Medical Mistrust, HIV-Related Conspiracy Beliefs, and The Need for Cognitive Closure among Urban-Residing African American Women: An Exploratory Study

Despite advances regarding access to care and overall treatment, medical mistrust remains an important factor regarding clinical research participation as well as prevention/treatment-seeking behaviors among African American women. Such attitudes may be a result of psychosocial variables such as HIV-related conspiracy endorsement as well as a need for cognitive closure (NFCC) that reinforces their beliefs of interpersonal and institutional discrimination. To explore how well these psychosocial factors predict medical mistrust, thirty-five urban-residing African American women completed a demographics survey, the Medical Mistrust Index (MMI), a HIV-related conspiracy beliefs survey, and the Need for Closure Scale (NFCS). Results showed that the overall model of age, HIV-related conspiracy beliefs, and NFCC accounted for 25.9% of variance in medical mistrust among participants. This suggests that medical mistrust among African American women may stem from the need to have clinical and health-related expectations in-line with historical and personal experiences of prejudice and mistreatment in order to avoid similar situations. Future studies should examine this dynamic within a larger population to determine possible strategies for addressing factors concerning medical mistrust among African American women and subsequently reduce persistent health disparities such as HIV

Acute kidney injury and renal recovery following Fontan surgeryCentral MessagePerspective

Objectives: Acute kidney injury has been described after Fontan surgery, but the duration and outcomes are unknown. We sought to describe the incidence of and risk factors for acute kidney injury and the phenotype of renal recovery, and evaluate the impact of renal recovery phenotype on outcomes. Methods: All children who underwent a Fontan operation at a single center between 2009 and 2022 were included. Data collected included Fontan characteristics, vasopressor use, all measures of creatinine, and postoperative outcomes. Logistic regression models were used to assess predictors of acute kidney injury and the association between acute kidney injury and outcomes. Results: We enrolled 141 children (45% female). Acute kidney injury occurred in 100 patients (71%). Acute kidney injury duration was transient (<48 hours) in 77 patients (55%), persistent (2-7 days) in 15 patients (11%), more than 7 days in 4 patients (3%), and unknown in 4 patients (3%). Risk factors for acute kidney injury included higher preoperative indexed pulmonary vascular resistance (odds ratio, 3.90; P = .004) and higher postoperative inotrope score on day 0 (odds ratio, 1.13, P = .047). Risk factors for acute kidney injury duration more than 48 hours included absence of a fenestration (odds ratio, 3.43, P = .03) and longer duration of cardiopulmonary bypass (odds ratio, 1.22 per 15-minute interval, P = .01). Acute kidney injury duration more than 48 hours was associated with longer length of stay compared with transient acute kidney injury (median 18 days [interquartile range, 9-62] vs 10 days [interquartile range, 8-16], P = .006) and more sternal wound infections (17% vs 4%, P = .049). Conclusions: Acute kidney injury after the Fontan operation is common. The occurrence and duration of acute kidney injury have significant implications for postoperative outcomes