bluuebunny/crossref_metadata_2025 huggingface dataset:
INFRASTRUCTURE, RESOURCES, SERVICES EVALUATION AND GAP ANALYSIS OF INTEGRATED MATERNAL AND CHILD DEVELOPMENT SERVICES IN INDIA
Authors: Kaur S. , Gupta R. , Khan I. D. , Jindal S. , Prajapati S. , Makkar A. , Rajmohan K. S.
Published: March 2019

Background. Integrated Child Development Services (ICDS) is an Indian community-centric government program organized under Anganwadi centres catering to supplementary nutrition, health and preschool education, primary healthcare, growth monitoring and counselling the children under six years old along with their mothers. It is the world’s largest outreach program in a developing country covering a population of 1.35 billion; the variations in service delivery were analysed involving cross-sectional rural and urban Anganwadi centers in New Delhi.
Methods. Data were collected by assessment of children and mothers, interview of Anganwadi workers and observation of service delivery parameters and conduction of activities. Infrastructural, beneficiaries, services and content were evaluated by a suitable pre-tested questionnaire based on the National Institute of Public Cooperation and Child Development (NIPCCD) evaluation proforma. The data was analysed by a descriptive statistics.
Results. Gaps were found in respect of infrastructure, resources, health and nutrition facilities especially at rural Anganwadi centre which was inadequate in terms of implementation of nutrition and health program, supplementary nutrition, preschool education and nutrition rehabilitation centre for existing beneficiaries. Both Anganwadi centres were not catering for new WHO growth standards and adolescent health.
Conclusions. Gaps found in respect of infrastructure, resources, health and nutrition facilities can affect performance of ICDS program and the services delivered by Anganwadi centres, which need a boost. Both urban and rural centres have a direct opportunity towards delivering adolescent health program focusing on nutrition and education of girls prior to their pregnancy, and adoption of new WHO growth standards.
PREVALENCE OF GESTATIONAL DIABETES MELLITUS IN AN URBAN INDIAN COHORT USING DIABETES IN PREGNANCY STUDY GROUP IN INDIA (DIPSI) CRITERIA – VALIDATING ONE-STEP APPROACH
Authors: Khan S. , Bal H. , Khan I. D. , Paul D.
Published: March 2019

Background. India is the “World’s Diabetes capital”, with half the diabetic population being women. Early detection of glucose intolerance during pregnancy offers a timely opportunity for screening, management and prevention of gestational diabetes mellitus (GDM) and prevents fetal complications.
Objective. The study assessed the prevalence of GDM in an Indian cohort using the Diabetes in Pregnancy Study group of India (DIPSI) criteria.
Methods. 200 pregnant women underwent two-phase testing with non-fasting 75-gram glucose challenge under Diabetes in Pregnancy Study group of India (DIPSI) criteria at <20 weeks and between 24-28 weeks period of gestation. A 3-hour 100-gm oral glucose tolerance test (OGTT) was used for confirmation. Repeat testing was done for women negative during the first-phase.
Results. Mean age was 24.26±3.75 years with 52.5% multigravidas. Mean Body Mass Index (BMI) was 20.7±3.07 kg/m2. The prevalence of GDM in study cohort was found to be 15.5% using the DIPSI criteria while the prevalence of GDM after 100 g OGTT was 13.0%. GDM was mostly seen to occur in women of 26-30-year age group. Statistically significant associations for age and GDM, and BMI and GDM were evidenced.
Conclusions. Maternal age of ≥25 years should be adopted as a risk factor for the development of GDM. The DIPSI criteria offer a cost-effective and an evidence-based protocol for a single-step definitive glucose test for both screening and diagnosis of pregnant patients belonging to any socio-economic strata; furthering its implementation for public health obstetrics.
OBESITY: A CAUSATIVE RISK FACTOR OF BREAST CANCER
Authors: Roy A. S. , Basu S. , Bandyopadhyay A.
Published: March 2019

Background. Obesity, a global health burden and one of the most deleterious diseases have substantially increased prevalence attributable to changing lifestyle of modern times. Persuasive evidence indicates obesity as an independent prognostic factor for developing malignancy in the form of breast cancer particularly in post-menopausal women.

Objective. This review aims to focus in comprehensive manner on the biochemical, hormonal and immunological pathways governing the obesity linked breast cancer so that potential treatments may be improvised consequently to provide a cure to this menace, threatening the lives of many.

Methods. Literature review of published materials that provide examination of recent or current literature on problem of obesity.

Results. Increased body fatness, mainly visceral adiposity may account for predisposing an obese individual to the risk of encountering cancer although the mechanisms for such cancers may vary depending upon the organ affected. Metabolic and biochemical alterations influencing obesity related carcinogenesis, consisting of heightened oxidative stress and bodily inflammation levels with the concomitant rise in pro-inflammatory cytokines are discussed. Pertinent references about elevated levels of serum insulin, insulin-like growth factor, sex steroids and the imbalance in adipokines (adiponectin and leptin) are included as well.

Conclusions. Persuasive evidence indicates obesity as an independent prognostic factor for developing malignancy in the form of breast cancer particularly in post-menopausal women. Generation of novel and effective therapeutic interventions for combating the ailment along with positive lifestyle modifications may be improvised consequently to provide a cure to this menace, threatening the lives of many.
DYNAMICS OF PERIODONTAL TISSUES MICROBIOCENOSIS UNDER THE COMPLEX TREATMENT OF CATARRHAL GINGIVITIS AND CHRONIC GASTRODUODENITIS IN THE ADOLESCENTS
Authors: Lisetska I. S. , Rozhko M. M. , Kutsyk R. V.
Published: March 2019

Background. The key links in the etiology and pathogenesis of periodontal tissue diseases are the quantitative and qualitative changes in the composition of the microflora of oral cavity, with the simultaneous deterioration of oral hygiene, reduction of local and general immunity, which occurs more often in the presence of somatic diseases.

Objective. The aim of the research was to determine the clinical and microbiological efficacy of the developed treatment-prophylactic complex in the adolescents with catarrhal gingivitis and chronic gastroduodenitis before and after treatment.

Methods. Changes were made to and before the treatment of clinical parameters, gingival microbiocenosis of 38 adolescents with generalized catarrhal gingivitis and chronic gastroduodenitis aged 12-18 years old, who comprised the main group. In the comparison group 25 adolescents of similar age diagnosed with generalized catarrhal gingivitis without any somatic diseases were involved.

Results. It has been established that used combination (drug of plant origin with antimicrobial properties + dental gel with Metronidazole benzoate and Chlorhexidine digluconate + capsules of probiotics) yields the conventional treatment as well as exceeds it for examined clinical indicators and indexes. The treatment and prophylaxis with suggested complex have proved a significant positive effect on the gums microbiocenosis in adolescents with generalized catarrhal gingivitis and underlying concomitant gastroduodenitis.

Conclusions. The suggested therapeutic and prophylactic complex provides a reduction in the massiveness and colonization frequency of the gum mucosa by pathogenic aerobic microflora (β-hemolytic streptococcus, golden staphylococcus, and yeast-like Candida fungi).
RECONSTRUCTIVE SURGERY OF SEVERE DAMAGES OF LOWER EXTREMITIES INTEGUMENT AFTER INJURY
Authors: Ponomarenko O. V.
Published: March 2019

Background. Injury of lower extremities requires the fastest and most effective method of closing wound surfaces.

Objective. The aim of the study was to define the indications and improve the reconstructive interventions for severe damage of lower extremities integument due to mechanical trauma.

Methods. During 2008-2016, 242 patients with defects of cover tissues of the body and extremities were operated in the clinic. Depending on the size, depth and degree of tissues damage, all were divided into 4 groups.

Results. The lower extremity was the most vulnerable segment (75.2% of patients). Damage Control tactics was used in 83% of cases. To protect the functionally tense areas, free plastics by a split skin graft (the 1st group – 12.8%, the 2nd – 20.4%, the 3rd – 37%, the 4th – 8.9%) were used for closure of the defect. If the wound defect affected functionally significant structures up to 1% of the body surface, the complex flaps of local tissues, tissues close to the defect and anatomically distant areas (the 2nd group – 6%, the 3rd – 10.6%, the 4th – 4.3%) were used. If the defect was more than 1% of the body surface only functionally tense areas were closed with compound complexes of tissues. The rest of the skin was restored by means of autodermoplastics. We suggested and approved our specific protocol of treatment of such injury.

Conclusions. Implementation of the suggested protocol of reconstructive interventions for closure of the defects of cover tissues of lower limbs allowed attaining a positive result in 98.8% of the interventions.
MELPHALAN-INDUCED CYTOTOXICITY IN THE BONE MARROW OF RATS BY FLOW CYTOMETRY MEASUREMENTS
Authors: Gerashchenko B I. , Todor I. M. , Shevchuk O. O. , Nikolaev V. G.
Published: March 2019

Background. Bone marrow (BM) that contains hematopoietic cells of various lineages is a sensitive target for a number of cytotoxic agents including chemotherapy drugs.

Objective. Flow cytometry (FCM) was chosen to test cytotoxicity in BM of rats, that received melphalan either intravenously (i.v.) or intraperitoneally (i.p.).

Methods. One group of rats received melphalan i.v. (3 mg/kg) followed by the BM examination on the 3rd and 7th day after drug administration, whereas another group of animals received this drug i.p. in total doses of 9 and 15 mg/kg followed by the BM examination on the next day after the 3rd and 5th injection of the drug. BM cells were stained with acridine orange and analyzed by FCM. Cytotoxicity was assessed by determining the percentage of total nucleated cells (TNC%) among the whole BM cell population and by determining the percentage of polychromatic erythrocytes (PCE%) among the whole population of enucleated erythrocytes.

Results. Regardless of the dose and regimen of melphalan administration, either i.v. or i.p. administered drug caused a significant reduction of TNC%. On the average, the i.p. administered drug resulted in about 2.0-fold decrease of TNC% (P<0.05), while the i.v. administered drug resulted in about 1.3-fold decrease of TNC% (P<0.05). As for enucleated erythrocytes, the i.p. administered drug resulted in about 1.4-fold decrease of PCE% (P<0.05), whereas the i.v. administered drug did not cause any changes in the PCE%.

Conclusions. Under these experimental conditions, i.p. administrated melphalan is considerably more cytotoxic than i.v. administered melphalan. This cytotoxic effect is preferentially due to impaired erythropoiesis.
Perda da graduação dos militares das forças auxiliares a partir de 1988
Authors: Silva Douglas Pereira da
Published: March 2019

Este trabalho visa explorar a perda da graduação dos militares de baixa hierarquia, denominado Praças, a partir da Constituição Federal de 1988, com o enigmático artigo 125, § 4°, que tanta turbulência trouxe ao mundo jurídico. O trabalho tem como ponto partida o artigo de Álvaro Lazzarini, denominado a Vitaliciedade de Servidores Militares Estaduais, publicada na Revista de Direito Administrativo, Rio de Janeiro n. 205, em 1996. O estudo analisa desde as primeiras decisões judiciais até às atuais, com jurisprudências do Supremo Tribunal Federal, Tribunais de Justiças Militares Estaduais e Tribunais de Justiças Estaduais e Tribunal do Distrito Federal, procurando oferecer um panorama da situação em todo território nacional. Ao final é dado enfoque à modificação radical do entendimento do Supremo Tribunal Federal. O trabalho possui grande interesse prático, devido ao grande número de Praças das Forças Auxiliares existentes no Brasil.
Ações afirmativas para mulheres no Brasil e nos Estados Unidos
Authors: Dantas Ana Cecília De Morais e Silva
Published: March 2019

O estudo compara o desenvolvimento de políticas de ações afirmativas para mulheres no Brasil e nos Estados Unidos. Para delimitar seu escopo, trabalha com três exemplos de cada um dos países, buscando interrelacioná-los. Principia situando juridicamente as ações afirmativas como decorrência de uma noção de igualdade em transformação, abordando o contexto de seu surgimento. Em seguida diferencia os sistemas de justiça dos Estados Unidos e do Brasil para então comparar as medidas adotadas por um e outro país.
O necessário controle de concentração de “teaming arrangements” no Brasil
Authors: Barbosa Allan Fuezi
Published: March 2019

Teaming arrangements correspondem aos agrupamentos entre concorrentes com vistas à participação em licitações. Na legislação brasileira anterior, a figura era analisada pelo CADE como um ato de concentração, sendo necessária a aprovação pela entidade para a regularidade do contrato público. Atualmente, a Lei n. 12.529/2011 prevê expressamente que tal modalidade de acordo não representa um ato de concentração, mas isso não significa uma imunidade antitruste quanto às condutas. Assim, diante dos riscos atrelados à reunião de concorrentes sem uma análise antitruste, propõe-se o reenquadramento normativo para que haja a apreciação estrutural desse ato antes da contratualização com o Poder Público.
Abstract 003: Metabolome-Wide Association Study With Habitual Physical Activity Among 4119 U.S. Participants
Authors: Ding Ming , Lasky-Su Jessica , Rexrode Kathryn , Lee I-min , Clish Clary , Eliassen A Heather , Willett Walter , Hu Frank , Kraft Peter
Published: March 2019

Background:
Being physically active has been associated with lower risks of cardiometabolic diseases. However, the biological mechanisms underlying these associations remain unclear, and can be investigated using a metabolomics approach.

Objective:
To identify plasma metabolites associated with habitual physical activity in a U.S. population.

Methods:
Our study population included 4119 participants in the Nurses’ Health Study (NHS), NHS II, and Health Professionals Follow-up Study (HPFS). Physical activity was assessed periodically by self-reported questionnaire starting from 1984 in NHS, 1989 in NHSII, and 1986 in HPFS. We used physical activity measured closest before blood collection as exposure. Metabolic profiling was conducted by liquid chromatography-mass spectrometry (LC-MS). Our study included 287 known metabolites, with 64% of them classified as lipids (58 triglycerides [TAGs], 13 diglycerides [DAGs], 13 cholesteryl esters [CEs], 6 lysophosphatidylethanolamines [LPEs], 37 phosphocholines [PCs], 10 lysophosphatidylcholines [LPCs], 24 phosphatidylethanolamines [PEs], and 25 carnitines). We examined associations of physical activity with plasma metabolites using linear regression, and corrected for multiple testing using tail probability of the proportion of false positives (TPPFP) and accounting for correlated tests using bootstrapping.

Results:
Using linear model adjusting for age, case-control status, labcode, smoking status, fasting status, alcohol intake, and diet quality, physical activity was significantly associated with 27 metabolites after correcting for multiple testing (TPPFP <0.05). Among the 27 identified metabolites, four CEs, eight PCs, and three LPCs were positively associated with physical activity, and five TAGs and four DAGs were inversely associated. After additionally adjusting for body mass index (BMI), the associations of physical activity with the majority of identified metabolites were attenuated; physical activity remained positively associated with three CEs (C18:2, C16:0, and C18:1), three PCs (C36:4 PC-A, C36:0 PC, C34:3 PC plasmalogen), and one LPC (C18:2). Enrichment analysis showed that physical activity was significantly positively associated with the CE category (P value for enrichment=0.048).

Conclusions:
We identified seven metabolites that were significantly associated with physical activity after adjusting for BMI, which may help identify biomarkers of physical activity and provide insight into biological mechanisms underlying the beneficial effect of being physically active on cardiometabolic health.
Abstract 005: Childhood Risk Factors and Cardiovascular Disease Outcomes in Adulthood. Preliminary Findings From the International Childhood Cardiovascular Cohort (i3C) Consortium
Authors: Raitakari Olli , Jacobs David R , Woo Jessica , Urbina Elaine M , Bazzano Lydia , Juonala Markus , Viikari Jorma , Chen Wei , Prineas Ronald , Steinberger Julia , Daniels Stephen , Sinaiko Alan , Venn Alison , Burns Trudy L , Hu Tian , Dwyer Terence
Published: March 2019

Background:
Atherosclerosis develops silently for decades before clinical cardiovascular disease (cCVD) occurs. Longitudinally, childhood risk factors predict adult pre-clinical atherosclerosis (carotid artery plaques, coronary artery calcification). There is currently no evidence directly linking childhood risk factors to cCVD.

Methods:
Using data from the i3C Consortium, consisting of five cohorts from the United States, one from Australia and one from Finland, we linked youth risk factors to adult cCVD. cCVD events were ascertained by re-contacting the participants in the US and Australia, then obtaining and medically adjudicating hospital records; and using the Finnish national health registry. Of 16,964 of these adult participants (mean age 49 years, range 24-67 years) who had been examined during ages 3-19 years, 201 people with any cCVD event (coronary artery, cerebrovascular, and peripheral artery disease, 70%, 25%, and 5% of events, respectively) have so far been ascertained. Analysis of deaths is in process. The associations between each youth risk variable and adult cCVD were examined in Cox proportional hazard models. Each model was additionally adjusted for childhood age, age at followup, sex and cohort/race. Continuous youth variables were z-scored for each participant’s last repeated measure during childhood.

Results:
Youth body mass index (BMI), serum total cholesterol (TC) and triglycerides, and systolic blood pressure were (all P <0.0001) positively associated with adult cCVD events. Regular smoking in youth was associated with a nearly 50% increased risk of adult cCVD (P=0.08). BMI and TC remained significant in the simultaneous risk factor model. The adjudication pipeline suggests that over 500 hospitalized cCVD events will be found when adjudication is complete. Regression using the full set of imputed events yielded similar findings.

Conclusion:
These international data find that exposure to CVD risk factors in youth predicts adult cCVD with implications for primordial CVD prevention.
Abstract 008: Poor Lower Extremity Physical Function Increases Risk for Cardiovascular Disease Events in Older Women: The OPACH Study
Authors: Bellettiere John , LaMonte Michael J , Unkart Jonathan , Kooperberg Charles , Stefanick Marcia L , Di Chongzhi , LaCroix Andrea Z
Published: March 2019

Background:
Good lower extremity physical functioning is paramount to healthy aging as it prevents social isolation, enables civic engagement, and facilitates physical activity. Strong evidence links physical functioning with all-cause mortality, but little is known about its relationship to cardiovascular disease (CVD).

Methods:
Women (n=5043, mean age=79±7) with no history of myocardial infarction or stroke completed the Short Physical Performance Battery (SPPB) consisting of three timed tasks to assess standing balance, strength (5 chair stands), and gait (4m walk). Results were summarized using prespecified cutpoints yielding a score from 0 (worst) to 12 (best). Women were followed for CVD events for up to 6 years. Hazard ratios (HR) were estimated for women with poor, low, moderate, and high functioning (respective SPPB ranges for each group; 0-3, 4-6, 7-9, and 10-12) using Cox proportional hazard models adjusted for several covariates including accelerometer-measured moderate to vigorous physical activity (MVPA) and sedentary behavior. Effect modification of associations between SPPB and CVD by age, MVPA, Reynolds Risk Score, race-ethnicity, and self-rated health were tested by including multiplicative interaction terms in fully adjusted Cox models with statistical significance for interactions set to 0.10.

Results:
Covariate-adjusted HRs (95% CIs) for CVD [
1.00
(ref.);
0.85
(0.62, 1.15);
0.69
(0.51, 0.93);
0.49
(0.35, 0.68)] and CVD mortality [
1.00
(ref.);
0.72
(0.45, 1.15);
0.44
(0.27, 0.72);
0.35
(0.19, 0.62)] decreased across poor, low, moderate, and high SPPB subgroups, respectively (p-trend<.001
Abstract 034: Omega-3 Fatty Acid Biomarkers and Incident Type 2 Diabetes: An Individual Participant-level Pooling Project of 20 Prospective Cohort Studies
Authors: Qian Frank , Ardisson Korat Andres V , Imamura Fumiaki , Marklund Matti , Tintle Nathan , Virtanen Jyrki K , Zhou Xia , Bassett Julie K , Lai Heidi , Hirakawa Yoichiro , Chien Kuo-Liong , Frazier-Wood Alexis C , Lankinen Maria , Murphy Rachel A , Samieri Cecilia , Geleijnse Johanna M , de Mello Vanessa , Forouhi Nita G ,   InterAct Consortium, Wu Jason H , Lemaitre Rozenn N , Micha Renata , Mozaffarian Dariush , Sun Qi
Published: March 2019

Background:
Effects of omega-3 fatty acids on the prevention of type 2 diabetes (T2D) are unclear. Relatively few prospective studies have utilized objective omega-3 biomarkers to assess risk.

Aims:
To assess the prospective relationship between circulating and tissue levels of alpha linoleic acid (ALA), eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA), and docosahexaenoic acid (DHA), with respect to risk of T2D.

Methods:
A global consortium of 20 prospective cohort studies from 14 nations with assessments of ALA, EPA, DPA, or DHA in adults (age > 18 years) were identified through July 2017 and included in this investigation. A pre-specified analytic protocol, including definitions for exposures, covariate list, disease outcome definitions, and subgroup analyses was developed and followed in new participant-level cohort analysis. Associations were pooled using inverse variance-weighted meta-analysis.

Results:
Among 65,147 participants, 16,693 incident cases of T2D occurred during follow-up (median follow-up in the cohorts ranged from 2.5 to 21.2 years). In pooled multivariate analysis, per interquintile range (difference between the midpoints of the first and fifth quintile for each fatty acid), EPA, DPA, DHA, and their sum (
Figure 1
) were associated with 8%, 21%, 18%, and 19% lower risk of T2D, respectively (all
P
<0.001). Higher levels of ALA were not significantly associated with T2D. Associations were consistent across different lipid compartments and pre-specified subgroups, including by age, sex, and geographic region, as well as in several sensitivity analyses.

Conclusion:
Higher circulating and tissue biomarkers of seafood-derived omega-3 fatty acids, EPA, DPA, and DHA, were associated with lower risk of T2D in a global consortium of prospective studies. Plant-derived ALA was not significantly associated with risk.
Abstract 046: Longitudinal Associations of Omega-6 and Omega-3 Plasma Phospholipid Polyunsaturated Fatty Acids With Dementia in Older Adults: the Cardiovascular Health Study
Authors: de Oliveira Otto Marcia C , Wu Jason H , Thacker Evan L , Lai Heidi , Lemaitre Rozenn N , McKnight Barbara , Padhye Nikhil , Song Xiaoling , King Irena B , Lopez Oscar , Siscovick David , Mozaffarian Dariush
Published: March 2019

Background:
Polyunsaturated fatty acids (PUFA) are essential nutrients for normal brain function, constituting nearly 35% of brain lipids. Experimental studies suggest that omega-3 and omega-6 PUFA, present in plant foods and fish, may reduce risk of dementia. Most prior studies assessed self-reported estimates and used one baseline measure of objective PUFA biomarkers, which may lead to poor estimation of long-term risk.

Aims:
Investigate prospective associations of serial measures of plasma phospholipid omega-3 (ALA [18:3], EPA [20:5], DPA [22:5], DHA [22:6]) and omega-6 (LA [18:2], AA [20:4]) PUFA with risk of total dementia and dementia subtypes (Alzheimer’s Disease [AD] and vascular and mixed dementia [VaD]) in older adults in the Cardiovascular Health Study.

Methods:
Among 3,307 U.S. adults aged ≥65y and free of stroke, cognitive impairment or dementia at baseline, circulating levels were measured serially at baseline, 6 years and 13 years using standardized methods. Dementia was identified using neuropsychological tests or hospitalization records adjudicated by CHS Cognition Study investigators, and by ICD-9 codes from linked Medicare administrative data. Prospective associations were assessed by multivariate-adjusted Cox models incorporating time-varying fatty acid measures and covariates.

Results:
During 22,288 person-years of follow-up (1992-2015), 1,164 dementia cases were identified, with 530 AD and 256 VaD cases. After adjustment for demographic, lifestyle and dietary factors, higher circulating levels of AA were associated with lower risk of total dementia and AD (see Table). There were no statistically significant associations between circulating omega-3 PUFA or LA and incident dementia.

Conclusion:
In older adults, higher circulating AA was inversely associated with risk of total dementia and AD, but not other dementia subtypes. These findings highlight the need to identify mechanisms influencing circulating AA levels that could be effective for the prevention of dementia later in life.
Abstract MP01: Cardiovascular Health Behavior and Health Factor Trends (1999-2014) and Projections to 2050: Results From the National Health and Nutrition Examination Surveys
Authors: Khan Sadiya S , Shah Nilay S , Ning Hongyan , Labarthe Darwin R , Huffman Mark D , Bundy Joshua D , O’Flaherty Martin , Capewell Simon , Lloyd-Jones Donald M
Published: March 2019

Introduction:
Cardiovascular disease (CVD) death rates have plateaued. Hence, strategic targets to achieve reduction in CVD death rates set by the American Heart Association (20% by 2020) and others are at risk. Public health initiatives are urgently needed to refocus prevention of CVD in terms of cardiovascular health (CVH) and reduce disparities in CVH. Therefore, we sought to describe US CVH trends from 1999-2014 and forecast to 2050.

Methods:
We included a representative sample of 39,835 cardiovascular disease-free, non-institutionalized US adults aged ≥20 years. We calculated population prevalence of ideal, intermediate, and poor health behaviors (smoking, diet, physical activity, and body mass index) and health factors (glucose, cholesterol, and blood pressure) and individual-level composite CVH score including all 7 metrics (0-14 points) by sex, race/ethnicity, and education level as a proxy for socioeconomic status. We created forecasts to 2030 and 2050 assuming that observed trends might continue in a linear fashion.

Results:
Improvements from 1999-2014 in population levels of ideal blood pressure (29 to 38%) and cholesterol (43 to 50%) have been offset by declines in prevalence of ideal body weight (33 to 25%) and glucose (61 to 48%) in men with similar patterns in women and across race and education. Mean CVH score is projected to decline in all adults (men [7.5→6.9], women [7.5→6.8], blacks [7.1→6.0], whites [7.6→6.8], high school education or less [7.1→6.3], and some college education or more [7.9→6.8]) from 2013-2014 to 2050.The
figure
shows population prevalence by education level of poor, intermediate, and ideal levels of CVH metrics in 2013-2014 and projected prevalence for 2030 and 2050.

Discussion:
Encouraging progress in cholesterol and blood pressure in recent decades has been negated by persistent disparities and declines in composite CVH. The sobering predictions for 2030 and beyond highlight an urgent need for more effective prevention policies for equitable achievement of ideal CVH.
Abstract MP12: The Risk of Adverse Outcomes Associated With Opioid Prescriptions in People With Chronic Kidney Disease
Authors: Novick Tessa K , Surapaneni Aditya , Ballew Shoshana , Shin Jung-Im , Alexander Caleb , Inker Lesley A , Chang Alex R , Grams Morgan E
Published: March 2019

Background:
Patients with chronic kidney disease have limited therapeutic options for pain control and commonly are prescribed opioids. However, many opioids and/or their metabolites are renally excreted, which may increase risk for adverse drug effects. The objective of this study was to assess the safety of prescription opioid use across the range of kidney function.

Methods:
We used electronic health data from adult primary care patients followed from 2011 to 2016 in the Geisinger Health System, a fully integrated tertiary care center in Pennsylvania. In a propensity-matched cohort, we used Cox proportional hazards regression to estimate the association between opioid prescription (defined as at least two opioid prescriptions between January 1, 2011 and December 31, 2012) and death, first hospitalization and non-pathologic fracture.

Results:
Among 105,328 patients in the study population (mean [SD] age 55.4 [15] years; 66.4% female; 0.1% black race), 20,600 individuals received at least two opioid prescriptions between 2011 and 2013. In the propensity-matched cohort, over a median follow-up of 4.1 years, at least two opioid prescriptions was not significantly associated with mortality (HR 1.19, 95% CI: 0.98 to 1.43), but was significantly associated with higher risk of hospitalization (HR 1.38, 95% CI: 1.26 to 1.50), and non-pathological fracture (HR 1.71, 95% CI: 1.50 to 1.94) (
Figure
). The risk of adverse outcomes associated with opiate prescription did not differ by level of estimated glomerular filtration rate.

Conclusions:
Opioid prescriptions were associated with increased risk for adverse events at all levels of kidney function.
Abstract MP16: Incremental Diagnostic Yield of 4 Weeks versus 2 Weeks of Ambulatory Heart Rhythm Monitoring for the Detection of Subclinical Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Rooney Mary R , Soliman Elsayed Z , Lutsey Pamela L , Norby Faye L , Loehr Laura R , Mosley Thomas , Zhang Michael , Gottesman Rebecca , Coresh Josef , Folsom Aaron R , Alonso Alvaro , Chen Lin Y
Published: March 2019

Introduction:
Subclinical atrial fibrillation (AF) has been associated with greater stroke risk; however, subclinical AF can be intermittent, and hence hard to detect. Little is known about the diagnostic yield of extending electrocardiogram (ECG) monitoring beyond 2 weeks on subclinical AF detection, particularly among individuals without a clinical indication.

Hypothesis:
Extending ECG monitoring from 2 weeks to 4 weeks will increase detection of AF

Methods:
We included ARIC study participants who attended visit 6 (2016-2017), without a history of AF, and who wore a leadless, ambulatory ECG monitor (Zio® XT Patch by iRhythm Technologies Inc.) twice, each time for up to a maximum of 2 weeks. AF history was based on ARIC ascertainment (hospitalization codes through 2016, ECGs at prior ARIC visits 1-5) or self-reported AF at visit 6. AF on the Zio® XT Patch was defined as an irregularly irregular rhythm with absent P-waves lasting ≥30 seconds.

Results:
We included 387 ARIC participants (mean ± SD aged 79 ± 4 years, 54% female, 11% non-white race). Mean recording time was 13.3 ± 1.7 days for the first Ziopatch, 13.1 ± 2.0 for the second patch, and 26.4 ± 2.9 for the combined 4 weeks. Based on ≤2 weeks of monitoring, the prevalence of subclinical AF was 2.6% (95% CI: 1.0-4.2%; n=10); this increased to 4.4% (95% CI: 2.4-6.4%; n=17) with ≤4 weeks of monitoring. Thus, the incremental diagnostic yield of 4 weeks versus 2 weeks of monitoring was 70% (95% CI: 41.6-98.4%). The mean time to first AF episode was 10.5 ± 8.0 days with a median of 13.4 days (IQR=2.0-19.7). Cumulative yield of AF detection over the monitoring time is shown in the
Figure
.

Conclusions:
Among elderly community-dwelling individuals, extending ECG monitoring from 2 weeks to 4 weeks increased detection of AF. These findings help inform the debate on ECG screening for subclinical AF; however, more research is needed to define the optimal duration of ECG monitoring time.
Abstract MP19: Socioeconomic Status and Incident Heart Failure Among Individuals with Diabetes, Obesity and Metabolic Syndrome: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Collison Amira O , Mathews Lena M , Kwak Lucia , Palta Priya , Matsushita Kunihiro , Carson April P , Crews Deidra C , Golden Sherita H , Vart Priya , Cooper Lisa A , Coresh Josef , Heiss Gerardo , Ndumele Chiadi E
Published: March 2019

Background:
Diabetes, obesity and metabolic syndrome (MS) are strong risk factors for incident heart failure (HF). Lower socioeconomic status (SES) is also linked to increased HF risk. Given the importance of lifestyle, self-management, and access to care in managing diabetes, MS and obesity, SES may confer greater risk among individuals with these conditions.

Hypothesis:
We hypothesized that lower SES is associated with greater risk for incident HF among individuals with diabetes, MS or obesity than among those without these conditions.

Methods:
We studied 12,938 ARIC participants (mean age: 53 years, 26% black, 56% female) from the baseline visit (1987-1989) without CVD and with BMI ≥18.5 kg/m
2
. Income, education, and area deprivation index were evaluated as single measures of SES and in a combined SES score (high, medium, low). We constructed Cox regression models to estimate hazard ratios (HRs) for HF associated with SES (through 12/31/16), stratified by diabetes, MS, and obesity status, separately, and with tests for interactions of SES with diabetes, MS or obesity.

Results:
There were 2,551 HF events over a median 27 years of follow-up. The lowest education level was more strongly associated with HF risk in the presence of diabetes (HR 3.17, 95% CI: 1.95-5.14), than in the absence of diabetes (HR 1.56, 95% CI: 1.31-1.86; p interaction <0.01)(Table). Significant interactions were also observed for diabetes and MS with most other SES measures, including the combined SES score. The combination of lowest education and diabetes was associated with an HR of 3.95 (3.21-4.87) for HF compared to the combination of highest education and no diabetes. There were no significant interactions between obesity and SES measures.

Conclusion:
Low SES is associated with elevated HF risk, particularly among individuals with diabetes and MS. There is urgent need to understand the underlying mechanisms for this association, which may inform tailored interventions to address the marked HF risk in those with both low SES and diabetes or MS.
Abstract MP34: Associations Muscle Quality, Muscle Strength, and Muscle Mass With All-Cause Mortality in Elderly Men and Women
Authors: Lee Chong-Do , Lee Samuel
Published: March 2019

Although muscle mass, muscle strength, and muscle quality are important risk factors for disability and mortality in elderly men and women, the associations of these variables with all-cause mortality remain less explored. PURPOSE: We investigated the associations of muscle quality, muscle strength, and muscle mass with all-cause mortality in elderly US men and women. We also compared the strength of these associations with all-cause mortality.

Methods:
Cox proportional hazards regression was used to examine the associations of muscle quality, muscle strength, and muscle mass with all-cause mortality. We followed 1,361 men and women, aged 60 to 85 years, who participated in the National Health and Nutrition Examination Survey 1999-2002. All participants completed baseline lifestyle factors, and muscle strength and muscle mass measurements. Body composition was estimated by Dual-energy X-ray absorptiometry. Appendicular skeletal muscle mass (SMS) was computed by combining lean tissues in both arms and legs, and relative muscle mass was computed as SMS divided by height in meters squared (AMS). Leg muscle strength (MST) was estimated using the Kin Com MP dynamometer. Leg muscle quality (MQI) was computed as the peak force (Newton) divided by lean mass in the right leg. We further categorized AMS, MST, and MQI as sex-specific quartile categories. The significance of AMS, MST, and MQI with all-cause mortality was also tested by the Cox hazards models with the likelihood ratio statistics with and without adjustment for multiple risk factors.

Results:
During an average of 9.8 years of follow-up (9,4687 person-years), there were a total of 372 all-cause deaths (85 CVD, 202 chronic diseases). After adjustment for multiple risk factors, the risks of all-cause mortality across MQI quartile categories were (95% CI) 1.00 (Q1, referent), 0.72 (0.55, 0.95), 0.66 (0.49, 0.90), and 0.50 (0.31, 0.80) (P for trend <0.001). The risks of all-cause mortality across MST categories were (95% CI) 1.00 (Q1, referent), 0.85 (0.59, 1.21), 0.50 (0.33, 0.75), and 0.46 (0.31, 0.67) (P for trend <0.001). The risks of all-cause mortality across AMS categories were (95% CI) 1.00 (Q1, referent), 0.77 (0.56, 1.07), 0.75 (0.52, 1.10), and 0.65 (0.47, 0.90) (P for trend = 0.01). As a single measure, after adjustment for multiple risk factors, the hazards for all-cause mortality across MQI, MST, and AMS were 0.97 (p<0.001), 0.99 (p<0.001), and 0.84 (p = 0.001), respectively. When we included all these variables in the fully-adjusted model, only MQI (p = 0.03) was a strong risk factor for all-cause mortality, but not for MST (p = 0.84) and AMS (p = 0.05).

Conclusion:
Muscle quality was a strong risk factor for all-cause mortality in elderly men and women when compared with muscle strength or relative muscle mass. The American Heart Association should emphasize the importance of improving muscle quality in this geriatric population.
Abstract MP47: Diabetes, Prediabetes, and Short-Term Cardiovascular Risk and Death in Older Adults
Authors: Tang Olive , Matsushita Kunihiro , Coresh Josef , Sharrett A. Richey , McEvoy John W , Windham Beverly G , Ballantyne Christie M , Selvin Elizabeth
Published: March 2019

Background:
Studies in middle-age adults have established prediabetes and diabetes as major cardiovascular disease (CVD) risk factors. Whether these associations persist among older adults is less clear.

Methods:
Older adults in the Atherosclerosis Risk in Communities (ARIC) Study who attended visit 5 (2013-2015; n = 5,791; ages 66-90) were followed for recurrent global CVD events (fatal or non-fatal myocardial infarction, stroke, and heart failure) and all-cause mortality. We used Cox proportional hazards and negative binomial regression to quantify and compare the independent associations of prediabetes (hemoglobin A1c [A1c]: 5.7-6.3%) and diabetes (prior diagnosis, medication use, or A1c ≥ 6.4%), traditional CVD factors, subclinical CVD (assessed using high sensitivity cardiac troponin [hs-cTnT]), and short-term risk of clinical outcomes in this older population.

Results:
Over a median follow-up of 4.6 years, there were 5,442 global CVD events (32% with at least one event) and 660 deaths. Diabetes, but not prediabetes, was significantly associated with both outcomes (
Table
). After adjustment for traditional risk factors, diabetes of shorter duration was no longer significantly associated with global CVD; however, diabetes of longer duration, renal disease, and subclinical CVD remained significantly associated with both outcomes. Higher risks of global CVD events and mortality were observed in Blacks compared to Whites.

Conclusions:
Prediabetes and short-term diabetes were not major independent predictors of short-term CVD events or death in older adults, especially compared to hypertension, kidney disease, long-term diabetes, and subclinical and prevalent CVD. Our results support focusing on these latter risk factors in older adults.
Abstract MP52: Racial Disparity in Habitual Sleep Pattern Among Adolescents is Modified by Caloric Intake
Authors: He Fan , Dong Huamei , Fernandez-Mendoza Julio , Bixler Edward O , Liao Jiangang , Vgontzas Alexandros N , Liao Duanping
Published: March 2019

Introduction:
Racial-ethnic minorities have been reported to sleep shorter and have worse sleep quality compared to non-Hispanic whites. Furthermore, nutrition intake has been associated with markers of inadequate habitual sleep. However, the role of nutrition intake on the racial disparity in habitual sleep has been rarely investigated, especially among adolescents.

Hypothesis:
We hypothesize that nutrition intake modifies the association between race/ethnicity and habitual sleep pattern in adolescents.

Methods:
We analyzed the data obtained from 421 adolescents who completed the follow-up examination of the Penn State Child Cohort (PSCC) study. We collected actigraphy-measured sleep durations on 7 consecutive nights and computed the intra-individual mean and standard deviation (SD), as measures of habitual sleep duration (HSD) and habitual sleep variability (HSV), respectively. We also measured participants’ daily macro-nutrients intakes, including total calorie, total fat, carbohydrates, and protein, through the Youth/Adolescent Food Frequency Questionnaire. Adjusted mean HSD and HSV among non-Hispanic whites and minorities were computed and compared by using analysis of covariance (ANCOVA), while controlling for age, sex, BMI percentile, total caloric intake, and socioeconomic status. The significance of an interaction between race/ethnicity and nutrition intake was further tested in ANCOVA models to assess the effect modification of nutrition intake on the racial differences in habitual sleep.

Results:
The mean (SD) age of the study population was 16.7 (2.3) years. The study population consisted of 79.3% non-Hispanic White, 13.0% African American, 4.6% Hispanics, 2.2% Asian, and 0.9% American Indian. After controlling for major covariates, adolescents who were self-identified as racial-ethnic minorities showed significantly shorter HSD (β(SE): 15.9 (6.7) minutes/night, p=0.02) and higher HSV (β(SE): 9.7 (4.8) minutes/night, p=0.04) compared to non-Hispanic whites. More importantly, nutrient intakes played a significant effect modification role in the racial-ethnic difference in HSV. Specifically, racial difference in HSV was significantly more pronounced among adolescents with higher caloric intake, especially from carbohydrates (p for interaction < 0.05).

Conclusion:
Adolescents belong to racial-ethnic minorities sleep objectively shorter and with greater night-to-night variability than non-Hispanic whites. The racial-ethnic difference in habitual sleep variability is more pronounced among adolescents with high caloric intake, particularly from carbohydrates. If confirmed, these data may suggest that the inter-relationship among habitual sleep duration, sleep variability, and caloric intake may contribute to the disproportionate cardiovascular disease risks among racial-ethnic minorities.
Abstract MP54: Sex-Related Differences in the Association of Social Isolation With Plasma Leptin Concentration
Authors: Sponholtz Todd R , Vasan Ramachandran S
Published: March 2019

Introduction:
Studies have reported a positive associations of depression and psychosocial stress and plasma leptin concentration. Social isolation has been linked to increased leptin signaling in male rats, but this association has not been investigated in humans.

Methods:
We investigated the cross-sectional association of social isolation and plasma leptin concentration among 2,729 Framingham Offspring Cohort participants at the 7
th
examination (1999-2001, mean age = 60.1 years, 42% men). Social isolation was measured using the Berkman-Syme Social Network Index: we assigned 1 point for being married, 1 point each for >2 close friends and >2 close relatives, 1 point for participation is social groups, and 1 point for participation in religious meetings ≥1-2 times per month. Social isolation was defined as a total of 0 points. Non-fasting plasma leptin levels were measured using a commercial immunoassay. The primary outcome was plasma leptin concentration. Secondary outcomes included caloric intake, measured by food frequency questionnaire, and volumes of abdominal subcutaneous adipose tissue (SAT), and visceral adipose tissue (VAT), measured by CT among 1,210 of the subjects between 2002 and 2005. Leptin concentration and adipose tissue volume were log-transformed due to skewed distributions. We estimated the associations of social isolation with all outcomes using linear regression. Models included age, body mass index, years of education, smoking status, physical activity index, hypertension, high blood glucose, and CES-D score as covariates. Because leptin levels and responses to social stress may vary among men and women, analyses were stratified by sex.

Results:
Socially isolated participants were younger and had higher CES-D scores than those who were not. Other characteristics were similar between the two groups. Plasma leptin concentration was 20% lower among socially isolated men (95% CI: -31, -6%) compared with men who were not isolated. Social isolation was also associated with lower caloric intake as well (β = -144.5 kcal, 95% CI: -287.1, -1.87 kcal). Among the subset of men for whom we had adipose tissue depot volume measurements (n=552), VAT volume appeared to be 10% lower among socially isolated men compared with non-isolated men (95% CI: -19, 1%), but this was not true of SAT (β = 1%, 95% C: -9, 10%). We did not observe differences in leptin concentration (β = -1%, 95% CI: -10, 15%), caloric intake (β = -39.1 kcal, 95% CI: -136.0, 57.7 kcal) or SAT β=4%, 95% CI: -3, 14%) according to social isolation among women. Socially isolated women appeared to have higher VAT (β = 10, 95% CI: -1, 10%)

Conclusions:
In our population of middle-aged and older adults, social isolation was associated with lower leptin levels among men, but not women. The lower leptin concentration observed among isolated men may reflect decreased caloric intake in response to social stress.