Department of Medicine

Existing research highlights TB's economic and social stigma burdens and impacts behavior in households, but virtually unexplored is the dynamics of TB and parenthood. This qualitative study examines the interplay between TB diagnosis and treatment, and parenting experiences, focusing on the intersections of individual agency, societal expectations, and access to resources. From March 2021 to January 2022, we conducted in-depth interviews with 98 TB patients in Buffalo City, South Africa, including 44 mothers and 54 fathers. Guided by the Network-Individual-Resource (NIR) model, we applied layered coding, memoing, and causal mapping to analyze experiences through the lens of agency and societal expectations. Mothers reported primary caregiving responsibilities, drawing motivation from their children, and relying on multigenerational family support for childcare and treatment-adherence. Children frequently provided emotional and practical care, such as cooking and medication reminders. Fathers more often distanced themselves to protect families from infection, faced isolation, and struggled to fulfill provider roles due to job loss. Extended family support for fathers was limited, with financial pressures exacerbating treatment challenges. These results illustrate how gender norms and resources structure the TB experience. Strengthening maternal caregiving networks and reimagining fatherhood beyond economic provision can foster better adherence and more equitable health outcomes.

Permissive cardiotoxicity is an evolving clinical practice pattern that balances the management of cancer treatment‐associated cardiotoxicities with the risk of interrupting lifesaving or life‐extending cancer treatments. This paradigm shift has been catalyzed by advancements in the diagnostic and therapeutic tools available to treating clinicians, as well as a recognition of the consequences of withholding or delaying cancer therapy. Permissive cardiotoxicity has become a central tenet in the practice of cardio‐oncologists; however, recognition and confidence in managing cardiotoxicity is also crucial for the general cardiologist and oncologist due to the growing population of patients with cancer. This review aims to (1) highlight the philosophy of permissive cardiotoxicity, (2) provide a framework for risk stratification of cardiovascular toxicities, (3) describe systems of care considerations for successful implementation of permissive cardiotoxicity, and (4) review the existing literature and guideline recommendations for specific cardiovascular toxicity mitigation.

Introduction The United States has seen a rise in methamphetamine use disorders and methamphetamine-involved deaths. However, there is limited information on methamphetamine at the consumer level. We leverage data from a community-based drug checking program in Los Angeles to investigate the makeup of the retail illicit methamphetamine market and the extent methamphetamine plays a role as an adulterant in other drugs. Methods Participants accessing a community-based drug checking program provided samples of drug products and completed brief interviews in Los Angeles County, California, from 2023 to 2025. Samples underwent laboratory-based qualitative and quantitative mass spectrometry. We quantitated the presence and concentration of methamphetamine as well as all other identified substances among samples expected only to be methamphetamine and samples expected to be another substance (e.g., fentanyl, heroin) where methamphetamine was found as an adulterant/contaminant. Results Of N=2193 total samples, n=652 (29.7%) were methamphetamine-positive on DART-MS. In samples expected to contain methamphetamine, the mean purity was 78.2% (SD 24.0%; range <1% to ≈100%). As an unexpected component, the mean methamphetamine purity was 17.8% (SD 32.3%) and was mostly found in samples expected to be fentanyl, heroin, other amphetamines. Conclusions Consumers in Los Angeles seeking methamphetamine appear to frequently obtain high-purity samples that are rarely adulterated with other substances, although we observed a wide variation in concentration between samples. In contrast, drugs purchased without the expectation of containing methamphetamine had high prevalence of methamphetamine adulteration/contamination. Future research should expand methamphetamine surveillance techniques and investigate how variability in illicit markets may impact health outcomes.

Purpose of ReviewImmunotherapies have revolutionized treatment strategies for cancer patients, improving the prognosis in many populations with advanced malignancies. Immune check point inhibitors (ICI) and Chimeric antigen receptor (CAR) T cell therapy are being increasingly used. As the real-world use of immunotherapies increases and indications expand, an understanding of potential cardiovascular toxicities is required.Recent Findings Arrhythmias are among the top reasons for seeking cardiovascular care in immunotherapy treated patients. ICI and CART therapies have been associated with arrhythmias with wide range of estimates reported in randomized clinical trials and retrospective studies. The pathophysiology and risk factors behind ICI and CART therapies is unclear. Summary In this review, we summarize the incidence, mechanisms, risk factors, impact on patient outcomes and management of ICI and CAR-T cell therapy-associated arrhythmia complications.

BackgroundAlcohol use during pregnancy remains a major public health concern in South Africa, particularly in communities with entrenched historical, social, and structural drivers of harmful drinking. Saldanha Bay, a peri-urban fishing community in the Western Cape, has among the highest reported rates of fetal alcohol spectrum disorder globally. Understanding the multilevel social and structural dynamics that sustain alcohol use in pregnancy is essential to inform contextually appropriate interventions.MethodsFormative qualitative research to inform the adaptation of a peer-led intervention to reduce alcohol use during pregnancy was conducted between January and June 2025. We held two focus group discussions, one with healthcare providers (n = 6) and one with community leaders (n = 7) and conducted in-depth interviews with male partners of women who drank during pregnancy (n = 15) and drinking peers (friends or family members; n = 16). We purposively recruited participants with support of a long-standing community partner and through snowball sampling. Data were collected in Afrikaans and English using semi-structured guides, audio-recorded, transcribed, translated, and analyzed thematically using NVivo. Analysis followed an iterative coding and memoing process, and reporting adhered to COREQ guidelines.ResultsSix interrelated themes emerged. First, couple-level dynamics, particularly male partner drinking, were perceived as the primary driver of continued alcohol use during pregnancy, with partner drinking heavily influencing maternal drinking behaviors. Trajectories ranged from mutual continuation to solidarity-driven reduction. Second, participants described that the need for social belonging and fear of isolation often outweighed pregnancy-related health motivations, especially in contexts where alcohol use is central to social life and pregnancies are unplanned. Third, intergenerational misinformation normalized and actively undermined medical advice during pregnancy and breastfeeding. Fourth, alcohol use functioned as a coping mechanism for stressors like poverty, violence, unplanned pregnancy, and partner absence; some participants described loss of control consistent with addiction. Fifth, there was strong expressed support for mentor-based interventions delivered by credible, relatable women with lived experience, ideally engaging partners and broader social networks. Sixth, participants emphasized that support should be community-based rather than clinic-based, combine group and individual support, and provide sustained engagement throughout pregnancy.ConclusionsFamily, peers and partners closest to women who use alcohol in pregnancy describe how addressing these issues in this context will require moving beyond individual behavior change to address intersecting relational and structural factors. Effective interventions must engage male partners, debunk family level myths and misinformation, and utilize trusted peers in non-stigmatized spaces and community-centered delivery models with sustained community support.

BackgroundUnderstanding the clinical, self-management, and resource needs of low-income, multilingual, racially and ethnically diverse safety-net patients with hypertension can guide interventions to improve outcomes in under-resourced communities.ObjectiveExplore barriers and contributors to equitable hypertension care.DesignWe conducted semi-structured virtual focus groups during April 2022 to April 2023.ParticipantsLos Angeles safety-net patients with hypertension (or their caregivers) self-identifying as Latino, Black/African American, Filipino, Korean, and Chinese were eligible; these groups had the lowest blood pressure control rates within a large public safety-net healthcare system.ApproachWe analyzed transcripts using reflexive thematic analysis.ResultsNine focus groups (43 hypertensive participants) across 5 racial/ethnic groups and 5 languages included three Latino (n = 13), two Black (n = 11), two Chinese (n = 12), one Filipino (n = 4), and one Korean (n = 3) groups. Most patients (70%) received care through a large public healthcare system, 19% at FQHCs, and 6% elsewhere. Thirty-seven percent were over 65, 91% saw a doctor last year, 77% were very low-income, 72% were foreign-born, and 58% preferred a language other than English. Themes illustrate opportunities to achieve equitable hypertension care and management: (1) diagnosis acceptance (gradually processing diagnosis, risk appreciation driving self-management); (2) desire for personalized guidance (guidance needed for reducing medication concerns, preference for solution-focused care, guidance on real-world lifestyle change strategies, physical mobility/disability/mental health limiting self-care); (3) clinical factors (clinical follow-through being primarily patient-initiated, comprehensive clinical support needs, variably accessible provider communication); and (4) community support environments (insufficient resource awareness or access, desires for social support).ConclusionsUnderstanding patient experiences can lead to specific, effective, culturally appropriate multilevel interventions for patients, providers, and systems to address the multiple factors affecting hypertension management. We use our findings to outline actionable primary care strategies and case studies for multilevel interventions.