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Limited information exists about African American parents' substance use and attitudes, independent of how they relate to their children. This study examined whether the behaviors and attitudes of a sample of African American parents differed from the general population of adults. Results indicated their attitudes were relatively more conservative, and that alcohol and illicit drug use were lower. Cigarette and marijuana use were comparable. Correlations between attitudes and behaviors were found. Findings suggest that increased educational efforts are needed among parents, especially about cigarettes, marijuana, and the negative impact these attitudes and behaviors may have on their children. [ABSTRACT FROM AUTHOR]

Obesity is a serious problem in the United States and is associated with hypertension, diabetes, and other health problems such as heart disease and some forms of cancer. There is a higher prevalence of being overweight among African American adults than among their Caucasian counterparts. The objective of this study was to assess baseline health behaviors and health status (hypertension, body mass indices, cholesterol and blood sugar levels) of African Americans participating in a community-based health education and physical fitness program. The sample consisted of 134 African American adults (30% males) from a low-income urban area in the Midwest. A health survey was administered to assess their health behaviors and previously diagnosed health problems. Additional data was obtained from health screenings to obtain current information on height, weight, and blood sugar, blood pressure and cholesterol levels. In addition to the sample being markedly overweight and obese (30% and 60% respectively), the results of the health screenings indicated a disproportionate number of participants (62%) with hypertension; 74% of the male participants had high blood pressure. Moreover, the self-reported data suggested that the participants had poor eating habits, sedentary lifestyles, and previously diagnosed health conditions (hypertension, diabetes, and high cholesterol levels) that were comparable to the results of their health screenings. These findings suggest that culturally-relevant, community-based programs that incorporate both nutrition education and physical fitness are needed in order to educate and motivate participants to decrease behaviors that put them at risk for obesity and other health related problems. [ABSTRACT FROM AUTHOR]

This study assessed the extent to which a belief in fate or destiny might explain certain health behaviors among African Americans. A survey of 1,253 African Americans in Alabama churches was conducted. Fifty-nine percent of the total sample indicated that they believe in fate or destiny. The findings of this study suggest that fate/destiny may influence health decisions. The study found a statistically significant difference between men and women regarding their belief in fate or destiny. Women reported believing in fate and destiny more than men. Surprisingly people with more education (i.e., college or postgraduate) believed in fate and destiny significantly more than high school dropouts and high school graduates. A belief in fate or destiny also varied by income level. Respondents who made more in annual income were more likely to believe in fate and destiny than people who made less. One behavior, breast exam had a statistically significant association with a belief in fate and destiny. Women who reported never having a breast exam were more likely to believe in fate and destiny than women who did not have a belief in fate or destiny. These findings highlight the need for practitioners to examine more closely the definition of fate and destiny and determine how this belief influences or does not influence health behaviors as once believed. The research suggests a closer examination of the role culture plays in health decision making which may be independent of a belief in fate and destiny. [ABSTRACT FROM AUTHOR]

Public health officials and researchers continue to be increasingly concerned about the health of populations of color, especially African Americans. A survey was administered in African American churches in two communities (Wichita, KS and Tuscaloosa, AL) to gather information concerning health behaviors and beliefs and to design interventions that might improve their health status. The study examined the homogeneity of attitudes, beliefs, and behaviors across these samples and to determine the readiness to change using the Transtheoritical Model. Individuals completed a 33-item survey: 6 demographic questions, 12 health behavior questions, 8 health belief questions, 3 church attendance questions, and 4 church-based health promotion program questions. The total sample consisted of 429 respondents. The results showed that 93% of respondents have had their blood pressure checked in the past 2 years. While only 44% indicated eating a high fiber diet during the week. Thirty percent of respondents indicated that their health was dependent on fate or destiny. The findings from this study confirm that among both samples that health attitudes, beliefs, and behaviors need to be changed to lower the risk of certain diseases and disorders. The findings also indicate that both samples have similar beliefs about health that may have important implications for disseminating information to the community. Innovative and culturally sensitive programs are needed in the African American community if disparities in health are to diminish. [ABSTRACT FROM AUTHOR]

This article describes a comprehensive evaluation used to examine the effects of a school/community partnership to reduce risk of adolescent pregnancy in a Midwestern military community. The overall initiative is described, followed by the evaluation system and key evaluation questions. The findings suggest that the school/community initiative changed the environment by implementing more than 139 community changes related to the mission (such as new programs, policies, and practices), influenced youth behaviors according to reported sexual activity, and may have influenced a modest reduction in average estimated pregnancy rate. Copyright (c) 1999 by Aspen Publishers, Inc. [ABSTRACT FROM AUTHOR]

Minors' access to alcohol and tobacco is a major public health concern because of the many deaths and disabilities associated with use and the ease with which minors purchase these products. We evaluated the effects of a community-based substance abuse coalition's efforts to reduce alcohol and tobacco products to minors. The intervention -- implemented entirely by coalition members -- consisted of adults and minors issuing citations to clerks in supermarkets, convenience stores and liquor stores, who were willing to sell alcohol and tobacco products to minors and issuing commendations to clerks who refused to sell. For those liquor stores receiving the citizen's surveillance, there was a marked decrease in alcohol sales to minors, from 83% to 33%; and in those liquor stores not experiencing the intervention, there was a smaller decrease in alcohol sales, from 45% to 36%. This study's findings suggest that citizen surveillance and feedback may be effective in reducing alcohol sales to minors when the intervention is fully implemented, but may be ineffective, at least in these doses, with tobacco sales. [ABSTRACT FROM AUTHOR]

We describe a case study evaluation of Kansas LEAN, a statewide partnership with the mission of reducing risks for chronic diseases through dietary and exercise modification. We used a case study design to examine five primary questions related to process and outcome: (a) were the goals of the partnership important to constituents? (process), (b) were constituents satisfied with the partnership (process), (c) were community or systems changes (new or modified programs, policies, or practices) facilitated by partnership efforts (outcome)?, (d) were these changes important to the partnership's mission (outcome)?, and (e) what critical events helped facilitate community changes (outcome)? several measurement instruments--a monitoring and feedback system, constituent surveys, and semistructured interviews--were used to address key evaluation questions. Kansas LEAN is a strong statewide partnership with involvement from key representatives throughout Kansas. It is an ongoing, comprehensive health promotion program that plans and implements multiple components, in a variety of settings, to create awareness, behavior change, and a supportive environment. Kansas LEAN has facilitated several important community or systems changes related to its mission. We conclude with a discussion of the challenges of evaluating partnerships that seek to reduce risks for chronic diseases. [ABSTRACT FROM AUTHOR]

Background: Binding sites in the costoclavicular space are commonly encountered during transvenous lead extraction. Severe adhesions may warrant use of more aggressive rotational cutting tools or surgical intervention. It is not known whether pre-procedural multidetector computed tomography (MDCT) can provide information about the likelihood that a patient will require costoclavicular intervention., Objective: The purpose of this study was to determine if there are pre-procedural MDCT findings associated with need for intervention in the costoclavicular space during lead extraction., Methods: Patients who underwent lead extraction and required use of stiffer rotational cutting tools (TightRail Sub-C) or surgical intervention in the costoclavicular space were included, as well as age- and sex-matched controls who did not require intervention. Pre-procedural MDCT was evaluated for patterns of lead tethering to bone and adjacent calcification., Results: Overall, 56 patients were included (n=20 Sub-C only, n=8 surgical intervention, and n=28 matched controls). The mean patient age of interventional cases was 65.0 ± 14.7 years, 18% were female, and the mean lead age was 12.3 ± 6.2 years. Four major patterns were identified on imaging: lead surrounded 360° by fat (intervention rate, 5/24 patients); lead tethered to bone by <180° (11/19); no tethering of lead but with associated calcifications (3/4); and lead tethered to bone by >180° (9/9). Tethering of at least one lead to bone by >180° was associated with a 100% rate of costoclavicular intervention, and the highest rate of surgical intervention (56%). Absence of any degree of bone tethering was associated with a 0% rate of surgical intervention., Conclusion: CT captures details of costoclavicular binding that appear to correlate with the need for adjunctive extraction techniques, including surgical intervention. CT may be useful in pre-procedural planning for adhesions in the costoclavicular space., (Copyright © 2024. Published by Elsevier Inc.)

Introduction: Conduction system pacing (CSP), often accomplished with lumenless pacing leads, is increasingly employed to achieve physiologic ventricular activation. There are limited data on the extraction of these leads. The objective of this study was to describe the safety and efficacy of extraction of CSP pacing leads and compare outcomes with extraction of non-CSP lumenless leads., Methods: Patients undergoing CSP/non-CSP lumenless lead removal were included. Outcomes of interest included rates of complete procedural success, complications, and successful reimplantation., Results: Overall, 23 patients were included (n = 14 with CSP and n = 9 with non-CSP lumenless leads implanted in the right atrium, right ventricle, or septum). The mean age was 52.7 ± 24.0 years, 30% were female, and the mean lead age was 4.5 ± 4.4 years. The complete procedural success rate was 100%. One serious complication occurred in the non-CSP group but was unrelated to the lead of interest. Manual traction alone was successful in 57% of CSP cases (mean lead age 2.4 ± 1.7 years) and in 11% of non-CSP cases (mean lead age 7.9 ± 5.3 years). Laser sheaths were used in 43% of CSP cases and 89% of non-CSP cases; rotational cutting tools were used in no CSP cases and in 33% of non-CSP cases. Reimplantation in the conduction system was attempted with a left bundle branch pacing lead and successful in 80% (n = 4/5)., Conclusion: Extraction of CSP and non-CSP lumenless leads is feasible with a high success rate and a good safety profile. CSP reimplantation after extraction is also feasible with good electrical performance., (© 2024 Wiley Periodicals LLC.)

Background: Gestational diabetes mellitus (GDM) is a common pregnancy complication with long-term health consequences for mothers and their children. The escalating trends of GDM coupled with the growing prevalence of maternal obesity, a significant GDM risk factor projected to approach nearly 60% by 2030 in Kansas, has emerged as a pressing public health issue., Methods: The aim of this study was to compare GDM and maternal obesity trends in rural and urban areas and investigate maternal demographic characteristics influencing the risk of GDM development over a 15-year period. Trend analyses and a binary logistic regression were employed utilizing 2005 to 2019 de-identified birth record vital statistics from the Kansas Department of Health and Environment (N = 589,605)., Results: Over the cumulative 15-year period, a higher prevalence of GDM was observed across age, race/ethnicity, education, and insurance source. Throughout this period, there was an increasing trend in both GDM and obese pre-pregnancy BMI age-adjusted prevalence, with noticeable rural-urban disparities. From 2005 to 2019, women, including Asians (OR: 2.73, 95% CI 2.58%-2.88%), American Indian or Alaskan Natives (OR: 1.58, 95%, CI 1.44-1.73%), Hispanics (OR: 1.42, 95% CI 1.37%-1.48%), women residing in rural areas (OR: 1.09, 95%, CI 1.06-1.12%), with advanced maternal age (35-39 years, OR: 4.83 95% CI 4.47%-5.22%; ≥40 years, OR: 6.36 95%, CI 5.80-6.98%), with lower educational status (less than high school, OR: 1.15, 95% CI 1.10%-1.20%; high school graduate, OR: 1.10, 95% CI 1.06%-1.13%), Medicaid users (OR: 1.10, 95% CI 1.06%-1.13%), or with an overweight (OR: 1.78, 95% CI 1.72%-1.84%) or obese (OR: 3.61, 95% CI 3.50%-3.72%) pre-pregnancy BMI were found to be at an increased risk of developing GDM., Conclusions: There are persistent rural-urban and racial/ethnic disparities present from 2005 to 2019 among pregnant women in Kansas with or at-risk of GDM. There are several socioeconomic factors that contribute to these health disparities affecting GDM development. These findings, alongside with prominent rising maternal obesity trends, highlight the need to expand GDM services in a predominantly rural state, and implement culturally-responsive interventions for at-risk women., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Historically, atrocities against Black, Indigenous, and Women of Color's (BIWoC) reproductive rights have been committed and continue to take place in contemporary society. The atrocities against BIWoC have been fueled by White supremacy ideology of the "desirable race" and colonial views toward controlling poverty and population growth, particularly that of "undesirable" races and ethnicities. Grounded in Critical Race Theory, this paper aims to provide a critical analysis of historical and contemporary violations of BIWoC reproductive rights; discuss interventions based on empowerment and advocacy principles designed to promote women's reproductive justice; and discuss implications for future research, action, and policy from the lenses of Critical Race Theory and Community Psychology. This paper contributes to the special issue by critically analyzing historical and contemporary racism and colonialism against BIWoC, discussing implications for future research and practice, and making policy recommendations., (© 2023 The Authors. American Journal of Community Psychology published by Wiley Periodicals LLC on behalf of Society for Community Research and Action.)

Importance: Complete hardware removal is a class I recommendation for cardiovascular implantable electronic device (CIED) infection, but practice patterns and outcomes remain unknown., Objective: To quantify the number of Medicare patients with CIED infections who underwent implantation from 2006 to 2019 and lead extraction from 2007 to 2019 to analyze the outcomes in these patients in a nationwide clinical practice cohort., Design, Setting, and Participants: This cohort study included fee-for-service Medicare Part D beneficiaries from January 1, 2006, to December 31, 2019, who had a de novo CIED implantation and a CIED infection more than 1 year after implantation. Data were analyzed from January 1, 2005, to December 31, 2019., Exposure: A CIED infection, defined as (1) endocarditis or infection of a device implant and (2) documented antibiotic therapy., Main Outcomes and Measures: The primary outcomes of interest were device infection, device extraction, and all-cause mortality. Time-varying multivariable Cox proportional hazards regression models were used to evaluate the association between extraction and survival., Results: Among 1 065 549 patients (median age, 78.0 years [IQR, 72.0-84.0 years]; 50.9% male), mean (SD) follow-up was 4.6 (2.9) years after implantation. There were 11 304 patients (1.1%) with CIED infection (median age, 75.0 years [IQR, 67.0-82.0 years]); 60.1% were male, and 7724 (68.3%) had diabetes. A total of 2102 patients with CIED infection (18.6%) underwent extraction within 30 days of diagnosis. Infection occurred a mean (SD) of 3.7 (2.4) years after implantation, and 1-year survival was 68.3%. There was evidence of highly selective treatment, as most patients did not have extraction within 30 days of diagnosed infection (9202 [81.4%]), while 1511 (13.4%) had extraction within 6 days of diagnosis and 591 (5.2%) had extraction between days 7 and 30. Any extraction was associated with lower mortality compared with no extraction (adjusted hazard ratio [AHR], 0.82; 95% CI, 0.74-0.90; P < .001). Extraction within 6 days was associated with even lower risk of mortality (AHR, 0.69; 95% CI, 0.61-0.78; P < .001)., Conclusions and Relevance: In this study, a minority of patients with CIED infection underwent extraction. Extraction was associated with a lower risk of death compared with no extraction. The findings suggest a need to improve adherence to guideline-directed care among patients with CIED infection.

Background: There is evidence to suggest that colchicine reduces the risk of recurrent atrial fibrillation (AF) after catheter ablation; however, the tolerability and safety of colchicine in routine practice is unknown., Methods: Patients undergoing catheter ablation for AF who received colchicine after ablation were matched 1:1 to patients who did not by age, sex, and renal function. Recurrent AF was compared between groups categorically at 12 months and via propensity weighted Cox proportional hazards models with and without a 3-month blanking period., Results: Overall, 180 patients (n = 90 colchicine and n = 90 matched controls) were followed for a median (Q1, Q3) of 10.3 (7.0, 12.0) months. Mean age was 65.3 ± 9.1 years, 33.9% were women, mean CHA 2 DS 2 -VASc score was 2.9 ± 1.5, and 51.1% had persistent AF. Most patients (70%) received colchicine 0.6 mg daily for a median of 30 days. In the colchicine group, 55 patients (61.1%) were receiving at least one known interacting medication with colchicine. After ablation, one patient required colchicine dose reduction and four patients required discontinuation. After adjusting for covariate imbalance using propensity weighting, no significant association between colchicine use and AF recurrence was identified (adjusted hazard ratio 0.94, 95% confidence interval [CI] 0.48-1.85; p = 0.853). No significant association was found between colchicine use and all-cause hospitalizations (adjusted odds ratio 0.74, 95% CI 0.28-1.96; p = 0.548)., Conclusion: Despite the frequent presence of drug-drug interactions, a 30-day course of colchicine is well-tolerated after AF ablation; however, we did not observe any association between colchicine and lower rates of AF recurrence or hospitalization., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Rotational cutting tools are increasingly used in transvenous lead extraction. There are limited data on their safety and efficacy, particularly when used adjunctively for stalled progression. The aim of this study was to evaluate the utilization, safety, and effectiveness of mechanical rotational cutting tools for transvenous lead extraction., Methods: Patients undergoing transvenous lead extraction at a single tertiary center (April 2015 to January 2021, n=586) were included in this retrospective analysis. The study characterized the 251 patients (42.8%) whose cases involved the TightRail mechanical cutting tool., Results: Among 251 patients, 526 leads were extracted and TightRail was used for 70.5%. The TightRail was used adjunctively with the laser for 65.2% of leads, 97.8% of the time as the second tool after stalled progression. Using a multivariable logistic regression model, we found that active-fixation leads (odds ratio, 2.78 [95% CI, 1.62-4.78]; P =0.0002), dual-coil leads (odds ratio, 3.39 [95% CI, 1.87-6.16]; P<0 .0001), and lead dwell time (odds ratio, 1.16 [95% CI for 1-year increase, 1.11-1.21]; P<0 .0001) were factors independently associated with adjunctive TightRail use. Stalled progression requiring TightRail occurred most often in the innominate vein and superior vena cava (59.3%). The clinical success rate was 96.8%, and the rate of major adverse events was 2.8%. Only 1 major adverse event was observed during TightRail use., Conclusions: Rotational cutting with TightRail was used in 42.8% of transvenous lead extractions, predominantly in an adjunctive manner after stalled laser progression in the innominate vein and superior vena cava, and more frequently for dual-coil and leads with longer dwell times. Adjunctive TightRail use carries a low risk of major complications., Competing Interests: Disclosures Dr Pokorney reports significant research support from Food and Drug Administration and modest research support from Janssen Pharmaceuticals, Bristol-Myers Squibb, Pfizer, Boston Scientific, and Gilead; modest advisory board/consulting support from Janssen Pharmaceuticals, Bristol-Myers Squibb, Pfizer, Boston Scientific, Medtronic, Philips, and Zoll. Dr Hegland and Lewis serve as consultants to Philips. Dr Piccini is supported by R01AG074185 from the National Institutes of Aging. He also receives grants for clinical research from Abbott, the American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips and serves as a consultant to Abbott, Abbvie, Ablacon, Altathera, ARCA biopharma, Bayer, Biotronik, Boston Scientific, Element Science, LivaNova, Medtronic, Milestone, ElectroPhysiology Frontiers, ReCor, Sanofi, Philips, and Up-to-Date. The other authors report no conflicts.

This article introduces a special issue of the American Journal of Community Psychology that features racial reckoning, resistance and the revolution in the context of a syndemic, the historical subjugation of communities of Color (COC) to racial hierarchies and the coronavirus (COVID-19). More specifically, this special issue underscores the need for community psychology and other allied disciplines to address this syndemic facing COC. The special issue delivers on the stories of the lived experiences from researchers and community members as it relates to COVID-19 and COC. Twelve articles are illuminated to challenge the field to create social change., (© 2023 The Authors. American Journal of Community Psychology published by Wiley Periodicals LLC on behalf of Society for Community Research and Action.)

This is a pilot study on compassion fatigue experienced by spiritual leaders. The sample consisted of 15 religious affiliations with a total of 41 participants (30 males and 11 females). In this sample, spiritual leaders were not experiencing significant levels of compassion fatigue, and they were satisfied with their work. There was a significant negative correlation between satisfaction and exhaustion, r  = -.62, n  = 35, p  < .01. Additionally, participants reported their coping strategies and support systems.

Abstract: A housing development of 87 new homes on approximately 300 acres of former farm land was found to have 19 homes with basement radon-222 ( 222 Rn) concentrations greater than 37,000 Bq m -3 , with the highest recorded result to date being 648,000 +/- 1,031 Bq m -3 , based upon the diffusion barrier charcoal canister result. The US Environmental Protection Agency (EPA) Action Level for 222 Rn is 148 Bq m -3 . This single-family housing development is in the southeast corner of Lehigh County, Pennsylvania, about 58 km northwest of Philadelphia, in a geologic unit known as the Epler Formation. Radon testing in homes in this development began in the fall of 2014 and is now complete. Initial testing consisted of charcoal canisters mailed to homeowners. Subsequent testing in newly built homes consisted of testing prior to occupancy. This testing was quite extensive, with continuous radon monitors, passive radon monitors, and grab sampling for radon gas and progeny in the basement and on the first floor of each home as well as gamma surveys in the basement, on the first and second floors, and outside of each home. All but one of the new houses in this development had passive radon resistant features installed during the construction phase. In all cases, fans were added to the passive systems to make them active systems, which were needed to control these extremely high radon levels. Additional radon mitigation work such as adding additional suction points was also needed in several homes to reduce levels to below EPA guidelines. The unique geology and high 226 Ra soil concentrations in this specific area are the causes of these extremely high radon levels. Radon measurement data both inside these homes and in the outdoor ambient air, as well as 238 U and 222 Ra rock and soil concentrations, are presented., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2022 Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.)

Background: Cardiac implanted electronic device (CIED) pocket and systemic infection remain common complications with traditional CIEDs and are associated with high morbidity and mortality. Leadless pacemakers may be an attractive pacing alternative for many patients following complete hardware removal for a CIED infection by eliminating surgical pocket-related complications as well as lower risk of recurrent complications., Objective: To describe use and outcomes associated with leadless pacemaker implantation following extraction of a CIED system due to infection., Methods: Patient characteristics and postprocedural outcomes were described in patients who underwent leadless pacemaker implantation at Duke University Hospital between November 11, 2014 and November 18, 2019, following CIED infection and device extraction. Outcomes of interest included procedural complications, pacemaker syndrome, need for system revision, and recurrent infection., Results: Among 39 patients, the mean age was 71 ± 17 years, 31% were women, and the most frequent primary pacing indication was complete heart block (64.1%) with 9 (23.1%) patients being pacemaker dependent at the time of Micra implantation. The primary organism implicated in the CIED infection was Staphylococcus aureus (43.6%). Nine of the 39 patients had a leadless pacemaker implanted before or on the same day as their extraction procedure, and the remaining 30 patients had a leadless pacemaker implanted after their extraction procedure. During follow-up (mean 24.8 ± 14.7 months) after leadless pacemaker implantation, there were a total of 3 major complications: 1 groin hematoma, 1 femoral arteriovenous fistula, and 1 case of pacemaker syndrome. No patients had evidence of recurrent CIED infection after leadless pacemaker implantation., Conclusions: Despite a prior CIED infection and an elevated risk of recurrent infection, there was no evidence of CIED infection with a mean follow up of over 2 years following leadless pacemaker implantation at or after CIED system removal. Larger studies with longer follow-up are required to determine if there is a long-term advantage to implanting a leadless pacemaker versus a traditional pacemaker following temporary pacing when needed during the periextraction period in patients with a prior CIED infection., (© 2022 Wiley Periodicals LLC.)

The purpose of this study was to examine patient and provider experiences of integrated behavioral health care at a Federally Qualified Health Center (FQHC). Using a mixed methodology design, both patients (n = 186) and providers (n = 17) completed a survey regarding satisfaction with care and the extent of integration at the clinic, as well as attended a focus group or interview (n = 11 patients; n = 12 providers) regarding their satisfaction and experiences. Both patients and providers found integration to be acceptable and satisfactory and the integration of services among different health care providers occurred fairly regularly. Themes from the provider and patient interviews/focus groups highlighted both positive aspects of the integration and specific challenges within the clinic. This more nuanced perspective of integration both replicates and extends upon previous research regarding satisfaction with integrated care and emphasizes the complexities and challenges of integration within community health clinics., (© 2021. National Council for Behavioral Health.)

Background: Procedural and clinical outcomes of patients undergoing extraction or removal of azygous coils are not well characterized., Objective: Evaluate outcomes in patients who undergo device extraction with an azygous coil in situ., Methods: Patients undergoing extraction with an azygous coil in situ between May 2015 and January 2021 were included in this retrospective single-center analysis. Outcomes included procedural success, use of laser and mechanical cutting tools during the procedure, procedural complications, and mortality., Results: We identified 2 patients undergoing device extraction with an azygous coil in situ with a dwell time greater than 12 months. The patients were male, aged 73 and 83 years. Both had a history of hypertension, atrial fibrillation, heart failure (ejection fractions <15% and 20%), and cardiomyopathy (nonischemic and ischemic), and presented with an infection (case 1 with a single-chamber ICD and Staphylococcus aureus bacteremia, case 2 with a cardiac resynchronization therapy defibrillator pocket infection). The mean dwell time of all 6 leads extracted was 6.43 years (range 1.33-12.63 years), and the 2 azygous coils had dwell times of 1.33 and 6.04 years. In case 1, the azygous coil was inferior to the cardiac silhouette, while in case 2 it was superior. A 14F laser sheath was employed to remove both azygous coils. Both extractions were a complete procedural success in which all leads were removed completely without intraoperative complications., Conclusion: These cases demonstrate the variable courses of azygous coils, provide proof of concept that they can be removed safely, and illustrate that azygous coils can be removed with the same techniques that are commonly used to remove other types of leads., (© 2022 Heart Rhythm Society. Published by Elsevier Inc.)

Background: Atrioventricular (AV)-synchronous single-chamber leadless pacing using a mechanical atrial sensing algorithm produced high AV synchrony in clinical trials, but clinical practice experience with these devices has not yet been described., Objective: To describe pacing outcomes and programming changes with AV-synchronous leadless pacemakers in clinical practice., Methods: Consecutive patients without persistent atrial fibrillation who received an AV-synchronous leadless pacemaker and completed follow-up between February 2020 and April 2021 were included. We evaluated tracking index (atrial mechanical sense followed by ventricular pace [AM-VP] divided by total VP), total AV synchrony (sum of AM-ventricular sense [AM-VS], AM-VP, and AV conduction mode switch), use of programming optimization, and improvement in AV synchrony after optimization., Results: Fifty patients met the inclusion criteria. Mean age was 69 ± 16.8 years, 24 (48%) were women, 24 (48%) had complete heart block, and 17 (34%) required ≥50% pacing. Mean tracking index was 41% ± 34%. Thirty-five patients (70%) received ≥1 programming change. In 36 patients with 2 follow-up visits, tracking improved by +9% ± 28% ( P value for improvement = .09) and +18% ± 19% ( P = .02) among 15 patients with complete heart block. Average total AV synchrony increased from 89% [67%, 99%] to 93% [78%, 100%] in all patients ( P = .22), from 86% [52%, 98%] to 97% [82%, 99%] in those with complete heart block ( P = .04), and from 73% [52%, 80%] to 78% [70%, 85%] in those with ≥50% pacing ( P = .09)., Conclusion: In patients with AV-synchronous leadless pacemakers, programming changes are frequent and are associated with increased atrial tracking and increased AV synchrony in patients with complete heart block., (© 2021 Published by Elsevier Inc. on behalf of Heart Rhythm Society.)

The purpose of this study was to examine the relationship between health behaviors and their levels of positive and negative affect and determine the overall level of physical health and mental health among members of the armed forces. Overall, the results showed that veterans in the Army, Navy and Marines are more often than members who are in the Air Force to be deployed. Members in the Army, Navy and Marines also experience higher levels of reported cases of PTSD, higher levels of negative affect (i.e. anxiety), a lower health composite score and report poorer perception of their own health. This study also showed that veterans of the Air Force had a stronger emphasis on their physical health which resulted in higher levels of positive affect (excited about life). Limitations and future directions of this research are discussed.

The current issue is a call to action on the mental health crisis America is experiencing. Prevention and intervention programs are needed to address the gap in services. This current issue gathers the voices and perspectives from various populations' lived experiences with the intent to develop recommendations and solutions.

Suicidality is a serious concern in this country. In the U.S. nearly 40,000 people die by suicide each year. It is the 10th leading cause of death. For those 15-24, it is the 2nd leading cause of death. Using data from the Add Health Longitudinal data set and data gathered from a local organization an examination of suicidality among African American youth was conducted. Given the trauma and low resourced situations many African American adolescents find themselves in, interventions are needed to address these health concerns before other issues such as education and other life options (i.e., careers) are addressed. Questions that participants were asked related to suicidal ideation and suicide attempts; did you ever seriously consider attempting suicide and did you attempt suicide? The results showed that the local sample had higher suicidal ideation than the Add health national sample (20% vs. 13.6%), respectively. The local sample had higher percentages of suicide attempts in the past twelve months compared to the National sample. There was a statistically significant difference between females and males in the sample. Limitations and future research are found in the discussion.

Perceived stress and mental health on college campuses is a major concern. College students are under a tremendous strain. This study was designed to measure the perceived stress among Whites and Nonwhites using the Perceived Stress Scale, the Center for Epidemiologic Studies Depression Scale Revised, Positive and Negative Affect Scale (PANAS) and other behavioral indicators (diet and nutrition) to determine the overall well-being of college students. College students attending a mid-sized University in the Midwest completed an 80 item online survey. The results showed that thirty-six percent of the sample displayed depressive symptoms, 10% of the respondents endorsed high perceived stress and 56% reported experiencing moderate stress levels. Females had higher levels of perceived stress than males and Whites displayed statistically significant lower depression scores than Nonwhites although Whites displayed significantly higher mean scores on the CES-D-R depression scores than Nonwhites. Overall, fruit intake of college students was as an indication of poor diet and nutrition among college students because they were not eating fruit in their diets prior to taking the survey. Limitations and future directions will be explored.

Stereotype threats have been documented in an academic and work setting and have been found to have a significant impact on an individual's behavior as it could be a barrier in receiving healthcare services. This paper explores the impact of health-related stereotype threats and its influence within a LGBT sample with the use of an online survey to explore underlying and unconscious barriers within mental health services. A series of regressions were used to analyze and explore the potential predictability the health-related stereotype threats may have on the fear of communicating with a physician, delay in mental health services, and poor mental health outcomes. High reports of health-related stereotype threats significantly predicted high reports of fear of the physician which could indicate that many LGBT patients are afraid to communicate with their providers about their mental health due to stereotype threats ( F (1,91) = 9.844, p  <  .005). In addition, high reports of health-related stereotype threats slightly but significantly predicted reported delays in seeking mental health services ( χ 2 (1) = 4.220, p  <  .05). In addition, although there was no significance related to positive affect scores, health related stereotype threats significantly predicted self-reported poor mental health outcomes ( F (1,90) = 4.545, p  <  .05) and high rates of negative affect scores (i.e., anxiety, depression; F (1,89) = 4.933, p  <  .05). Recommendations and future study will also be discussed.

African Americans' rates of mental illness are similar to those of the general population, however, their rates of utilization of any mental health service is lower than many other ethnic/racial groups, specifically, non-Hispanic, Whites. Many African Americans do not receive adequate treatment for mental health issues due to several barriers to help-seeking behavior. Despite these barriers, African American communities have traditionally sought support from pastors or ministers of historically black churches in times of crises or when experiencing mental health issues. Research has shown that African Americans rely on faith, family, and their churches for emotional support rather than turning to health care professionals. To address the stigma of mental health and identify barriers to seeking mental health care in African American communities in Wichita, KS, a local Wichita historically black church, developed and hosted a mental/emotional health awareness conference. Approximately 30% of the 249 participants who attended the conference were surveyed to assess conference impact, conference satisfaction, and barriers to seeking mental health services. Results indicated approximately 37% of those surveyed lived in lower-income neighborhoods. Conference impact and satisfaction were both rated favorably. Lastly, the top three barriers to mental health care were: (1) "I don't want to be labeled," (2) "I can't afford it," and (3) "I don't know where to go for care." These data highlight the need for stigma reducing interventions and for additional policy changes to address the disparity in health-seeking behaviors of African Americans.

Background: African American women continue to die at a higher rate than White women from breast cancer. Kansas has a high death rate among African American women. Their voices needed to be heard., Objectives: This exploratory study will ask the following questions: 1) Were African American and White women having different breast cancer treatment experiences with their health care providers? And 2) How satisfied were they with their treatment?, Method: A total of 15 breast cancer survivors were recruited to participate in this qualitative research study. We conducted focus groups in two communities in the Midwest. Forty percent of the sample was White women, 53% of the sample was African American women and 7% of the sample was Hispanic/Latina., Results: Overall six themes emerged. Generally both African American women and White women were satisfied with their health care; both felt they were treated equally by health care professionals. However, they felt that health care professionals should pay more attention to their significant others and to continue to educate young women about early detection., Conclusions: As a result of the focus groups a gap in services emerged in educating the patient's partners about what is needed for their significant others and what role partners play in the recovery process., (Published by Elsevier Inc.)

Objectives: This study sought to determine the indications, characteristics, and outcomes of cardiovascular implantable electronic device (CIED) surgery in patients with LVAD., Background: Many patients with a left ventricular assist device (LVAD) will require implantable cardioverter-defibrillator generator change or device revision or are candidates for de novo implantable cardioverter-defibrillator implantation following LVAD implantation., Methods: We performed an observational retrospective study of all LVAD recipients who subsequently underwent CIED surgery at Duke University Hospital from 2009 to 2019., Results: A total of 159 patients underwent CIED surgery following LVAD implantation, including generator change (n = 93), device revision (n = 38), and de novo implant (n = 28). The median (interquartile range) time from LVAD implantation to CIED surgery was 18.1 months (5.5 to 35.1 months). Pre-operative risk for infection was elevated in the overall cohort with a median (interquartile range) Prevention of Arrhythmia Device Infection Trial (PADIT) score of 7.0 (5.0 to 9.0). Pocket hematoma occurred in 21 patients (13.2%) following CIED surgery. Antimicrobial envelops were used in 43 patients (27%). Device infection due to CIED surgery occurred in 5 (3.1%) patients and occurred only in patients who developed post-operative pocket hematoma (p < 0.001). Mortality at 1 year following CIED surgery was 20% (n = 32)., Conclusions: CIED surgery following LVAD implantation is associated with an increased risk for pocket hematoma and CIED infection. Further studies are needed to determine the risk-benefit ratio of CIED surgery in patients with LVADs., (Copyright © 2020 American College of Cardiology Foundation. All rights reserved.)

Background: There are limited data on the performance of the subcutaneous implantable cardioverter-defibrillator (S-ICD) in patients with a left ventricular assist device (LVAD)., Objective: The purpose of this study was to describe the clinical course and outcomes of patients with both an S-ICD and an LVAD at our institution and via a systematic review of published studies., Methods: We performed a retrospective cohort study of all patients who underwent LVAD implantation from 2009 to 2019 at Duke University Hospital. We also performed a systematic review of studies involving patients with an S-ICD and LVAD using the PubMed/Embase databases., Results: Of 588 patients undergoing LVAD implantation with a preexisting implantable cardioverter-defibrillator, 4 had an S-ICD in situ after LVAD implantation. All 4 patients developed electromagnetic interference (EMI) in the primary/secondary vectors after LVAD implantation, resulting in inappropriate implantable cardioverter-defibrillator shocks in 2 patients. Sensing in the alternate vector was adequate immediately postoperatively in 1 patient. Postoperative undersensing was present in the alternate vector in 3 patients but improved at first outpatient follow-up in 2 patients, allowing tachy therapies to be reenabled. Eight studies involving 27 patients were identified in the systematic review. EMI was common and frequently absent in the alternate vector (6 of 7 patients)., Conclusion: Undersensing and EMI are common after LVAD implantation in patients with an S-ICD in situ, particularly in the primary and secondary sensing vectors. Undersensing in the alternate vector may improve during follow-up, obviating the need for device revision or extraction., (Copyright © 2020 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)

Due to the growing number of patients treated with cardiac implantable electronic devices (CIEDs) there is an increased need for lead management, evaluation, and extraction. While CIED lead extraction has many indications, a consistent approach to preprocedural planning should be applied in all cases, including a thorough consultation with careful review of the patient's medical and device history, as well as a discussion of informed consent and shared decision-making with the patient and their loved ones. The use of chest X-ray, echocardiography, and computed tomography (CT) scan can further help with risk stratification and procedural planning. Intraprocedural echocardiography (transesophageal or intracardiac) is recommended and allows early recognition of cardiothoracic injury. Establishing an extraction team with cardiology/electrophysiology, anesthesiology, and CT surgery is is crucial to a successful and safe CIED extraction practice, including immediately available surgical backup. This hands-on review will address how to approach patients who are undergoing lead extraction, as well as several innovations in preprocedure and intraprocedural risk assessment., (© 2019 Wiley Periodicals, Inc.)

Objectives: The goal of this study was to assess the utility of transvenous lead extraction for cardiovascular implantable electronic device (CIED) infection in patients with a left ventricular assist device (LVAD)., Background: The use of transvenous lead extraction for the management CIED infection in patients with a durable LVAD has not been well described., Methods: Clinical and outcomes data were collected retrospectively among patients who underwent lead extraction for CIED infection after LVAD implantation at Duke University Hospital., Results: Overall, 27 patients (n = 6 HVAD; n = 15 HeartMate II; n = 6 Heartmate III) underwent lead extraction for infection. Median (interquartile range) time from LVAD implantation to infection was 6.1 (2.5 to 14.9) months. Indications included endocarditis (n = 16), bacteremia (n = 9), and pocket infection (n = 2). Common pathogens were Staphylococcus aureus (n = 10), coagulase-negative staphylococci (n = 7), and Enterococcus faecalis (n = 3). Sixty-eight leads were removed, with a median lead implant time of 5.7 (3.6 to 9.2) years. Laser sheaths were used in all procedures, with a median laser time of 35.0 s (17.5 to 85.5s). Mechanical cutting tools were required in 11 (40.7%) and femoral snaring in 4 (14.8%). Complete procedural success was achieved in 25 (93.6%) patients and clinical success in 27 (100%). No procedural failures or major adverse events occurred. Twenty-one patients (77.8%) were alive without persistent endovascular infection 1 year after lead extraction. Most were treated with oral suppressive antibiotics after extraction (n = 23 [82.5%]). Persistent infection after extraction occurred in 4 patients and was associated with 50% 1-year mortality., Conclusions: Transvenous lead extraction for LVAD-associated CIED infection can be performed safely with low rates of persistent infection and 1-year mortality., (Copyright © 2020 American College of Cardiology Foundation. All rights reserved.)

Introduction: Lead dysfunction can lead to serious consequences including failure to treat ventricular tachycardia or fibrillation (VT/VF). The incidence and mechanisms of lead dysfunction following left ventricular assist device (LVAD) implantation are not well-described. We sought to determine the incidence, mechanisms, timing, and complications of right ventricular lead dysfunction requiring revision following LVAD implantation., Methods: Retrospective observational chart review of all LVAD recipients with pre-existing implantable cardioverter-defibrillator (ICD) from 2009 to 2018 was performed including device interrogation reports, laboratory and imaging data, procedural reports, and clinical outcomes., Results: Among 583 patients with an ICD in situ undergoing LVAD implant, the median (interquartile range) age was 62.5 (15.7) years, 21% were female, and the types of LVADs included HeartWare HVAD (26%), HeartMate II (52%), and HeartMate III (22%). Right ventricular lead revision was performed in 38 patients (6.5%) at a median (25th, 75th) of 16.4 (3.6, 29.2) months following LVAD. Mechanisms of lead dysfunction included macrodislodgement (n = 4), surgical lead injury (n = 4), recall (n = 3), insulation failure (n = 8) or conductor fracture (n = 7), and alterations in the lead-myocardial interface (n = 12). Undersensing requiring revision occurred in 22 (58%) cases. Clinical sequelae of undersensing included failure to detect VT/VF (n = 4) and pacing-induced torsade de pointes (n = 1). Oversensing occurred in 12 (32%) and sequelae included inappropriate antitachycardia pacing ([ATP], n = 8), inappropriate ICD shock (n = 6), and ATP-induced VT (n = 1)., Conclusion: The incidence of right ventricular lead dysfunction following LVAD implantation is significant and has important clinical sequelae. Physicians should remain vigilant for lead dysfunction after LVAD surgery and test lead function before discharge., (© 2020 Wiley Periodicals, Inc.)

Background: Diabetes mellitus (DM) is an independent risk factor for atrial fibrillation (AF). Few studies have compared clinical outcomes after catheter ablation between patients with and those without DM., Objective: The purpose of this study was to compare AF ablation outcomes in patients with and those without DM., Methods: We performed a retrospective analysis of 351 consecutive patients who underwent first-time AF ablation. Clinical outcomes included freedom from recurrent atrial arrhythmia, symptom burden (Mayo AF Symptom Inventory score), cardiovascular and all-cause hospitalizations, and periprocedural complications., Results: Patients with DM (n = 65) were older, had a higher body mass index, more persistent AF, more hypertension, and larger left atrial diameter ( P <.05 for all). Median (Q1, Q3) total radiofrequency duration [64.0 (43.6, 81.4) minutes vs 54.3 (39.2, 76.4) minutes; P = .132] and periprocedural complications ( P = .868) did not differ between patients with and those without DM. After a median follow-up of 29.5 months, arrhythmia recurrence was significantly higher in the DM group compared to the no-DM group after adjustment for baseline differences (adjusted hazard ratio [HR] 2.24; 95% confidence [CI] 1.42-3.55; P = .001). There was a nonsignificant trend toward higher AF recurrence with worse glycemic levels (HR 1.29; 95% CI 0.99-1.69; P = .064)., Conclusion: Although safety outcomes associated with AF ablation were similar between patients with and those without DM, arrhythmia-free survival was significantly lower among patients with DM. Poor glycemic control seems to an important risk factor for AF recurrence., (© 2020 Heart Rhythm Society. Published by Elsevier Inc.)

Cardiac implantable electronic devices (CIEDs) frequently need to be extracted due to infection, hardware failure, and other causes. The extraction of the CIED is typically performed using percutaneous methods. While these procedures are mostly performed without incident there is a small risk of significant complications. Dedicated imaging pre-CEID removal to include the central veins and heart with multidetector computed tomography (MDCT) can be utilized to evaluate the lead course and termination, the integrity of the central veins and cardiac chambers, and identify potential complications that may alter the lead extraction procedure as well as reimplantation of subsequent leads. Indications for preprocedural imaging, the technique of dedicated preprocedural lead extraction MDCT, and the approach to the interpretation of the images is discussed in this review., (© 2020 Wiley Periodicals, Inc.)