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Microinfarcts in the Deep Gray Matter on 7T MRI: Risk Factors, MRI Correlates, and Relation to Cognitive Functioning-The SMART-MR Study.

AJNR Am J Neuroradiol 2022 May 26. Epub 2022 May 26.

Julius Center for Health Sciences and Primary Care (R.G., I.R., M.I.G.)

Background And Purpose: The clinical relevance of cortical microinfarcts has recently been established; however, studies on microinfarcts in the deep gray matter are lacking. We examined the risk factors and MR imaging correlates of microinfarcts in the deep gray matter on 7T MR imaging and their relation to cognitive functioning.

Materials And Methods: Within the Second Manifestations of ARTerial disease-Magnetic Resonance (SMART-MR) study, 213 patients (mean age, 68 [SD, 8] years) had a risk-factor assessment, 7T and 1. Read More

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Views about Primary Care health checks for autistic adults: UK survey findings.

BJGP Open 2022 May 26. Epub 2022 May 26.

Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Morpeth, UK.

Background: Compared to the general population, autistic adults experience higher rates of physical and mental health conditions, premature morbidity and mortality, and barriers to healthcare. A health check for autistic people may improve their health outcomes.

Aim: To establish the views of autistic people toward a primary care health check for autistic people. Read More

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Current Landscape of Produce Prescription Programs in the US.

J Nutr Educ Behav 2022 Jun;54(6):575-581

Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA.

Objective: To understand the design and implementation models of US produce prescription programs.

Methods: In a mixed-methods study, program providers completed an online survey and an individual phone interview regarding their 2019 programming.

Results: Twenty-three programs completed surveys; 20 completed interviews. Read More

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Increased risk of incident knee osteoarthritis in those with greater work-related physical activity.

Occup Environ Med 2022 May 26. Epub 2022 May 26.

Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts, USA.

Objective: Occupations involving greater physical activity may increase risk for knee osteoarthritis (OA). Existing studies have not evaluated work-related physical activity before OA onset. Hence, we aimed to evaluate the association between work-related physical activity and knee OA incidence. Read More

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Call for Formalized Pathways in Vascular Medicine Training: JACC Review Topic of the Week.

J Am Coll Cardiol 2022 May;79(21):2129-2139

Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

The burden of vascular diseases and complexity of their management have been growing. Vascular medicine specialists may help to bridge gaps in care, especially as part of multidisciplinary teams. However, there is a limited number of vascular medicine specialists because of constraints in training. Read More

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Gender Differences in Takotsubo Syndrome.

J Am Coll Cardiol 2022 May;79(21):2085-2093

University of Foggia, Department of Medical and Surgical Sciences, Foggia, Italy.

Background: Male sex in takotsubo syndrome (TTS) has a low incidence and it is still not well characterized.

Objectives: The aim of the present study is to describe TTS sex differences.

Methods: TTS patients enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry were analyzed. Read More

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Fracture Risk of Sodium-Glucose Cotransporter-2 Inhibitors in Chronic Kidney Disease.

Clin J Am Soc Nephrol 2022 May 26. Epub 2022 May 26.

Institute for Clinical and Evaluative Sciences (ICES), London, Ontario, Canada.

Background And Objectives: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been associated with a higher risk of skeletal fractures in some randomized, placebo-controlled trials. Secondary hyperparathyroidism and increased bone turnover (also common in CKD) may contribute to the observed fracture risk. We aimed to determine if SGLT2 inhibitor use associates with a higher risk of fractures compared with dipeptidyl peptidase-4 (DPP-4) inhibitors, which have no known association with fracture risk. Read More

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Mediator or moderator? The role of obesity in the association between age at menarche and blood pressure in middle-aged and elderly Chinese: a population-based cross-sectional study.

BMJ Open 2022 May 26;12(5):e051486. Epub 2022 May 26.

Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China.

Objective: We investigated the moderation/mediation between the age of menarche and obesity parameters in predicting blood pressure (BP) in middle-aged and elderly Chinese.

Design: Our study is a population-based cross-sectional study.

Setting: Participants in this study came from the China Health and Retirement Longitudinal Study (CHARLS). Read More

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Preferences of Australian healthcare providers regarding education on long-term health after hypertensive disorders of pregnancy: a qualitative study.

BMJ Open 2022 May 26;12(5):e055674. Epub 2022 May 26.

Discipline of Women's Health, University of New South Wales Faculty of Medicine and Health, Sydney, New South Wales, Australia.

Objectives: To explore Australian healthcare providers' (HCPs') preferred content, format and access to education regarding long-term health after hypertensive disorder of pregnancy (HDP), in order to guide the development of education programmes.

Design And Setting: A qualitative study using a framework analysis was undertaken. Registered HCP who were practising in Australia and previously completed a survey about long-term health after HDP were invited to participate. Read More

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Emergency department and urgent care clinician perspectives on digital access to past medical histories.

BMJ Health Care Inform 2022 May;29(1)

Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.

Objective: To explore emergency department (ED) and urgent care (UC) clinicians' perceptions of digital access to patients' past medical history (PMH).

Methods: An online survey compared anticipated and actual value of access to digital PMH. UTAUT2 (Unified Theory of Acceptance and Use of Technology 2) was used to assess technology acceptance. Read More

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Improving referrals to community mental health services in the liaison setting.

BMJ Open Qual 2022 May;11(2)

Newham Mental Health Liaison and Psychological Medicine Team, Barts Health NHS Trust, London, UK.

The East London Foundation Trust (ELFT) psychiatric liaison team (PLT) at Newham University Hospital (NUH) is responsible for referring adult patients they have reviewed, on to community mental health services on discharge where appropriate, and also to notify their existing team for follow-up on discharge when already under the care of a community service. This should then lead to appropriate ongoing management of the patient's mental health needs in terms of continued support and assessment of risk, further assessment of mental state, titration of medications and prevention of further admissions.Following an ELFT incident review where it was noted that a patient was not referred to community services on discharge, a retrospective case note review was undertaken over an 11-month period to define the baseline efficacy of current referrals. Read More

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The unintended consequences of COVID-19 vaccine policy: why mandates, passports and restrictions may cause more harm than good.

BMJ Glob Health 2022 May;7(5)

Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland, USA.

Vaccination policies have shifted dramatically during COVID-19 with the rapid emergence of population-wide vaccine mandates, domestic vaccine passports and differential restrictions based on vaccination status. While these policies have prompted ethical, scientific, practical, legal and political debate, there has been limited evaluation of their potential unintended consequences. Here, we outline a comprehensive set of hypotheses for why these policies may ultimately be counterproductive and harmful. Read More

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Assessing the burden of COVID-19 in developing countries: systematic review, meta-analysis and public policy implications.

BMJ Glob Health 2022 May;7(5)

Western Sydney Diabetes, Western Sydney Local Health District, Blacktown, New South Wales, Australia

Introduction: The infection fatality rate (IFR) of COVID-19 has been carefully measured and analysed in high-income countries, whereas there has been no systematic analysis of age-specific seroprevalence or IFR for developing countries.

Methods: We systematically reviewed the literature to identify all COVID-19 serology studies in developing countries that were conducted using representative samples collected by February 2021. For each of the antibody assays used in these serology studies, we identified data on assay characteristics, including the extent of seroreversion over time. Read More

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Optimizing Post-Acute Care Patient Safety: A Scoping Review of Multifactorial Fall Prevention Interventions for Older Adults.

J Appl Gerontol 2022 May 26:7334648221104375. Epub 2022 May 26.

Department of Sociology, 14669California State University Los Angeles, Los Angeles, CA, USA.

Accidental falls are preventable adverse events for older post-acute care (PAC) patients. Yet, due to the functional and medical care needs of this population, there is little guidance to inform multidisciplinary prevention efforts. This scoping review aims to characterize the evidence for multifactorial PAC fall prevention interventions. Read More

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Responding to emerging oral healthcare needs with CARE: Design of the CARE curriculum model.

J Dent Educ 2022 May 26. Epub 2022 May 26.

Department of Primary Care, High Point University Workman School of Dental Medicine, High Point, North Carolina, USA.

The release of the National Institutes of Health report, Oral Health in America: Advances and Challenges, in 2022 identified a pressing concern about oral healthcare and that "the job is far from finished." The High Point University Workman School of Dental Medicine utilized this report as inspiration to facilitate the design of the Clinician-Advocate-Researcher-Entrepreneur Curriculum. The aspiration was to create a novel curriculum and experiential model to prepare learners for the future of dental medicine, including addressing these public oral healthcare needs. Read More

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Association of Ankle Sprain Frequency With Body Mass and Self-Reported Function: A Pooled Multisite Analysis.

J Sport Rehabil 2022 May 26:1-6. Epub 2022 May 26.

School of Health and Kinesiology, University of Nebraska, Omaha, NE,USA.

Context: Ankle sprains result in pain and disability. While factors such as body mass and prior injury contribute to subsequent injury, the association of the number of ankle sprains on body anthropometrics and self-reported function are unclear in this population. Therefore, the purpose of this investigation was to assess differences in anthropometric measurements and self-reported function between the number of ankle sprains utilizing a large, pooled data set. Read More

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Association between thoracic epidural block and major complications after pleurectomy/decortication for malignant pleural mesothelioma under general anesthesia.

Reg Anesth Pain Med 2022 May 20. Epub 2022 May 20.

Department of Anesthesiology and Pain Medicine, Hyogo Medical University, School of Medicine, Nishinomiya, Hyogo, Japan

Introduction: A curative-intent surgical procedure, pleurectomy/decortication, for malignant pleural mesothelioma is accompanied by a high incidence of major postoperative complications. Although epidural block, which suppresses nociception during and after surgery, reportedly has both benefits and disadvantages in terms of outcomes after thoracic surgery for other diseases, the effects of epidural block on major complications after pleurectomy/decortication have not been evaluated. The aim of this study was to evaluate the association between epidural block and major postoperative complications following pleurectomy/decortication. Read More

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Health effects of exposure to residential air pollution in patients with pulmonary arterial hypertension: A cohort study in Belgium.

Eur Respir J 2022 May 26. Epub 2022 May 26.

Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases & Metabolism (CHROMETA), KU Leuven, Leuven, Belgium

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Excess ventilation and exertional dyspnoea in heart failure and pulmonary hypertension.

Eur Respir J 2022 May 26. Epub 2022 May 26.

Professor Emeritus, John Rankin Laboratory of Pulmonary Medicine, Dept of Population Health Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA.

Increased ventilation relative to metabolic secondary to alveolar hyperventilation and/or increased physiological dead space (excess ventilation) is a key cause of exertional dyspnoea. Excess ventilation has assumed a prominent role in the functional assessment of patients with heart failure (HF) with reduced (r) or preserved (p) ejection fraction, pulmonary arterial hypertension (PAH), and chronic thromboembolic PH (CTEPH). We herein provide the key pieces of information to the caring physician to a) gain unique insights into the seeds of patients' shortness of breath, and b) develop a rationale for therapeutically lessening excess ventilation to mitigate this distressing symptom. Read More

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Patterns of Adverse Childhood Experiences and Cardiovascular Risk Factors in U.S. Adults.

Stress Health 2022 May 26. Epub 2022 May 26.

VA San Diego Healthcare System, Mental Health, 3350 La Jolla Villiage Drive, San Diego, California, US.

Adverse Childhood Experiences (ACEs) are associated with poor health yet, we know little about how distinct patterns of ACE types are associated with cardiovascular (CVD) risk factors. The current study 1) examined associations of latent ACE classes with modifiable CVD risk factors including high cholesterol, smoking, diabetes, hypertension, high triglycerides, physical inactivity, overweight/obesity, and lifetime depression; and 2) examined the impact of socioeconomic status-related (SES) factors on these relationships. Using a cross-sectional analysis of the NESARC-III (n=36,309) data, four latent classes of ACEs were previously identified: 1) low adversity, 2) primarily household dysfunction, 3) primarily maltreatment, and 4) multiple adversity types. Read More

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PREVALENCE AND IMPACT OF COMORBIDITIES IN INDIVIDUALS WITH COPD: A SYSTEMATIC REVIEW.

Tuberc Respir Dis (Seoul) 2022 May 27. Epub 2022 May 27.

State University of Bahia (UNEB), Brazil.

Objectives: To describe the frequency of comorbidities associated with COPD and their relation with relevant outcomes.

Methods: A systematic review based on the PRISMA methodology was performed. The systematic search was carried until July 2021, using the MEDLINE, Lilacs and Scielo databases to identify studies related to COPD and its comorbidities. Read More

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Factors Influencing Palliative Care Access and Delivery for Great Plains American Indians.

J Pain Symptom Manage 2022 May 23. Epub 2022 May 23.

Massachusetts General Hospital, Division of Palliative Care and Geriatric Medicine, Boston, MA, USA.

Context: Despite the known importance of culturally tailored palliative care (PC), American Indian people (AIs) in the Great Plains lack access to such services. While clinicians caring for AIs in the Great Plains have long acknowledged major barriers to serious illness care, there is a paucity of literature describing specific factors influencing PC access and delivery for AI patients living on reservation land.

Objectives: This study aimed to explore factors influencing PC access and delivery on reservation land in the Great Plains to inform the development culturally tailored PC services for AIs. Read More

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"Calling the Spirit Back:" Spiritual Needs Among Great Plains American Indians.

J Pain Symptom Manage 2022 May 23. Epub 2022 May 23.

Massachusetts General Hospital, Division of Palliative Care and Geriatric Medicine, Boston, MA, USA.

Context: American Indians (AIs) are disproportionately affected by serious illness such as cancer. Colonization, cultural genocide, and trauma have adversely affected AIs' ability to attain health and well-being, and in many cases led to the loss of the right to practice traditional ceremonies and rituals. Still many AIs describe well-being as being rooted in spirituality. Read More

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Heterogeneity of treatment effect in a randomized trial of a communication intervention.

J Pain Symptom Manage 2022 May 23. Epub 2022 May 23.

Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, WA, USA.

Context: Interventions to promote serious illness conversations have shown promise in promoting high-quality care. However, in randomized trials, some participants may benefit more from the intervention than others.

Objectives: To examine heterogeneity of treatment effect and identify subgroups of patients with serious illness who might benefit most from interventions to enhance communication about goals of care. Read More

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