bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations of Income Volatility With Incident Cardiovascular Disease and All-Cause Mortality in a US Cohort
Authors: Elfassy Tali , Swift Samuel L. , Glymour M. Maria , Calonico Sebastian , Jacobs David R. , Mayeda Elizabeth R. , Kershaw Kiarri N. , Kiefe Catarina , Zeki Al Hazzouri Adina 
Published: January 2019

Background:
Income volatility is on the rise and presents a growing public health problem. Because in many epidemiological studies income is measured at a single point in time, the association of long-term income volatility with incident cardiovascular disease (CVD) and mortality has not been adequately explored. The goal of this study was to examine associations of income volatility from 1990 to 2005 with incident CVD and all-cause mortality in the subsequent 10 years.

Methods:
The Coronary Artery Risk Development in Young Adults Study is an ongoing prospective cohort study conducted within urban field centers in Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA. We studied 3937 black and white participants 23 to 35 years of age in 1990 (our study baseline). Income volatility was defined as the intraindividual SD of the percent change in income across 5 assessments from 1990 to 2005. An income drop was defined as a decrease of ≥25% from the previous visit and less than the participant’s average income from 1990 to 2005. CVD events (fatal and nonfatal) and all-cause mortality between 2005 and 2015 were adjudicated with the use of medical records and death certificates. CVD included primarily acute events related to heart disease and stroke.

Results:
A total of 106 CVD events and 164 deaths occurred between 2005 and 2015 (incident rate, 2.76 and 3.66 per 1000 person-years, respectively). From Cox models adjusted for sociodemographic, behavioral, and CVD risk factors, higher income volatility and more income drops were associated with greater CVD risk (high versus low volatility: hazard ratio, 2.07; 95% CI, 1.10–3.90; ≥2 versus 0 income drops: hazard ratio, 2.54; 95% CI, 1.24–5.19) and all-cause mortality (high versus low volatility: hazard ratio, 1.78; 95% CI,1.03–3.09; ≥2 versus 0 income drops: hazard ratio, 1.92; 95% CI, 1.07–3.44).

Conclusions:
In a cohort of relatively young adults, income volatility and drops during a 15-year period of formative earning years were independently associated with a nearly 2-fold risk of CVD and all-cause mortality.
Mind-Body Interventions, Psychological Stressors, and Quality of Life in Stroke Survivors
Authors: Love Mary F. , Sharrief Anjail , Chaoul Alejandro , Savitz Sean , Beauchamp Jennifer E. Sanner 
Published: January 2019

Background and Purpose—
Psychological stressors, including poststroke depression, poststroke anxiety, and posttraumatic stress disorder, are highly prevalent in stroke survivors. These symptoms exact a significant toll on stroke survivors. Clinical and research efforts in stroke recovery focus on motor disability, speech and language deficits, and cognitive dysfunction while largely neglecting psychological stressors. Evidence suggests mind-body interventions in other chronic illness populations decrease symptoms of depression, regulate immune responses, and promote resilience, yet similar studies are lacking in stroke populations. This review aims to synthesize evidence of the effects of mind-body interventions on psychological stressors, quality of life, and biological outcomes for stroke survivors.

Methods—
A systematic search of PubMed, PsycINFO, and CINAHL was conducted from database inception to November 2017.

Results—
Eight studies were included in the review, with a total of 292 participants. Mind-body interventions included yoga or tai chi. Of the 5 included randomized controlled trials, most were pilot or feasibility studies with small sample sizes. Psychological stressors, including poststroke depression and anxiety, along with the quality of life, improved over time, but statistically significant between-group differences were largely absent. The 3 included studies with a qualitative design reported themes reflecting improvement in psychological stressors and quality of life. No included studies reported biological outcomes.

Conclusions—
Studies of mind-body interventions suggest a possible benefit on psychological stressors and quality of life; however, rigorously designed, sufficiently powered randomized controlled trials with mixed-methods design are warranted to delineate specific treatment effects of these interventions. Studies with both biological and psychological stressors as outcomes would provide evidence about interaction effects of these factors on stroke-survivor responses to mind-body interventions.
Vertebral Artery Patency and Thrombectomy in Basilar Artery Occlusions
Authors: Boeckh-Behrens Tobias , Pree David , Lummel Nina , Friedrich Benjamin , Maegerlein Christian , Kreiser Kornelia , Kirschke Jan , Berndt Maria , Lehm Manuel , Wunderlich Silke , Mosimann Pascal J. , Fischer Urs , Zimmer Claus , Kaesmacher Johannes 
Published: January 2019

Background and Purpose—
Factors influencing recanalization success in basilar artery occlusions are largely unknown. Preliminary evidence has suggested that flow arrest in the vertebral artery contralateral to the catheter bearing vertebral artery may facilitate recanalization. The aim of this analysis was to assess the impact of anatomic variations and flow conditions on recanalization success in basilar artery occlusion treated with mechanical thrombectomy.

Methods—
Consecutive basilar artery occlusions treated with second-generation thrombectomy devices at a single-center were retrospectively analyzed. Baseline patients’ characteristics, occlusion length, collateral circulation, underlying stenosis, incomplete occlusions, and patency of the vertebral arteries were analyzed with regards to recanalization success. Aplastic or hypoplastic vertebral artery contralateral to the catheter position was defined as contralateral low flow condition. Logistic regression analysis was used to examine the association between anatomic variations and flow conditions in relation to complete recanalization and the modified Rankin Scale score while controlling for several potentially confounding variables. Clinical impact was evaluated using the modified Rankin Scale score of ≤3.

Results—
One hundred fifteen patients were included (mean age 71.5±12.8, m:f=2:1, median National Institutes of Health Stroke Scale =15, interquartile range =10–22). Complete recanalization was more often observed in patients with contralateral low flow conditions (80.6% versus 50.0%), which remained an independent predictor of complete recanalization in multivariable analysis (adjusted odds ratio, 5.81; 95% CI, 1.97–17.19). Patients with complete posterior recanalization had lower in-hospital mortality (16.4% versus 41.7%) and more often achieved modified Rankin Scale score of ≤3 (49.4% versus 8.3%), even after adjusting for potential confounders (adjusted odds ratio, 15.93; 95% CI, 1.42–179.00).

Conclusions—
Contralateral low flow condition (vertebral artery aplasia or hypoplasia) seems to be an independent factor for fewer distal emboli and complete recanalization in basilar artery occlusion patients treated by modern endovascular devices. Complete recanalization reflecting the absence of peri-interventional clot fragmentation brings clear clinical benefit. Further studies are warranted to evaluate the need for contralateral flow modulation or ipsilateral balloon guide catheter during posterior circulation thrombectomy in patients with bilaterally patent vertebral arteries.
Safety of Carotid Revascularization in Patients With a History of Coronary Heart Disease
Authors: Volkers Eline J. , Algra Ale , Kappelle L. Jaap , Becquemin Jean-Pierre , de Borst Gert J. , Brown Martin M. , Bulbulia Richard , Calvet David , Eckstein Hans-Henning , Fraedrich Gustav , Gregson John , Halliday Alison , Hendrikse Jeroen , Howard George , Jansen Olav , Roubin Gary S. , Bonati Leo H. , Brott Thomas G. , Mas Jean-Louis , Ringleb Peter A. , Greving Jacoba P. ,   on behalf of the Carotid Stenosis Trialists’ Collaboration
Published: January 2019

Background and Purpose—
We investigated whether procedural stroke or death risk of carotid artery stenting (CAS) compared with carotid endarterectomy (CEA) is different in patients with and without history of coronary heart disease (CHD) and whether the treatment-specific impact of age differs.

Methods—
We combined individual patient data of 4754 patients with symptomatic carotid stenosis from 4 randomized trials (EVA-3S [Endarterectomy Versus Angioplasty in Patients With Symptomatic Severe Carotid Stenosis], SPACE [Stent-Protected Angioplasty Versus Carotid Endarterectomy], ICSS [International Carotid Stenting Study], and CREST [Carotid Revascularization Endarterectomy Versus Stenting Trial]). Procedural risk was defined as any stroke or death ≤30 days after treatment. We compared procedural risk between both treatments with Cox regression analysis, stratified by history of CHD and age (<70, 70–74, ≥75 years). History of CHD included myocardial infarction, angina, or coronary revascularization.

Results—

One thousand two hundred ninety-three (28%) patients had history of CHD. Procedural stroke or death risk was higher in patients with history of CHD. Procedural risk in patients treated with CAS compared with CEA was consistent in patients with history of CHD (8.3% versus 4.6%; hazard ratio [HR], 1.96; 95% CI, 0.67–5.73) and in those without (6.9% versus 3.6%; HR, 1.93; 95% CI, 1.40–2.65;
P
interaction
=0.89). In patients with history of CHD, procedural risk was significantly higher after CAS compared with CEA in patients aged ≥75 (CAS-to-CEA HR, 2.78; 95% CI, 1.32–5.85), but not in patients aged <70 (HR, 1.71; 95% CI, 0.79–3.71) and 70 to 74 years (HR, 1.09; 95% CI, 0.45–2.65). In contrast, in patients without history of CHD, procedural risk after CAS was higher in patients aged 70 to 74 (HR, 3.62; 95% CI, 1.80–7.29) and ≥75 years (HR, 2.64; 95% CI, 1.52–4.59), but equal in patients aged <70 years (HR, 1.05; 95% CI, 0.63–1.73; 3-way
P
interaction
=0.09).

Conclusions—
History of CHD does not modify procedural stroke or death risk of CAS compared with CEA. CAS might be as safe as CEA in patients with history of CHD aged <75 years, whereas for patients without history of CHD, risk after CAS compared with CEA was only equal in those aged <70 years.
Impact of prosthetic heart valves on pregnancy in Bangladeshi women
Authors: Ranjan Redoy , Adhikary Dipannita , Saha Sanjoy Kumar , Mandal Sabita , Hasan Kamrul , Adhikary Asit Baran 
Published: January 2019

Background: This study evaluated pregnancy outcome in women with a prosthetic heart valve, especially with the oral anticoagulation therapy that must be weighed against the risk of intracardiac thrombosis. Methods: This multicenter, retrospective, cohort study was undertaken between January 2012 and June 2017. The principal maternal outcome variables included bleeding and thromboembolic complications, infective endocarditis, prosthetic valve thrombosis and heart failure. However, the main foetal outcome variables included miscarriage, mortality, preterm baby, warfarin embryopathy, low birthweight and the mode of delivery. Results: A total of 265 pregnancies in women with prosthetic heart valves were evaluated in two groups: Group I (n = 182) covers a mechanical valve, while Group II (n = 82) covers a bioprosthetic valve. The mean age of the patients was 25.2 ± 2.5 years and 24.5 ± 5.2 years in Group I and Group II, respectively. Approximately 80% of the patients had normal echocardiography findings. However, Group I (mechanical prostheses) has a higher incidence (11.54%) of thrombus formation in comparison with the bioprostheses. Hemorrhagic complications and spontaneous miscarriage were statistically significant (p⩽0.05) between the study groups. However, normal pregnancy outcome (91.57%) was significantly higher (p⩽0.05) in Group II compared to Group I (61.54%). Mean birthweight and mean APGAR score were found normal in both study groups. Only 2.75% of patients have warfarin embryopathy in Group I. Furthermore, comparison of SF-36 scores for HRQOL (Health-Related Quality of Life) before and after pregnancy were statistically insignificant among the study population. Conclusion: Proper antenatal care and early risk stratification are the fundamental measures to improve the maternal and foetal outcomes in a patient with a prosthetic heart valve.
Frequency of use of elastic compression stockings in patients with chronic venous disease of the lower extremities
Authors: Ayala-García Marco Antonio , Reyes Jorge Sanchéz , Muñoz Montes Norberto , Guaní-Guerra Eduardo 
Published: January 2019

Objective To determine the frequency of use of elastic compression stockings in patients with lower extremity chronic venous disease. Methods An explorational, prospective, transversal, observational, descriptive, analytical study including 168 patients was performed. We identified the proportion of patients using elastic compression stockings. The odds ratio (OR) was used to determine the relation between elastic compression stocking use and previous medical attention for chronic venous disease. Results Only 59 patients (35.1%) were using elastic compression stockings at the time of the study. We determined that the patients who had received previous medical attention to manage chronic venous disease in their lower extremities were >3 times more likely to use elastic compression stockings than patients who had not received previous medical attention (OR = 3.3, p < 0.0001). Conclusions Although there is sufficient evidence of the effectiveness of elastic compression stockings for treating chronic venous disease in the lower extremities, their use is relatively infrequent (35.1%).
Predictors of Health Self-Management Program Preference Among Lower-to-Middle Wage Employed Adults With Chronic Health Conditions
Authors: Kneipp Shawn M. , Horrell Lindsey , Gizlice Ziya , Smith Matthew Lee , Linnan Laura , Brady Teresa 
Published: January 2019

Purpose: We examined the extent to which demographic, chronic disease burden, and financial strain characteristics were associated with a preference for engaging in the Chronic Disease Self-Management Program (presented as a “health self-management program” [HSMP]) over a financial self-management program (FSMP) and a no program preference (NPP) group among employed adults. Design: Cross-sectional, correlation design using baseline data from a randomized controlled trial (RCT). Subjects: The analytic sample included 324 workers aged 40 to 64 years with 1 or more chronic disease conditions recruited into the RCT from 2015 to 2017. Measures: Chronic disease burden measures included the number of chronic conditions, body mass index (BMI), and the 8-item and 15-item Patient Health Questionnaire (PHQ-8 and PHQ-15). Financial strain was measured as the inability to purchase essentials and food assistance receipt. Both individual and household measures of income were assessed. Analyses: Multinomial logistic regression and post-hoc marginal effects models. Results: Moderate-to-severe depressive symptoms increased the likelihood of having an HSMP preference when compared with those preferring the FSMP (RR = 4.2, P < .05) but not those having NPP; while higher BMI marginally increased HSMP preference over FSMP preference, but not NPP groups (RR = 1.04, P < .05). Financial strain differentially, but significantly, reduces the likelihood of HSMP preference at varying levels of household poverty, depressive symptom severity, and financial strain. Conclusion: Middle-aged, lower-to-middle income workers with moderate-to-severe depressive symptoms opt for HSMPs over FSMPs, but preference for HSMPs significantly diminished when they are experiencing financial strain.
Key Drivers of State Preemption of Food, Nutrition, and Agriculture Policy: A Thematic Content Analysis of Public Testimony
Authors: Pomeranz Jennifer L. , Pertschuk Mark 
Published: January 2019

Purpose: Local communities are often active public health policy makers, so state preemption—when the state withdraws authority from local governments—can hinder public health progress. Kansas enacted the most sweeping law in the nation preempting food, nutrition, and agricultural policy. Design: Qualitative thematic content analysis was used on public comments to identify and evaluate common and key arguments. A codebook was developed using an iterative process. Open coding was applied to all comments. Setting: All testimony and comments submitted by individuals and organizations to the Kansas State Legislature on the preemptive bill. Participants: Eight types of commentators submitted 34 written and 12 oral comments. Measures: The data were evaluated on a latent level to examine underlying drivers of preemption. Results: Comments addressed 18 themes, referenced 366 times; 68% in opposition. Common themes included local control, food labeling, public health, need for statewide standards, and debate over food regulation. Key themes included the need for state and federal uniformity to support businesses and consumers, debate over topics not in the bill, the value of local control, confusion over bill coverage, and outside influences. Conclusion: Confusion about bill language and coverage, the combination of food and agricultural issues, and backing by multinational corporations helped propel preemption forward in Kansas. Food policy stakeholders nationally can anticipate similar arguments and strategies in their state.
Anticoagulation of a Percutaneous Left Ventricular Assist Device Using a Low-Dose Heparin Purge Solution Protocol: A Case Series
Authors: Newsome Andrea Sikora , Taylor Ashley , Garner Seth 
Published: January 2019

Background Impella CP® is a percutaneous left ventricular assist device that requires a heparin–dextrose purge solution. The manufacturer recommends heparin 50 units/mL, but supratherapeutic anticoagulation has been observed with this concentration. Objective The purpose of this evaluation was to observe the efficacy and safety of a low-dose heparin-based purge solution (25 units/mL in dextrose 20%). The primary outcome evaluated percentage of activated clotting times (ACTs) below therapeutic range. Secondary objectives included evaluating the incidence of device thrombosis and rate of heparin-induced thrombocytopenia (HIT). Platelet trends were characterized. Methods A single-site retrospective review was conducted for all adults with the Impella CP from January 2015 to December 2017. Results A total of 18 patients were included. The percentage of ACT readings within goal of 160 to 200 seconds was 49%, and 38% of readings were subtherapeutic. Per BARC bleeding criteria, 22% (n = 4) patients experienced class IIIa bleeding and 39% (n = 7) experienced class II bleeding. Though 4 (22%) patients were tested for HIT, no patients were positive. Patients showed universal reductions in platelet counts. Conclusions The use of a low-dose anticoagulation protocol of heparin 25 units/mL in dextrose 20% as needed warrants further evaluation.
Psychometric evaluation of the Informed Consent Process Scale in Chinese
Authors: Chen Shu Yu , Chang Shu-Chen Susan , Lin Chiu-Chu , Lou Qingqing , Anderson Robert M 
Published: January 2019

Background: Informed consent is essential for the ethical conduct of clinical research and is a culturally sensitive issue. But, a measurable Chinese version of the scale to evaluate the informed consent process has not yet been explored in the existing literature. Research objectives: This study aimed to develop and psychometrically test the Chinese version of the Informed Consent Process Scale. Research design: Back-translation was conducted to develop the Chinese version of the questionnaire. A cross-sectional survey was administered, after which an exploratory factor analysis was conducted. Participants: We recruited a total of 375 participants who had experience in signing an informed consent form within the previous 3 years in Taiwan. Ethical considerations: This study was approved by two Institutional Review Boards and the autonomy of the participants was respected. Findings: The Chinese version of the Informed Consent Process Scale is composed of three factors with 23 items showing evidence of acceptable reliability and validity. Three major factors were extracted and labeled: Factor 1 – ‘Understanding of the research’, Factor 2 – ‘Trust and confidence’ and Factor 3 – ‘Doubt and uncertainty’. The three factors accounted for is 52.954 of the total variance with Cronbach’s α of .917. Discussion and conclusion: The finding corroborates previous studies showing that participants had too little understanding on the informed consent forms they signed and implied the need to clarify the critical points in clinical research. The psychometric results indicated good internal consistency and validity for this newly constructed instrument, and it was found worthy of conducting further testing and application.
Factors That Influence Attitudes Toward End-of-Life Care Among Medical Students: Nationwide Survey for Fourth-Year Korean Medical Students
Authors: Kim Do Yeun , Kim Kyong-Jee , Shin Sung Joon , Heo Dae Seog , Lee Soon Nam , Nam Eun Mi 
Published: January 2019

Background: Positive attitudes for end-of-life (EOL) care along with adequate education are key factors for the provision of quality EOL care. This national study was conducted to identify the factors that influence attitudes toward EOL care on medical students. Method: An anonymous survey was designed and administered to fourth-year medical students at all 41 medical schools in Korea. Topics related to EOL care were assessed in classroom teaching, bedside teaching, and feedback experiences during clinical clerkships. Seven questions for self-rated attitudes and affecting factors were analyzed toward EOL care. Results: With a response rate of 49.2%, the median number of topics recognized by the students as having been delivered was 5 of 11 topics in classroom lectures and 1 of 8 topics in clinical experience. Although few (21.2%) participants indicated that they felt ready for EOL care practice, nevertheless, most felt that they should have adequate knowledge of and preparation for clinical competency in EOL care. Several parameters including respondent’s demographics and exposure to EOL care topics in classroom and in bedside teaching influenced the responses to all 7 attitude questions. However, having more than 1 bedside experience was the only factor positively affecting all attitudinal measures. Conclusions: Clinical experience related to EOL care seems to be the utmost priory in fostering positive attitudes and competency among medical students.