive error.