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In Tanzania, young women aged 15-24 are at high risk for HIV and nearly half (45%) of women experience pregnancy or childbirth before age 19. The HIV epidemic has motivated many parents to overcome cultural taboos and talk with their children about sexuality, but few studies in Tanzania have examined how young adults perceive these discussions. In-depth interviews with 31 Tanzanian college women (ages 18-25) reveal how they make sense of sexuality messages from mothers that are sometimes vague, admonishing and fear-based. Participants identified how mothers focused on the health, educational and social consequences of premarital sex and emphasised the avoidance of men as a strategy to maintain virginity. Mothers avoided providing specific information about safer-sex practices, or strategies to negotiate romantic relationships, sexual pressures or sexual desires. Findings offer insight into how relational and cultural contexts influence mothers' sexual socialisation and can inform education and intervention approaches that consider the changing cultural landscape. Future qualitative research with mothers is recommended to develop programmes that are more responsive to mothers' and daughters' needs.

Students targeted by homophobic discrimination are at risk for poor academic outcomes, yet few studies have examined how witnessing discrimination affects students. This study examined the impact of direct and indirect experiences of heterosexism on feelings of safety, belongingness, and connectedness among a sample of 1,702 students at a public university in the Western United States. Sexual minority students were more likely to be a target of and witness to discrimination, and they reported significantly lower levels of safety and belongingness. Hierarchical multiple regression analyses revealed that witnessing discriminatory acts contributed significantly to lower levels of safety, belongingness, and connectedness among heterosexual students, even after accounting for personal experiences with discrimination. For sexual minority students, witnessing discrimination was not associated with school outcomes, but hearing peers intervene against slurs was associated with increased belongingness. Perceptions of the campus climate were robustly associated with student outcomes, regardless of sexual orientation.

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year's edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update. © 2013 American Heart Association, Inc.

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update. The Statistical Update is a critical resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best available national data on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, use of medical procedures and operations, and costs associated with the management of these diseases in a single document. Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2012 alone, the various Statistical Updates were cited ≈3500 times (data from Google Scholar). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year's edition includes a new chapter on peripheral artery disease, as well as new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update. © 2013 American Heart Association, Inc.

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update*The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document*Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions*In 2011 alone, the various Statistical Updates were cited ≈1500 times (data from ISI Web of Science)*In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled*For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year*This year's edition also implements a new chapter organization to reflect the spectrum of cardiovascular health behaviors and health factors and risks, as well as subsequent complicating conditions, disease states, and outcomes*Also, the 2013 Statistical Update contains new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals*Below are a few highlights from this year's Update . © 2013 American Heart Association, Inc.

Each year, the American Heart Association (AHA), in conjunction with the Centers for Disease Control and Prevention, the National Institutes of Health, and other government agencies, brings together the most up-to-date statistics on heart disease, stroke, other vascular diseases, and their risk factors and presents them in its Heart Disease and Stroke Statistical Update.*The Statistical Update is a valuable resource for researchers, clinicians, healthcare policy makers, media professionals, the lay public, and many others who seek the best national data available on heart disease, stroke, and other cardiovascular disease-related morbidity and mortality and the risks, quality of care, medical procedures and operations, and costs associated with the management of these diseases in a single document Indeed, since 1999, the Statistical Update has been cited >10 500 times in the literature, based on citations of all annual versions. In 2011 alone, the various Statistical Updates were cited ∼1500 times (data from ISI Web of Science). In recent years, the Statistical Update has undergone some major changes with the addition of new chapters and major updates across multiple areas, as well as increasing the number of ways to access and use the information assembled. For this year's edition, the Statistics Committee, which produces the document for the AHA, updated all of the current chapters with the most recent nationally representative data and inclusion of relevant articles from the literature over the past year. This year's edition also implements a new chapter organization to reflect the spectrum of cardiovascular health behaviors and health factors and risks, as well as subsequent complicating conditions, disease states, and outcomes. Also, the 2013 Statistical Update contains new data on the monitoring and benefits of cardiovascular health in the population, with additional new focus on evidence-based approaches to changing behaviors, implementation strategies, and implications of the AHA's 2020 Impact Goals. Below are a few highlights from this year's Update. © 2013 American Heart Association, Inc.

Tirzepatide, a once-weekly GIP/GLP-1 receptor agonist, reduces blood glucose and body weight in people with type 2 diabetes. The cardiovascular (CV) safety and efficacy of tirzepatide have not been definitively assessed in a cardiovascular outcomes trial. Tirzepatide is being studied in a randomized, double-blind, active-controlled CV outcomes trial. People with type 2 diabetes aged ≥40 years, with established atherosclerotic CV disease, HbA1c ≥7% to ≤10.5%, and body mass index ≥25 kg/m2 were randomized 1:1 to once weekly subcutaneous injection of either tirzepatide up to 15 mg or dulaglutide 1.5 mg. The primary outcome is time to first occurrence of any major adverse cardiovascular event (MACE), defined as CV death, myocardial infarction, or stroke. The trial is event-driven and planned to continue until ≥1,615 participants experience an adjudication-confirmed component of MACE. The primary analysis is noninferiority for time to first MACE of tirzepatide vs dulaglutide by demonstrating an upper confidence limit <1.05, which will also confirm superiority vs a putative placebo, and also to determine whether tirzepatide produces a greater CV benefit than dulaglutide (superiority analysis). Over 2 years, 13,299 people at 640 sites in 30 countries across all world regions were randomized. The mean age of randomized participants at baseline was 64.1 years, diabetes duration 14.7 years, HbA1c 8.4%, and BMI 32.6 kg/m2. Overall, 65.0% had coronary disease, of whom 47.3% reported prior myocardial infarction and 57.4% had prior coronary revascularization. 19.1% of participants had a prior stroke and 25.3% had peripheral artery disease. The trial is fully recruited and ongoing. SURPASS-CVOT will provide definitive evidence as to the CV safety and efficacy of tirzepatide as compared with dulaglutide, a GLP-1 receptor agonist with established CV benefit. [ABSTRACT FROM AUTHOR]

Therapies that could further prevent the development of heart failure (HF) and other cardiovascular and metabolic events in patients with recent myocardial infarction (MI) represent a large and unmet medical need. DAPA-MI is a multicenter, parallel-group, registry-based, randomized, double-blind, placebo-controlled phase 3 trial in patients without known diabetes or established HF, presenting with MI and impaired left ventricular systolic function or Q-wave MI. The trial evaluated the effect of dapagliflozin 10 mg vs placebo, given once daily in addition to standard of care therapy, on death, hospitalization for HF (HHF), and other cardiometabolic outcomes. The primary objective of the trial was to determine, using the win-ratio method, if dapagliflozin is superior to placebo by comparing the hierarchical composite outcome of death, HHF, nonfatal MI, atrial fibrillation/flutter, new onset of type 2 diabetes mellitus, HF symptoms as measured by New York Heart Association Functional Classification at last visit, and body weight decrease ≥5% at last visit. Assuming a true win-ratio of 1.20 between dapagliflozin and placebo, 4,000 patients provide a statistical power of 80% for the test of the primary composite outcome. A registry-based randomized controlled trial framework allowed for recruitment, randomization, blinding, and pragmatic data collection of baseline demographics, medications, and clinical outcomes using existing national clinical registries (in Sweden and the UK) integrated with the trial database. The trial explores opportunities to improve further the outcome of patients with impaired LV function after MI. The innovative trial design of DAPA-MI, incorporating national clinical registry data, has facilitated efficient patient recruitment as well as outcome ascertainment. ClinicalTrials.gov Identifier NCT04564742. [ABSTRACT FROM AUTHOR]

There is growing attention to lesbian, gay, bisexual, transgender, queer and questioning (LGBTQ) issues in schools, including efforts to address such issues through the curriculum. This study examines whether students' perceptions of personal safety and school climate safety are stronger when curricula that include LGBTQ people are present and supportive. LGBTQ and straight middle and high school students from California (1232 students from 154 schools) participated in the 2008 Preventing School Harassment survey. They reported their experience of LGBTQ-inclusive curriculum, its level of supportiveness and perceptions of safety. Multilevel methods allowed for an examination of differences between individuals in the same school while controlling for differences between schools. LGBTQ-inclusive curricula were associated with higher reports of safety at the individual and school levels, and lower levels of bullying at the school level. The amount of support also mattered: supportive curricula were related to feeling safer and awareness of bullying at the individual and school levels. The implications of school- versus student-level results for educational policy and practices are discussed.

BACKGROUND:Patients with heart failure (HF) have a high burden of symptoms and physical limitations, regardless of ejection fraction (EF). Whether the benefits of SGLT2 (sodium-glucose cotransporter-2) inhibitors on these outcomes vary across the full range of EF remains unclear.METHODS:Patient-level data were pooled from the DEFINE-HF trial (Dapagliflozin Effects on Biomarkers, Symptoms, and Functional Status in Patients With Heart Failure With Reduced Ejection Fraction) of 263 participants with reduced EF (≤40%), and PRESERVED-HF trial (Effects of Dapagliflozin on Biomarkers, Symptoms and Functional Status in Patients With Preserved Ejection Fraction Heart Failure) of 324 participants with preserved EF (≥45%). Both were randomized, double-blind 12-week trials of dapagliflozin versus placebo, recruiting participants with New York Heart Association class II or higher and elevated natriuretic peptides. The effect of dapagliflozin on the change in the Kansas City Cardiomyopathy Questionnaire (KCCQ) Clinical Summary Score (CSS) at 12 weeks was tested with ANCOVA adjusted for sex, baseline KCCQ, EF, atrial fibrillation, estimated glomerular filtration rate, and type 2 diabetes. Interaction of dapagliflozin effects on KCCQ-CSS by EF was assessed using EF both categorically and continuously with restricted cubic spline. Responder analyses, examining proportions of patients with deterioration, and clinically meaningful improvements in KCCQ-CSS were conducted using logistic regression.RESULTS:Of 587 patients randomized (293 dapagliflozin, 294 placebo), EF was ≤40, >40-≤60, and >60% in 262 (45%), 199 (34%), and 126 (21%), respectively. Dapagliflozin improved KCCQ-CSS at 12 weeks (placebo-adjusted difference 5.0 points [95% CI, 2.6–7.5]; P<0.001). This was consistent in participants with EF≤40 (4.6 points [95% CI, 1.0–8.1]; P=0.01), >40 to ≤60 (4.9 points [95% CI, 0.8–9.0]; P=0.02) and >60% (6.8 points [95% CI, 1.5–12.1]; P=0.01; Pinteraction=0.79). Benefits of dapagliflozin on KCCQ-CSS were also consistent when analyzing EF continuously (Pinteraction=0.94). In responder analyses, fewer dapagliflozin-treated patients had deterioration and more had small, moderate, and large KCCQ-CSS improvements versus placebo; these results were also consistent regardless of EF (all Pinteractionvalues nonsignificant).CONCLUSIONS:In patients with HF, dapagliflozin significantly improves symptoms and physical limitations after 12 weeks of treatment, with consistent and clinically meaningful benefits across the full range of EF. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the inter- and intra-examiner agreement among international experts on the diagnosis of gingival recession defects (GRDs) using the 2018 Classification of Gingival Recession Defects and Gingival Phenotype as proposed in the 2017 World Workshop.Materials and Methods: Standardized intraoral photographs from twenty-eight GRDs were evaluated twice by sixteen expert periodontists. Recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ) and presence of root steps (RS) were recorded and used for the analysis. Intra- and inter-examiner agreements were calculated for individual variables and for the overall classification. ICC with 95% CI was used for RD and KTW; kappa with 95% CI was used for GT, CEJ and RS; quadratic weighted kappa with 95% CI was used for RT.Results: Overall intra- and inter-examiner agreements were highest for KTW (0.95 and 0.90), lowest for GT (0.75 and 0.41), with the other variables in between (RD: 0.93 and 0.68, RS: 0.87 and 0.65, RT: 0.79 and 0.64, CEJ: 0.75 and 0.57). Overall intra- and inter-examiner agreements for the matrix were 62% and 28%, respectively. Significant effects existed between one variable's measurement and other variables' agreements.Conclusions: The 2018 Classification of GRDs and Gingival Phenotype is clinically reproduceable within the examiners, and when the variables forming the matrix are analyzed individually. The between-examiner agreement for the complete matrix showed lower reproducibility. The agreement was highest for KTW and RD, and least for GT. This article is protected by copyright. All rights reserved. [ABSTRACT FROM AUTHOR]

In this study we estimated the combined effects of violence experiences, parenting processes, and community poverty on sexual onset, alcohol or other drug (AOD) use at last sex, multiple sex partners, and prior pregnancy in a sample of 7th-, 9th-, and 11th-grade adolescents (n = 7,891), and the subsample of sexually experienced adolescents (n = 2,108). Multilevel multivariate logistic regression analyses revealed that having experienced any interpersonal violence, and low levels of perceived parental warmth and parental knowledge predicted sexual onset. Adult sexual abuse or peer sexual coercion increased the odds for AOD use at last sex and having multiple sexual partners. When demographic, violence experiences and parenting behaviors were accounted for, poverty was not associated with sexual onset, AOD use at last sex, or multiple sex partners. Results suggest prevention efforts to reduce teen dating violence may be especially important to diminish sexually risky behaviors among adolescents. (Contains 3 tables.)

Students' perceptions of their school climates are associated with psychosocial and academic adjustment. The present study examined the role of school strategies to promote safety in predicting students' perceptions of safety for gender nonconforming peers among 1415 students in 28 high schools. Using multilevel modeling techniques, we examined student- and school-level effects on students' perceptions of safety for gender nonconforming peers. We found that older students, bisexual youth, Latino youth, and youth who experienced school violence perceived their gender nonconforming male peers to be less safe. Similarly, we found that older students and students who experienced school violence and harassment due to gender nonconformity perceived their gender nonconforming female peers to be less safe. At the school-level, we found that when schools included lesbian, gay, bisexual, transgender, and queer (LGBTQ) issues in the curriculum and had a Gay-Straight Alliance, students perceived their schools as safer for gender nonconforming male peers. (Contains 3 tables.)

Transgender youth experience negative school environments and may not benefit directly from interventions defined to support Lesbian, Gay and Bisexual (LGB) youth. This study utilized a multi-method approach to consider the issues that transgender students encounter in school environments. Using data from two studies, survey data (total n = 2260, 68 transgender youth) from study 1 and focus groups (n = 35) from study 2, we examine transgender youth's experience of school harassment, school strategies implemented to reduce harassment, the protective role of supportive school personnel, and individual responses to harassment, including dropping out and changing schools. In both studies, we found that school harassment due to transgender identity was pervasive, and this harassment was negatively associated with feelings of safety. When schools took action to reduce harassment, students reported greater connections to school personnel. Those connections were associated with greater feelings of safety. The indirect effects of school strategies to reduce harassment on feelings of safety through connection to adults were also significant. Focus group data illuminate specific processes schools can engage in to benefit youth, and how the youth experience those interventions.

Studies of spoken and signed language processing reliably show involvement of the posterior superior temporal cortex. This region is also reliably activated by observation of meaningless oral and manual actions. In this study we directly compared the extent to which activation in posterior superior temporal cortex is modulated by linguistic knowledge irrespective of differences in language form. We used a novel cross-linguistic approach in two groups of volunteers who differed in their language experience. Using fMRI, we compared deaf native signers of British Sign Language (BSL), who were also proficient speechreaders of English (i.e., two languages) with hearing people who could speechread English, but knew no BSL (i.e., one language). Both groups were presented with BSL signs and silently spoken English words, and were required to respond to a signed or spoken target. The interaction of group and condition revealed activation in the superior temporal cortex, bilaterally, focused in the posterior superior temporal gyri (pSTG, BA 42/22). In hearing people, these regions were activated more by speech than by sign, but in deaf respondents they showed similar levels of activation for both language forms--suggesting that posterior superior temporal regions are highly sensitive to language knowledge irrespective of the mode of delivery of the stimulus material. (Contains 1 figure and 1 table.)

This article explores the opportunity to create spaces within the family, school, and community that specifically promote the well-being of transgender adolescents and young adults. When social contexts are supportive, transgender youth report significantly less risk. Supportive home and school environments have been linked to better outcomes among transgender youth. In some cases support via youth organizations can mitigate the influences of a negative home or school environment through direct services to youth and their families, outreach to community allies, and advocacy in local policies. The article concludes with recommendations for youth organizations to be inclusive and supportive of all gender identities and expressions. (Contains 1 table and 2 boxes.)

Policies originally designed to address food insecurity are in need of revision due to rising rates of obesity among those they serve. Within the context of national policies, this article uses an ecological perspective to consider the links between food insecurity and obesity. The recommendations include adjusting the nutritional standards of the National School Lunch Program (NSLP), updating program options for the NSLP to include some family-based meals, and increasing funding to evidence-based community programs such as the Expanded Food and Nutrition Education Program (EFNEP).

A growing body of research indicates that lesbian, gay, bisexual, and transgender (LGBT) students are often unsafe at school. Little research has examined school safety for students with LGBT parents. We examined adolescents' perceptions of school safety for students with LGBT parents using data from a survey of 2,302 California sixth through twelfth grade students. We examined the influence of adolescents' personal characteristics and school environments on perceptions of school safety for students with LGBT parents. Compared to heterosexual students, adolescents who identified as LGBT were less likely to perceive their schools as safe for students with LGBT parents. Students who received education on LGBT issues knew where to get information about LGBT issues and had teachers that step in to prevent harassment were more likely to say that their schools were safe for students with LGBT parents. Implications for educational policy and practice are discussed. (Contains 2 tables.)

This study examined the relative contribution of psychological engagement with a service activity and number of hours spent in that activity as predictors of change over time in community belonging and social responsibility. Sixty-eight primarily rural adolescents participated as teen leaders in a sexuality education program, and completed assessments of social responsibility and community belonging before and after program participation. Psychological engagement with the service activity and number of hours spent were used to predict changes in social responsibility and community belonging, while controlling for gender, prior program participation, and sexual behaviour history. Psychological engagement, but not number of hours spent, accounted for significant unique variability of change in community belonging and social responsibility.