Endocrine disruptor-induced epimutagenesis in vitro : Insight into molecular mechanisms.

Endocrine disrupting chemicals (EDCs) such as bisphenol S (BPS) are xenobiotic compounds that can disrupt endocrine signaling following exposure due to steric similarities to endogenous hormones within the body. EDCs have been shown to induce disruptions in normal epigenetic programming (epimutations) that accompany dysregulation of normal gene expression patterns that appear to predispose disease states. Most interestingly, the prevalence of epimutations following exposure to many different EDCs often persists over multiple subsequent generations, even with no further exposure to the causative EDC. Many previous studies have described both the direct and prolonged effects of EDC exposure in animal models, but many questions remain about molecular mechanisms by which EDCs initially induce epimutations or contribute to the propagation of EDC-induced epimutations either within the exposed generation or to subsequent generations. Additional questions remain regarding the extent to which there may be differences in cell-type specific susceptibilities to various EDCs, and whether this susceptibility is correlative with expression of relevant hormone receptors and/or the location of relevant hormone response elements (HREs) in the genome. To address these questions, we exposed cultured mouse pluripotent (induced pluripotent stem [iPS]), somatic (Sertoli and granulosa), and germ (primordial germ cell like [PGCLC]) cells to BPS and measured changes in DNA methylation levels at the epigenomic level and gene expression at the transcriptomic level. We found that there was indeed a difference in cell-type specific susceptibility to EDC-induced epimutagenesis and that this susceptibility correlated with differential expression of relevant hormone receptors and, in many cases, tended to generate epimutations near relevant HREs within the genome. Additionally, however, we also found that BPS can induce epimutations in a cell type that does not express relevant receptors and in genomic regions that do not contain relevant HREs, suggesting that both canonical and non-canonical signaling mechanisms can be disrupted by BPS exposure. Most interestingly, we found that when iPS cells were exposed to BPS and then induced to differentiate into PGCLCs, the prevalence of epimutations and differentially expressed genes (DEGs) initially induced in the iPSCs was largely retained in the resulting PGCLCs, however, >90% of the specific epimutations and DEGs were not conserved but were rather replaced by novel epimutations and DEGs following the iPSC to PGCLC transition. These results are consistent with a unique concept that many EDC-induced epimutations may normally be corrected by germline and/or embryonic epigenetic reprogramming but that due to disruption of the underlying chromatin architecture induced by the EDC exposure, many novel epimutations may emerge during the reprogramming process as well. Thus, it appears that following exposure to a disruptive agent such as an EDC, a prevalence of epimutations may transcend epigenetic reprogramming even though most individual epimutations are not conserved during this process.

Evaluation of the Safer Use of Antipsychotics in Youth Study on Population Level Antipsychotic Initiation: An Interrupted Time Series Analysis.

Background: Antipsychotics carry a higher-risk profile than other psychotropic medications and may be prescribed for youth with conditions in which other first-line treatments are more appropriate. This study aimed to evaluate the population-level effect of the Safer Use of Antipsychotics in Youth (SUAY) trial, which aimed to reduce person-days of antipsychotic use among participants. Methods: We conducted an interrupted time series analysis using segmented regression to measure changes in prescribing trends of antipsychotic initiation rates pre-SUAY and post-SUAY trial at four U.S. health systems between 2013 and 2020. Results: In our overall model, adjusted for age and insurance type, antipsychotic initiation rates decreased by 0.73 (95% confidence interval [CI]: 0.30, 1.16, p = 0.002) prescriptions per 10,000 person-months before the SUAY trial. In the first quarter following the start of the trial, there was an immediate decrease in the rate of antipsychotic initiations of 6.57 (95% CI: 0.99, 12.15) prescriptions per 10,000 person-months. When comparing the posttrial period to the pretrial period, there was an increase of 1.09 (95% CI: 0.32, 1.85) prescriptions per 10,000 person-months, but the increasing rate in the posttrial period alone was not statistically significant (0.36 prescriptions per 10,000 person-months, 95% CI: -0.27, 0.99). Conclusion: The declining trend of antipsychotic initiation seen between 2013 and 2018 (pre-SUAY trial) may have naturally reached a level at which prescribing was clinically warranted and appropriate, resulting in a floor effect. The COVID-19 pandemic, which began in the final three quarters of the posttrial period, may also be related to increased antipsychotic medication initiation.

Principles for Primary Care Screening in the Context of Population Health.

A key component of primary care pediatrics is health promotion through screening: applying a test or procedure to detect a previously unrecognized disease or disease risk. How do we decide whether to screen? In 1965, Wilson and Jungner published an influential set of screening principles focused on the health problem's importance, the screening tool's performance, and the evidence for treatment efficacy. However, if we want realistic estimates of the population effects of routine screening, we must also account for the health care system's real-world functioning and disparities in care. We offer revised principles to guide discussions about routine screening in the primary care setting. We add to Wilson and Jungner's principles: 1. A focus on life course epidemiology and its consequences for population health, 2. A need to screen for the early stages of chronic health problems, 3. A concern for screening's acceptability to providers and the community, 4. A recommendation for estimating the uncertainty in benefits and harms in evaluating screening, 5. Inclusion of systematic plans for population data collection and monitoring, and 6. Recognition that achieving population health improvement requires a high-performing system with sufficient throughput and monitoring to deliver accessible, affordable, and effective care, especially for the groups experiencing the greatest inequities in access. Above all, instead of assuming best practices in treatment delivery and monitoring after screening, we argue for realism about the health care system functioning in routine practice.

Suicide prevention for substance using youth experiencing homelessness: study protocol for a randomized controlled trial.

BACKGROUND: While research on substance using youth experiencing homelessness (YEH) is increasing, there is a dearth of information regarding effective prevention interventions for these youth. Suicide is the leading cause of death among YEH and most youth do not access services that may be available to them. Therefore, this study seeks to address this gap in the research literature with the goal to identify an effective suicide prevention intervention that can be readily adopted by communities that serve these youth. METHODS: Three hundred (N = 300) YEH with recent substance use and suicidal ideation or a recent suicide attempt will be recruited from the streets as well as a drop-in center serving YEH. After the baseline assessment, all youth will be randomly assigned to Cognitive Therapy for Suicide Prevention (CTSP) + Services as Usual (SAU) (N = 150) or to SAU alone (N = 150). SAU includes outreach, advocacy, and service linkage whereas YEH who receive CTSP will also receive ten CTSP sessions and an optional nine booster sessions. Follow-up assessments will be conducted at 3, 6, 9, and 12 months post-baseline. Theoretically derived mediators (e.g., cognitive distortions) will be tested to shed light on mechanisms associated with change, and the moderating effects of sex, race, sexual orientation, and baseline service connection will be examined. In order to ease future dissemination of the intervention to agencies serving YEH, we will rigorously assess acceptability, feasibility, fidelity, and cost associated with the delivery of our intervention approach using a mixed-methods approach. DISCUSSION: This study adds to a very small number of clinical trials seeking to prevent lethal suicide among a very high-risk group by addressing suicidal ideation directly rather than underlying conditions. It is hypothesized that youth receiving CTSP + SAU will show greater reductions in suicidal ideation (primary outcome), substance use, and depressive symptoms (secondary outcomes) over time compared to SAU alone, as well as improved risk and protective factors. TRIAL REGISTRATION: NCT05994612. Date of Registration: August 16, 2023.

The clip cage conundrum: Assessing the interplay of confinement method and aphid genotype in fitness studies.

Behavior and fitness are important ecological traits frequently measured in insect bioassays. A common method to measure them in soft-bodied herbivorous insects involves confining individuals to plant leaves using clip cages. Although studies have previously highlighted the negative effects of clip cages on leaf physiology, little is known about the impact that using this confinement method has on insect fitness. The responses of different aphid genotypes/clones to different containment methods have not previously been investigated. Here we measured key fitness traits (intrinsic rate of natural increase, mean relative growth rate, time to reach reproductive adulthood and population doubling time) in the potato aphid, Macrosiphum euphorbiae Thomas (Hemiptera: Aphididae), when confined to plants using two methods: (1) clip cages to confine aphids to individual strawberry leaves and (2) a mesh bag to confine aphids to whole strawberry plants. Our study identified a strong negative impact on all the measured aphid fitness traits when using clip cages instead of mesh bags. We also identified genotype-specific differences in response to confinement method, where clip cage confinement differentially affected the fitness of a given aphid genotype compared to the same genotype on whole plants. These results suggest that clip cage use should be carefully considered when experiments seek to quantify insect fitness and that whole plants should be used wherever possible. Given the prevalence of clip cage use in insect bioassays, our results highlight the need for caution when interpreting the existing literature as confinement method significantly impacts aphid fitness depending on their genotype.

Rural-urban differences in social and emotional protective factors and their association with child health and flourishing.

BACKGROUND: Children in rural communities experience higher mortality rates and less access to health care services than those in urban communities. Protective factors like social support also vary by geography, but their contribution to differences in child health is understudied. Understanding geographic variation in protective health factors could provide insight into their impact on health and guide future intervention strategies. RESEARCH OBJECTIVE: To examine protective factors' association with child flourishing and child health status in rural and urban communities. METHODS: Publicly available data from the National Survey of Children's Health, 2018-2021, with nonmissing geographic data (N = 150,493) were used to assess the relationship between protective factors and child flourishing and health by rurality. Multivariate survey-weighted probit models examined these relationships, adjusting for child and caregiver characteristics. FINDINGS: More than a third of children were not flourishing, according to parental report. An estimated 62% of rural children were flourishing compared to 66% of urban children (P<0.001). Urban caregivers also were more likely to report better adult mental and physical health status. Nevertheless, rural children were reported to receive more social support than urban children, while their caregivers reported more emotional support and living in supportive and safe neighborhoods (P<0.001). Rural caregivers reported more support from places of worship and less from counselors/other mental health care providers than urban caregivers. CONCLUSIONS: Despite higher reported caregiver emotional support and child social support, fewer rural children are flourishing. Health systems and community organizations able to leverage these existing social and emotional protective factors in rural communities could help close this gap.

Staphylococcus aureus Modulates Carotenoid and Phospholipid Content in Response to Oxygen-Restricted Growth Conditions, Triggering Changes in Membrane Biophysical Properties.

Staphylococcus aureus membranes contain carotenoids formed during the biosynthesis of staphyloxanthin. These carotenoids are considered virulence factors due to their activity as scavengers of reactive oxygen species and as inhibitors of antimicrobial peptides. Here, we show that the growth of S. aureus under oxygen-restricting conditions downregulates carotenoid biosynthesis and modifies phospholipid content in biofilms and planktonic cells analyzed using LC-MS. At oxygen-restrictive levels, the staphyloxanthin precursor 4,4-diapophytofluene accumulates, indicating that the dehydrogenation reaction catalyzed by 4,4'-diapophytoene desaturases (CrtN) is inhibited. An increase in lysyl-phosphatidylglycerol is observed under oxygen-restrictive conditions in planktonic cells, and high levels of cardiolipin are detected in biofilms compared to planktonic cells. Under oxygen-restriction conditions, the biophysical parameters of S. aureus membranes show an increase in lipid headgroup spacing, as measured with Laurdan GP, and decreased bilayer core order, as measured with DPH anisotropy. An increase in the liquid-crystalline to gel phase melting temperature, as measured with FTIR, is also observed. S. aureus membranes are therefore less condensed under oxygen-restriction conditions at 37 °C. However, the lack of carotenoids leads to a highly ordered gel phase at low temperatures, around 15 °C. Carotenoids are therefore likely to be low in S. aureus found in tissues with low oxygen levels, such as abscesses, leading to altered membrane biophysical properties.

Lessons learned from housing first, rapid rehousing trials with youth experiencing homelessness.

BACKGROUND: Youth, 18 to 24 years, experiencing homelessness (YEH) are recognized as having developmental challenges dissimilar to older adults. Yet, research on efforts to end homelessness and prevent or intervene in drug use and mental health problems among youth have lagged behind that of adults. The Housing First (HF) Model which underlies Permanent Supportive Housing (PSH) and Rapid Re-Housing (RRH) has become preferred over treatment-first models. METHODS AND RESULTS: We provide an overview of PSH and RRH studies to date and summarize our current understanding of their utility for use with YEH. Finally, we review our team's current and past randomized trials testing RRH with YEH, providing lessons learned and recommendations. CONCLUSION: Current research efforts to guide best practices are hampered by a lack of fidelity to HF principles, lack of randomized design, and lack of focus on youth. Lessons learned and recommendations from our work are offered to facilitate the future work of those who seek to end homelessness and address drug use and mental health problems among youth.

Hair Collection for Cortisol Among Youth Experiencing Homelessness.

BACKGROUND: Investigations of chronic physiological stress measured by hair cortisol are rapidly expanding among community samples of adolescents and adults. However, research examining physiological stress among youth experiencing homelessness is nascent despite the youth's increased risk for adverse exposures and subsequent impaired mental health. OBJECTIVE: This article aimed to examine the feasibility of collecting hair for measuring cortisol among diverse youth experiencing homelessness and gain an understanding of variation in participation. METHODS: Analysis of survey and hair participation data from three pilot studies among youth experiencing homelessness was conducted. Survey measures included sociodemographic characteristics (age, race and ethnicity, sex assigned at birth, and sexual orientation) and reasons for nonparticipation. Descriptive analysis examined participation rates in hair collection for cortisol measurement, including sociodemographic differences in participation. RESULTS: Participation in the hair sampling for cortisol was high for the combined sample (88.4%), with some variation across the three pilot studies. Insufficient hair for cutting was the most common reason for not participating; Black and multiracial youth, as well as male youth, had a higher prevalence of nonparticipation. DISCUSSION: The collection of hair for cortisol research among youth experiencing homelessness is feasible, and integration of physiological measures of stress into research with this vulnerable population should be considered, given their high risk for adversity and death by suicide and drug overdose. Methodological considerations and avenues for potential research are discussed.

Healthcare Use Among Black and White Congenital Heart Disease Medicaid Enrollees.

Congenital heart disease (CHD) is the most common birth anomaly in the US. Research shows lost-to-follow-up trends and racial disparities in healthcare use. This study examines racial differences in healthcare use among Medicaid-covered children with CHD. Using 2010-2019 claims data from a pediatric Medicaid Accountable Care Organization, 960 Black and White children with complex CHD and ≥ 3 years of continuous Medicaid coverage were identified. Three cohorts were constructed (starting age: < 1-year-olds, 1-5-year-olds, 6-15-year-olds) and followed for 3 years. Multivariate analysis assessed annual healthcare use (cardiology, primary care, emergency department) by race, adjusting for patient and provider covariates. Overall, 51% of patients had an annual cardiology visit, and 54% had an annual primary care visit. Among the 1-5-year-old cohort, Black children were predicted to be 13% less likely to have an annual cardiology visit compared to their White counterparts (p = 0.001). Older Black children were predicted to be more likely to have a primary care visit compared to their White counterparts. Nearly half of Medicaid-enrolled children with complex CHD did not receive recommended cardiology care. Young Black children were less likely to receive an annual cardiac visit, while older Black children were more likely to receive primary care. While the percentage with an annual cardiac visit was low, the majority had seen a cardiologist within the 3-year window, suggesting these children are still receiving cardiology care, if less frequently than recommended. Opportunities exist for cardiology and primary care to collaborate to ensure patients receive timely recommended care.

Trends in Office-Based Anxiety Treatment Among US Children, Youth, and Young Adults: 2006-2018.

BACKGROUND AND OBJECTIVES: Anxiety disorder diagnoses in office-based settings increased for children through the mid-2010s, but recent changes in diagnosis and treatment are not well understood. The objectives of the current study were to evaluate recent trends in anxiety disorder diagnosis and treatment among children, adolescents, and young adults. METHODS: This study used serial cross-sectional data from the National Ambulatory Medical Care Survey (2006-2018), a nationally representative annual survey of US office-based visits. Changes in anxiety disorder diagnosis and 4 treatment categories (therapy alone, therapy and medications, medications alone, or neither) are described across 3 periods (2006-2009, 2010-2013, 2014-2018). Multinomial logistic regression compared differences in treatment categories, adjusting for age group, sex, and race/ethnicity, contrasting the last and middle periods with the first. RESULTS: The overall proportion of office visits with an anxiety disorder diagnosis significantly increased from 1.4% (95% confidence interval [CI] 1.2-1.7; n = 9 246 921 visits) in 2006 to 2009 to 4.2% (95% CI 3.4-5.2; n = 23 120 958 visits) in 2014 to 2018. The proportion of visits with any therapy decreased from 48.8% (95% CI 40.1-57.6) to 32.6% (95% CI 24.5-41.8), but there was no significant change in the overall use of medications. The likelihood of receiving medication alone during office visits was significantly higher in the last, relative to the first period (relative risk ratio = 2.42, 95% CI 1.24-4.72). CONCLUSIONS: The proportion of outpatient visits that included a diagnosis of anxiety increased over time, accompanied by a decrease in the proportion of visits with therapy.

Cost of Implementing an Evidence-Based Intervention to Support Safer Use of Antipsychotics in Youth.

To estimate the cost of implementing a clinical program designed to support safer use of antipsychotics in children and adolescents (youth) age 3-17 years at the time of initiating an antipsychotic medication. We calculate the costs of implementing a psychiatric consultation and navigation program for youth prescribed antipsychotic medications across 4 health systems, which included an electronic health record (EHR) decision support tool, consultation with a child and adolescent psychiatrist, and up to 6 months of behavioral health care navigation, as well as telemental health for patients (n = 348). Cost data were collected for both start-up and ongoing intervention phases and are estimated over a 1-year period. Data sources included study records and time-in-motion reports, analyzed from a health system perspective. Costs included both labor and nonlabor costs (2019 US dollars). The average total start-up and ongoing costs per health system were $34,007 and $185,174, respectively. The average total cost per patient was $2,128. The highest average ongoing labor cost components were telemental health ($901 per patient), followed by child and adolescent psychiatrist consultation ($659), and the lowest cost component was primary care/behavioral health provider time to review/respond to the EHR decision support tool and case consultation ($24). For health systems considering programs to promote safer and targeted use of antipsychotics among youth, this study provides estimates of the full start-up and ongoing costs of an EHR decision support tool, psychiatric consultation service, and psychotherapeutic services for patients and families.Trial registration: Clinicaltrials.gov, NCT03448575.

Study of CdS/CdS Nanoparticles Thin Films Deposited by Soft Chemistry for Optoelectronic Applications.

Chalcogenides semiconductors are currently being studied as active layers in the development of electronic devices in the field of applied technology. In the present paper, cadmium sulfide (CdS) thin films containing nanoparticles of the same material as the active layer were produced and analyzed for their application in fabricating optoelectronic devices. CdS thin films and CdS nanoparticles were obtained via soft chemistry at low temperatures. The CdS thin film was deposited via chemical bath deposition (CBD); the CdS nanoparticles were synthesized via the precipitation method. The construction of a homojunction was completed by incorporating CdS nanoparticles on CdS thin films deposited via CBD. CdS nanoparticles were deposited using the spin coating technique, and the effect of thermal annealing on the deposited films was investigated. In the modified thin films with nanoparticles, a transmittance of about 70% and a band gap between 2.12 eV and 2.35 eV were obtained. The two characteristic phonons of the CdS were observed via Raman spectroscopy, and the CdS thin films/CdS nanoparticles showed a hexagonal and cubic crystalline structure with average crystallite size of 21.3-28.4 nm, where hexagonal is the most stable for optoelectronic applications, with roughness less than 5 nm, indicating that CdS is relatively smooth, uniform and highly compact. In addition, the characteristic curves of current-voltage for as-deposited and annealed thin films showed that the metal-CdS with the CdS nanoparticle interface exhibits ohmic behavior.

Panorama de la ectasia coronaria en el Instituto Nacional de Cardiología Ignacio Chávez: un estudio transversal / Outlook of coronary ectasia at the National Institute of Cardiology Ignacio Chávez: a cross-sectional study

Resumen Introducción: La ectasia coronaria (EC) es una remodelación patológica con una prevalencia mundial baja. Se define como una dilatación difusa mayor a 1.5 veces el diámetro de los segmentos adyacentes de esta o diferentes arterias coronarias. Objetivo: Documentar las características clínicas y angiográficas, y el tratamiento médico que reciben los pacientes con diagnóstico de EC en el Instituto Nacional de Cardiología (INC). Métodos: Estudio de tipo transversal con diseño no experimental descriptivo, con un muestreo por conveniencia no probabilístico. Resultados: De 69 pacientes que asistieron al INC con diagnóstico de EC la mayor parte eran hombres, con una media de edad de 56 ± 11 años, el factor de riesgo coronario más común en los pacientes con EC fue el tabaquismo, en 40 (58%); se asoció un infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en 45 (65.2%), de localización frecuente en la cara inferior 18 (40%), relacionado con la arteria más afectada, la coronaria derecha 48 (69.6%), seguida de la circunfleja 39 (56.5%). Destaca el uso preferente de la terapia antiplaquetaria dual con anticoagulante (APD+ACO) en 40 (58%) al egreso de cada paciente del INC. Conclusión: La EC es una remodelación patológica no infrecuente en el INC. En este estudio se evidenció que el SCA-IAMCEST es la manifestación más típica de la EC, la coronariografía diagnóstica identificó un Markis tipo 3, por lo que se esperaría una tasa baja de mortalidad y recurrencia de eventos cardiovasculares y a pesar de no existir un consenso sobre la terapia ideal, en el INC se prefiere el tratamiento individualizado, recomendando modificación en el estilo de vida y empleando como tratamiento médico el uso de la triple terapia (APD+ACO) solo al momento de egreso del paciente.

Abstract Introduction: Coronary Ectasia (CE) is a pathological remodeling with a low worldwide prevalence. It is defined as a diffuse dilatation greater than 1.5 times the diameter of the adjacent segments of the same or different coronary arteries. Objective: To document the clinical and angiographic characteristics, and medical treatment at the discharge of patients diagnosed with coronary ectasia who attended the National Institute of Cardiology (INC). Methods: Cross-sectional study with a non-experimental descriptive design, with a non-probabilistic convenience sampling. Results: Of 69 patients who attended the INC with a diagnosis of CD, most were men, with a mean age of 56 + 11 years, the most common coronary risk factor in patients with CE was smoking 58% (40); it was associated mostly with an acute myocardial infarction ST-segment elevation (STEMI) 65.2% (45), of frequent location in the lower face 40% (18), correlated with the most affected artery is the Right Coronary Artery (CD) 69.6% (48), followed by the circumflex (Cx) 56.5% (39). A mean LVEF of 47 + 9.72 was evident within the ventricular function. As well as the preferential use of dual antiplatelet therapy with anticoagulant (DAP + OAC) in 58% (40) at the discharge of each patient from the INC. Conclusion: CE is a not uncommon pathological remodeling in INC. This study showed that STEMI is the most typical manifestation of CE, diagnostic coronary angiography identified a type 3 Markis, so a low rate of mortality and recurrence of cardiovascular events would be expected, and despite the lack of consensus on the ideal therapy, at the INC individualized treatment is preferred, recommending lifestyle changes, and using triple therapy (DAP + OAC) as a medical treatment only at the time of patient discharge.

Mountain wetland soil carbon stocks of Huascarán National Park, Peru.

Although wetlands contain a disproportionately high amount of earth's total soil carbon, many regions are still poorly mapped and with unquantified carbon stocks. The tropical Andes contain a high concentration of wetlands consisting mostly of wet meadows and peatlands, yet their total organic carbon stocks are poorly quantified, as well as the carbon fraction that wet meadows store compared to peatlands. Therefore, our goal was to quantify how soil carbon stocks vary between wet meadows and peatlands for a previously mapped Andean region, Huascarán National Park, Peru. Our secondary goal was to test a rapid peat sampling protocol to facilitate field sampling in remote areas. We sampled soil to calculate carbon stocks of four wetland types: cushion peat, graminoid peat, cushion wet meadow, and graminoid wet meadow. Soil sampling was conducted by using a stratified randomized sampling scheme. Wet meadows were sampled to the mineral boundary using a gouge auger, and we used a combination of full peat cores and a rapid peat sampling procedure to estimate peat carbon stocks. In the lab, soils were processed for bulk density and carbon content, and total carbon stock of each core was calculated. We sampled 63 wet meadows and 42 peatlands. On a per hectare basis, carbon stocks varied strongly between peatlands (avg. 1092 MgC ha-1) and wet meadows (avg. 30 MgC ha-1). Overall, wetlands in Huascarán National Park contain 24.4 Tg of carbon with peatlands storing 97% of the total wetland carbon and wet meadows accounting for 3% of the wetland carbon in the park. In addition, our results show that rapid peat sampling can be an effective method for sampling carbon stocks in peatlands. These data are important for countries developing land use and climate change policies as well as providing a rapid assessment method for wetland carbon stock monitoring programs.

Women with Acute Myocardial Infarction: Clinical Characteristics, Treatment, and In-Hospital Outcomes from a Latin American Country.

Background: Women are underrepresented in acute myocardial infarction (AMI) studies. Furthermore, there is scarce information regarding women with AMI in Latin America. Aims: To describe the presentation, clinical characteristics, risk factor burden, evidence-based care, and in-hospital outcome in a population of women with AMI admitted to a coronary care unit (CCU) in Mexico. Methods: Retrospective cohort study including patients with AMI admitted from January 2006 to December 2021 in a CCU. We identified patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). We described demographic characteristics, clinical variables, treatment, and in-hospital outcomes according to gender. Cox regression analysis was used to identify predictors of mortality. Results: Our study included 12,069 patients with AMI, of whom 7,599 had STEMI and 4,470 had NSTEMI. Women represented 19.6% of the population. Women had higher rates of hypertension, diabetes, stroke, and atrial fibrillation than men. For STEMI, women were less likely to receive reperfusion therapy (fibrinolysis; 23.7 vs. 28.5%, p < 0.001 and primary percutaneous coronary intervention (PCI); 31.2 vs. 35.1%, p = 0.001) and had more major adverse events than men: heart failure (4.2 vs. 2.5%, p = 0.002), pulmonary edema (3.4% vs. 1.7%, p < 0.001), major bleeding (2.1% vs. 1%, p = 0.002), stroke (1.3% vs. 0.6%, p = 0.008), and mortality (15.1% vs. 8.1%, p < 0.001). For NSTEMI, women were less likely to undergo coronary angiography or PCI and had more major bleeding and mortality. Multivariate Cox regression analysis revealed that females had an increase in mortality in STEMI and NSTEMI (HR 1.21, CI 1.01-1.47, p = 0.05 and HR 1.39, CI 1.06-1.81, p = 0.01). Conclusion: Real-world evidence from a hospital in a Latin American low- to middle-income country (LMIC) showed that women with AMI had more comorbidities, received less reperfusion treatment or invasive strategies, and had worse outcomes. In STEMI and NSTEMI, female gender represented an independent predictor of in-hospital mortality.

Outlook of coronary ectasia at the National Institute of Cardiology Ignacio Chávez: a cross-sectional study.

INTRODUCTION: Coronary Ectasia (CE) is a pathological remodeling with a low worldwide prevalence. It is defined as a diffuse dilatation greater than 1.5 times the diameter of the adjacent segments of the same or different coronary arteries. OBJECTIVE: To document the clinical and angiographic characteristics, and medical treatment at the discharge of patients diagnosed with coronary ectasia who attended the National Institute of Cardiology (INC). METHODS: Cross-sectional study with a non-experimental descriptive design, with a non-probabilistic convenience sampling. RESULTS: Of 69 patients who attended the INC with a diagnosis of CD, most were men, with a mean age of 56 + 11 years, the most common coronary risk factor in patients with CE was smoking 58% (40); it was associated mostly with an acute myocardial infarction ST-segment elevation (STEMI) 65.2% (45), of frequent location in the lower face 40% (18), correlated with the most affected artery is the Right Coronary Artery (CD) 69.6% (48), followed by the circumflex (Cx) 56.5% (39). A mean LVEF of 47 + 9.72 was evident within the ventricular function. As well as the preferential use of dual antiplatelet therapy with anticoagulant (DAP + OAC) in 58% (40) at the discharge of each patient from the INC. CONCLUSION: CE is a not uncommon pathological remodeling in INC. This study showed that STEMI is the most typical manifestation of CE, diagnostic coronary angiography identified a type 3 Markis, so a low rate of mortality and recurrence of cardiovascular events would be expected, and despite the lack of consensus on the ideal therapy, at the INC individualized treatment is preferred, recommending lifestyle changes, and using triple therapy (DAP + OAC) as a medical treatment only at the time of patient discharge.

INTRODUCCIÓN: La ectasia coronaria (EC) es una remodelación patológica con una prevalencia mundial baja. Se define como una dilatación difusa mayor a 1.5 veces el diámetro de los segmentos adyacentes de esta o diferentes arterias coronarias. OBJETIVO: Documentar las características clínicas y angiográficas, y el tratamiento médico que reciben los pacientes con diagnóstico de EC en el Instituto Nacional de Cardiología (INC). MÉTODOS: Estudio de tipo transversal con diseño no experimental descriptivo, con un muestreo por conveniencia no probabilístico. RESULTADOS: De 69 pacientes que asistieron al INC con diagnóstico de EC la mayor parte eran hombres, con una media de edad de 56 ± 11 años, el factor de riesgo coronario más común en los pacientes con EC fue el tabaquismo, en 40 (58%); se asoció un infarto agudo de miocardio con elevación del segmento ST (IAMCEST) en 45 (65.2%), de localización frecuente en la cara inferior 18 (40%), relacionado con la arteria más afectada, la coronaria derecha 48 (69.6%), seguida de la circunfleja 39 (56.5%). Destaca el uso preferente de la terapia antiplaquetaria dual con anticoagulante (APD+ACO) en 40 (58%) al egreso de cada paciente del INC. CONCLUSIÓN: La EC es una remodelación patológica no infrecuente en el INC. En este estudio se evidenció que el SCA-IAMCEST es la manifestación más típica de la EC, la coronariografía diagnóstica identificó un Markis tipo 3, por lo que se esperaría una tasa baja de mortalidad y recurrencia de eventos cardiovasculares y a pesar de no existir un consenso sobre la terapia ideal, en el INC se prefiere el tratamiento individualizado, recomendando modificación en el estilo de vida y empleando como tratamiento médico el uso de la triple terapia (APD+ACO) solo al momento de egreso del paciente.

Social Needs as a Risk Factor for Positive Postpartum Depression Screens in Pediatric Primary Care.

OBJECTIVE: The goal of this study was to examine the association between self-reported social needs and postpartum depression (PPD) symptoms of mothers screened in pediatric primary care clinics. METHODS: This retrospective cohort study used electronic health record data from 3616 pediatric patients (age 0-6 months), whose mothers completed the Edinburgh Postpartum Depression Scale (EPDS) and a social needs screening in a large pediatric primary care network between April 2021 and February 2022. Mothers were screened for four self-reported social needs (food, housing, transportation, and utilities). Logistic regression evaluated the association between the report of any social need and a positive EPDS screen (≥ 10), adjusting for demographic and clinical characteristics and ZIP code-level poverty. RESULTS: Overall, 8.6% of mothers screened positive for PPD and 10.0% reported any social needs. The odds of a positive depression screen were significantly higher among mothers who reported any social need compared to those not reporting a social need (OR 4.18, 95% CI 3.11-5.61). The prevalence of all depressive symptoms on the EPDS was significantly higher among those who reported any social need, relative to those reporting no needs. Mothers reporting any social needs were significantly more likely to report thoughts of self-harm (6.9% vs 1.5%, P < .005). CONCLUSIONS: Self-report of social need was significantly associated with positive PPD screens during infant well-child visits. Social needs may be a target of future interventions addressing PPD in pediatric settings. Improving care for social needs may have added benefit of alleviating the risk of PPD.

Housing and supportive services for substance use and self-efficacy among young mothers experiencing homelessness: A randomized controlled trial.

AIMS: Homeless mothers with young children in their care contend with high rates of substance use and low self-efficacy. However, a limited number of studies have examined these outcomes associated with housing and supportive services. DESIGN: Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. SETTINGS: The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city. PARTICIPANTS: The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care. MEASUREMENTS: We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale. FINDINGS: Overall, mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only. CONCLUSIONS: Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.