bluuebunny/crossref_metadata_2025 huggingface dataset:
ДИДАКТИЧНІ АСПЕКТИ ВИКЛАДАННЯ МЕДИЧНОЇ ФІЗИКИ У ВИЩОМУ МЕДИЧНОМУ НАВЧАЛЬНОМУ ЗАКЛАДІ
Authors: Palasiuk B. M.
Published: March 2020

Важливою складовою базової підготовки майбутнього медика залишається медична та біологічна фізика, оскільки саме у процесі вивчення цього предмета здійснюється розвиток природничо-наукового мислення студентів. Медична фізика вивчається на першому курсі вищого медичного закладу. На початку вивчення матеріалу студенти повинні володіти фундаментальними теоріями з фізики, які розглядалися у середніх навчальних закладах. Сформована у них наукова та фізична картина світу за шкільні роки під час вивчення природничих наук у виші лише розширюється та поглиблюється. Таким чином реалізується принцип наступності вивчення фізики у системі неперервної освіти. Специфіка дидактичного підходу до вивчення фізики в медичному університеті значною мірою зумовлена тим, що для спеціаліста-фізика основним є фізична суть явищ природи, а для фахівця-медика об’єктом дослідження є людина. Для фахівців медичної галузі фізика виступає як фундаментальна природничо-наукова дисципліна, і для них головним є вміння використовувати знання фізики при розв’язанні фахових проблем. Викладачі кафедри підготували нову навчально-методичну літературу для дисциплін, які викладаються на кафедрі. У нових навчальних посібниках приділено багато уваги практичному аспекту можливого використання набутих знань у майбутній діяльності лікаря, відображено останні досягнення фізичної науки в галузі медичної діагностики та лікування. Однією з форм проведення практичних занять на кафедрі є використання елементів проблемного навчання. Створення проблемних ситуацій активізує пізнавальну діяльність студентів на занятті. У професійній діяльності лікаря важливу роль відіграє вміння правильно діагностувати захворювання. В основі більшості діагностичних методів лежать фізичні закони, теорії, наукові факти, а також фізичні властивості об’єктів і закономірності перебігу фізичних явищ, тому виникає необхідність навчати майбутнього лікаря діагностичної діяльності  уже на етапі вивчення медичної фізики. У цьому аспекті застосовуємо компетентнісний підхід, у рамках якого закладаються основи діагностичних компетенцій.
ЕКСПЕРТНА ОЦІНКА АМЕРИКАНСЬКОЇ СИСТЕМИ ВИЩОЇ МЕДИЧНОЇ ОСВІТИ
Authors: Horpinich T. I.
Published: March 2020

У статті здійснено порівняльний аналіз експертних оцінок американських вчених у галузі медичної освіти з метою розгляду можливості використання американського досвіду організації професійної підготовки лікарів у США. Подано характеристику експертного оцінювання як наукового методу. Обґрунтовано необхідність застосування цього методу для оцінки можливості впровадження досвіду США з організації професійної підготовки лікарів. У ході дослідження встановлено, що всіма американськими експертами закцентовано увагу на високому професіоналізмі й відповідальності викладачів, вирішальній ролі ступеневості медичної освіти, інтеграції навчання і наукових досліджень, теорії і клінічної практики, важливому значенні етапу резидентури, симуляційного навчання і потужного фінансування галузі.
ІСТОРИКО-ПЕДАГОГІЧНЕ ПІДҐРУНТЯ ПРОФЕСІЙНОЇ ПІДГОТОВКИ ЛІКАРІВ В УНІВЕРСИТЕТАХ США
Authors: Mukan N. V. , Blavt O. Z.
Published: March 2020

У статті проаналізовано праці американських науковців ХХ – початку ХХІ ст., які стосуються проблем розвитку медичної освіти в США. Доведено необхідність систематизації педагогічної інформації для узагальнення наявного теоретичного досвіду в контексті медичної освіти. Узагальнено положення масштабного аналітичного дослідження медичної освіти в США та Канаді, яке отримало назву Звіту Флекснера і стало підґрунтям докорінних реформ американської медичної освіти. Проаналізовано сучасні наукові дослідження, спрямовані на вдосконалення системи підготовки лікарів у США. На основі проаналізованих праць зроблено висновки про вектор сучасної педагогічної науки в США в контексті медичної освіти. Встановлено, що до основних питань, які розглянуто у фундаментальних педагогічних дослідженнях американської медичної освіти, належать проблеми якості підготовки фахівців, конкурентоспроможних на ринку праці, впровадження більш досконалих стандартів навчання лікарів, механізми оцінки якості медичної освіти.
ЄВРОПЕЙСЬКА МЕДИЧНА ОСВІТА: МОДЕЛЬ ПОЛЬЩІ
Authors: Pereviznyk B. O. , Kovalchuk T. A. , Dzhavadova N. A
Published: March 2020

Програма студентської мобільності Ерасмус є однією з найбільших міжнародних програм обміну у світі, яка дала змогу отримати досвід семестрового навчання у європейських університетах більш ніж трьом мільйонам учасників від початку її функціонування. Щороку студенти різноманітних європейських, як медичних, так і немедичних ВНЗ, мають змогу брати участь у даній програмі, отримуючи унікальну можливість інтегруватися в іншу систему навчання, працювати над власними науковими ідеями та розробками, розвинути свій майбутній професійний нетворкінг, подорожувати та пізнати життя, культуру, традиції та побут в європейській країні. У статті висвітлено ключові характеристики навчального процесу, можливості наукового розвитку та студентського дозвілля у Вроцлавському медичному університеті (Польща) через призму участі в програмі обміну Ерасмус. В даній роботі проаналізовано, а також описано структуру й особливості проведення практичних занять та лекцій на клінічних кафедрах для старшокурсників, навантаження студентами на одного викладача, оцінку та контроль студентських знань під час практичних занять, а також в кінці семестру, можливість вибору елективних курсів, поняття та умови для застосування ректорських годин. З 18 лютого 2015 р. у Вроцлавському медичному університеті з метою покращення навчального процесу була запроваджена внутрішньоуніверситетська система оцінки якості освіти SONA, що передбачає стандартизоване анкетування студентів з подальшим трансфером опитувальників у навчальний відділ з метою аналізу та подальшої розробки схем покращення якості медичної освіти. У даній статті також йдеться про студентські асоціації університету, їх структуру, цілі та особливості функціонування, наукові видання різного ступеня цитування, в яких публікуються дослідники з різних країн світу.
Abstract 06: Social Networks are Associated With Ideal Cardiovascular Health in Young Black Females: A Latent Class Analysis
Authors: Scott Jewel , Silva Susan , Simmons Leigh Ann
Published: March 2020

Black females experience diminished cardiovascular health (CVH) earlier than other females in the U.S. Young adulthood is a pivotal period for developing and maintaining positive health behaviors and social relationships. Social isolation is a risk factor for cardiovascular disease morbidity and mortality, and that risk may begin early in life. Research with middle-aged adults suggests race and sex moderate the association between social isolation and CVH, underscoring the need to further elucidate this relationship in young Black females.

Hypothesis:
We assessed the hypothesis that (a) there are distinct latent classes of social networks for young Black females; (b) latent social network classes are associated with CVH; and (c) perceived stress and depression mediate this relationship.

Methods:
Data are from 517 Black females, age 24-32, who participated in the National Longitudinal Adolescent to Adult Health Study, a population cohort study. Social network included three components of the Berkman Syme Index (number of close friends, religious participation, volunteer/community service activities) and perceived isolation. The primary outcome was the AHA Ideal CVH score, a composite measure that includes diet, physical activity, BMI, smoking, cholesterol, blood pressure, and glucose. Proposed mediators were perceived stress and depression. A latent class analysis was conducted to identify distinct social network subgroups. General and generalized linear models were used to test for subgroup differences in ideal CVH and mediator effects.

Results:
The best fit latent class analysis identified a three-class model: (1) strong, diverse, social network, 31.5%; (2) moderate social network with no perceived social isolation, 42.6%; and limited social network with perceived social isolation, 25.9%. All subsequent analyses covaried for income because these subgroups differed on income (p=0.0003) and low income was associated with lower ideal CVH scores (p<0.001). Social network was associated with ideal CVH (p=0.004), with the strong, diverse network subgroup having better CVH scores compared to the other subgroups (p<0.005), which did not differ. Black women with a strong, diverse or a moderate network with no perceived isolation had lower probability of perceived stress and depression compared to those with a limited network and perceived isolation (p<0.018). Perceived stress and depression, however, were not associated with CVH scores and did not mediate the social network-CVH relationship.

Conclusion:
In young Black women, social networks may influence health behaviors and overall cardiovascular health, independent of mental health status. Future research should explore mediators of this relationship to effectively tailor lifestyle interventions to establish and maintain CVH and reduce health disparities.
Abstract 07: Association of Social Network Characteristics With Cardiovascular Health and Coronary Artery Calcium in South Asians: The Mediators of Atherosclerosis in South Asians Living in America (MASALA) Study
Authors: Shah Nilay S , Huffman Mark D , Khan Sadiya S , Schneider John A , Siddique Juned , Kanaya Alka M , Kandula Namratha
Published: March 2020

Introduction:
South Asian Americans (SAs) have disproportionately high burden of poor cardiovascular health (CVH) and CVD, which may be influenced by people within their social network (SN). We examined the association of SN characteristics and SN member (“alter”) health with CVH and coronary artery calcium (CAC) in SAs to identify targets for CVD prevention in this high-risk community.

Hypothesis:
Smaller SN size and worse alter health is associated with poor CVH and CAC in SAs.

Methods:
In 699 SAs in the MASALA Study, SN characteristics (size, density, proportion of kin or SA ethnicity), alter health status (self-report of an alter with high blood pressure [HTN], hyperlipidemia [HL], heart disease, diabetes, or stroke), CVH score (0-14, based on poor, intermediate, or ideal blood pressure, cholesterol, glucose, physical activity, diet, weight, and smoking), and CAC data were collected between 2016-2018. Multiple logistic regression evaluated the association of SN characteristics or alter health with prevalent CVH and CAC.

Results:
Participants were mean age 59±9 years and 43% women. Mean CVH score was 8.9±1.9, median CAC score 8 (range 0 - 4217). SNs were mean 6±3 people, density 79±26%, 72±28% kin, 88±23% SA ethnicity; 48% had an alter with HTN, 42% with HL, 18% with heart disease, 40% with diabetes, and 2% with stroke. A 1-person larger SN size was associated with a 19% higher odds of ideal vs. poor CVH in men (p=0.02), and an 11% lower odds of CAC in women (p=0.05, Table). In men, having at least 1 alter with HTN or HL was associated with a 58% or 54% lower odds of ideal vs. poor CVH (p=0.03, p=0.04), and having at least 1 alter with HL was associated with a 78% higher odds of CAC (p=0.05). No associations were seen between other SN characteristics, nor alters with other CVD risk factors, and CVH or CAC.

Conclusions:
In SAs, larger SN size was associated with better CVH. Having a SN member with HTN or HL may be associated with poorer CVH and CAC. Interventions to increase SN size or target SN member CVH may promote CVH in this high-risk population.
Abstract 09: The Health Freedom Path to Wellness Program: A Novel Educational and Behavioral Intervention to Promote Cardiovascular Health Equity
Authors: Purnell Tanjala S , Glenn-Smith Ina , Bae Sunjae , Vargas Grecia , Hines Anika L , Charleston Jeanne
Published: March 2020

Background:
African Americans (AAs) and adults living in urban communities continue to experience disproportionately high rates of cardiovascular disease (CVD) and associated risk factors (e.g., hypertension, diabetes, obesity) despite decades of recognition of these disparities.

Methods:
The Health Freedom Path to Wellness Program is an innovative community-based educational and behavioral intervention to reduce disparities in CVD risk factors. The goal of this study was to test the effectiveness of the Circle of Friends (COF) educational and social support component of the Health Freedom intervention. The Health Freedom-COF incorporated six weekly one-hour long sessions led by lay health workers trained in CVD health education based on the AHA’s Simple 7 guidelines, blood pressure (BP) measurement, physical activity, and behavior change strategies, and culminated in a 5K celebration walk that gives participants an opportunity to learn about Maryland’s important role in the Underground Railroad.

Results:
Study participants included 353 adults in Maryland (93% AAs, mean age: 53 years; 85% female; and 35% with annual incomes <$50,000). At baseline, mean BP(SD) was 127.4 (17.6)/77.1 (10.8) mmHg; mean weight in pounds (SD) was 191.6 (45.2); 43.1% had diagnosed hypertension, and 15.0% had diabetes. Compared with their pre-intervention assessments, adults who completed the intervention experienced an average reduction of -5.2 mm Hg systolic blood pressure (95% CI: 4.1-6.3, p<0.001) and -3.3 mm Hg diastolic BP (95% CI: 2.5-4.1, p<0.001). At baseline, only 3.3% of participants reported a weekly consumption of 5+ fruit servings; 5.9% reported 5+ vegetable servings, and 12.8% reported 5+ days of physical activity. However, after completing the program, 22.4% of participants reported a weekly consumption of 5+ fruit servings; 28.6% reported 5+ vegetable servings, and 46.7% reported 5+ days of physical activity.

Conclusions:
The Health Freedom educational and behavioral intervention was associated with improvements in blood pressure, diet, and physical activity among socially at-risk adults.
Abstract 11: Prospective Association of Tet2 Mediated Clonal Hematoopoiesis and Heart Failure and Its Subtypes in Postmenopausal Women
Authors: Eaton Chuck , Raffield Laura M , Bick Alexander , Roberts Mary , Manson Joann E , Reiner Alexander
Published: March 2020

Background:
Recent studies have shown that hematopoietic stems cells can undergo clonal expansion secondary to somatic mutations, termed clonal hematopoiesis of indeterminate potential (CHIP). TET2 is frequently mutated in individuals with CHIP and has been associated with coronary heart disease in humans and Heart Failure in mice models. We investigated whether any of the top three somatic mutations ( DNMT3A,TET2, ASXL1) associated with CHIP were prospectively associated with heart failure (HF), heart failure with preserved ejection fraction (HFPEF) or heart failure with reduced ejection fraction (HFrEF) in post menopausal women.

Methods:
A subcohort of 5214 postmenopausal women in the Women’s Health Intiative were evaluated for CHIP and HF. CHIP was determined at the Broad Institute via whole genome sequencing using the GATK4 MuTect2 somatic variant caller through the NHLBI TOPMed project. Hospitalized heart failure was based upon trained physician record review. HFpEF was defined as an EF
>
50% and HFrEF as EF<50% . Cox proportional hazards model were evaluate adjusting for age, race, income, education, cigarette smoking, body mass index, coronary heart disease, atrial fibrillation, diabetes , hypertension, systolic blood pressure, and stroke. Inverse probability weighting was used to account for selection bias associated with the subcohort selection.

Results:
Of the 5214 postmenopausal women, 597 developed HF, 283 HFpEF and 204 HFrEF. N=408 had CHIP. The top 3 gene mutations associated with CHIP (N=364) were DNMT3A (4.8%), TET2 (1.7%) and ASXL1 (0.5%). Women with CHIP associated with any of the top 3 mutations and with TET2 were associated with HF, HFpEF but not HFrEF. DNMT3A and ASXL1 CHIP mutations were not associated HF, HFpEF or HFrEF (See Table ).

Conclusion:
CHIP associated with the top 3 somatic mutations and TET2 were prospectively associated with HF and HFpEF consistent with animal models and the concept of HFpEF being associated with pathologic aging. Replication of these findings in other cohorts is warranted.
Abstract 12: Skeletal Muscle Density, Not Size, is Beneficially Associated With Incident Coronary Heart Events: The Multi-Ethnic Study of Atherosclerosis
Authors: Unkart Jonathan , Bellettiere John , Larsen Britta A , Criqui Michael H , Vella Chantal A , Miljkovic Iva , McClelland Robyn , Ouyang Pamela , Allison Matthew A
Published: March 2020

Introduction:
Fat infiltration into muscle reduces muscle density and increases the risk for metabolic dysfunction, mobility disability and mortality. We assessed abdominal muscle density and muscle area in relation to incident coronary heart disease (CHD) events.

Methods:
Adults (mean age 64.6 ± 9.6) from the Multi-Ethnic Study of Atherosclerosis body composition ancillary study had computed tomography (CT)-derived measures of muscle density, muscle area and visceral fat at the L2-L4 spinal column levels between 2002-05 and were followed for incident events. Using sex-stratified Cox proportional hazards regression, associations of muscle density and muscle area (in the same model) with CHD events were assessed using restricted cubic splines with adjustment for confounders including visceral adiposity and BMI.

Results:
After 10.3±2.9 years of follow up, 924 males had 70 CHD (7.6%) events and 945 females had 44 CHD (4.7%) events. Muscle density was higher in males (44.5±4.9 HU) than females (40.1±5.2 HU), as was muscle area (116.7±23.9 vs. 80.4±23.9 cm
2
, respectively). Among males, and in mutually adjusted models, each incremental SD of muscle density was inversely associated with CHD (HR=0.67; 95%CI=0.49-0.92), while each SD of muscle area was associated with higher risk of CHD (HR=1.75; 95%CI=1.34-2.28; Figure). Overall patterns were similar but less strong among females for density (HR=0.79; 95%CI=0.50-1.22) and area (HR=1.17; 95%CI=0.79-1.73).

Conclusions:
Greater muscle density is associated with lower CHD risk, while greater muscle size is associated with increased CHD risk. These associations were independent of traditional CHD risk factors and measures of visceral and total body adiposity. Quantity and quality of skeletal muscle may represent distinct aspects of aging and physical functioning that are important in heart health.
Abstract 27: Group- Plus Home-based Tai Chi Program Improves Physical Function and Psychosocial Well-being Among Patients With Coronary Heart Disease
Authors: Liu Ting , Chair Sek Ying , Chan Aileen W
Published: March 2020

Introduction:
Substantial evidences demonstrate impaired physical health and decreased psychosocial well-being among patients with coronary heart disease (CHD). Tai Chi is an effective exercise option in cardiac rehabilitation to manage CHDs. There has been an increasing focus on home-based cardiac rehabilitation to improve participation rate, while none of studies emphasized the effect of home-based Tai Chi program.

Hypothesis:
A group- plus home-based Tai Chi program improves physical function (aerobic endurance, lower-body strength, lower-body flexibility, and agility and dynamic balance), and psychosocial well-being (perceived stress, social support, exercise self-efficacy) among CHD patients.

Methods:
In this randomized controlled trial, 98 community-dwelling patients with CHD (mean age: 69.2±4.68 years; 69 women; 29 men) were randomized to Tai Chi (n=49) or control group (n=49). Participants in Tai Chi group first attended 6 weeks supervised group-based Tai Chi classes that were scheduled as follows: 2 times/week for week 1 and 2, 3 times/week for weeks 3 and 4, and then 4 times/week for week 5 and 6, with 60 minutes/class. After that, participants in Tai Chi group practiced home-based Tai Chi 4 times/week, 60 minutes for each time, for another 6 weeks. Outcomes, namely, aerobic endurance, lower-body strength, lower-body flexibility, and agility and dynamic balance were tested by 2-Minute Step Test (steps), Chair Stand Test (times), Chair Sit-and-Reach Test (cm), and 8-Foot Up-and-Go Test (seconds), respectively. Other outcomes included perceived stress, social support, and exercise self-efficacy. Data were collected at baseline, post group-based Tai Chi training at 6-week, post Tai Chi intervention at 12-week, and at 24-week follow-up assessment. Generalized estimating equations models were used to compare changes in outcomes over time between groups.

Results:
Compared to changes in control group, Tai Chi showed significant improvements in aerobic endurance (+12 steps), lower-body strength (+3 times), agility and dynamic balance (log-transformed score: -0.058s), perceived stress, emotional support, belonging support, tangible support, and exercise self-efficacy at 24-week. Significant improvement in lower-body flexibility (4 cm) was only achieved at 12-week, compared to changes in control group. No significant changes in self-esteem support over time between groups were observed. Intervention adherence: Tai Chi=79.6% (39 of 49) (attending ≥75% of total Tai Chi sessions). Attrition rate: Tai Chi=20.4% (10 of 49), control=24.5% (12 of 49).

Conclusions:
This Tai Chi program significantly improve physical function and psychosocial well-being among CHD patients, indicating that Tai Chi could be taught in group sessions and then continued independently as a home exercise routine for health promotion in CHD patients.
Abstract 33: Associations of Gestational Cardiovascular Health With Pregnancy Outcomes: The Hyperglycemia and Adverse Pregnancy Outcome Study
Authors: Perak Amanda M , Lancki Nicola , Kuang Alan , Labarthe Darwin R , Shah Svati H , Lowe Lynn , Scholtens Denise , Lloyd-Jones Donald M , Lowe William ,   HAPO Study Cooperative Rsch Group
Published: March 2020

Introduction:
Combinations of risk factor levels typically contribute more to population burdens of disease than single adverse risk factors. CVH (as defined by the AHA) characterizes a range of health levels, but its significance in pregnancy for obstetric and neonatal outcomes is unknown.

Methods:
Data from the Hyperglycemia and Adverse Pregnancy Outcome Study were analyzed, including 1,754 mother-child dyads from 9 field centers in 6 countries: US (26%), Barbados (24%), UK (20%), China (15%), Thailand (8%), and Canada (7%). Maternal CVH was scored (0-10 points, with 10 most favorable) at a mean of 28 (range 23-34) weeks’ gestation using 5 metrics (
Table
). Cord blood was collected at delivery, neonatal anthropometrics were measured within 72 hours, and medical records were abstracted for obstetric outcomes. Logistic regression was utilized to test associations of gestational CVH with obstetric and neonatal outcomes, adjusted for center and maternal and infant characteristics (
Table
footnote).

Results:
The mean gestational CVH score was 8.2 (SD 1.5) out of 10; 18% of mothers had all ideal, 37% had 1+ intermediate, 34% had 1 poor, and 9% had 2+ poor metrics. In fully adjusted models (
Table
), odds ratios per 1 point higher (better) CVH score were 0.65 (95% CI, 0.56-0.76) for preeclampsia, 0.89 (0.78-1.00) for unplanned primary cesarean section (among primiparous mothers), 0.84 (0.77-0.93) for large for gestational age infant, 0.87 (0.79-0.97) for infant sum of skinfolds >90
th
percentile, and 0.77 (0.69-0.86) for infant insulin sensitivity index (20/[C-peptide*glucose]) <10
th
percentile. CVH categories were also associated with outcomes; for example, compared with mothers with all metrics ideal, odds ratios for preeclampsia were 2.00 (0.71-7.14) for mothers with 1+ intermediate, 4.34 (1.63-15.09) for mothers with 1 poor, and 9.40 (3.22-34.52) for mothers with 2+ poor metrics.

Conclusion:
More favorable levels of gestational CVH were associated with healthier obstetric and neonatal outcomes in this multinational cohort.
Abstract 36: The Role of Sleep as a Cardiovascular Health Metric: Does It Improve Cardiovascular Disease Risk Prediction? Results From The Multi-Ethnic Study of Atherosclerosis
Authors: Makarem Nour , Castro-Diehl Cecilia , St-Onge Marie-Pierre , Redline Susan , Shea Steven , Lloyd-jones Donald M , Ning Hongyan , Aggarwal Brooke
Published: March 2020

Background:
The AHA Life’s Simple 7 (LS7) is a measure of cardiovascular health (CVH). Sufficient and healthy sleep has been linked to higher LS7 scores and lower cardiovascular disease (CVD) risk, but sleep has not been included as a CVH metric.

Hypothesis:
A CVH score that includes the LS7 plus sleep metrics would be more strongly associated with CVD outcomes than the LS7 score.

Methods:
Participants were n=1920 diverse adults (mean age: 69.5 y) in the MESA Sleep Study who completed 7 days of wrist actigraphy, overnight in-home polysomnography, and sleep questionnaires. Logistic regression and Cox proportional hazards models were used to compare the LS7 score and 4 new CVH scores that incorporate aspects of sleep in relation to CVD prevalence and incidence (Table). There were 95 prevalent CVD events at the Sleep Exam and 93 incident cases during a mean follow up of 4.4y.

Results:
The mean LS7 score was 7.3, and the means of the alternate CVH scores ranged from 7.4 to 7.8. Overall, 63% of participants slept <7h, 10% had sleep efficiency <85%, 14% and 36% reported excess daytime sleepiness and insomnia, respectively, 47% had obstructive sleep apnea, and 39% and 25% had high night-to-night variability in sleep duration and sleep onset timing. The LS7 score was not significantly associated with CVD prevalence or incidence (Table). Those in the highest vs. lowest tertile of CVH score 1, that included sleep duration, and CVH score 2, that included sleep characteristics linked to CVD in the literature, had lower odds of prevalent CVD. Those in the highest vs. lowest tertile of CVH scores 3 and 4, which included sleep characteristics linked to cardiovascular risk in MESA, had lower odds of prevalent CVD and lower risk of developing CVD.

Conclusions:
CVH scores that include sleep were more strongly associated with CVD prevalence and incidence than the traditional LS7 score. The incorporation of sleep as a metric of CVH, akin to other health behaviors, may improve CVD risk prediction. Findings warrant confirmation in larger samples and over longer follow-up.
Abstract 38: Prospective Study of Midlife Sedentary Behavior, Physical Activity, and Cognitive Function: The CARDIA Study
Authors: Whitaker Kara M , Pettee Gabriel Kelley , Chen Baojiang , Ahrens Monica , Sternfeld Barbara , Sidney Stephen , Jacobs David R , Palta Priya , Yaffe Kristine
Published: March 2020

Introduction:
Evidence suggests moderate to vigorous intensity physical activity (MVPA) has beneficial effects on various domains of cognitive function; however, less than half of adults meet MVPA guidelines. Alternate approaches, such as reducing sedentary behavior (SED) with concurrent increases in light-intensity physical activity (LPA) may resonate more strongly with the adult population.

Objective:
To determine if accelerometer measured SED, LPA, and MVPA at ages 38-50 years is prospectively associated with measures of cognitive function.

Methods:
We studied 1,842 Black and White men and women enrolled in CARDIA who participated in the year 20 (2005-06) and year 25 (2010-11) and/or year 30 (2015-16) exams. SED, LPA, and MVPA were measured by the ActiGraph 7164 accelerometer at year 20. Cognitive function tests at the year 25 and 30 exams included the Rey Auditory Verbal Learning Test (RAVLT, memory), Digit Symbol Substitution Test (DSST, processing speed), and Stroop Test (executive function). Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA at year 20 with repeated measures (unstructured covariance) of the cognitive function raw test scores at years 25 and 30.

Results:
In men, substituting 30 minutes of SED with 30 minutes of LPA was associated with a decrease in the RAVLT (-0.05) and DSST (-0.76), and increase in Stroop (0.45) scores, indicating worse performance (see
Table
). Substituting SED or LPA with MVPA was associated with an increase in RAVLT (0.15, 0.20) and DSST (1.21, 2.00), and decrease in Stroop (-0.68, -1.17) scores, respectively, indicating better performance. In women, who had higher cognitive function scores than men, substituting SED or LPA with MVPA was associated with worse performance on the Stroop test (0.70, 0.63), contrary to our hypothesis.

Conclusions:
Statistical substitution of time from lower-intensity activities (SED or LPA) with MVPA, but not SED with LPA, resulted in better cognitive performance in men, but not women, over 10 years.
Abstract 44: Childhood Predictors of Type 2 Diabetes in Young Adulthood to Middle-age: The International Childhood Cardiovascular Cohort (i3c) Consortium
Authors: Hu Tian , Jacobs David R , Sinaiko Alan R , Bazzano Lydia A , Burns Trudy L , Daniels Stephen R , Dwyer Terence , Juonala Markus , Prineas Ronald J , Raitakari Olli T , Urbina Elaine M , Venn Alison , Woo Jessica G , Steinberger Julia
Published: March 2020

Introduction:
Although childhood obesity is related to incident adult type 2 diabetes (T2DM), whether other childhood risk factors relate to T2DM is not clear and no childhood risk score has been established to help with prediction of T2DM.

Methods:
We examined childhood risk factors in The International Childhood Cardiovascular Cohort (i3C) Consortium with a goal of developing a risk score for predicting adult T2DM. The pooled datasets included childhood measurements during the 1970s to 1990s. Participants were re-contacted at mean age 40 yr and completed a health questionnaire including self-report of adult T2DM (occurrence age, medication use).

Results:
N = 4,425 i3C participants with measurements during ages 3-19 yr. 225 (5.1%) reported onset of T2DM between ages 20-55 (mean 38.4) years (82% reported use of a valid antidiabetic medication). After stepwise regression, age-sex standardized deviates (mean of all repeated measures during ages 3-19 yr) of body mass index (BMI), glucose and ln(insulin) were associated with incident T2DM; the unadjusted risk curves visibly steepened at about 0.75 standard deviates (Figure, top panel). In multivariable models, BMI, glucose and ln(insulin) in a single model were associated with adult T2DM after adjustment for sex, race, cohort, and individual mean childhood age and calendar year. Prediction of incident T2DM was directly related to the number of the three risk factors with levels above +0.75 standard deviates (0: 3.2% (96/2966), 1: 6.2% (63/1,012), 2: 14.3% (56/392), 3:18.2% (10/55); the corresponding adjusted HR (95%CI) for the counts were 1 (reference), 1.8 (1.3, 2.4), 4.7 (3.3, 6.5), and 6.7 (3.5, 13.1), respectively). The +0.75 standard deviates in natural units are given in the Figure (bottom panel), e.g. about 92 mg/dL for glucose at age 12-14.

Conclusion:
The study suggests that a childhood risk score composed of BMI, glucose and insulin is a strong predictor of adult T2DM. Provisionally suggested cutpoints are lower than currently defined normal.
Abstract 45: The Association of Cumulative Systolic Blood Pressure With Cardiovascular Disease: Findings From the Lifetime Risk Pooling Project Cohorts
Authors: Reges Orna , Ning Hongyan , Wilkins John T , Lloyd-jones Donald M , Allen Norrina B
Published: March 2020

Background:
Blood pressure (BP) is a known risk factor for cardiovascular disease (CVD), but prior studies have predominantly focused on single measurements of BP. Previous studies which have examined longitudinal BP have been mostly limited to a single cohort and have examined BP during older age.

Objective:
To assess the association of cumulative systolic BP (SBP) in middle age with CVD using individual-level pooled data from 5 US community-based cardiovascular disease cohorts.

Methods:
Among participants from the Lifetime Risk Pooling Project, we defined the index date as the earliest SBP measurement taken within 45-65 yr of age with ≥2 previous SBP measurements during the prior 5 years. Multivariate Cox proportional hazards models, with and without current SBP, were used to assess the association of cumulative 5-years SBP (Cum5ySBP, defined as 4 quarters {q1to q4} of SBP mm Hg-years) with any CVD, coronary heart disease, stroke, and heart failure. Models were adjusted for age, sex, race, education, BMI, smoking status, diabetes, total cholesterol level, and use of hypertensive medications as well as index SBP.

Results:
The association of Cum5ySBP with CVD over an average of 12.9 years was assessed for 13,957 individuals (54.6% women; mean age: 59.6 yr). Cum5ySBP was significantly associated with CVD incidence, with higher risk as the Cum5ySBP increased {Cum5ySBP: HRq2: 1.34 (1.20-1.48), HRq3: 1.71 (1.55-1.90), and HRq4: 2.16 (1.95-2.40)} (Figure 1A). The Cum5ySBP remained significant even when index SBP was incorporated into the model {Cum5ySBP: HRq2: 1.12 (1.01-1.25), HRq3: 1.24 (1.10-1.39), and HRq4: 1.19 (1.03-1.37)} (Figure 1B), as well as when evaluated separately for each type of CVD event.

Conclusions:
Cum5ySBP is a significant risk factor of CVD, above and beyond current BP. The risk for any CVD component increased with increases in cumulative SBP. These findings emphasize the importance of early treatment for individuals with high BP in order to reduce the cumulative burden of SBP and ultimately prevent CVD outcomes.
Abstract 48: Plant-based Diet Index and Cardiometabolic Risk Markers: Exploring the Role of the Gut Microbiome
Authors: Li Yanping , Satija Ambika , Wang Dong , Ivey Kerry L , Li Jun , Li Ruifeng , Baden Megu , Wilkinson Jeremy , Chan Andrew , Huttenhower Curtis , Rimm Eric B , Hu F , Sun Qi
Published: March 2020

Objectives:
To investigate the association between a plant-based diet index and microbial composition and functionality, as well as the inter-relationships between plant-based diets, gut microbiome, and cardiometabolic risk markers.

Design and method:
Metagenomic profiling was performed on 916 fecal samples collected among 301 men who participated in the Men’s Lifestyle Validation Study. Using data from a food frequency questionnaire, a Plant-based Diet Index (PDI) was derived to assess the adherence to a plant-based diets. The associations between PDI adherence and the relative abundance of microbial species and pathways were evaluated using Multivariate Association with Linear Models (MaAsLin2). P values below 0.25 after false discovery rate correction following the Benjamini-Hochberg method were considered statistically significant.

Results:
After multivariate adjustment, the value of the PDI score was significantly and positively associated with the ratio of Firmicutes to Bacteroidetes (Spearman r=0.10, P=0.005). Specifically, the PDI was significantly associated with the relative abundance of 77 taxa (including 39 species) out of 506 filtered taxa and 15 pathways (out of 80 filtered features). In particular, a higher adherence to the PDI was significantly, positively, associated with of the relative abundance of Firmicutes and of pathways involving degradation of complex plant carbohydrates. It was also inversely associated with the relative abundance of Bacteroidetes and Proteobacteria, as well as pathways involved in the urea cycle and amino acid biosynthesis. We also found that 14 species significantly interacted with PDI in modulating plasma ratio of TG to HDL-C. The association of PDI with lower TG to HDL ratio was significantly strengthened in the presence of the species positively correlated with the PDI score, such as
Ruminococcus lactaris
,
Haemophilus parainfluenzae,
and
Methanobrevibacter smithii
or in the absence of the species inversely correlated with the PDI score, such as
Paraprevotella
spp.

Conclusions:
A greater adherence to a plant-based diet was associated with a microbial profile featured by higher abundance of species in Firmicutes and depletion of species in Bacteroidetes and Proteobacteria, and such a profile may further strengthen the favorable associations between plant-based diets and human cardiometabolic risk.
Abstract 51: Effects of Dietary Patterns on Subclinical Cardiac Damage: Results From the DASH Trial
Authors: Juraschek Stephen P , Kovell Lara C , Appel Lawrence J , Miller Edgar R , Sacks Frank M , Christenson Robert H , Rebuck Heather , Chang Alexander R , Mukamal Kenneth J
Published: March 2020

Background:
The Dietary Approaches to Stop Hypertension (DASH) diet (rich in fruit (F), vegetables (V), low-fat dairy, and fiber, and reduced in saturated fat and cholesterol) lowered blood pressure (BP) and low-density lipoprotein cholesterol after 8 weeks compared with a typical American diet. However, direct effects on cardiovascular damage are unknown.

Hypothesis:
The DASH diet reduces cardiac injury, strain, and inflammation compared to a typical American diet.

Methods:
The DASH feeding study was a 3-arm, parallel-design, randomized controlled trial of adults with systolic BP (SBP) <160 mm Hg and diastolic BP (DBP) of 80-95 mm Hg, without cardiovascular disease (CVD) and not taking BP medications. Participants were randomized to 8 weeks of monitored feeding with: a typical American diet with 3.6 servings of F/V per day (ref), a F/V-enriched diet (8.5 servings of F/V per day), or the DASH diet (9.6 servings of F/V per day). Calories were adjusted to keep weight constant throughout feeding. We compared the effects of these diets on 3 cardiac biomarkers: high-sensitivity cardiac troponin I (hs-cTnI), N-terminal b-type pro natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hs-CRP), measured in stored serum collected at baseline and after feeding.

Results:
Of the 257 participants with available specimens, 33% were aged >50 yrs, 48% were women, and 56% were non-white. Mean baseline SBP/DBP was 131/85 mmHg. Compared to control, the F/V-enriched diet reduced hs-cTnI by 53% (95% CI: 18, 73;
P
= 0.008) and NT-proBNP by 24% (95% CI: 7, 38;
P
= 0.01) (
Figure
). Similarly, compared to control, DASH reduced hs-cTnI by 49% (95% CI: 11, 71;
P
= 0.02) and NT-proBNP by 20% (95% CI: 2, 35;
P
= 0.04). Hs-CRP did not differ between diets, and none of the markers differed between DASH and F/V-enriched diets.

Conclusions:
In adults with high BP but not CVD, both F/V-enriched and DASH diets lowered sensitive markers of cardiac injury and strain over 8 weeks. Our study demonstrates early, direct cardiovascular benefits from diets rich in F/V.
Abstract 54: Addressing Cardiovascular Health Using Artificial Intelligence: Randomized Clinical Trial to Increase Physical Activity in Cancer Survivors Using Intelligent Voice Assist (Amazon Alexa) for Patient Coaching
Authors: Hassoon Ahmed , Baig Yasmin , Naimann Daniel , Celentano David , Lansey Dina , Stearns Vered , Schrack Jennifer , Martin Seth S , Appel Lawrence J
Published: March 2020

Importance:
Physical Activity (PA) has numerous health benefits to cancer survivors, but motivation remains problematic. Coaching may increase PA and improve survivorship outcomes, but it is challenging to deliver personalized coaching at scale

Objective:
To determine if the use of a novel Artificial Intelligence (AI) agent delivered by smart speaker (Amazon Echo) increases PA among overweight or obese cancer survivors compared to autonomous SMS or standard health education publications

Method:
A single center 3-arm randomized clinical trial in Maryland, USA with 1:1:1 allocation. One-week base-line period followed by 4-week interventions. Participants were adult overweight or obese physically inactive cancer survivors (who completed their active treatments three or more months prior to the time of recruitment) with an emphasis on racial/ethnic minorities. Interventions were: (A) on-demand AI coaching using interactive digital voice assist on Amazon Echo; (B) autonomous data-driven text message via mobile phone; or (C) NCI health education materials about the benefit of PA for cancer survivors (Control). Outcome was the change in average steps per day from baseline to the end of follow-up

Results:
Of 90 candidates, 42 were enrolled and randomized (N=14 in each arm). 90.5% of the participants were female, 36% Black/African American, average age was 62.1(SD 9.8) years, with average BMI of 32.9(SD 5.0). The majority were breast cancer survivors (85.7%). No differences in baseline characteristics or baseline PA levels found between the groups. After 4-week intervention, only group (A) achieved significant gain in PA adding 3618.2 steps/day (95% CI: 2490.1 - 4764.2, P <0.001). Group (A) also achieved significant net gain in PA compared to group (B) & (C), table 1. Group (A) also peaked around 10k steps/day each week, figure 1.

Conclusions:
Using AI voice-assist may be a practical method to deliver scalable individualized behavioral health coaching to address cardiovascular health in cancer survivors.
Abstract 55: Sodium Sensitivity, Sodium Resistance, and Incidence of Hypertension
Authors: He Jiang , Huang Jian-Feng , Chen Jing , Chen Ji-Chun , Lu Xiangfeng , Hu Dongsheng , He Hua , Li Jian-Xin , Cao Jie , Chen Chung-Shiuan , Li Changwei , Bazzano Lydia A , Kelly Tanika N , Gu Dongfeng
Published: March 2020

Background:
Blood pressure responses to dietary sodium intake vary among individuals. However, it is unknown whether sodium sensitivity and sodium resistance predict incidence of hypertension.

Methods:
We conducted a feeding study, including a 7-day low-sodium diet (51.3 mmol/day) and a 7-day high-sodium diet (307.8 mmol/day), among 1,718 Chinese individuals with normal blood pressure in 2003-2005 and follow-up studies in 2008-2009 and 2011-2012. Three blood-pressure measurements and 24-hour urinary sodium excretion were obtained on each of 3 days during baseline, low- and high-sodium interventions, and follow-up visits. Latent class models were used to identify subgroups that share a similar underlying trajectory in blood-pressure responses to dietary sodium intake.

Results:
Three trajectories of systolic blood pressure responses to dietary sodium intake were identified (Figure). Mean (standard deviation) changes in systolic blood pressure were -13.7 (5.5), -4.9 (3.0), and 2.4 (3.0) mmHg during the low-sodium intervention, and 11.2 (5.3), 4.4 (4.1) and -0.2 (4.1) mmHg during the high-sodium intervention (
P<
0.001 for group differences) in high sodium-sensitive, moderate sodium-sensitive, and sodium-resistant groups, respectively. Compared to individuals with moderate sodium sensitivity, multiple-adjusted odds ratio (95% confidence intervals) for incident hypertension were 1.44 (1.03 to 1.99) for those with high sodium sensitivity and 1.42 (1.02 to 1.97) for those with sodium resistance (
P
<0.001 for quadratic trend). Furthermore, a J-shaped association between systolic blood pressure responses to high sodium intake and incident hypertension was identified (
P
<0.001). Similar results were observed for diastolic blood pressure.

Conclusions:
Individuals with either high sodium sensitivity or sodium resistance are at an increased risk for developing hypertension.
Abstract MP08: Targeted Healthy Food Incentives Influence Grocery Purchase Quality and Purchase of Targeted Foods: Results From the Randomized Controlled Crossover Smart Cart Study
Authors: Vadiveloo Maya K , Parker Haley W , Guan Xintong , Atlas Stephen , Perraud Elie , Buchanan Ashley , Thorndike Anne N
Published: March 2020

Introduction:
Incentives can increase healthy food purchases, but less is known about whether they improve dietary quality. The Smart Cart Study evaluated whether healthful food incentives based on customer preferences and purchase history increased grocery purchase quality and the proportion of spending on targeted foods.

Hypothesis:
Targeted incentives will increase grocery purchase quality as measured by the Grocery Purchase Quality Index- 2016 (GPQI) and percent spending on targeted healthful foods.

Methods:
Adults (n=224) who shopped at an independent supermarket for ≥50% of their groceries, participated in the store’s loyalty program, and completed study questionnaires were enrolled in summer 2018. All participants received a 5% loyalty card discount. The intervention group received targeted weekly coupons (~$10 value) with brief education to improve purchase quality for 13-weeks. A computerized study algorithm allocated targeted healthy food coupons to participants’ loyalty cards by using purchase history, dietary preferences, and diet quality. The control group received weekly brief education and occasional generic coupons. After a brief washout, the groups crossed over. GPQI-16 scores (range 0-75) were calculated from cumulative food purchasing data by comparing actual to recommended spending within 11 food groups, with higher scores reflecting higher purchase quality; % spending on targeted vs. all foods was also compared. Paired t-tests examined differences between groups.

Results:
Participants with extreme spending (i.e. top/bottom 1%) were excluded, leaving an analytic sample of 207 mostly white adults (95%), with mean age of 56 and 50% with household incomes ≥100K. The Table shows changes in GPQI-16 scores and % spending in the first 13-week intervention period, followed by the cross-over intervention period.

Conclusions:
Results from this pilot trial suggest that targeted healthy supermarket incentives are feasible and are promising tools to help improve diet quality and health.
Abstract MP13: Prospective Associations of Prenatal Sedentary Behavior and Physical Activity Trajectories With Adverse Pregnancy Outcomes
Authors: Barone Gibbs Bethany , Jones Melissa A , Jakicic John M , Jeyebalan Arundhathi , Whitaker Kara M , Catov Janet M
Published: March 2020

Background:
Adverse pregnancy outcomes (APO) are risk factors for future cardiovascular disease. Though factors such as obesity increase the risk of APO, whether patterns of prenatal sedentary behavior (SED) or physical activity are associated with APO is unclear.

Methods:
This cohort study measured objective SED, steps, and moderate-vigorous intensity physical activity (MVPA) during each trimester of pregnancy. Women were instructed to wear two monitors for 7 d: a thigh-mounted activPAL3 micro to measure SED and steps, and an Actigraph GT3X on an elastic waist belt to measure MVPA. Women also completed a detailed wear log. Data were considered valid with ≥4 d of ≥10 hr of wear. Physician-diagnosed APO (gestational hypertension, preeclampsia, gestational diabetes, preterm birth, or intrauterine growth restriction) were abstracted from medical records by trained research personnel. Growth mixture modelling was used to construct separate SED, steps, and MVPA trajectories across pregnancy. Associations between trajectory groups and APO were evaluated using logistic regression with adjustment for prepregnancy BMI, race, education, and age.

Results:
Women (n=100) had mean (SD) age 31.2 (4.8) yr, pregnancy BMI 26.2 (6.8) kg/m
2
, and were 25% non-white. Trajectory analyses revealed three groups within each SED, steps, and MVPA (see Table). Nineteen women (19%) had at least one APO: gestational hypertension and/or preeclampsia (n=13), gestational diabetes (n=3), preterm birth (n=6), or intrauterine growth restriction (n=4). High vs. low SED trajectory was associated with more than 6-fold higher odds of APO. Medium and high vs. low steps trajectory was associated with lower odds of APO, but only medium vs. low trajectories were statistically different. MVPA trajectory was not associated with APO risk (see Table).

Conclusion:
Reducing SED and increasing daily steps, though not increasing MVPA, could be novel intervention targets for reducing APO and future cardiovascular risk in pregnant women.