"Black Is Not Monolithic": Complexities in COVID-19 Vaccine Decision-Making.

BACKGROUND: Longstanding inequities in the USA have resulted in the disproportionate impact of COVID-19 on Black Americans. Coupled with medical mistrust, COVID-19 vaccine uptake is lower in Black populations. METHODS: We sought to understand the perspectives of Black parents on the COVID-19 pandemic, COVID-19 vaccination for themselves and their children, and trust with the medical community. Using qualitative methodology, we conducted in-depth semi-structured in-person interviews of Black parents of children admitted to the inpatient pediatric units in our tertiary academic medical center in Connecticut from July to November 2021. We used the grounded theory approach, and the constant comparative method until saturation was reached. RESULTS: We interviewed 20 parents who identified as Black; 50% were vaccinated against COVID-19. The following 5 themes and sub-themes emerged: (1) mixed feelings influenced COVID-19 vaccine decision-making ranging from much needed relief and feelings of uncertainty, distrust, and fear; (2) COVID-19 vaccine uptake was influenced by individual and family's health concerns and job or school mandates; (3) deferring the COVID-19 vaccine was influenced by the perception of risk and concerns about vaccine integrity; (4) institutional mistrust within the Black community bred by systemic racism influenced vaccine decision-making; and (5) conflicted feelings about the COVID-19 vaccine for their child. CONCLUSION: Our findings reiterate the complexities around vaccine decision-making and underscore the importance of recognizing the pervasive influence of institutional mistrust when counseling Black families about the COVID-19 vaccine.

Exploratory insights from the right-sided electrocardiogram following prolonged endurance exercise.

BACKGROUND: Prolonged strenuous exercise has a profound effect on cardiac function. The right heart may be more susceptible to this imposition; yet, right-sided chest leads have not been utilised in this setting. METHODS: Thirty highly trained athletes at the 2014 Western States 100-mile Endurance Run from Squaw Valley to Auburn, California (body mass 68 ± 12 kg, age 45 ± 10 years, 57 ± 15 miles per week) were recruited for the study. Pre- and post-race, a right-sided 12-lead ECG was obtained and data were extracted for P, R and S waves, J point, ST segment and T wave amplitude. Data were compared using Students T-test and statistical significance set as P < .05. RESULTS: There was a significant increase in P wave amplitude (29%) and QTc interval (4%) pre- to post-race from standard 12-lead ECG. From the right-sided12-lead ECG, a 23% (P = .01) and 38% (P = .03) increase in J point amplitude in V1R and V2R and a 22% (P = .05) increase in ST segment integral in V2R and V3R were evident. T wave inversion was evident in leads V2R-V6R in 50-90% of athletes, respectively. Close examination revealed marked heterogeneity in individual ECGs. CONCLUSIONS: Completion of a 100-mile ultra-marathon resulted in significant changes in the right-sided ECG alongside more marked responses in specific individuals. P wave, ST segment and T wave changes post-race are indicative of acute exercise-induced right heart electrical adaptation.

Blood lipid responses to plant stanol ester supplementation and aerobic exercise training.

The purpose of this study was to determine the independent and combined effects of plant stanol ester (PSE) margarine and aerobic exercise on blood lipid concentrations and related intravascular enzymes in 26 healthy sedentary, middle-aged men and postmenopausal women (age, 53 +/- 8 years; body mass index, 27 +/- 1.0, % fat, 28.5 +/- 2). In a stratified double-blind manner, participants were randomly assigned to either a PSE (n = 17) or a placebo (CON, n = 9) margarine group. Participants supplemented their daily diets with 42 g of margarine spread (PSE = 3 g; CON, PSE = 0 g, of approximately equal energy content) for 9 weeks. During the last 4 weeks of margarine supplementation (MS), participants expended 400 kcal on a treadmill 5 d/wk at 65% of VO(2) reserve (2000 kcal/wk). Fasting blood samples were obtained before initiating and after 4 weeks of MS and after exercise training. All blood samples were analyzed for total cholesterol, low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), hepatic lipase, lipoprotein lipase, and cholesterol ester transfer protein activities. Total cholesterol (-10%), low-density lipoprotein cholesterol (-13%), and triglyceride (-18%) concentrations decreased after 4 weeks of MS in the PSE group, but not in the CON group (P < .05 for all). Four weeks of aerobic exercise increased HDL-C by 21% in the CON group (P < .05) and by 4% in the PSE group (P > .05). Total cholesterol-HDL-C ratio decreased significantly (P < .05) in the PSE group, but not in the CON group. No other significant alterations were observed with either PSE or exercise. Our findings suggest that PSE is effective in reducing blood cholesterol concentrations and that exercise can increase HDL-C in middle-aged men and postmenopausal women. Our findings also suggest that PSE supplementation may attenuate the exercise-induced increase in HDL-C.