Association of neighborhood parks with child health in the United States.

While there is evidence that parks support pediatric health, there have been no national studies looking at both physical and mental health. We assessed whether the presence of a neighborhood park is associated with pediatric physical or mental health across the U.S. using a nationally representative cross-sectional random sample of American children ages 0-17. Caregivers reported on the park presence in their child's neighborhood and the child's physical activity, screen-time, sleep, weight, and diagnosis of anxiety, depression, or attention deficit hyperactivity disorder (ADHD). Covariates included child and family sociodemographics and, for 29 states, neighborhood urbanicity. Caregivers reported on 49,146 children (mean age 9.4 years; 49% female). There were 11,791 (24%) children living in neighborhoods lacking a park; children in non-urban locations (aOR 2.19, 95% CI 1.40-1.67) or below the federal poverty level (aOR = 1.48, 95%CI 1.38-1.58) had higher odds of lacking a park. Irrespective of sociodemographics, children lacking parks were more likely to be physically inactive (aOR1.36, 95% CI 1.24, 1.48), have excessive screen-time (aOR = 1.19, 95% CI 1.14, 1.25), or obtain inadequate sleep (aOR = 1.23, 95% CI 1.18, 1.29). Children without parks were more likely obese (aOR = 1.32, 95% CI 1.21, 1.43), overweight (aOR 1.25, 95%CI 1.17, 1.33), or diagnosed with ADHD (aOR 1.20, 95% CI 1.12, 1.29), but not more anxious or depressed (aOR = 1.04, 95%CI 0.97, 1.11). Associations between parks and pediatric physical and mental health suggests that the provision of neighborhood parks could represent a low-cost childhood health intervention.

Utility of Equilibrium Radionuclide Angiogram-Derived Measures of Dyssynchrony to Predict Outcomes in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy.

We evaluated a novel scintigraphic method using new parameters of mechanical left ventricular (LV) dyssynchrony and correlated it with clinical outcomes in heart failure patients with reduced ejection fraction receiving cardiac resynchronization therapy (CRT). METHODS: Sixty-six advanced heart failure patients referred for CRT with an LV ejection fraction (EF) of < 35% and QRS ≥ 120 ms were studied. We performed equilibrium radionuclide angiography (ERNA) before and 6 mo after CRT. We assessed ventricular dyssynchrony with parameters derived from the first harmonic phase (Ø) analysis of the ERNA time-activity curve and evaluated change in these parameters after 6 mo of CRT. These parameters include novel indices of synchrony (S), a measure of intraventricular contraction order, and entropy (E), a measure of intraventricular contraction disorder, and interventricular synchrony (IVS), a measure of synchronous biventricular function. RESULTS: Forty-seven (71%) patients improved clinically (responders) at 6 mo after CRT whereas 19 (28.8%) showed no change in New York Heart Association class or worsened (nonresponders). The post-CRT changes in QRS duration (P = 0.006), echocardiographic (P = 0.03) and ERNA LVEF (P = 0.0007), LVS (P = 0.004), LVE (P = 0.006), LV standard deviation of ventricular phase (LVSDØ) (P = 0.004), and IVS (P = 0.05) were significantly different between responders and nonresponders. Sixty-two percent of responders had either an LVS < 0.84 or an IVS ≥ 18.8° as opposed to only 16% of nonresponders (P = 0.001). Twenty-nine of 32 (91%) patients with either of these measures responded to CRT (P < 0.01). CONCLUSION: LVS and IVS are novel measures of LV dyssynchrony derived from ERNA planar analysis. A baseline value of LVS < 0.84 or IVS ≥ 18.8° predicts a positive response to CRT.

Comparison of radionuclide angiographic synchrony analysis to echocardiography and magnetic resonance imaging for the diagnosis of arrhythmogenic right ventricular cardiomyopathy.

BACKGROUND: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable arrhythmia syndrome entailing a high risk of sudden cardiac death. Discernment from benign arrhythmia disorders, particularly right ventricular outflow tract ventricular tachycardia (RVOT VT), may be challenging, providing an impetus to explore alternative modalities that may facilitate evaluation of patients with suspected ARVC. OBJECTIVE: We evaluated the role of equilibrium radionuclide angiography (ERNA) as a diagnostic tool for ARVC. METHODS: ERNA measures of ventricular synchrony-synchrony (S) and entropy (E)-were examined in patients with ARVC (n = 16), those with RVOT VT (n = 13), and healthy controls (n = 49). The sensitivity and specificity of ERNA parameters for ARVC diagnosis were compared with those of echocardiography (ECHO) and cardiovascular magnetic resonance (CMR). RESULTS: ERNA right ventricular synchrony parameters in patients with ARVC (S = 0.91 ± 0.07; E = 0.61 ± 0.1) differed significantly from those in patients with RVOT VT (S = 0.99 ± 0.01 [P = .0015]; E = 0.46 ± 0.05 [P < .001]) and healthy controls (S = 0.97 ± 0.02 [P = .003]; E = 0.48 ± 0.07 [P = .001]). The sensitivity of ERNA synchrony parameters for ARVC diagnosis (81%) was higher than that for ECHO (38%; P = .033) and similar to that for CMR (69%; P = .162), while specificity was lower for ERNA (89%) than that for ECHO and CMR (both 100%; P = .008). CONCLUSION: ERNA right ventricular synchrony parameters can distinguish patients with ARVC from controls with structurally normal hearts, and its performance is comparable to that of ECHO and CMR for ARVC diagnosis. These findings suggest that ERNA may serve as a valuable imaging tool in the diagnostic evaluation of patients with suspected ARVC.