National trends in revision procedures in post-mastectomy breast reconstruction: Autologous vs implant-based approaches.

BACKGROUND: Breast reconstruction involves collaborative decision-making between patients and surgeons, but the need for multiple revisions after the initial reconstructive surgery process can burden patients and the healthcare system. This study explored how the type of breast reconstruction (autologous [ABR], immediate implant-based reconstruction [IBR], or two-stage IBR) impacts postreconstruction revision rates. METHOD: Using MarketScan Databases, a retrospective database study (2007-2021) was conducted, identifying revision procedures through Current Procedural Terminology codes. Statistical analysis with linear models, adjusted for patient characteristics and surgical factors, used a significance threshold of p < 0.05. RESULTS: Among 58,264 patients, 6.2% of ABR patients, 3.8% of immediate IBR patients, and 3.6% of two-stage IBR patients underwent future revisions. IBR had a 51% lower incidence rate of revision operations than ABR (incidence rate ratio = 0.49, p < 0.001). Within IBR, there was no significant difference in the number of operations between immediate IBR (0.06 ± 0.32) and two-stage IBR (0.05 ± 0.32, p = 0.95). Immediate IBR demonstrated 12% (OR = 0.88, p = 0.0022) and 70% (OR = 0.30, p < 0.001) lower odds of requiring breast revision and fat grafting compared to ABR, respectively. Two-stage reconstruction had 66 % lower odds of requiring only fat grafting than ABR (OR = 0.34, p < 0.001). CONCLUSION: ABR necessitated a higher number of total revision procedures after completion of the initial reconstruction. These findings will better equip providers and patients to counsel patients in understanding their reconstructive journey, planning their reconstructions and timing, and provide more accurate estimates of the number of procedures that will be required to reach their aesthetic goals and final outcome.

Provision of medications to treat opioid use disorder via a mobile health unit: A scoping review.

INTRODUCTION: Mobile health units (MHUs) provide a variety of low-barrier services to populations that face systemic barriers to healthcare access. However, MHUs are not a common delivery method for medications to treat opioid use disorder (MOUD), and, of these, there is no consensus regarding MHU targeted objectives and outcomes. This scoping review seeks to summarize the state of the literature examining the delivery of MOUD by MHUs in the United States. METHODS: A search of PubMed, PsycInfo, and CINAHL on February 21, 2023, found 223 articles. Two authors completed title and abstract and full text reviews and extracted data relevant to intervention and study design, program objectives, and study outcomes. Ten articles fit the study's inclusion criteria (nine total interventions). RESULTS: Of the 10 studies, six were cohort designs, three were cross-sectional (one with qualitative interviews), and one study conducted qualitative interviews only. Most studies were located in the Northeastern United States. MHU interventions primarily aimed to provide MOUD and to retain populations in treatment. Two interventions aimed to engage patients and then transfer them to fixed-site MOUD providers. Across four interventions that provided buprenorphine, 1- and 3-month retention rates varied from 31.6 % to 72.3 % and 26.2 % to 58.5 %, respectively. Qualitative interviews found that MOUD delivery from the MHU was characterized by less stigma/judgment and greater privacy compared to fixed-site, and it was flexible and low-barrier. MHUs were reportedly underutilized by the target populations, suggesting a lack of awareness from community members with opioid use disorder. CONCLUSIONS: MHUs that deliver MOUD are both under-provided and -utilized. Future research should continue to assess MOUD provision from MHUs with an emphasis on robust study design, application to other formulations of MOUD, and evaluation of outcomes such as participant satisfaction and key informant perceived challenges. REGISTRATION: Submitted to Open Science Framework (OSF) Repository on February 6, 2023.

A Systematic Narrative Review of Recent Obesity Interventions with Black Women in the United States.

OBJECTIVES: This study is to comprehensively review recent obesity interventions for Black women in the United States. METHODS: We searched PubMed and EBSCOhost for articles published between 2013 and 2022 using a comprehensive search strategy. Two reviewers screened titles, abstracts, and full texts. Data from the included articles were extracted. Qualitative themes related to the intervention designs were identified across studies. RESULTS: Fifty-two studies were included in the review. Interventions typically aimed to reduce weight by targeting diet and/or physical activity. Intervention activities were delivered virtually and in-person via several formats including didactic content and interactive sessions. Outcomes were assessed through a variety of research designs. Across papers, we identified six key themes of intervention design: integration of technology, centering community and culture, personalization of content, use of social support, skill-building through intervention activities, and addressing comorbid health conditions. CONCLUSIONS: To address the obesity epidemic, future research can build upon key lessons learned from recent interventions tailored to Black women.

Impact of post-operative infection on revision procedures in breast reconstruction: A marketscan database analysis.

BACKGROUND: Esthetic complications, such as capsular contracture and soft-tissue contour defects, hinder the desired outcomes of breast reconstruction. As subclinical infection is a prevailing theory behind capsular contracture, we investigated the effects of post-operative infections on these issues and revision procedures. METHODS: We conducted a retrospective database study (2007-2021) on breast reconstruction patients from the MarketScan® Databases. Esthetic complications were defined by their associated revision procedures and queried via CPT codes. Severe capsular contracture (Grade 3-4) was defined as requiring capsulotomy or capsulectomy with implant removal or replacement. Moderate and severe soft-tissue defects were determined by the need for fat grafting or breast revision, respectively. Generalized linear models were used, adjusting for comorbidities and surgical factors (p < 0.05). RESULTS: We analyzed the data on 62,510 eligible patients. Post-operative infections increased the odds of capsulotomy (OR 1.59, p < 0.001) and capsulectomy (OR 2.30, p < 0.001). They also raised the odds of breast revision for severe soft-tissue defects (OR 1.21, p < 0.001). There was no significant association between infections and fat grafting for moderate defects. Patients who had post-operative infections were also more likely to experience another infection after fat grafting (OR 3.39, p = 0.0018). In two-stage reconstruction, infection after tissue expander placement was associated with greater odds of infection after implant placement. CONCLUSION: Post-operative infections increase the likelihood of developing severe soft-tissue defects and capsular contracture requiring surgical revision. Our data reinforce the role of infections in the pathophysiology of capsular contracture. Additionally, infections elevate the risk of subsequent infections after fat grafting for moderate defects, further increasing patient morbidity.

Old tech but not low tech: telephone-based treatment provision for substance use.

The future of telemedicine for substance use treatment hangs by a thread, as the United States awaits approval of proposed regulations and laws to increase care access in light of the 2022 Centers for Medicare and Medicaid Services revisions allowing for audio-only care. Telemedicine improves patient care access and outcomes. Audio-only telemedicine can be an effective and viable modality for individuals without technology resources (devices, internet services, and literacy), those with reduced telehealth service utilization (Black individuals or those with unstable housing, who are older, with low income, or with low education), and those living in rural locations. Studies suggest that telephone visits for buprenorphine treatment are well-accepted by patients and providers, making telephone visits essential in care access to reduce disparities. Telephone counseling for patients in substance use treatment is convenient, flexible, and empowering and can augment therapeutic alliances and treatment goals. Both providers and patients advocate for patient-centered hybrid care to include telephone-only treatment, which enhances service productivity and care access; reduces no-show rates, costs, and stigma; and is sustainable. Numerous solutions can expand technology access, proficiency, assimilation, and trust. Despite being "old" technology, the telephone remains an essential resource for substance use treatment.

Contextualizing medications for opioid use disorder and peer support service provision in the probation system with implementation science.

BACKGROUND: Medications for opioid use disorder (MOUD) is an evidence-based approach that reduces opioid-related mortality, particularly among criminal legal-involved persons who are at increased risk of adverse outcomes related to OUD. Implementing evidence-based approaches in the context of probation settings requires an in-depth understanding of specific contexts to improve intervention efficacy and effectiveness. Here, we use the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to understand implementation contexts for MOUD provision in the probation setting. METHODS: In-depth individual interviews were conducted with key programmatic stakeholders (treatment providers and probation staff involved in service provision for people on probation). The study examined stakeholder perspectives regarding MOUD and Peer Support Service (PSS) implementation among people who are involved in community supervision. Deductive and inductive thematic analysis was conducted, and subsequently the codes, subcodes, and themes were mapped onto the EPIS framework to better understand implementation contexts. RESULTS: We deduced key inner, outer, and bridging contexts that shape treatment service provision for individuals with OUD who are on probation. Inner contexts include a strong organizational climate that supports MOUD implementation and enthusiasm for peer support services. Outer contexts include difficulty navigating insurance among providers, treatment costs, and systemic stigma towards MOUD. Bridging contexts include a lack of collaboration/communication between relevant agencies (e.g., probation and courts). CONCLUSIONS: Findings indicate the implementation is complex and requires a coordinated effort between correctional systems, probation agencies, and community-based treatment providers.

Voices of Musicians: Virtual Live Bedside Music Concerts in Inpatient Care.

The COVID-19 pandemic presented unprecedented challenges to patients, family members, and healthcare staff that resulted in increased stress and isolation and decreased quality of life. We evaluate the impact of a novel virtual concert program, the Vital Sounds Initiative (VSI) of Project: Music Heals Us (PMHU), which began at the beginning of the pandemic to combat patient isolation and provide employment to professional musicians. Using a qualitative analysis of VSI data, we examined post-concert written responses by musicians. These responses were coded by independent coders via inductive coding and thematic analysis. Between 7 April 2020 and 20 July 2022, 192 musicians played 2203 h of music for 11,222 audience members in 39 care facilities nationwide. A total of 114 musicians submitted a total of 658 responses. Three main themes (with corresponding subthemes) arose: (1) Patient Experience; (2) Musician Experience; (3) Caregiver (family or staff) Experience. The responses offered valuable insight into the overwhelmingly positive aspects of the virtual concerts. Overall, we found that VSI favorably impacts individuals at every level, including the patients, musician, and caregivers. These findings provide preliminary evidence for the benefits of virtual music concerts. Upscaling similar virtual music interventions/programs should be considered.

COVID-19 vaccination in correctional systems in the United States.

Overcrowding and limited ability to social distance contribute to high rates of COVID-19 outbreaks in correctional facilities. Despite the Centers for Disease Controls' recommendations, incarcerated persons and correctional staff report a high prevalence of vaccine-hesitance. We sought to identify reasons underlying COVID-19 vaccine hesitation and refusal in correctional systems. We used Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines to design the review. We searched PubMed abstracts and reviewed literature relevant to COVID-19 vaccine uptake and hesitancy in correctional systems of the United States (n = 23). Reasons for vaccine hesitancy among incarcerated people and correctional staff include efficacy, safety concerns, lack of information, and distrust. Findings reveal higher vaccine hesitancy among young and Black residents whereas facilities in close collaborations with state health departments exhibited higher vaccination rates. Correctional facilities must prioritize communication and education to improve the current state of vaccine hesitancy.

Discrepancies in Skin Cancer Screening Reporting Among Patients, Primary Care Physicians, and Patient Medical Records.

Skin cancer incidence in the United States has risen rapidly in recent decades, underscoring the need for accessible and effective prevention practices. The full-body skin examination (FBSE) is the quintessential tool for secondary skin cancer prevention, but the US Preventive Services Task Force (USPSTF) states there is insufficient evidence to recommend the examination for the general or at-risk population. Variable performance of FBSEs among primary care providers (PCPs) is a barrier to accurate studies, and variability in measurement of that performance can be a major impediment to assessment of FBSEs in practice. To better understand the degree of variability, we performed a multicenter, cross-sectional study of FBSEs reported among 53 PCPs and 3343 patients. The results highlight the need for standardization of FBSEs and more rigorous criteria for skin cancer screening.

Incongruence between Physician, Patient, and Medical Chart Report of Skin Cancer Prevention Counseling.

Skin cancer incidence in the United States has risen rapidly in recent decades, underscoring the need for accessible and effective prevention practices. Skin cancer prevention counseling can lead to increased sun protective behavior and early detection; however, little is understood regarding the frequency and content of counseling among primary care providers (PCPs). We performed multi-center cross-sectional surveys among 53 providers and 3343 of their patients and chart review asking whether skin cancer prevention counseling occurred and details of that counseling. Only 10−25% of patients reported that counseling occurred. Among the providers who reported counseling, there were higher odds that their patients recollected they were advised to use sunscreen or protective clothing, on how to use sunscreen, on signs of skin cancer, to perform a self-skin exam (all p < 0.001), and were provided with written materials (p < 0.01). Eight percent of prevention counseling was chart documented despite being highly associated with patient and physician recollection of counseling (p < 0.001). These results highlight the need for consistent and clear delivery of skin cancer primary prevention.

Barriers and poor telephone counseling experiences among patients receiving medication for opioid use disorders.

OBJECTIVE: The COVID-19 pandemic catalyzed the relaxation of regulations surrounding Medication for Opioid Use Disorders (MOUD) treatment, including a shift from in-person to telehealth counseling services adjunct to MOUD treatment. We examine how patient-level barriers impact their counseling experiences. METHODS: We examine data from n = 264 participants who completed a cross-sectional survey regarding their experiences with telephone counseling adjunct to MOUD between July to November 2020. Variables examined include: convenience and satisfaction with telephone counseling, comfort and change in relationship with counselor, and how telephone counseling helped with anxiety, depression, anger, substance use, and recovery. Participants also listed the barriers they faced when using telephone counseling. RESULTS: Thirty-one percent of the sample (n = 81) reported experiencing one or more barriers to telephone counseling. Satisfaction with counseling, perceived convenience, comfort, and beneficial effects of counseling on substance use were associated with increased odds of reporting no barriers (range of p.038 to <0.001). CONCLUSIONS: Many participants reported barriers to telehealth counseling, and these barriers were in turn associated with poorer counseling experiences. PRACTICE IMPLICATIONS: Many treatment providers plan to integrate telehealth service provision in their healthcare delivery model, but more research on patient-level barriers and its impact on treatment is needed.

Patient Experiences with the Transition to Telephone Counseling during the COVID-19 Pandemic.

Background: To identify and document the treatment experiences among patients with opioid use disorder (OUD) in the context of the rapid move from in-person to telephone counseling due to the COVID-19 pandemic. Methods: Participants (n = 237) completed a survey with open-ended questions that included the following domains: (1) satisfaction with telephone counseling, (2) perceived convenience, (3) changes to the therapeutic relationship, (4) perceived impact on substance use recovery, and (5) general feedback. Responses were coded using thematic analysis. Codes were subsequently organized into themes and subthemes (covering 98% of responses). Interrater reliability for coding of participants' responses ranged from 0.89 to 0.95. Results: Overall, patients reported that telephone counseling improved the therapeutic experience. Specifically, 74% of respondents were coded as providing responses consistently indicating "positive valency". "Positive valency" responses include: (1) feeling supported, (2) greater comfort and privacy, (3) increased access to counselors, and (4) resolved transportation barriers. Conversely, "negative valency" responses include: (1) impersonal experience and (2) reduced privacy. Conclusions: Telephone counseling presents its own set of challenges that should be investigated further to improve the quality of care and long-term patient outcomes.

Medication for Opioid Use Disorder Service Provision and Telephone Counseling: A Concurrent Mixed-Methods Approach.

Using quantitative and qualitative evidence, this study triangulates counselors' perspectives on the use of telemedicine in the context of Opioid Use Disorder (OUD) treatment. A concurrent mixed-methods design examined counselors' experiences with telephone counseling during the COVID-19 pandemic. N = 42 counselors who provided OUD counseling services completed a close-ended, quantitative survey examining their experiences in addressing clients' anxiety, depression, anger, substance use, therapeutic relationship, and substance use recovery using telephone counseling. The survey also assessed comfort, convenience, and satisfaction with telephone counseling. Counselors also completed open-ended responses examining satisfaction, convenience, relationship with patients, substance use, and general feedback with telephone counseling. The synthesis of quantitative and qualitative evidence indicated that a majority of counselors had positive experiences with using telephone counseling to provide services to clients undergoing OUD treatment. Convenience, greater access to clients, and flexibility were among the reasons cited for their positive experience. However, counselors also expressed that the telephone counseling was impersonal, and that some clients may have difficulties accessing appropriate technology for telehealth adoption. Findings suggest that further research with counselors is needed to identify the key elements of an effective integration of telephone counseling with traditional in-person treatment approaches in the post-pandemic era.

Physical Activity Levels among Preschool-Aged Children in Family Child Care Homes: A Comparison between Hispanic and Non-Hispanic Children Using Accelerometry.

Obesity prevalence among Hispanic children is twice that of non-Hispanic white children; Hispanic children may also engage in less physical activity (PA) compared to non-Hispanic white children. A large number of U.S. preschool-aged children are cared for in Family Child Care Homes (FCCH), yet few studies have examined PA levels and ethnicity differences in PA levels among these children. We examine baseline data from a cluster-randomized trial (Healthy Start/Comienzos Sanos) to improve food and PA environments in FCCHs. Children aged 2-to-5-years (n = 342) wore triaxial accelerometers for two days in FCCHs. Variables examined include percentage of time (%) spent in sedentary, and light, moderate, and vigorous PA. The full dataset (n = 342) indicated sedentary behavior 62% ± 11% of the time and only 10% ± 5% of the time spent in moderate-to-vigorous PA. Among children in the upper-median half of wear-time (n = 176), Hispanic children had significantly greater % sedentary time vs. Non-Hispanic children (66.2% ± 8.3% vs. 62.6% ± 6.9%, p = 0.007), and lower % light PA (25.4% ± 6.3% vs. 27.7% ± 4.9%, p = 0.008) and moderate PA (5.5% ± 2.1% vs. 6.4% ± 2.2%, p = 0.018). Our results highlight that PA levels were lower among our sample compared to previous studies, and that Hispanic children were more sedentary and less active compared to non-Hispanic white children.

Changes in Fathers' Body Mass Index, Sleep, and Diet From Prebirth to 12 Months Postbirth: Exploring the Moderating Roles of Parenthood Experience and Coparenting Support.

BACKGROUND: While research has examined prenatal to postnatal changes in women's weight, sleep, and diet, much less is known about these changes among fathers. PURPOSE: This study aimed to (a) examine changes in fathers' body mass index (BMI), sleep, and diet from 1 month before birth to 5-6 months following birth, and from 5-6 months to 11-12 months following birth and (b) explore the moderating roles of parenthood experience and coparenting support. METHODS: 169 fathers (mean age 35.5 years, 58.9% White) participated. Fathers completed an intake survey shortly after their infant's birth to recall their height and weight, nighttime sleep hours, fruit and vegetable intake, soda intake, and fast food intake for the month prior to birth. When their child was 6 and 12 months old, fathers reported their weight, sleep, and diet again for the past 4 weeks (i.e., 4 week periods spanning 5-6 months and 11-12 months following birth). Generalized estimating equations were used to answer our research questions. RESULTS: Fathers reported higher BMI (Δ = 0.22 kg/m2; 95% confidence interval [CI] = 0.06, 0.38; p = .008) and less nighttime sleep duration (Δ = -0.21 hr; 95% CI = -0.38, -0.05; p = .012) at 5-6 months following birth compared to 1 month prior to birth. Fathers' diet remained stable over the three timepoints. No evidence was found to support the moderating roles of parenthood experience and coparenting support on fathers' weight and behavior changes. CONCLUSIONS: 5-6 months following birth may be an important point of intervention for fathers to promote a return to prebirth BMI and sleep levels.

Correlates of Objectively Measured Sleep and Physical Activity Among Latinx 3-To-5-Year Old Children.

PURPOSE: Latinx children have the highest prevalence of obesity in the US. Physical activity (PA) and sleep are important risk factors for this health disparity, yet limited evidence exists examining objectively measured data among this population. We aim to identify correlates of sleep and PA, as well as the association between sleep and PA, among a sample of Latinx children. DESIGN AND METHODS: A cross-sectional study was conducted with thirty Latinx 3-to-5-year old children who wore GT3X+ triaxial accelerometers for five consecutive days, from which we examined sleep and PA constructs. Linear regression and ANOVA were used to examine study constructs. RESULTS: Sedentary behavior, light PA, and MVPA (moderate-to-vigorous PA) were 51.7, 5.6, and 2.6 min/h respectively. Total sleep duration averaged 9.6 h, sleep efficiency averaged 80.0%, and sleep variability averaged 1.30 h/night. Higher household income was associated with sleep variability (F = 7.240, p = .012) and lower sedentary behavior (F = 5.481, p = .027), and higher sleepiness was associated with lower MVPA (ß = -0.503, p = .005) and higher child BMI (ß = 0.531, p = .033). MVPA was associated with higher sleep efficiency (ß = 0.441, p = .016). CONCLUSIONS: Household income emerged as a correlate of sleep variability and sedentary behavior in our study. In addition, we found that MVPA levels were associated with sleep efficiency. PRACTICE IMPLICATIONS: Our results signal an impetus for further research (particularly with larger, multi-site study designs) examining study constructs among Latinx children.

Effects of Coparenting Quality, Stress, and Sleep Parenting on Sleep and Obesity Among Latinx Children: A Path Analysis.

INTRODUCTION: We sought to examine the associations among parent-level constructs, sleep-related parenting practices, and child sleep in Latinx families. METHOD: A quantitative study was conducted with 101 Latinx parents of children aged 2-5 years. Key variables that were examined included parental stress, coparenting quality, bedtime routine consistency, parent-child sleep interactions, and child's sleep duration. RESULTS: Path analysis results indicated that (1) parent stress had a direct effect on child sleep duration (p =.005) and was mediated by parent-child sleep interactions (p =.021); (2) coparenting quality had a direct effect on child sleep duration (p =.001) and was mediated by bedtime routine consistency (p =.010); and (3) bedtime routine consistency had an indirect effect on child body mass index percentile and was mediated by sleep duration (p =.049). DISCUSSION: Coparenting quality and parental stress may be important constructs to consider when designing interventions to improve Latinx child sleep duration.

Exploring Parenting Contexts of Latinx 2-to-5-Year Old Children's Sleep: Qualitative Evidence Informing Intervention Development.

PURPOSE: Poor sleep quality is associated with childhood obesity, and Latinx children have the highest prevalence of obesity in the United States. Parents are key agents to ensuring good sleep quality among children, but limited research has examined sleep parenting among Latinx working parents who may have added responsibilities. DESIGN AND METHODS: Working Latinx parents of 2-to-5-year old children participated in in-depth interviews exploring parenting and familial contexts of child sleep. Main topics in the interview guide included sleep-related parenting practices, social support, cultural influences, and intervention service delivery and content preferences. Thematic analysis was used to analyze data. RESULTS: Twenty parents completed the interview. The following themes emerged: Sleep parenting, sleep knowledge, impact of familial structures, family commitments, child temperament, and broader contextual factors on sleep, and intervention content and design ideas. Across participants, employment was reported to be a barrier to effective sleep parenting. Parents also reported engaging in practices that may interfere with sleep quality such as using screen time as a distraction and reducing naptime during the weekends to increase the amount of family time. Family-level factors such as co-parenting and spousal support were reported to facilitate sleep parenting. Participants also indicated the need for more sleep parenting knowledge and a preference for mobile platforms and social media to deliver information. CONCLUSIONS: Results not only fill critical gaps in the literature, but also highlight the variability in parents' approaches to sleep parenting and an urgent need for intervention/programming efforts to target Latinx parent's sleep knowledge and parenting.

Cumulative Social Risk and Cardiovascular Disease Among Adults in South Korea: A Cross-Sectional Analysis of a Nationally Representative Sample.

INTRODUCTION: The Framingham risk score (FRS) is widely used to predict cardiovascular disease (CVD), but it neglects to account for social risk factors. Our study examined whether use of a cumulative social risk score in addition to the FRS improves prediction of CVD among South Korean adults. METHODS: We used nationally representative data on 19,147 adults aged 19 or older from the Korea National Health and Nutrition Examination Survey 2013-2016. We computed a cumulative social risk score (range, 0-3) based on 3 social risk factors: low household income, low level of education, and single-living status. CVD outcomes were stroke, myocardial infarction, and angina. Weighted logistic regression examined the associations between cumulative social risk, FRS, and CVD. McFadden pseudo-R2 and area under receiver operating characteristic curve (AUC) assessed model performance. We conducted mediation analyses to quantify the association between cumulative social risk score and CVD outcomes that is not mediated by the FRS. RESULTS: A unit increase in social risk was associated with 89.4% higher risk of stroke diagnosis, controlling for the FRS (P < .001). The FRS explained 8.0% of stroke diagnosis (R2) with fair discrimination (AUC = 0.728), and adding the cumulative social risk score enhanced R2 and AUC by 2.4% and 0.039. In the association between cumulative social risk and stroke, the proportion not mediated by the FRS was 65% (P < .001). We observed similar trends in myocardial infarction and angina, such that an increase in social risk was associated with increased relative risk of disease and improved disease diagnosis, and a large proportion of the association was not mediated by the FRS. CONCLUSION: Controlling for the FRS, cumulative social risks predicted stroke, myocardial infarction, and angina among adults in South Korea. Future research is needed to examine non-FRS mediators between cumulative social risk and CVD.

Physical activity and risk of cardiovascular events and all-cause mortality among kidney transplant recipients.

BACKGROUND: Insufficient physical activity (PA) may increase the risk of all-cause mortality and cardiovascular disease (CVD) morbidity and mortality among kidney transplant recipients (KTRs), but limited research is available. We examine the relationship between PA and the development of CVD events, CVD death and all-cause mortality among KTRs. METHODS: A total of 3050 KTRs enrolled in an international homocysteine-lowering randomized controlled trial were examined (38% female; mean age 51.8 ± 9.4 years; 75% white; 20% with prevalent CVD). PA was measured at baseline using a modified Yale Physical Activity Survey, divided into tertiles (T1, T2 and T3) from lowest to highest PA. Kaplan-Meier survival curves were used to graph the risk of events; Cox proportional hazards regression models examined the association of baseline PA levels with CVD events (e.g. stroke, myocardial infarction), CVD mortality and all-cause mortality over time. RESULTS: Participants were followed up to 2500 days (mean 3.7 ± 1.6 years). The cohort experienced 426 CVD events and 357 deaths. Fully adjusted models revealed that, compared to the lowest tertile of PA, the highest tertile experienced a significantly lower risk of CVD events {hazard ratio [HR] 0.76 [95% confidence interval (CI) 0.59-0.98]}, CVD mortality [HR 0.58 (95% CI 0.35-0.96)] and all-cause mortality [HR 0.76 (95% CI 0.59-0.98)]. Results were similar in unadjusted models. CONCLUSIONS: PA was associated with a reduced risk of CVD events and all-cause mortality among KTRs. These observed associations in a large, international sample, even when controlling for traditional CVD risk factors, indicate the potential importance of PA in reducing CVD and death among KTRs.