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Background: The increased contamination of illicit drugs with fentanyl in the United States drug market has contributed to escalating mortality from drug overdose. Leisure and hospitality service industry workers are encountering opioid-triggered overdoses in their workplaces, such as restaurants and bars. Consequently, this increases the need for overdose education and naloxone distribution (OEND) training, which has been limited. We aimed to describe the experiences among service industry workers encountering an overdose in their workplace. Methods: We conducted in-depth qualitative interviews with service industry workers in Little Five Points (L5P), Atlanta, between October 2019 and April 2020 and triangulated methods with participant observations and fieldwork. Purposive criterion sampling methods were applied to recruit from different establishments in the L5P commercial district, which comprised restaurants, bars, retail shops, and theaters. After an initial seed sample was identified by engaging key stakeholders during fieldwork (business owners, managers, and the business association), a snowball sample followed for a final sample of N = 15. To contextualize the local population of harm reduction workers, people who use drugs and/or obtain safer drug consumption supplies in L5P (sterile syringes, safer using kits, naloxone), and service industry workers and their customers in L5P, the first author volunteered with an Atlanta syringe services program from October 2019 to April 2020. The first author conducted participant observations during the syringe exchange program and field notes were taken during observation (44 hours). This engagement ensured a rich, thick description. We used a pragmatic approach to thematic data analysis for this study. Data were analyzed iteratively and inductively from interviews and observations. Two independent researchers reviewed transcripts to identify passages in the data related to the question of interest. The passages were contextualized within the full data set independently to understand the relationships in developing a theory of what was commonly occurring across participants' experiences, and these relationships led to emerging salient themes regarding encountering an opioid overdose at work. Results: One salient theme related to overdose response emerged with the service industry workers included fear of negative consequences of overdose response, specifically, fear of disease transmission from artifacts of drug use and overdose response, including the spread of blood-borne disease, violence, and exposure to unintentional overdose. When discussing drug use, participants' beliefs about the potential for personal danger from drug use artifacts (syringes and discarded drugs) and violence were identified as barriers to opioid overdose responses. Conclusions/Implications for Occupational Health Practice: Our findings provide valuable insights for tailoring OEND training for service industry workers to confront fears associated with opioid overdose response in their places of work to decrease mortality from the opioid epidemic. Harm reduction approaches need to be sensitive to the places in which overdose occurs and who the overdose responder is likely to be, which requires appropriately tailoring OEND training for service industry workers. [ABSTRACT FROM AUTHOR]

Background Data are limited on influenza vaccine effectiveness (VE) in the prevention of influenza-related hospitalizations in older adults and those with underlying high-risk comorbidities. Methods We conducted a prospective, test-negative, case-control study at 2 US hospitals from October 2018–March 2020 among adults aged ≥50 years hospitalized with acute respiratory illnesses (ARIs) and adults ≥18 years admitted with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) exacerbations. Adults were eligible if they resided in 1 of 8 counties in metropolitan Atlanta, Georgia. Nasopharyngeal and oropharyngeal swabs were tested using BioFire FilmArray (bioMérieux, Inc.) respiratory panel, and standard-of-care molecular results were included when available. Influenza vaccination history was determined from the Georgia vaccine registry and medical records. We used multivariable logistic regression to control for potential confounders and to determine 95% confidence intervals (CIs). Results Among 3090 eligible adults, 1562 (50.6%) were enrolled. Of the 1515 with influenza vaccination history available, 701 (46.2%) had received vaccination during that season. Influenza was identified in 37 (5.3%) vaccinated versus 78 (9.6%) unvaccinated participants. After adjustment for age, race/ethnicity, immunosuppression, month, and season, pooled VE for any influenza-related hospitalization in the eligible study population was 63.1% (95% CI, 43.8–75.8%). Adjusted VE against influenza-related hospitalization for ARI in adults ≥50 years was 55.9% (29.9–72.3%) and adjusted VE against influenza-related CHF/COPD exacerbation in adults ≥18 years was 80.3% (36.3–93.9%). Conclusions Influenza vaccination was effective in preventing influenza-related hospitalizations in adults aged ≥50 years and those with CHF/COPD exacerbations during the 2018–2020 seasons. [ABSTRACT FROM AUTHOR]

Background Hepatitis C virus (HCV) infection causes dysregulation and suppression of immune pathways involved in the control of tuberculosis (TB) infection. However, data on the role of chronic hepatitis C as a risk factor for active TB are lacking. We sought to evaluate the association between HCV infection and the development of active TB. Methods We conducted a cohort study in Georgia among adults tested for HCV antibodies (January 2015–September 2020) and followed longitudinally for the development of newly diagnosed active TB. Data were obtained from the Georgian national programs of hepatitis C and TB. The exposures of interest were untreated and treated HCV infection. A Cox proportional hazards model was used to calculate adjusted hazard ratios (aHRs). Results A total of 1 828 808 adults were included (median follow-up time: 26 months; IQR: 13–39 months). Active TB was diagnosed in 3163 (0.17%) individuals after a median of 6 months follow-up (IQR: 1–18 months). The incidence rate per 100 000 person-years was 296 among persons with untreated HCV infection, 109 among those with treated HCV infection, and 65 among HCV-negative persons. In multivariable analysis, both untreated (aHR = 2.9; 95% CI: 2.4–3.4) and treated (aHR = 1.6; 95% CI: 1.4–2.0) HCV infections were associated with a higher hazard of active TB, compared with HCV-negative persons. Conclusions Adults with HCV infection, particularly untreated individuals, were at higher risk of developing active TB disease. Screening for latent TB infection and active TB disease should be part of clinical evaluation of people with HCV infection, especially in high-TB-burden areas. [ABSTRACT FROM AUTHOR]

Background: Congenital central hypoventilation syndrome (CCHS), a rare disease caused by variants in the paired-like homeobox 2B (PHOX2B) gene, affects regulation of respiration necessitating lifelong assisted ventilation (AV). Most patients require full-time AV during infancy and some patients may sustain adequate spontaneous ventilation during wakefulness and change AV modalities at a later age. The aims of this study were to assess the changes in duration and modalities of AV, long-term respiratory outcomes, and to correlate them with PHOX2B genotypes. Methods: We conducted a retrospective study of patients with CCHS treated at our institution between January 1997 and May 2022. Results analyzed included: clinical presentation, PHOX2B genotype, modality and duration of AV at diagnosis and follow-up, survival, and transition to adult care. Results: We identified 30 patients with CCHS—8 with PHOX2B nonpolyalanine repeat mutations (NPARMs), 21 with polyalanine repeat mutations (PARMs), and 1 with unknown PHOX2B genotype. The median age at presentation was 0.25 months (IQR 0.1-0.7 months). At diagnosis of CCHS, 24 (80%) patients required continuous AV and 28 (93%) received AV via tracheostomy. Twenty-six patients required sleep-only AV at a median age of 9 months (IQR 6-14 months). Nine patients requiring sleep-only AV underwent tracheostomy decannulation at a median age of 11.2 years (IQR 5.9-15.7 years) and used noninvasive positive pressure ventilation or diaphragm pacing. There was insufficient evidence to conclude that patients with PARMs and NPARMs differed by age at presentation (P =.39), tracheostomy (P =.06), and transition to sleep-only AV (P =.9). Six patients transitioned to adult care, 23 continued receiving pediatric care, and 1 patient died due to complications from Hirschsprung's disease. Conclusion: Our study demonstrates prolonged survival and good long-term respiratory outcomes possibly related to the early diagnosis of CCHS, optimizing AV strategies, and multidisciplinary care. The increasing number of patients attaining adulthood highlights the necessity for multidisciplinary care for adults with CCHS. [ABSTRACT FROM AUTHOR]

Objectives: In response to a surge of drug overdoses involving polysubstance use among Atlanta service industry workers that resulted in the deaths of five people in the Atlanta area in the summer of 2021, a local community of harm reductionists and nurses organized opioid education and naloxone distribution (OEND) training sessions specifically customized for service industry workers in Atlanta. After the sessions, the nurses and harm reductionists asked attendants to participate in a study concerning their response to overdoses. The reason nurses and harm reductionists conducted the study was to determine the efficacy of OEND training adapted for those working in the service industries as well as to evaluate and possibly modify the training sessions for future use. This pre‐post study examined if and how participants' knowledge and attitudes toward an opioid‐involved overdose changed after engaging with the OEND training. If the study determined that the sessions were successful in teaching service industry workers how to mitigate the immediate and devastating effects of overdose, we recommend expanding and implementing both adaptable training sessions like the OEND training referenced, as well as accompanying studies to improve the training sessions' effectiveness. Design: The pre‐post study used convenience sampling to recruit participants in emergent OEND training. Participants completed an abbreviated version the Opioid Overdose Attitudes Scale (OOAS) which measured how, and to what degree, they changed their attitudes towards overdoses and their responses to them. Participants also completed an abbreviated version of the Opioid Overdose Knowledge Scale (OOKS) which measured how effectively the OEND increased their knowledge when it came to properly responding to an overdose, which included implementing naloxone as part of immediate rehabilitation treatment. Paired nonparametric tests assessed changes in participants' OOAS/OOKS scores. Results: A total of 161 individuals attended, and 72 consented to be in the study. The sample predominately consisted of white (76.4%) and female (66.7%) adults whose age averaged 34.3 years. Attitude and knowledge score improvements were statistically significant: approximately 11 points (p <.001) and 3 points (p <.001), respectively. Conclusions: This rapidly implemented training was associated with improving attitudes and knowledge about responding to an opioid‐involved overdose. We recommend expanding the scope of studies like these in order to develop and examine effective, dynamic, and targeted OEND training tailored towards specific community groups and situations, such as polysubstance overdose among service industry workers. As the opioid epidemic worsens, it is critical to equip community members themselves with the skills and tools to recognize and respond to opioid overdoses as a frontline prevention to overdose deaths. [ABSTRACT FROM AUTHOR]

Childhood-onset systemic lupus erythematosus (cSLE) is an autoimmune disease associated with significant morbidity and mortality. Rituximab is a B-cell depleting therapy utilized in the treatment of SLE. In adults, rituximab has been associated with increased risk of adverse outcomes in patients who develop coronavirus disease 2019 (COVID-19). We aimed to assess the impact of prior rituximab treatment on clinical outcomes from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in children with SLE. To describe the impact of rituximab on outcomes from SARS-CoV-2 infection, we conducted a retrospective study of pediatric SLE patients in our center diagnosed with COVID-19 who had previously received rituximab between February 2019 and October 2022. Patients' clinical characteristics, disease activity, and outcomes were assessed. Of the eight subjects assessed, five required hospitalizations for COVID-19, four required ICU admission, and two were seen in the emergency department for their symptoms. One patient ultimately expired from her illness. The median time between rituximab administration and COVID-19 diagnosis was 3 months. We assessed the clinical outcomes, including the need of ICU admission and fatal outcome, of COVID-19 in our cSLE patient population after rituximab administration. Approximately 60% of our patients required hospitalization for their illness, and seven out of eight patients required healthcare utilization to include hospitalization and/or emergency department visits. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is one of the most common pregnancy complications. Uncontrolled GDM increases the risk of negative pregnancy outcomes for both the pregnant individual and the infant. African Americans (AAs) have higher maternal morbidity and infant mortality rates than non-Hispanic whites (NHWs). The goal of the current study was to examine racial differences in the effect of GDM on birth outcomes. The data from the Pregnancy Risk Assessment Monitoring System (PRAMS) was analyzed with a focus on four states in the southern U.S. (Alabama, Georgia, Louisiana, and Mississippi). The results presented suggest that AAs are at lower risk of GDM than NHW individuals. Even with the lower risk of GDM, AAs are at higher risk of pre-term births. In addition, socioeconomic factors and access to prenatal care play a role in birth outcomes including moderating the effect of GDM on outcomes. A discussion of potential policy interventions that may improve pregnancy outcomes is discussed including increased use of doulas to support pregnant people. [ABSTRACT FROM AUTHOR]

Multimorbidity, the presence of two or more chronic disease diagnoses, is associated with an increased risk of mortality and high health care costs in the general population and older adults. However, little evidence is available about the prevalence and impact of multimorbidity in obstetric populations. The goal of this analysis was to estimate the association between multimorbidity and severe maternal morbidity (SMM) and 90-day postpartum readmission in an obstetric cohort in Atlanta, Georgia. We conducted a retrospective cohort study of livebirths and stillbirths at Grady Memorial Hospital, from October 2015 to April 2021. To determine preexisting chronic conditions, we linked information on births to inpatient diagnoses within the prior year. Multimorbidity was defined as the presence of two or more chronic disease diagnoses at birth or within the prior year. We conducted multivariable log binomial regression to estimate risk ratios and 95% confidence intervals for the crude and adjusted (for age, race/ethnicity, parity, and insurance) association between multimorbidity (two or more chronic conditions vs. zero or one) and SMM (at or within 42 days after birth) or 90-day postpartum readmission for any reason. Of 14,225 included births, 10.1% were to patients with multimorbidity. Overall, SMM complicated 7.5% of births, and the 90-day readmission rate was 2.4%. Both SMM and readmission were more common among women with multimorbidity (SMM, 18.6% among women with multimorbidity compared with 6.3% without; 90-day readmission, 5.4% compared with 2.1%). Adjusting for potential confounders, multimorbidity was associated with increased risk of SMM (adjusted risk ratio, 2.9; 95% confidence interval, 2.5–3.0) and readmission (adjusted risk ratio, 2.2; 95% confidence interval, 1.7–2.9). Individuals entering pregnancy with two or more chronic diseases were at an increased risk of SMM and postpartum readmission compared with individuals with one or zero chronic disease diagnoses. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Individuals who experience brain injury and are uninsured often do not have access to health care services following their injury. The Georgia Rehabilitation Services Volunteer Partnership (GA RSVP) Clinic is a free outpatient rehabilitation program for uninsured individuals with acquired brain injury (ABI) and/or spinal cord injury (SCI) for all racial and ethnic backgrounds. While the clinic serves people with ABI and SCI, this clinical focus article will focus on people with ABI by describing the clinic, lessons learned from operations, an ABI patient case study, and future directions. Method: Our mission is to provide free outpatient rehabilitation care that maximizes independence, wellness, and community participation. The clinic has been in operation since September 2020, staffed by volunteers who provide services once a month in donated space at a rehabilitation hospital. We currently have 69 active volunteers, seven founding Board of Directors, and 17 founding Advisory Board members. We provide education to clients and their families and run peer and family support groups. For clients who cannot attend due to medical or transportation challenges, we have added telehealth services. We have 11 partner organizations as well as individual donor’s financial support. The Chair of the clinic volunteers 50% of time managing clinic operations. Results: From September 2020 to December 2021, we provided care for 40 clients: 23 clinic admissions and 17 were provided information/referral services to access necessary health care services. Conclusions: A volunteer, free outpatient rehabilitation clinic is feasible and can contribute to improved outcomes for uninsured individuals with ABI. Further research to understand impact on patient outcomes is needed. [ABSTRACT FROM AUTHOR]

Background The COVID-19 pandemic has resulted in unprecedented healthcare challenges, and COVID-19 has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. However, studies of candidemia and COVID-19 coinfection have been limited in sample size and geographic scope. We assessed differences in patients with candidemia with and without a COVID-19 diagnosis. Methods We conducted a case-level analysis using population-based candidemia surveillance data collected through the Centers for Disease Control and Prevention's Emerging Infections Program during April–August 2020 to compare characteristics of candidemia patients with and without a positive test for COVID-19 in the 30 days before their Candida culture using chi-square or Fisher's exact tests. Results Of the 251 candidemia patients included, 64 (25.5%) were positive for SARS-CoV-2. Liver disease, solid-organ malignancies, and prior surgeries were each >3 times more common in patients without COVID-19 coinfection, whereas intensive care unit–level care, mechanical ventilation, having a central venous catheter, and receipt of corticosteroids and immunosuppressants were each >1.3 times more common in patients with COVID-19. All-cause in-hospital fatality was 2 times higher among those with COVID-19 (62.5%) than without (32.1%). Conclusions One-quarter of candidemia patients had COVID-19. These patients were less likely to have certain underlying conditions and recent surgery commonly associated with candidemia and more likely to have acute risk factors linked to COVID-19 care, including immunosuppressive medications. Given the high mortality, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Stroke is an important cause of mortality and morbidity in children. The aim of the study was to evaluate long-term neurological outcome in children with arterial ischemic stroke (AIS) and explore predictive factors that affect poor outcome. Fifty-six patients aged between 1 month and 17 years who were treated at M. Iashvili Children's Central Hospital, Tbilisi, Georgia, with an onset of stroke from 2007 to 2017 were included. To explore predictive factors of outcome, the following data were collected: demographic characteristics, risk factors, he presenting signs, radiological features, and presence of stroke recurrence. Neurological status at discharge and long-term neurological outcome at least 1 year after stroke was evaluated according to Pediatric Stroke Outcome Measure subscale. The reported outcome after childhood stroke was variable with long-term neurological deficits in one-third of patients (30.4%). The neurological outcome was worse in males, in patients with multiple stroke episodes, and in those with infarctions involving a combination of cortical and subcortical areas. Pediatric AIS carries the risk of long-term morbidity, and neuroimaging has a predictive influence on outcome. [ABSTRACT FROM AUTHOR]

Familial Hypercholesterolemia (FH) is associated with an increased risk of atrial fibrillation due to coronary artery disease (CAD). Our study sought to estimate the clinical outcome of patients admitted for atrial fibrillation with a history of FH. Using the National Inpatients Sample Database of 2019, patients admitted with a principal diagnosis of atrial fibrillation with or without FH as a secondary diagnosis were identified. The primary outcome was inpatient mortality with secondary outcomes being the restoration of cardiac rhythm, acute kidney injury, ablation, intraoperative and post-procedure complications, cardiogenic shock, length of hospital stay, and charges. 427,544 patients were admitted for atrial fibrillation. Of those, 0.03% had a history of FH. There were no differences in in-hospital mortality (p= 0.0692), ablation (p=0.38310), intraoperative and post-procedure complication (p=0.7622), return of cardiac rhythm (p=0.6594), cardiogenic shock (p=0.7037) and acute kidney injury (p=0.9729). However, patients with FH had reduced length of hospital stay (2.4 days, 95% CI 1.8–2.9 VS 3.3 days, 95% CI 3.3–3.3) and hospital charges ($34,760.8, 95% CI $22,182.88 - $47,338.72 VS $48,833.33 95% CI $47,334.81 - $50,331.85). This study shows that there is no statistically significant difference in in-hospital mortality among patients with FH when compared to the general population admitted for atrial fibrillation. Patients with Familial hypercholesterolemia had reduced length of hospital stay and charges. No [ABSTRACT FROM AUTHOR]

Dyslipidemia (DLP) and Heart Failure (HF) are growing diseases worldwide. Patients with cardiometabolic risk factors such as Non-Alcoholic Fatty Liver Disease (NAFLD) are at increased risk for adverse outcomes. Nevertheless, there is limited scientific evidence of clinical outcomes of NAFLD in patients with DLP and HF. We aimed to investigate clinical outcomes and resource utilization in patients with DLP and HF affected by NAFLD. We queried NIS between 2017-2020 for adult patients who were hospitalized with DLP and HF and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), intubation, length of stay (LOS), and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was significant. There were 11,328,309 hospitalizations with DLP and HF and 364,545 (3.2%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 69.6 vs 73 yrs; males 56.1% vs 52.5%; Caucasians 67.4% vs 69.7%; pulmonary hypertension (PH) 17.9% vs 14.4%; PE 3.8% vs 4.7%; DM 62.8% vs 54.5%; PVD 4.9% vs 6.2%; AF 44.9% vs 44.5%; CKD 54.6% vs 47.7%; hemodialysis 9.2% vs 6.4%; obesity 27% vs 26%; anemia 9.6% vs 6.9%; ACS 17.3% vs 14.4%; history of MI 16% vs 18.9%; stroke 2% vs 2.9%, COPD 33.3% vs 35%; alcohol use 6.1% vs 2.7%, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). DLP and HF group demonstrated significantly higher mortality, worse clinical outcomes, and resource utilization. Patients were younger, male, with more frequent PH, DM, AF, CKD, hemodialysis, obesity, anemia, ACS and alcohol use. NAFLD shows association with metabolic syndrome, renal and cardiac dysfunction. Early identification of NAFLD in patients with DLP and HF is beneficial to improve outcomes. Further research is necessary to describe long-term outcomes in this population. No [ABSTRACT FROM AUTHOR]

There is a general acceptance that posture affects the blood pressure (BP) and current studies suggest there is a significant difference in blood pressure measured in supine and sitting position. It is still unclear whether supine BP is a better predictor of hypertension related target organ damage compared to sitting BP. To understand the difference between supine blood pressure and sitting blood pressure and to investigate whether supine BP is better related to target organ damage. The cross-sectional study included 590 participants with age over than 18-year-old individuals without medical history of diabetes or Parkinson syndrome. At enrollment, BP measurements including supine and sitting BP were recorded. Additionally, medical history, renal function, urine albumin creatinine ratio (UACR), and transthoracic echocardiography were obtained. There were 590 individuals with average age of 53.49±13.93 years old in our study, among which 256 were males (43.4%) and 374 were hypertensive (Table 1). The average supine systolic BP was about 4.80±7.98 mmHg higher than sitting systolic BP and the average supine diastolic BP was about 1.31±6.67 mmHg higher than sitting diastolic BP. (Table 2) In hypertensive group, supine systolic BP and sitting systolic BP are both related to increased risk of left ventricle hypertrophy (OR 1.047 and 1.030, P<0.01) and abnormal UACR (OR 1.055 and 1.058, both P<0.01). Supine systolic BP has better power to distinguish whether left ventricle is hypertrophy (area under the curve, AUC=0.645 vs. 0.63 and UACR is abnormal (AUC=0.746 vs. 0.711) compared to sitting systolic BP (Table 3). Compared to sitting blood pressure, supine blood pressure has better correlations to hypertension-mediated organ damage, including left ventricle hypertrophy and abnormal UACR. No [ABSTRACT FROM AUTHOR]

A 47-year-old African American female presented to the Preventive Cardiology program with heterozygous familial hypercholesterolemia (HeFH), with a pathogenic variant in LDLR (c.582C>T(p.Glu228*)) and an LDL-C level of 262 mg/dL on alirocumab 150 mg biweekly and ezetimibe 10 mg daily. She was intolerant to statins due to myalgias. Family history was notable for her mother who died from an MI at age 50, her maternal aunt who had CABG in her 60s, and a maternal cousin who died from an MI at age 52. Subsequent work-up revealed a high coronary artery calcium (CAC) score, moderate aortic stenosis, and elevated lipoprotein(a) [Lp(a)]. To describe disease consequences when both severe HeFH and elevated Lp(a) are present, treatment challenges, and the importance of family screening. Electronic health records of the patient and her children were reviewed. Genetic testing was completed by Invitae. A CT showed a CAC score of 645.8 (>95th percentile for age, gender), substantial calcifications of the aortic valve cusps and atherosclerotic calcification of the aorta and aortic root. Echocardiogram showed an aortic valve mean gradient 18 mmHg, peak velocity 2.8 m/s, and valve area 1 cm2. The patient's Lp(a) level was 428 nmol/L (5.7x normal). Bempedoic acid was added to her treatment, however her LDL-C remained >200 mg/dL, so it was decided to initiate lipoprotein apheresis. She required chest ports for apheresis but then tolerated sessions every two weeks. Pre-apheresis labs showed an LDL-C of 75 mg/dL and Lp(a) 146 mg/dL (4.9x normal). A genetic counselor discussed family screening for both FH and Lp(a). Her 19-year-old daughter and 25-year-old son were then evaluated in the Preventive Cardiology clinic. Both underwent sequencing and deletion/duplication analysis of the LDLR gene. The familial variant was absent, and no other pathogenic variants were detected. Her daughter had an LDL-C of 121 mg/dL and Lp(a) of 147 nmol/L and her son had an LDL-C of 101 mg/dL and an Lp(a) of 360 nmol/L. Both were started on low dose rosuvastatin for long-term ASCVD risk reduction. The combination of HeFH and elevated Lp(a) can present with extensive vascular and valvular disease that should be comprehensively screened for even in asymptomatic patients. The decision to begin lipoprotein apheresis in this patient was motivated by the extent of her subclinical ASCVD in an effort to slow disease progression and prevent onset of a symptomatic event until additional therapies are available. No [ABSTRACT FROM AUTHOR]

Based on extensive clinical trial data demonstrating lower LDL-C reduces heart attacks, strokes, and need for interventional surgery, the 2018 Multidisciplinary Guideline on the Management of Blood Cholesterol calls for initiation and intensification of lipid-lowering therapies (LLT) if LDL-C exceeds defined thresholds in high and very high (H/VH) risk patients. Achievement of below-threshold LDL-C levels in H/VH risk patients was assessed using real-world data from the Family Heart Database (n=>324 million patients). A subset of 38,110,734 guideline-defined, H/VH risk patients with sufficient diagnosis, procedure, medication, and lab data was analyzed. Patient histories were divided into contiguous episodes characterized by the LLT use (including none), prescription filling, and LDL-C level. Most H/VH risk patients (72%; n= 27,525,227) never achieved LDL-C below guideline thresholds. For those achieving periods below recommended LDL-C thresholds, mean duration was 159 days. Majority of HCPs (81%; n= 632,114) never prescribed combination LLT, though the guideline provides direction and rationale for doing so. Despite effective and safe LLT, most H/VH patients remain above guideline-recommended LDL-C thresholds and those achieving persistent episodes below LDL-C thresholds do so for only brief durations. For the highest risk American patients, lack of prescribing combination LLT and low adherence to prescribed LLT fails to prevent future cardiovascular events. Yes The Family Heart Foundation is a 501c3 public charity research and advocacy organization that receives contributions and sponsorships from individuals, foundations, and pharmaceutical companies. This research was partially funded by Amgen, although it played no role in study design, conduct, interpretation or plans for publication. [ABSTRACT FROM AUTHOR]

Hypertensive disorders of pregnancy (HDP) are a leading cause of severe maternal morbidity (SMM), yet mediation by cesarean delivery is largely unexplored. We investigated the association between HDP and SMM in a cohort of deliveries at a safety-net institution in Atlanta, Georgia, during 2016–2018. Using multivariable generalized linear models, we estimated adjusted risk differences, adjusted risk ratios, and 95% confidence intervals for the association between HDP and SMM. We examined interactions with cesarean delivery and used mediation analysis with 4-way decomposition to estimate excess relative risks. Among 3,723 deliveries, the SMM rate for women with and without HDP was 124.4 per 1,000 and 52.0 per 1,000, respectively. The adjusted risk ratio for the total effect of HDP on SMM was 2.55 (95% confidence interval (CI): 2.15, 3.39). Approximately 55.2% (95% CI: 25.7, 68.5) of excess relative risk was due to neither interaction nor mediation, 24.9% (95% CI: 15.4, 50.0) was due to interaction between HDP and cesarean delivery, 9.6% (95% CI: 3.4, 15.2) was due to mediation, and 10.3% (95% CI: 5.4, 20.3) was due to mediation and interaction. HDP are a potentially modifiable risk factor for SMM; implementing evidence-based interventions for the prevention and treatment of HDP is critical for reducing SMM risk. [ABSTRACT FROM AUTHOR]

Objectives: To determine mortality rates among adults with critical illness from coronavirus disease 2019.Design: Observational cohort study of patients admitted from March 6, 2020, to April 17, 2020.Setting: Six coronavirus disease 2019 designated ICUs at three hospitals within an academic health center network in Atlanta, Georgia, United States.Patients: Adults greater than or equal to 18 years old with confirmed severe acute respiratory syndrome-CoV-2 disease who were admitted to an ICU during the study period.Interventions: None.Measurements and Main Results: Among 217 critically ill patients, mortality for those who required mechanical ventilation was 35.7% (59/165), with 4.8% of patients (8/165) still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 30.9% (67/217) and 60.4% (131/217) patients have survived to hospital discharge. Mortality was significantly associated with older age, lower body mass index, chronic renal disease, higher Sequential Organ Failure Assessment score, lower PaO2/FIO2 ratio, higher D-dimer, higher C-reactive protein, and receipt of mechanical ventilation, vasopressors, renal replacement therapy, or vasodilator therapy.Conclusions: Despite multiple reports of mortality rates exceeding 50% among critically ill adults with coronavirus disease 2019, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness. [ABSTRACT FROM AUTHOR]

There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications. [ABSTRACT FROM AUTHOR]

Introduction: The increasing use of new psychoactive substances (NPS) represents a growing public health challenge. This is the first study in Georgia that aims to explore the characteristics of NPS users, patterns of use, and perception of health risks. Methods: We conducted an online survey in which individuals who have used NPS during the past 12 months filled in a structured questionnaire that covered socio-demographics, drug use practices, and perception of effects of NPS use. Results: The final database consisted of 353 questionnaires. Cannabis-, MDMA- and LSD-type NPS were most often used substances. Majority obtained NPS from friends and used NPS in a group of friends. Majority of the respondents did not attribute any physical and mental health problems to NPS use. A range of negative effects was reported. Discussion: Respondents identified a range of negative and positive health and social effects and linked them to the consumption of a particular NPS. Results of this research are important for guiding future efforts to assess health risks associated with NPS use, and to propose harm reduction strategies to mitigate those risks. [ABSTRACT FROM AUTHOR]

Importance: Invasive nontypeable Haemophilus influenzae (NTHi) infection among adults is typically associated with bacteremic pneumonia. Nontypeable H influenzae is genetically diverse and clusters of infection are uncommon.Objective: To evaluate an increase in invasive NTHi infection from 2017-2018 among HIV-infected men who have sex with men in metropolitan Atlanta, Georgia.Design, Setting, and Participants: A population-based surveillance study with a cohort substudy and descriptive epidemiological analysis identified adults aged 18 years or older with invasive NTHi infection (isolation of NTHi from a normally sterile site) between January 1, 2008, and December 31, 2018 (final date of follow-up).Exposures: Time period, HIV status, and genetic relatedness (ie, cluster status) of available NTHi isolates.Main Outcomes and Measures: The primary outcome was incidence of invasive NTHi infection (from 2008-2016 and 2017-2018) among persons with HIV and compared with NTHi infection from 2008-2018 among those without HIV. The secondary outcomes were assessed among those aged 18 to 55 years with invasive NTHi infection and included epidemiological, clinical, and geographic comparisons by cluster status.Results: Among 553 adults with invasive NTHi infection (median age, 66 years [Q1-Q3, 48-78 years]; 52% male; and 38% black), 60 cases occurred among persons with HIV. Incidence of invasive NTHi infection from 2017-2018 among persons with HIV (41.7 cases per 100 000) was significantly greater than from 2008-2016 among those with HIV (9.6 per 100 000; P < .001) and from 2008-2018 among those without HIV (1.1 per 100 000; P < .001). Among adults aged 18 to 55 years with invasive NTHi infections from 2017-2018 (n = 179), persons with HIV (n = 31) were significantly more likely than those from 2008-2018 without HIV (n = 124) to be male (94% vs 49%, respectively; P < .001), black (100% vs 53%; P < .001), and have septic arthritis (35% vs 1%; P < .001). Persons with HIV who had invasive NTHi infection from 2017-2018 (n = 31) were more likely than persons with HIV who had invasive NTHi infection from 2008-2016 (n = 24) to have septic arthritis (35% vs 4%, respectively; P = .01). Pulsed-field gel electrophoresis of 174 of 179 NTHi isolates from 18- to 55-year-olds identified 2 genetically distinct clonal groups: cluster 1 (C1; n = 24) and cluster 2 (C2; n = 23). Whole-genome sequencing confirmed 2 clonal lineages of NTHi infection and revealed all C1 isolates (but none of the C2 isolates) carried IS1016 (an insertion sequence associated with H influenzae capsule genes). Persons with HIV were significantly more likely to have C1 or C2 invasive NTHi infection from 2017-2018 (28/31 [90%]) compared with from 2008-2016 among persons with HIV (10/24 [42%]; P < .001) and compared with from 2008-2018 among those without HIV (9/119 [8%]; P < .001). Among persons with C1 or C2 invasive NTHi infection who had HIV (n = 38) (median age, 34.5 years; 100% male; 100% black; 82% men who have sex with men), 32 (84%) lived in 2 urban counties and an area of significant spatial aggregation was identified compared with those without C1 or C2 invasive NTHi infection.Conclusions and Relevance: Among persons with HIV in Atlanta, the incidence of invasive nontypeable H influenzae infection increased significantly from 2017-2018 compared with 2008-2016. Two unique but genetically related clonal strains were identified and were associated with septic arthritis among black men who have sex with men and who lived in geographic proximity. [ABSTRACT FROM AUTHOR]

Background: This study examined the relationship between prenatal exposure to alcohol, manifested through fetal alcohol syndrome (FAS) and pFAS, and hypertension in children and adolescents. Methods: This study was designed to analyze the association between fetal alcohol spectrum disorders (FASD) Status and hypertension status. FAS/pFAS‐diagnosed respondents (n = 125) were collected from a FASD Clinical database in Atlanta, Georgia. Non‐FAS/pFAS respondents (n = 500) were taken from the National Health and Nutrition Examination Survey (NHANES). Chi‐square analyses were used to examine the extent to which FASD status, sex, race/ethnicity, medication use, and obesity status each related to hypertension status. A logistic regression was performed analyzing the relationship between FASD status (y/n: independent) and hypertension status (y/n: dependent) while controlling for age, sex, race/ethnicity, medication use, and obesity status. Results: Univariate relationships between hypertension status and FASD status (OR = 8.46, p < 0.001), medication use (OR = 3.25, p < 0.001), and obesity status (OR = 3.03, p = 0.02) proved to be statistically significant (p < 0.05). FASD status significantly predicted hypertension status (β = 2.31, OR = 10.06, p < 0.001) after accounting for age, sex, race/ethnicity, medication use, and obesity status. Conclusions: The major findings of this study suggest a significant relationship between FASD and hypertension in youth. Race/ethnicity and obesity also proved important in predicting hypertensive blood pressure readings independent of FASD diagnosis. Further research is needed to isolate prenatal alcohol exposure (PAE) as a factor promoting increased hypertension and to assess the risk for hypertension in alcohol‐affected adults. The relationship between FASD and hypertension in clinically‐referred children and adolescents was investigated. Logistic regression indicated a significant predictive relationship between FASD and elevations in both systolic and diastolic blood pressure after controlling for age, sex, race/ethnicity, medication use, and obesity status. Race/ethnicity and obesity also proved significant in predicting hypertension independently of FASD diagnosis. Further research is needed to isolate prenatal alcohol exposure as a factor in youth hypertension and to assess the risk for hypertension in alcohol‐affected adults. [ABSTRACT FROM AUTHOR]

Due to a liver defect in lipid metabolism, patients with inherited heterozygous familial hypercholesterolemia (FH) are especially at risk for atherosclerotic cardiovascular disease (ASCVD). This likelihood is due to the cumulative effect of high cholesterol which starts at a young age. Gilbert's Syndrome (GS) is a separate genetic liver disease that results in mildly increased serum unconjugated bilirubin which is postulated to be cardioprotective for ASCVD. Both GS and FH represent two separate genetic liver diseases, one beneficial and one a leading cause of morbidity and mortality. It appears that the deleterious effect of one mutation may be offset by the beneficial effect of the second mutation resulting in an inverse relationship between the two diseases. The incidence of GS is reported to be 16%, however, that figure is probably an underestimate. GS is underdiagnosed and under reported as it is considered benign and is usually an incidental finding. Identifying concurrent GS and FH is important because it can affect treatment choices for hypercholesteremia. This review examined the recent literature and analyzed the current evidence that suggests that the combination of FH and concurrent GS affords cardiovascular protection. 37 publications were reviewed to synthesize and evaluate the quality of existing evidence and to shed some light on the possible mechanisms of this association, identify research gaps, and shape future research. This was a systematic review of peer-reviewed publications. Publications were identified using databases: EBSCO Discovery, World Cat, PubMed, OVID, Google Scholar, Springer, Theime, Elsevier/Scopus, Science Direct, and Cochrane Collaboration. Publications ranged from 2003-2021 and included studies on adults from age 18-80 and bench studies using Gunn rats. Recent retrospective and prospective studies indicate that mildly elevated levels of serum bilirubin (especially the UGTA1A*28 allele), in patients with concurrent GS and FH, are protective against ASCVD. Gilbert's Syndrome is postulated be cardioprotective for ASCVD. The inverse relationship between ASCVD and GS has not become mainstream and is overdue. This review underscores the importance of identifying patients with circulating bilirubin from GS and with concurrent hypercholesteremia, especially FH. These are not uncommon diseases, and their co-existence has been underestimated because GS is considered benign and underreported. The potential exists for patients with hypercholesteremia and silent Gilbert's Syndrome to be overtreated or unnecessarily treated with statins. It is recommended that both FH and Gilbert's Syndrome be routinely screened for in pediatric and adult populations especially prior to statin prescribing. Special thanks to Michael Brown, M.D., 1985 Nobel Prize recipient, for his interest and encouragement. No [ABSTRACT FROM AUTHOR]

Dyslipidemia (DLP) and chronic kidney disease (CKD) are global diseases affecting millions worldwide. Non-Alcoholic Fatty Liver Disease (NAFLD) is an emerging disease that predisposes to adverse outcomes. Nevertheless, there is limited scientific evidence of clinical outcomes of NAFLD in patients with DLP & CKD. We sought to investigate clinical outcomes and resource utilization in population with DLP & CKD affected by NAFLD. We queried NIS between 2017-2020 for adult patients who were hospitalized with DLP & CKD and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), acute kidney injury (AKI), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic, linear and Poisson regression analyses were used to estimate clinical outcomes. P-value < 0.05 was significant. There were 11,116,540 hospitalizations with DLP & CKD and 366,290 (3.2%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 69.4 vs. 72.6 yrs; males 55.6% vs 54.4%; Caucasians 63.0% vs 65.2%; HF 54.4% vs 48.7%; pulmonary hypertension (PH) 13.0% vs 9.6%; PE 3% vs 4%; DM 69.6% vs 60.9%; AF 34.6% vs 32.7%; AKI 53.7% vs 42.3%; requiring hemodialysis 16.4% vs 13.3%; obesity 24.7% vs 23.7%; anemia 25.0% vs 20.5%; ACS 12.3% vs 11.0%; history of MI 12.5% vs 14.5%; stroke 1.9% vs 3.4%, COPD 25.4% vs 26.2%; alcohol use 5.2% vs 1.9%, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). DLP & CKD group demonstrated significantly higher mortality, worse clinical outcomes and resource utilization. Patients were younger, male, predominantly Caucasian, with more frequent HF, PH, DM, AF, AKI, hemodialysis, obesity, anemia, ACS and alcohol use. NAFLD is associated with more profound cardiac and renal insufficiency, metabolic syndrome. Awareness of NALFD and its early identification is important to improve health outcomes. Further research is necessary to describe long-term outcomes in this population. No [ABSTRACT FROM AUTHOR]

The 2018 Multidisciplinary Guideline on the Management of Blood Cholesterol calls for initiation and intensification of lipid-lowering therapy (LLT) if low density lipoprotein cholesterol (LDL-C) exceeds thresholds in high and very high (H/VH) risk patients. Despite LDL-C being a major modifiable cardiovascular risk factor, most patients fail to meet guideline thresholds. To assess the consequences of failure to achieve LDL-C guideline thresholds using the Family Heart Database of >324 million individuals. This retrospective analysis assessed annual cardiovascular event (CE) rates in H/VH risk patients as defined by the guidelines. It included individuals who had > 48 months of diagnosis, procedure, medication, and lab result data with > 3 cholesterol results. Patient histories were divided into contiguous episodes characterized by LLT use (including no therapy, mono and combination therapy), prescriptions filled, and LDL-C level. An 18-month baseline period was utilized to determine the covariates for the propensity score matching (PSM). Individuals with a cardiovascular event (CE) during the baseline were excluded. Cohorts included individuals either "Above Threshold" or "Below Threshold" for at least 70% of the study period (including baseline). Following the baseline period, individuals were observed for at least 30 months to determine the date of the first CE and annual incidence rates (AIR) were calculated. 39,117 and 17,232 individuals met the criteria for the Above Threshold and Below Threshold cohorts respectively. A 1:1 PSM resulted in 14,755 in each cohort. The AIRs were 2.2% and 1.5% for the Above Threshold and Below Threshold groups respectively, a 44.2% (p < 0.0002) higher rate in the Above Threshold group. Total CEs (first and subsequent) were also significantly higher 49% (p< 0.0002) in the Above Threshold than the Below Threshold group (3,510 vs 2,356). In this real-world evaluation of H/VH risk individuals achieving lipid guideline thresholds reduces cardiovascular events. Greater emphasis on achieving LDL-C control could improve cardiac health at a population level. Yes The Family Heart Foundation is a 501c3 public charity research and advocacy organization that receives contributions and sponsorships from individuals, foundations, and pharmaceutical companies. This research was partially funded by Amgen, although it played no role in study design, conduct, interpretation or plans for publication. [ABSTRACT FROM AUTHOR]

Objectives African American maternal caregiver support for prevention of childhood obesity may be a factor in implementing, monitoring, and sustaining children's positive health behaviors. However, little is known about how perceptions of childhood obesity risk factors and health complications influence caregivers' support of childhood obesity prevention strategies. The objective of this study was to determine if childhood obesity risk factors and health complications were associated with maternal caregivers' support for prevention initiatives. Methods A convenience sample of maternal caregivers (N = 129, ages 22-65 years) completed the childhood obesity perceptions (COP) survey. A linear regression was conducted to determine whether perceptions about childhood obesity risk factors and subsequent health complications influenced caregivers' support for prevention strategies. Results Caregivers' perceptions of childhood obesity risk factors were moderate (M = 3.4; SD = 0.64), as were their perceptions of obesity-related health complications (M = 3.3; SD = 0.75); however, they perceived a high level of support for prevention strategies (M = 4.2; SD = 0.74). In the regression model, only health complications were significantly associated with caregiver support (β = 0.348; p < 0.004). Conclusions Childhood obesity prevention efforts should emphasize health complications by providing education and strategies that promote self-efficacy and outcome expectations among maternal caregivers. [ABSTRACT FROM AUTHOR]

Importance: Data regarding the contribution of red blood cell (RBC) transfusion and anemia to necrotizing enterocolitis (NEC) are conflicting. These associations have not been prospectively evaluated, accounting for repeated, time-varying exposures.Objective: To determine the relationship between RBC transfusion, severe anemia, and NEC.Design, Setting, and Participants: In a secondary, prospective, multicenter observational cohort study from January 2010 to February 2014, very low-birth-weight (VLBW, ≤1500 g) infants, within 5 days of birth, were enrolled at 3 level III neonatal intensive care units in Atlanta, Georgia. Two hospitals were academically affiliated and 1 was a community hospital. Infants received follow-up until 90 days, hospital discharge, transfer to a non-study-affiliated hospital, or death (whichever came first). Multivariable competing-risks Cox regression was used, including adjustment for birth weight, center, breastfeeding, illness severity, and duration of initial antibiotic treatment, to evaluate the association between RBC transfusion, severe anemia, and NEC.Exposures: The primary exposure was RBC transfusion. The secondary exposure was severe anemia, defined a priori as a hemoglobin level of 8 g/dL or less. Both exposures were evaluated as time-varying covariates at weekly intervals.Main Outcomes and Measures: Necrotizing enterocolitis, defined as Bell stage 2 or greater by preplanned adjudication. Mortality was evaluated as a competing risk.Results: Of 600 VLBW infants enrolled, 598 were evaluated. Forty-four (7.4%) infants developed NEC. Thirty-two (5.4%) infants died (all cause). Fifty-three percent of infants (319) received a total of 1430 RBC transfusion exposures. The unadjusted cumulative incidence of NEC at week 8 among RBC transfusion-exposed infants was 9.9% (95% CI, 6.9%-14.2%) vs 4.6% (95% CI, 2.6%-8.0%) among those who were unexposed. In multivariable analysis, RBC transfusion in a given week was not significantly related to the rate of NEC (adjusted cause-specific hazard ratio, 0.44 [95% CI, 0.17-1.12]; P = .09). Based on evaluation of 4565 longitudinal measurements of hemoglobin (median, 7 per infant), the rate of NEC was significantly increased among VLBW infants with severe anemia in a given week compared with those who did not have severe anemia (adjusted cause-specific hazard ratio, 5.99 [95% CI, 2.00-18.0]; P = .001).Conclusions and Relevance: Among VLBW infants, severe anemia, but not RBC transfusion, was associated with an increased risk of NEC. Further studies are needed to evaluate whether preventing severe anemia is more important than minimizing RBC transfusion. [ABSTRACT FROM AUTHOR]

Background: Limited contemporary data compare the clinical and psychosocial characteristics and acute management of patients hospitalized with an initial vs a recurrent episode of acute coronary disease. We describe these factors in a cohort of patients recruited from 6 hospitals in Massachusetts and Georgia after an acute coronary syndrome.Materials and Methods: We performed structured baseline in-person interviews and medical record abstractions for 2174 eligible and consenting patients surviving hospitalization for an acute coronary syndrome between April 2011 and May 2013.Results: The average patient age was 61 years, 64% were men, and 47% had a high school education or less; 29% had a low general quality of life, and 1 in 5 were cognitively impaired. Patients with a recurrent coronary episode had a greater burden of previously diagnosed comorbidities. Overall, psychosocial burden was high, and more so in those with a recurrent vs those with an initial episode. Patients with an initial coronary episode were as likely to have been treated with all 4 effective cardiac medications (51.6%) as patients with a recurrent episode (52.3%), but were significantly more likely to have undergone cardiac catheterization (97.9% vs 92.9%) and a percutaneous coronary intervention (73.7% vs 60.9%) (P < .001) during their index hospitalization.Conclusions: Patients with a first episode of acute coronary artery disease have a more favorable psychosocial profile, less comorbidity, and receive more invasive procedures but similar medical management, than patients with previously diagnosed coronary disease. Implications of the high psychosocial burden on various patient-related outcomes require investigation. [ABSTRACT FROM AUTHOR]

Background Tricuspid annular plane systolic excursion ( TAPSE) has emerged as a novel and reliable measure of right ventricular ( RV) function. The purpose of this study was to determine the effect of pulmonary hypertension ( PH) therapy on TAPSE in pediatric patients and compare TAPSE to other quantitative measures of RV function. Methods A retrospective review of medical records and echocardiograms of patients in the PH clinic from January 2011 to August 2013 was done. Echocardiograms were analyzed prior to initiation or addition of a PH drug and at least 8 weeks later. Following quantitative measures of RV function were compared: TAPSE, TAPSE age-based z-score, RV fractional area change ( RVFAC), tricuspid annular S′, tricuspid inflow E/tricuspid annular E′ velocity ( TV E/E′), and RV myocardial performance index ( RVMPI). Results Of the 37 patients included in this study (median age 0.6 years), 23 (62.2%) were treatment naive and others had a new PH drug added to their regimen at the time of the baseline echocardiogram. The median duration between the baseline and follow-up echocardiogram was 8 (2-25) months. There was a significant improvement in TAPSE and TAPSE age-based z-score on the follow-up echocardiogram. RVFAC, tricuspid S′, TV E/E′, and RVMPI did not show a statistically significant change. Conclusion In contrast to the other echocardiographic markers of RV function, TAPSE, and TAPSE age-based z-score significantly improve after initiation or addition of PH therapy and can be used for serial noninvasive monitoring of RV function in pediatric PH patients. [ABSTRACT FROM AUTHOR]

Test anxiety and its correlates were examined with college students with and without specific reading disability (RD; n = 50 in each group). Results indicated that college students with RD reported higher test anxiety than did those without RD, and the magnitude of these differences was in the medium range on two test anxiety scales. Relative to college students without RD, up to 5 times as many college students with RD reported clinically significant test anxiety. College students with RD reported significantly higher cognitively based test anxiety than physically based test anxiety. Reading skills, verbal ability, and processing speed were not correlated with test anxiety. General intelligence, nonverbal ability, and working memory were negatively correlated with test anxiety, and the magnitude of these correlations was medium to large. When these three cognitive constructs were considered together in multiple regression analyses, only working memory and nonverbal ability emerged as significant predictors and varied based on the test anxiety measure. Implications for assessment and intervention are discussed. [ABSTRACT FROM PUBLISHER]

Background and Purpose: In gymnastics, the wrist is exposed to many different stresses including increased extension, especially during back handsprings. Currently a wrist extension angle during impact that places the wrist in danger has not been established. The purpose of this study was to: (1) determine the mean impact wrist angle during a standing back handspring in female preadolescent and adolescent gymnasts and (2) determine which factors predict impact wrist angles. Methods: Fifty female gymnasts from six facilities, ages 8-15 were included in this study. Each gymnast completed a questionnaire about gymnastics participation and history of wrist pain. Active range of motion of the shoulder, elbow, wrist, hip, and ankle was measured. Each gymnast was asked to perform a standard back handspring, which was videotaped. The wrist and shoulder flexion angles, at maximum impact, were recorded and measured using motion analysis software. Two-sample t-test was used to assess the relationship between impact wrist angle and wrist pain. Multiple linear regression was used to determine the association between related variables and impact wrist angle. Results: The mean back handspring impact wrist angle was 95°. Fifteen subjects (30%) reported wrist pain. Years of participation (p = 0.02) and impact shoulder angle (p = 0.04) were predictive of impact wrist angles. Conclusion: Shoulder angles and years of participation correlate with impact wrist angles during the performance of a standing back handspring. Future studies are necessary to determine if addressing these factors can affect the impact wrist angles. [ABSTRACT FROM AUTHOR]

Objectives. We investigated whether eventual causes of death among a cohort of inmates imprisoned in the southeastern United States differed from those in previous prisoner studies. Methods. We matched 23 510 prisoners in Georgia, a state with historically low levels of heroin consumption but moderate amounts of injection drug use, who were incarcerated on June 30, 1991, to death registries through 2010. Main exposure was 4-year time intervals over 2 decades of observation; main outcome was mortality from liver disease, HIV, and overdose. Results. Although the HIV-related mortality rate exceeded that from liver-related conditions before 2003, liver disease subsequently surpassed HIV as a cause of death. Among 3863 deaths, 22 (0.6%) occurred within 2 weeks after release from prison. Of these, only 2 were caused by accidental poisoning (likely drug overdose). Cardiovascular disease and cancer were the most frequent causes of death in this aging cohort. Conclusions. Our study design deemphasized immediate deaths but highlighted long-term sequelae of exposure to viral hepatitis and alcohol. Treating hepatitis C and implementing interventions to manage alcohol use disorders may improve survival among prisoners in the Southeast. (Am J Public Health. 2015;105:e51–e57. doi:10.2105/AJPH.2014.302546) [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the longitudinal effect of marijuana and heavy alcohol use on the productivity status of nonmetropolitan African American young adults. This analysis was based on secondary data from the Family and Community Health Study. For alcohol, the study evaluated the effects on productivity status for individuals with heavy alcohol use trajectories from adolescence into young adulthood while marijuana effects were evaluated during the period when adolescents are more likely to have initiated usage (14–16 years of age). Productivity status was measured when study participants were between 18 and 21 years, for both alcohol and marijuana. Multivariate logistic regression models were used to test the association between subjects’ drug use and productivity. Bivariate analysis of the effects of marijuana use indicate that marijuana users by age 16 are 35% less likely to be productive at age 21 than those who have not initiated marijuana use (p < .005). After controlling for individual, community, and family factors, the multivariate logistic models for alcohol and marijuana use suggest that early adolescence drug use (marijuana and heavy alcohol use) do not have an impact on productivity status during early adulthood. Analyzing and understanding the different drug use trajectories in relation to a productivity outcome is important for policies and research geared to preventing drug use and in identifying its relation with micro- and macro-level labor market outcomes. [ABSTRACT FROM PUBLISHER]

Background Down syndrome ( DS, OMIM #190685) is the most commonly identified genetic form of intellectual disability with congenital heart defect ( CHD) occurring in 50% of cases. With advances in surgical techniques and an increasing lifespan, this has necessitated a greater understanding of the neurodevelopmental consequences of CHDs. Herein, we explore the impact of CHD on language development in children with DS. Methods Twenty-nine children with DS were observed systematically in parent-child interactions using the Communication Play Protocol to evaluate their language use; they also completed the Mullen Scales of Early Learning and Mac Arthur Communication Development Inventory. Mean ages were 31.2 months for children with DS and CHD ( DS + CHD, n = 12) and 32.1 months for children with DS and a structurally normal heart ( DS − CHD, n = 17). Results Compared with the DS − CHD controls, the DS + CHD group revealed lower scores in multiple areas, including fine motor skills and expressive and receptive vocabulary. Whereas most differences were not statistically significant, the Communication Development Inventory word count and symbol-infused joint engagement differed significantly ( P < 0.01) and marginally ( P = 0.09) between groups. Conclusions Finding that CHDs may account for part of the variation in language delay allows us to consider the specific mechanisms underlying the impact of CHDs on language acquisition in children with DS. Conclusions from this first study on early language outcomes of children with DS + CHD may be useful for clinicians in providing developmental surveillance and early intervention programmes with specific emphasis on language therapy as part of long-term follow-up for children with DS + CHD. [ABSTRACT FROM AUTHOR]

The article presents a study on the effect of the simplified modified Rankin Scale questionnaire (smRSq) on patients with initial stroke severities. It mentions the use of the telestroke system by the National Institutes of Health Stroke Scale (NIHSS). It also discusses the scoring at the modified Rankin Scale (mRS).

Background: Restless legs syndrome (RLS) is considerably more common among adults with chronic kidney disease (CKD) than in the general population and is associated with increased morbidity and mortality. There is limited information on RLS in children with CKD. Failure to account for conditions that might mimic RLS can lead to overdiagnosis of this syndrome. Methods: In a prospective, cross-sectional study, RLS prevalence was compared between pediatric CKD patients and healthy children. RLS was assessed via a questionnaire that included exclusion of mimics. Sleep characteristics and health-related quality of life (HRQoL) were also assessed. Results: Restless legs syndrome was more prevalent in CKD patients ( n = 124) than in 85 normal children (15.3 vs. 5.9 %; p = 0.04). There was no significant association between RLS and CKD stage, CKD etiology, CKD duration, and dialysis or transplant status. Children with RLS were more likely to rate their sleep quality as fairly bad or very bad (41.2 vs. 8.8 %; p = 0.003) and report using sleep medications (42.1 vs. 14.7 %; p = 0.01). RLS was associated with lower HRQoL by parent report ( p = 0.03). Only five of the 19 patients (26.3 %) with CKD and RLS had discussed RLS symptoms with a healthcare provider, and only one of these patients had been diagnosed with RLS prior to this study. Conclusions: The prevalence of RLS is increased in children with CKD and appears to be underdiagnosed. Systematic screening for RLS and sleep problems would therefore appear to be warranted in children with CKD. [ABSTRACT FROM AUTHOR]

Objectives: This study examined changes in the use of complementary and alternative medicine (CAM) therapies by U.S. adults aged 18 years or older with chronic disease-related functional limitations between 2002 and 2007. Design: The study was a cross-sectional survey. Setting/location: The study was conducted in the United States. Subjects: The study comprised adults aged 18 years or older with chronic disease-related functional limitations. Methods: Data were obtained from the 2002 and 2007 U.S. National Health Interview Survey to compare the use of 22 CAM therapies ( n=9313 and n=7014, respectively). Estimates were age adjusted to the year 2000 U.S. standard population. Results: The unadjusted and age-standardized prevalence of overall CAM use (22 therapies comparable between both survey years) was higher in 2007 than in 2002 (30.6% versus 26.9%, p<0.001 and 34.4% versus 30.6%, p<0.001, respectively). Adults with functional limitations that included changing and maintaining body position experienced a significant increase in CAM use between 2002 and 2007 (31.1%-35.0%, p<0.01). The use of deep breathing exercises was the most prevalent CAM therapy in both 2002 and 2007 and increased significantly during this period (from 17.9% to 19.9%, p<0.05). The use of meditation, massage, and yoga also increased significantly from 2002 and 2007 (11.0%-13.5%, p<0.01; 7.0%-10.9%, p<0.0001; and 5.1% to 6.6%, p<0.05, respectively), while the use of the Atkins diet decreased (2.2%- 1.4%, p<0.01). Conclusions: Among U.S. adults with chronic disease-related functional limitations, the overall increase in CAM use from 2002 to 2007 was significant, particularly among those with changing and maintaining body position limitations. [ABSTRACT FROM AUTHOR]

Summary: Despite adolescent black females experiencing the highest rates of obesity, the effect of excess fat mass on bone structure and strength in this population is unknown. Our findings in postadolescent black females suggest that excess weight in the form of fat mass may adversely influence cortical bone structure and strength. Introduction: Although adolescent obesity has been associated with reduced bone structure and strength in white females, this relationship has not been studied in adolescent black females, a population experiencing the highest rates of obesity. Our objective was to compare bone structure and strength between postadolescent black females with normal and high levels of adiposity. Methods: Black females with ≤32% body fat were classified as normal body fat (NF; n = 33, aged 19.3 ± 1.3 years); females exceeding this cutoff were classified as high body fat (HF; n = 15, aged 19.0 ± 1.1 years). Using peripheral quantitative computed tomography, tibial and radial bones were scanned at the 4% (trabecular) and 20% (cortical) sites from the distal metaphyses. Fat-free soft-tissue mass (FFST) and %body fat were assessed by dual-energy X-ray absorptiometry. Results: After controlling for either FFST or body weight, the HF vs. NF group had lower total cross-sectional area (CSA; 9-17%), cortical CSA (6-15%), and strength-strain index (SSI; 13-24%) at the cortical site of the tibia (all p < 0.05). At the cortical site of the radius, the HF vs. NF group had lower total CSA (14%, p = 0.03), cortical CSA (9%, p = 0.04), and SSI (15%, p = 0.07) after control for body weight. There were no group differences in either the FFST-adjusted cortical bone values at the radius or in the trabecular bone parameters (body weight- or FFST-adjusted) at the tibia and radius. Conclusions: Consistent with our adiposity and bone data in late-adolescent white females, our findings in black females entering adulthood also suggest that obesity may adversely influence cortical bone strength. [ABSTRACT FROM AUTHOR]

Objective: To define the incidence and clinical spectrum of group B streptococcus infection in adults. To characterize groups at increased risk for infection.Design: Retrospective population-based surveillance of group B streptococcus infections occurring in adults. Patients were identified by review of microbiology records at all surveillance area hospital laboratories. Demographic and clinical data were abstracted from patient medical records.Setting: Metropolitan Atlanta, Ga, 1982 through 1983.Patients: We identified 70 adult patients with invasive group B streptococcus infections; 14 infections occurred in pregnant women and 56 in nonpregnant adults.Results: The annual incidence of group B streptococcus infection in men and nonpregnant women was 2.4 cases per 100,000 population. Incidence increased with age and was higher in blacks than in whites. The case-fatality rate was 32%. Group B streptococcus was most often isolated from blood (71%) and soft tissue (16%). Common clinical presentations included skin and soft-tissue infection (36%), bacteremia without focus (34%), pneumonia (11%), arthritis (9%), and endocarditis (9%). Compared with the general population's risk of infection, the risk of infection in persons with diabetes mellitus was increased 10.5-fold (95% confidence interval [CI], 7.8 to 14.4); in persons with cancer, it was increased 16.4-fold (95% CI, 11.5 to 23.3).Conclusions: Group B streptococcus infections cause serious disease in adults as well as in neonates, providing an additional rationale for vaccine development. Determining the incidence of adult disease and groups at greatest risk will help in focusing prevention efforts. [ABSTRACT FROM AUTHOR]

The article reports that infection with West Nile virus (WNV) can result in significant longterm sequelae, such as cognitive and functional impairment, as well as new-onset depression, according to data from an ongoing study funded by the National Institutes of Health presented at the International Conference on Emerging Infectious Diseases in Atlanta, Georgia. According to lead investigator Dr. Kristy O. Murray from University of Texas Health Science Center, people who have the greatest sequelae are those who had the most severe form of the disease, which is encephalitis. Persistent symptoms from WNV infection were reported by 60.1% of the cohort 1 year after infection.

Focuses on the West Nile Virus Southeast Conference held on January 14-15, 2003 in Atlanta, Georgia. Aim of the conference; Topics discussed; Speakers in the event.

The article presents a case study of a 24-year-old white man with pruritic rash on his right buttock after being exposed to soil who was diagnosed with hookworm-associated reactive spondyloarthritis.