المؤلفون: Amrollahi, Fatemeh, Kennis, Brent, Shashikumar, Supreeth, Taylor, Stephanie, Ford, James, Rodriguez, Arianna, Weston, Julia, Maheshwary, Romir, Nemati, Shamim, Wardi, Gabriel, Meier, Angela, Malhotra, Atul

المصدر: Critical Care Explorations. 6(6)

مصطلحات موضوعية: Humans, Patient Readmission, Female, Male, Social Determinants of Health, Retrospective Studies, Middle Aged, Sepsis, Aged, Adult, United States, Logistic Models, Risk Factors, Cohort Studies

الوصف: OBJECTIVES: To determine the predictive value of social determinants of health (SDoH) variables on 30-day readmission following a sepsis hospitalization as compared with traditional clinical variables. DESIGN: Multicenter retrospective cohort study using patient-level data, including demographic, clinical, and survey data. SETTINGS: Thirty-five hospitals across the United States from 2017 to 2021. PATIENTS: Two hundred seventy-one thousand four hundred twenty-eight individuals in the AllofUs initiative, of which 8909 had an index sepsis hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Unplanned 30-day readmission to the hospital. Multinomial logistic regression models were constructed to account for survival in determination of variables associate with 30-day readmission and are presented as adjusted odds rations (aORs). Of the 8909 sepsis patients in our cohort, 21% had an unplanned hospital readmission within 30 days. Median age (interquartile range) was 54 years (41-65 yr), 4762 (53.4%) were female, and there were self-reported 1612 (18.09%) Black, 2271 (25.49%) Hispanic, and 4642 (52.1%) White individuals. In multinomial logistic regression models accounting for survival, we identified that change to nonphysician provider type due to economic reasons (aOR, 2.55 [2.35-2.74]), delay of receiving medical care due to lack of transportation (aOR, 1.68 [1.62-1.74]), and inability to afford flow-up care (aOR, 1.59 [1.52-1.66]) were strongly and independently associated with a 30-day readmission when adjusting for survival. Patients who lived in a ZIP code with a high percentage of patients in poverty and without health insurance were also more likely to be readmitted within 30 days (aOR, 1.26 [1.22-1.29] and aOR, 1.28 [1.26-1.29], respectively). Finally, we found that having a primary care provider and health insurance were associated with low odds of an unplanned 30-day readmission. CONCLUSIONS: In this multicenter retrospective cohort, several SDoH variables were strongly associated with unplanned 30-day readmission. Models predicting readmission following sepsis hospitalization may benefit from the addition of SDoH factors to traditional clinical variables.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/2kq258tg
https://escholarship.org/content/qt2kq258tg/qt2kq258tg.pdf

المؤلفون: Katz, Ronit, Chaves, Paulo, Hoofnagle, Andrew, Kizer, Jorge, Bansal, Nisha, Ix, Joachim, Ganz, Tomas, Sharma, Shilpa

المصدر: ESC Heart Failure. 11(3)

مصطلحات موضوعية: Heart failure, Iron, Left ventricular ejection fraction, Left ventricular mass, Humans, Heart Failure, Aged, Female, Male, Independent Living, Incidence, Iron Deficiencies, Anemia, Iron-Deficiency, United States, Risk Factors, Follow-Up Studies, Aged, 80 and over, Iron

الوصف: AIMS: Among persons with prevalent heart failure (HF), iron deficiency has been linked to HF admissions, and intravenous iron replacement improves HF outcomes. Recent studies in persons with chronic kidney disease (CKD) demonstrate that iron deficiency is associated with incident HF. This study aimed to determine the relationship of iron status with incident HF in community-dwelling older adults irrespective of their kidney function. METHODS: In this case-cohort study, 1,006 Cardiovascular Health Study participants (785 from the random sub-cohort [including 193 HF cases] and 221 additional HF cases [N = 414 total HF cases]) aged ≥ 65 years without HF (41% with CKD), we used weighted Cox models to evaluate associations of iron status with incident HF. Participants were categorized based on quartiles of transferrin saturation and ferritin as iron replete (27.3%), functional iron deficiency (7.7%), iron deficiency (11.8%), mixed iron deficiency (5.6%), high iron (9.3%) and non-classified (38.1%), consistent with prior studies. RESULTS: Compared to older persons who were iron replete, those with iron deficiency were at higher risk of incident HF (HR 1.47; 1.02-2.11) in models adjusting for demographics, HF risk factors, and estimated glomerular filtration rate. Other iron categories did not associate with incident HF. The relationship of iron deficiency with incident HF did not differ by CKD status (interaction P value 0.2). CONCLUSIONS: Among community-dwelling elders, iron deficiency is independently associated with incident HF, an association that was similar irrespective of CKD status. Our findings support conduct of clinical trials of iron replacement for prevention of HF in older adults with iron deficiency.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/7sg3b3cv

المؤلفون: Weinstein, Shayna, Alsamman, Sana, Lee, Christopher, Dooley, Erin, Ganson, Kyle, Testa, Alexander, Gooding, Holly, Kiss, Orsolya, Baker, Fiona, Pettee Gabriel, Kelley, Nagata, Jason

المصدر: BMC Public Health. 24(1)

مصطلحات موضوعية: Adolescent, Blood pressure, Cardiovascular disease, Cholesterol, Diabetes, Digital media, Dyslipidemia, Hemoglobin A1c, Hypertension, Physical activity, Screen use, Humans, Screen Time, Adolescent, Male, Female, Cardiovascular Diseases, Exercise, Child, Heart Disease Risk Factors, United States, Sedentary Behavior, Risk Factors, Blood Pressure, Glycated Hemoglobin

الوصف: BACKGROUND: According to the Physical Activity Guidelines Advisory Committee Scientific Report, limited evidence is available on sedentary behaviors (screen time) and their joint associations with physical activity (steps) for cardiovascular health in adolescence. The objective of this study was to identify joint associations of screen time and physical activity categories with cardiovascular disease (CVD) risk factors (blood pressure, hemoglobin A1c, cholesterol) in adolescence. METHODS: This study analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, comprising a diverse sample of 4,718 U.S. adolescents aged 10-15 years between 2018 and 2021. Steps were measured by a Fitbit wearable device and levels were categorized as low (1,000-6,000), medium (> 6,000-12,000), and high (> 12,000) averaged daily step counts. Self-reported recreational screen time hours per day were classified as low (0-4), medium (> 4-8), and high (> 8) hours per day. CVD risk factors including blood pressure, hemoglobin A1c, and cholesterol (total and HDL) were measured. RESULTS: The analytical sample averaged 6.6 h of screen time per day and 9,722 steps per day. In models including both screen time and steps, the high screen time category was associated with a 4.27 higher diastolic blood pressure percentile (95% CI 1.83-6.73) and lower HDL cholesterol (B= -2.85, 95% CI -4.77 to -0.94 mg/dL) compared to the low screen time category. Medium (B = 3.68, 95% CI 1.24-6.11) and low (B = 7.64, 95% CI 4.07-11.20) step categories were associated with higher diastolic blood pressure percentile compared to the high step category. The medium step category was associated with lower HDL cholesterol (B= -1.99, 95% CI -3.80 to -0.19 mg/dL) compared to the high step category. Findings were similar when screen time and step counts were analyzed as continuous variables; higher continuous step count was additionally associated with lower total cholesterol (mg/dL). CONCLUSIONS: Combinations of low screen time and high steps were generally associated with favorable cardiovascular health markers including lower diastolic blood pressure and higher HDL cholesterol, which can inform future adolescent health guidelines.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/7t06g9j3

المؤلفون: Maestre, Gladys, Hill, Carl, Griffin, Percy, Hall, Stephen, Hu, William, Flatt, Jason, Babulal, Ganesh, Thorpe, Roland, Henderson, J Neil, Buchwald, Dedra, Manson, Spero, Cicero, Ethan, Gilmore‐Bykovskyi, Andrea, Gamaldo, Alyssa, Glover, Crystal, Barnes, Lisa, Kind, Amy, James, Bryan, Al Hazzouri, Adina Zeki, Wharton, Whitney, Caramelli, Paulo, Szanton, Sarah, Whitmer, Rachel, Torres, Jada Benn, Deters, Kacie, Okonkwo, Ozioma, Das, Rina, Martinez‐Gonzalez, Karen, Carrillo, Maria

المصدر: Alzheimer's & Dementia. 20(4)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Biological Psychology, Clinical Sciences, Neurosciences, Psychology, Acquired Cognitive Impairment, Brain Disorders, Neurodegenerative, Alzheimer's Disease, American Indian or Alaska Native, Health Disparities, Social Determinants of Health, Prevention, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD), Minority Health, Dementia, Behavioral and Social Science, Aging, Neurological, Good Health and Well Being, Adult, Humans, Alaska Natives, Alzheimer Disease, Health Inequities, Healthcare Disparities, Risk Factors, Sexual and Gender Minorities, United States, White, disparities, diversity, LGBTQIA, racial/ethnic minorities, sexual and gender minorities, LGBTQIA plus, LGBTQIA+, Geriatrics, Clinical sciences, Biological psychology

الوصف: Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well-resourced, non-Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowledge gap about Alzheimer's-related risk factors in those other groups. The Alzheimer's Association hosted a virtual conference on June 14-16, 2021, supported in part by the National Institute on Aging (R13 AG072859-01), focused on health disparities. The conference was held entirely online and consisted of 2 days of core programming and a day of focused meetings centered on American Indian and Alaska Natives and on LGBTQIA+ populations. Over 1300 registrants attended discussions focused on the structural and systemic inequities experienced across diverse groups, as well as ways to investigate and address these inequities.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/809361n8
https://escholarship.org/content/qt809361n8/qt809361n8.pdf

المؤلفون: Hariri, Lida, Hogaboam, Cory, Jenkins, R, Kaminski, Naftali, Kim, Grace, Königshoff, Melanie, Kolb, Martin, Kotton, Darrell, Kropski, Jonathan, Lasky, Joseph, Magin, Chelsea, Maher, Toby, McCormick, Mark, Moore, Bethany, Nickerson-Nutter, Cheryl, Oldham, Justin, Podolanczuk, Anna, Raghu, Ganesh, Rosas, Ivan, Rowe, Steven, Schmidt, William, Schwartz, David, Shore, Jessica, Spino, Cathie, Craig, J, Martinez, Fernando, Montesi, Sydney, Gomez, Christian, Beers, Michael, Brown, Robert, Chattopadhyay, Ishanu, Flaherty, Kevin, Garcia, Christine, Gomperts, Brigitte

المصدر: American Journal of Respiratory and Critical Care Medicine. 209(4)

مصطلحات موضوعية: interstitial lung disease, pulmonary fibrosis, United States, Humans, National Heart, Lung, and Blood Institute (U.S.), Lakes, Idiopathic Pulmonary Fibrosis, Risk Factors, Biomedical Research

الوصف: Despite progress in elucidation of disease mechanisms, identification of risk factors, biomarker discovery, and the approval of two medications to slow lung function decline in idiopathic pulmonary fibrosis and one medication to slow lung function decline in progressive pulmonary fibrosis, pulmonary fibrosis remains a disease with a high morbidity and mortality. In recognition of the need to catalyze ongoing advances and collaboration in the field of pulmonary fibrosis, the NHLBI, the Three Lakes Foundation, and the Pulmonary Fibrosis Foundation hosted the Pulmonary Fibrosis Stakeholder Summit on November 8-9, 2022. This workshop was held virtually and was organized into three topic areas: 1) novel models and research tools to better study pulmonary fibrosis and uncover new therapies, 2) early disease risk factors and methods to improve diagnosis, and 3) innovative approaches toward clinical trial design for pulmonary fibrosis. In this workshop report, we summarize the content of the presentations and discussions, enumerating research opportunities for advancing our understanding of the pathogenesis, treatment, and outcomes of pulmonary fibrosis.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/5092667m

المؤلفون: Lewey, Jennifer, Beckie, Theresa M, Brown, Haywood L, Brown, Susan D, Garovic, Vesna D, Khan, Sadiya S, Miller, Eliza C, Sharma, Garima, Mehta, Laxmi S, Care, Perioperative and Resuscitation and Council on Cardiovascular and Stroke Nursing on behalf of the American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology Council on Cardiopulmonary Critical

المصدر: Circulation. 149(7)

مصطلحات موضوعية: Reproductive Medicine, Biomedical and Clinical Sciences, Health Sciences, Heart Disease, Clinical Research, Maternal Health, Cardiovascular, Maternal Morbidity and Mortality, Pregnancy, Hypertension, Women's Health, Clinical Trials and Supportive Activities, Prevention, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Reproductive health and childbirth, Good Health and Well Being, Female, United States, Humans, Cardiovascular Diseases, American Heart Association, Postpartum Period, Pregnancy Outcome, Blood Pressure, Risk Factors, AHA Scientific Statements, cardiovascular diseases, diabetes, gestational, postpartum period, pregnancy, pregnancy complications, primary prevention, American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, and Council on Cardiovascular and Stroke Nursing, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences, Sports science and exercise

الوصف: Adverse pregnancy outcomes are common among pregnant individuals and are associated with long-term risk of cardiovascular disease. Individuals with adverse pregnancy outcomes also have an increased incidence of cardiovascular disease risk factors after delivery. Despite this, evidence-based approaches to managing these patients after pregnancy to reduce cardiovascular disease risk are lacking. In this scientific statement, we review the current evidence on interpregnancy and postpartum preventive strategies, blood pressure management, and lifestyle interventions for optimizing cardiovascular disease using the American Heart Association Life's Essential 8 framework. Clinical, health system, and community-level interventions can be used to engage postpartum individuals and to reach populations who experience the highest burden of adverse pregnancy outcomes and cardiovascular disease. Future trials are needed to improve screening of subclinical cardiovascular disease in individuals with a history of adverse pregnancy outcomes, before the onset of symptomatic disease. Interventions in the fourth trimester, defined as the 12 weeks after delivery, have great potential to improve cardiovascular health across the life course.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/2575k3t1
https://escholarship.org/content/qt2575k3t1/qt2575k3t1.pdf

المؤلفون: Miao, Guanhong, Pechlaner, Raimund, Malloy, Kimberly, Zhang, Ying, Umans, Jason, Mayr, Manuel, Willeit, Johann, Kiechl, Stefan, Zhao, Jinying, Fiehn, Oliver

المصدر: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. 13(3)

مصطلحات موضوعية: American Indian, Strong Heart Study, cardiovascular disease, coronary heart disease, longitudinal lipidomics, Humans, American Indian or Alaska Native, Coronary Disease, Dyslipidemias, Lipidomics, Phosphatidylcholines, Risk Factors, Triglycerides, United States

الوصف: BACKGROUND: Dyslipidemia is an independent risk factor for coronary heart disease (CHD). Standard lipid panel cannot capture the complexity of the blood lipidome (ie, all molecular lipids in the blood). To date, very few large-scale epidemiological studies have assessed the full spectrum of the blood lipidome on risk of CHD, especially in a longitudinal setting. METHODS AND RESULTS: Using an untargeted liquid chromatography-mass spectrometry, we repeatedly measured 1542 lipid species from 1835 unique American Indian participants who attended 2 clinical visits (≈5.5 years apart) and followed up to 17.8 years in the Strong Heart Family Study (SHFS). We first identified baseline lipid species associated with risk of CHD, followed by replication in a European population. The model adjusted for age, sex, body mass index, smoking, hypertension, diabetes, low-density lipoprotein cholesterol, estimated glomerular filtration rate, education, and physical activity at baseline. We then examined the longitudinal association between changes in lipid species and changes in cardiovascular risk factors during follow-up. Multiple testing was controlled by the false discovery rate. We found that baseline levels of multiple lipid species (eg, phosphatidylcholines, phosphatidylethanolamines, and ceramides) were associated with the risk of CHD and improved the prediction accuracy over conventional risk factors in American Indian people. Some identified lipids in American Indian people were replicated in European people. Longitudinal changes in multiple lipid species (eg, acylcarnitines, phosphatidylcholines, and triacylglycerols) were associated with changes in cardiovascular risk factors. CONCLUSIONS: Baseline plasma lipids and their longitudinal changes over time are associated with risk of CHD. These findings provide novel insights into the role of dyslipidemia in CHD.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/9n01m4pp

المؤلفون: Haas, Cameron, Engels, Eric, Clarke, Megan, Kreimer, Aimée, Luo, Qianlai, Pfeiffer, Ruth, Qiao, Baozhen, Pawlish, Karen, Monterosso, Analise, Shiels, Meredith, Palefsky, Joel

المصدر: Journal of the National Cancer Institute. 116(1)

مصطلحات موضوعية: Male, Female, Humans, United States, HIV Infections, Acquired Immunodeficiency Syndrome, Risk Factors, Anal Canal, Carcinoma in Situ, Anus Neoplasms, Carcinoma, Squamous Cell, Papillomavirus Infections

الوصف: BACKGROUND: Anal intraepithelial neoplasia grade III is a precursor to squamous cell carcinoma of the anus for which rates are nearly 20-fold higher in people with HIV than in the general population in the United States. We describe trends in anal intraepithelial neoplasia grade III diagnosis and risk of squamous cell carcinoma of the anus following anal intraepithelial neoplasia grade III by HIV status and sex. METHODS: We used data from a population-based linkage between cancer and HIV registries in 11 US states; Puerto Rico; and Washington, DC, during 1996-2019. We identified all individuals with a diagnosis of anal intraepithelial neoplasia grade III and determined their HIV status. We estimated the average annual percentage change of anal intraepithelial neoplasia grade III using Poisson regression stratified by HIV status and sex. We estimated the 5-year cumulative incidence of squamous cell carcinoma of the anus following an anal intraepithelial neoplasia grade III diagnosis stratified by sex, HIV status, and prior AIDS diagnosis. RESULTS: Among people with HIV, average annual percentage changes for anal intraepithelial neoplasia grade III were 15% (95% confidence interval [CI] = 12% to 17%) per year among females and 12% (95% CI = 11% to 14%) among males. Average annual percentage changes for those without HIV were 8% (95% CI = 7% to 8%) for females and 8% (95% CI = 6% to 9%) for males. Among people with HIV, a prior AIDS diagnosis was associated with a 2.7-fold (95% CI = 2.23 to 3.40) and 1.9-fold (95% CI = 1.72 to 2.02) increased risk of anal intraepithelial neoplasia grade III diagnosis for females and males, respectively. Five-year cumulative incidence of squamous cell carcinoma of the anus following anal intraepithelial neoplasia grade III for people with HIV with a prior AIDS diagnosis were 3.4% and 3.7% for females and males, respectively. CONCLUSIONS: Rates of anal intraepithelial neoplasia grade III diagnoses have increased since 1996, particularly for people with HIV, likely influenced by increased screening. A prior AIDS diagnosis was strongly associated with risk of anal intraepithelial neoplasia grade III diagnosis.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/3c7352z7

المؤلفون: Joglar, José, Chung, Mina, Armbruster, Anastasia, Benjamin, Emelia, Chyou, Janice, Cronin, Edmond, Deswal, Anita, Eckhardt, Lee, Goldberger, Zachary, Gopinathannair, Rakesh, Gorenek, Bulent, Hess, Paul, Hlatky, Mark, Hogan, Gail, Ibeh, Chinwe, Indik, Julia, Kido, Kazuhiko, Kusumoto, Fred, Link, Mark, Linta, Kathleen, McCarthy, Patrick, Patel, Nimesh, Patton, Kristen, Perez, Marco, Piccini, Jonathan, Russo, Andrea, Sanders, Prashanthan, Streur, Megan, Thomas, Kevin, Times, Sabrina, Tisdale, James, Valente, Anne, Van Wagoner, David, Marcus, Gregory

المصدر: Journal of the American College of Cardiology. 83(1)

مصطلحات موضوعية: ACC/AHA Clinical Practice Guidelines, acute coronary syndrome, alcohol, anticoagulants, anticoagulation agents, antiplatelet agents, apixaban, atrial fibrillation, atrial flutter, cardioversion, catheter ablation, coronary artery disease, coronary heart disease, dabigatran, edoxaban, exercise, heart failure, hypertension, idarucizumab, left atrial appendage occlusion, myocardial infarction, obesity, percutaneous coronary intervention, pulmonary vein isolation, risk factors, rivaroxaban, sleep apnea, stents, stroke, surgical ablation, thromboembolism, warfarin, Humans, United States, Atrial Fibrillation, American Heart Association, Cardiology, Thromboembolism, Risk Factors

الوصف: AIM: The 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS: A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE: Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation and the 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/1td7c9g3
https://escholarship.org/content/qt1td7c9g3/qt1td7c9g3.pdf

المؤلفون: Silver, Diana, Bae, Jin, Macinko, James

المصدر: PLoS ONE. 19(3)

مصطلحات موضوعية: United States, Humans, Wounds, Gunshot, Firearms, Suicide, Homicide, Risk Factors

الوصف: Firearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.

وصف الملف: application/pdf

URL الوصول: https://escholarship.org/uc/item/0hf6x7jq