Dyadic Associations Between Grandparent-Grandchild Familial Values and Successful Aging: Mediating Role of Quality of Life.

The current study aimed to determine the reciprocal associations between the familial values and successful aging of grandparents and grandchildren and the extent to which quality of life accounts for these reciprocal associations. Data was collected from 270 grandparent-grandchild pairs living together. Actor-Partner Independence Model indicated that familial values of both grandparents and grandchildren showed significant associations with their own successful aging (actor effects), whereas familial values of grandchildren showed significant associations with the successful aging of grandparents (partner effects). Grandchildren's quality of life mediated the actor and partner effects of familial values on the successful aging of grandchildren; whereas grandparents' quality of life only mediated the actor effect of familial values on the successful aging of grandparents. These findings showed the interdependence of grandparents and grandchildren while emphasizing the importance of grandparents-grandchildren familial values and quality of life in enhancing successful aging.

Associations among traumatic experiences, threat exposure, and mental health in Pakistani journalists.

Pakistan is considered to be relatively unsafe for journalists; however, little is known about how working in situations that involve a high risk of trauma exposure and personal threat impacts journalists' mental health. The present study aimed to examine the associations among reporting on topics that carry a high risk of trauma exposure; work-related personal threat exposure; and symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, and stress in a sample of Pakistani journalists. Participants completed online assessments to report the extent of their exposure to trauma and threat in the last 6 months with regard to reporting on militancy, crime, bomb blasts, and natural disasters and exposure to electronic, verbal, and physical threats; stalking; kidnapping; and detention. Further, we assessed symptoms of PTSD, depression, anxiety, and stress using self-report instruments. Of the 296 participants, 34.1% showed clinically significant levels of PTSD, moderately elevated levels of depression, and severely elevated levels of anxiety. Linear regression analyses demonstrated an association between PTSD symptoms and a higher frequency of reporting on natural disasters, ß = 2.40, p = .004, whereas symptoms of anxiety, depression, and stress were associated with a lower frequency of reporting on bomb and suicide blasts, ßs = -.93 - 1.61, p = <.001 - .047. Ideally, these findings will raise awareness about their situation, inform prevention and intervention efforts dedicated to journalists' mental health, and promote future research to elucidate the causal factors implicated in mental health symptoms in this population.

Parents as Role Models: Associations Between Parent and Young Children's Weight, Dietary Intake, and Physical Activity in a Minority Sample.

Objective We examined the association between parent and child fruit and vegetable (F&V) intake, physical activity (PA), and body mass index in an ethnic minority and low-income sample. Methods The study sample consisted of 86 children ages 5-7 years (80% Hispanic) and their parents. Three parent health variables (healthy weight, recommended F&V servings per day, and recommended weekly PA) were used to create a healthy role model index. Associations between the parent index and corresponding child health behaviors and weight were examined. Results Most parents (53.5%) were not healthy role models, 30.2% were limited healthy role models, 16.3% were good role models, and none were excellent role models; most parents and children did not meet guidelines for healthy weight, F&V intake, and PA. Parents who scored higher on the index were more likely to have children with higher levels of F&V. Furthermore, parents who had a healthy weight were 3.7 times more likely to have a child who had a healthy weight. Additionally, parents who were consuming the recommended servings of F&V per day were 10 times more likely to have children who were also consuming the recommended servings of F&V per day compared to parents who were not consuming the recommended servings of F&V per day. Conclusions for Practice These findings suggest the important role of parental modeling of healthy behaviors to their young children among minority/low-income families. Parents may serve as an important mechanism of change for children's health status by increasing their own healthy lifestyle behaviors.

Emotional and Behavioral Problems in Children and Adolescents in Central Kenya.

Emotional and behavioral problems (EBP) during childhood and adolescence are a common concern for parents and mental health stakeholders. However, little has been documented about their prevalence in Kenyan children and adolescents. This study aimed to close this gap. The study included Child Behavior Checklist reports from 1022 Kenyan parents on their children (ages 6-18 years) and Youth Self-Reports from 533 adolescents (ages 12-18) living in Kenya's Central Province. EBP in Kenya are highly prevalent compared to multi-cultural standards for parent reports, with 27 and 17% scoring in the borderline and clinical range, respectively. Based on parent reports, younger children scored higher on EBP than older children, and higher on internalizing problems. Based on self-reports girls scored higher than boys, particularly on internalizing problems. The study provides evidence on elevated parent-reported EBP in Kenyan youths. Mental health providers should focus on interventions that reduce EBP in Kenyan youths.

Consistency of prediction across generation: explaining quality of life by family functioning and health-promoting behaviors.

PURPOSE: The study aimed to investigate the consistency of relationship between family functioning, health-promoting behaviors, and quality of life across generations in joint families. METHOD: The sample comprises of 79 joint families (N = 316 members, n = 79 grandparents (grandfathers = 27, grandmothers = 52) n = 158 parents (fathers = 79, mothers = 79), and n = 79 grandchildren (girls = 61, boys = 18)). Data were collected on Self-Report Family Inventory, SFI, Health-Promoting Lifestyle Profile II, HPLP-II, and World Health Organization Quality of Life Scale BREF WHO QOL BREF. All three variables, i.e., family functioning, health-promoting behaviors, and quality of life, were modeled as latent variables. Analyses were conducted separately for each group. RESULTS: Results showed that in grandparents, family functioning predicted (ß = .44, p < .01,) health-promoting behaviors (R (2) = .20), which in turn predicted (ß = .26, p < .05) quality of life (R (2) = .85). Family functioning appears to have significant indirect effects (ß = .34, p < .01) through health-promoting behaviors on quality of life. The model fit indices showed a good fit (IFI = .917, CFI = .910, RMSEA = .078) of the model of the data. For all other groups, i.e., fathers, mothers, and grandchildren, family functioning and health-promoting behaviors independently predicted quality of life (R (2) = .55, .67, and .54, respectively). CONCLUSION: Our results showed that family functioning and health-promoting behaviors are consistent predictors of quality of life across generations.

Open versus endovascular repair of abdominal aortic aneurysm: Incidence of cardiovascular events in 632 patients in a department of defense cohort over 6-year follow-up.

BACKGROUND: Abdominal aortic aneurysm (AAA) is common with unacceptably high rates of mortality and morbidity with unknown rates of complications after repair in the Department of Defense (DoD). METHODS: All patients treated at a DOD or VA clinic or medical facility with a diagnosis of AAA identified by ICD-9 code search were identified by Patient Administration Systems and Biostatistics Activity (PASBA) using the Standard Inpatient Data Record (SIDR) and Composite Ambulatory Patient Encounter Record (CAPER) from January 2006 till December 2011. The primary outcome was death, myocardial infarction (MI), stroke, and cardiac arrhythmia between subjects who underwent endovascular aortic repair (EVAR) or open aortic repair (OAR). RESULTS: A total of 8314 patients were screened to identify 632 patients who underwent surgical repair of non-ruptured AAA. EVAR was performed in 497 patients (78.6%) and OAR in 135 patients (21.4%). Mortality at 30 days was less common in EVAR patients (1.6% vs. 6.7%, p = 0.004), but was not sustained (16.9% vs. 17.8%, p = 0.797). Mean survival free from mortality was not different between the two groups (EVAR vs. OAR: 6.14 ± 0.13 years vs. 6.11 ± 0.22 years, p = 0.378). The composite endpoint of MI, stroke, arrhythmia, or death was not different between groups at 30 days (EVAR vs. OAR: 12.9% vs. 14.1%, p = 0.774) or in long-term follow-up population (EVAR vs. OAR: 40.6% vs. 31.9%, p = 0.073) though there was a trend toward higher event rates in the EVAR. The composite endpoint of MI, stroke, and arrhythmia occurred in 198 patients (31%). CONCLUSION: EVAR was associated with lower 30-day mortality rates; however, this benefit was not sustained in longer-term follow-up. There is no difference in the rates of stroke, myocardial infarction, or cardiac arrhythmia at 30 days or in long-term follow-up.

Assessing diabetes support in adolescents: factor structure of the Modified Diabetes Social Support Questionnaire (M-DSSQ-Family).

OBJECTIVES: To determine the underlying factor structure of diabetes specific support using a modified diabetes family social support questionnaire, the M-DSSQ-Family, in one half of a sample of adolescents with type 1 diabetes, confirm it in the second half, test invariance in factor structure across gender and age, and test the reliability of the resulting scales. METHOD: The study included 11-19 yr old youngsters with type 1 diabetes, who are all on daily insulin injection or pump. A total of 437 adolescents (54.5% girls; mean age 14.7 yr; mean diabetes duration 6.1 yr) participated in the study. RESULTS: Exploratory factor analyses in the first half of the random sample suggested five factors including 45 items with loading ≥ 0.40 and explaining 40% of item variance. Confirmatory factor analysis in the remainder of the sample showed good indices of fit with exclusion of only five items. The final model with five underlying factors including 'Guidance and Supervision (10 items, α = 0.84)', 'Encouragement of Self-care and Exercise (8 items, α = 0.82)', 'Support in Critical Situations (6 items, α = 0.90)', 'Nourishment (9 items, α = 0.84)', and 'Emotional Support (7 items, α = 0.81)' was confirmed across gender and age. In a second order factor analysis, all five factors loaded on one overall factor Diabetes Social Support-Family (α = 0.93). CONCLUSION: The 40-item M-DSSQ-Family presented a different view of traditional aspect of diabetes social support from family which may be more fruitful for adolescents. In addition, it emerged as a valid and reliable measure of family support for Dutch adolescents with type 1 diabetes.

Expectations in Romantic Relations and Psychological Well-Being of Adolescents in Pakistan: Moderating Role of Parental Support.

The objective of the current study was to investigate the role of perceived parental support as a moderator in the association between adolescents' expectations in romantic relations and their psychological well-being. The sample consisted of 647 adolescents (boys = 285, girls = 362). Their age ranged from 16 to 18 years (M = 17.19 years, SD = .77) and they were regular students in different colleges of Islamabad and Rawalpindi. They completed the Perceived Parental Support Scale, the Well-being Questionnaire-W-BQ12 and the Romantic Relations Scale for Adolescents. The results showed that there were significant gender differences on expectations in romantic relations and psychological well-being with girls scoring higher than boys on expectations in romantic relations while boys scoring higher than girls on psychological well-being. The results also indicated that there was a significant negative association between expectations in romantic relations and psychological well-being. Findings of the moderation analysis showed that perceived parental support moderated the association. Simple slope analysis indicated that there was a significant negative slope for low and medium levels of perceived parental support while the slope was non-significant for high levels of perceived parental support. These results indicated that perceived parental support counters the negative effect of expectations in romantic relations on psychological well-being during adolescence. It is suggested that perceived parental support is important in planning interventions to improve the well-being of adolescents.

Sedentary behavior moderates the relationship between physical activity and cardiometabolic risk in young Latino children.

This study investigated the role of objectively measured moderate-vigorous physical activity (MVPA) and sedentary behavior on cardiometabolic risk factors of young Latino children. We hypothesized that MVPA would be associated with lower cardiometabolic risk when sedentary behavior is low. We studied 86 primarily low-income, Latino children using a cross-sectional study design. The study sample consisted of 51 girls and 35 boys, with mean age 5.6 (SD = .53) years. Physical activity was measured by accelerometry, anthropometric measures obtained, and fasting blood samples were used to measure cardiometabolic risk factors. Greater levels of sedentary behavior were associated with increased waist circumference (rs = .24, p < .05) and metabolic risks. MVPA, however, had significant beneficial associations with all cardiometabolic risk factors (rs-range = -.20 to -.45, p < .05) with the exception of plasma insulin. MVPA predicted latent variables representing anthropometric risk (ß = -.57, p < .01), cardiac risk (ß = -.74, p < .01), and metabolic risk (ß = -.88, p < .01). Sedentary behavior significantly moderated the effect of MVPA on anthropometric (ß-interaction = .49, p < .01), cardiac (ß-interaction = .45, p < .01), and metabolic risk (ß-interaction = .77, p < .01), such that more MVPA was associated with better health outcomes under conditions of lower sedentary behavior. The model explained 13%, 22%, and 45% variance in anthropometric, cardiac, and metabolic risk factors, respectively. Increased MVPA is associated with decreased cardiometabolic risk in young Latino children, particularly when sedentary behavior is low.

This study investigated the role of objectively measured moderate­vigorous physical activity (MVPA) and sedentary behavior on cardiometabolic risk factors of young Latino children. We hypothesized that MVPA would be associated with lower cardiometabolic risk when sedentary behavior is low. The study sample consisted of 51 girls and 35 boys, with mean age 5.6 (SD = .53) years. Participants were primarily low-income, Latino children. We found that greater levels of sedentary behavior were associated with increased waist circumference and metabolic risks. MVPA, however, had significant beneficial associations with all cardiometabolic risk factors with the exception of insulin. MVPA predicted latent variables representing anthropometric risk, cardiac risk, and metabolic risk. Sedentary behavior significantly moderated the effect of MVPA on anthropometric, cardiac, and metabolic risk, such that more MVPA was associated with better health outcomes under conditions of lower sedentary behavior. We conclude that an increased MVPA is associated with decreased cardiometabolic risk in young Latino children, particularly when sedentary behavior is low.

Iso-osmolar radio contrast iodixanol in patients with chronic kidney disease.

BACKGROUND: Although radio contrast volume has been associated with worsening post-procedural kidney function, this relationship has not been extensively studied using an iso-osmolar contrast agent in chronic kidney disease patients. METHODS: We retrospectively studied patients undergoing cardiac catheterization at the University of Minnesota from 2000 to 2004, using the iso-osmolar contrast agent, iodixanol. All patients were included who had calculated creatinine clearance (CCR) < 60 mL/min, not on dialysis, and serum creatinine measured on the same day and within 7 days after the procedure. Comparison of a subgroup with severe chronic kidney disease and diabetes mellitus was compared to a similar historical control group that used the low-osmolar contrast agent, iohexol. RESULTS: Serum creatinine and CCR were 2.9 +/- 1.5 mg/dL and 33.4 +/- 12.0 mL/min (mean +/- standard deviation), respectively, at baseline in 117 cases. Peak creatinine increased by 0.03 +/- 0.7 mg/dL after 84.3 +/- 67.3 mL of iodixanol was used. Contrast-induced nephropathy definition was fulfilled in 22 (18.8%) cases. A non-significant negative correlation was found between the volume of iodixanol and the change in creatinine (r2 = 0.0011, p = 0.7254). A subgroup with severe chronic kidney disease and diabetes mellitus with iodixanol had a significantly lower creatinine increase (n = 25, 0.09 +/- 0.5 mg/dL), compared to historical controls (n = 42, 0.7 +/- 0.8 mg/dL) with iohexol (p < 0.001). A non-significant positive correlation between volume of contrast and change in creatinine was found in this subgroup who received iodixanol (n = 25, r2 = 0.0756, p = 0.1835), but was significant in the historical controls who received iohexol (n = 42, r2 = 0.135, p = 0.017). CONCLUSIONS: The volume of iso-osmolar radio contrast does not affect the incidence of contrast-induced nephropathy in patients with chronic kidney disease. A randomized trial evaluating the incidence of contrast nephropathy would verify the safety of ad hoc versus staged angiographic procedures in this population.

Use and limitations of magnetic resonance phase-contrast assessment of coronary flow reserve in a model of collateral dependence.

Phase-contrast magnetic resonance imaging (PC-MRI) is useful for assessing coronary artery flow reserves (CFR) in man and acute animal models with intermediate coronary lesions. The present study examines the use of PC-MRI for assessing CFR in a model with critical stenosis and collateral dependence. PC-MRI quantitative flow measurements from the proximal left anterior descending (LAD) and left circumflex (LCX) coronary arteries were compared with myocardial tissue perfusion reserve measurements (microsphere techniques) after placement of a 2.25-mm ameroid constrictor on the proximal LCX in a porcine model; measurements were obtained at implantation (n = 4) and at 3 to 4 weeks (n = 4) and 6 weeks (n = 5) postimplantation. CFR is defined as the ratio of maximal hyperemic flow to baseline flow. Hyperemia was induced using intravenous adenosine (140 mg/kg/min). Collateral dependence in the LCX distri bution was evidenced by angiographic findings of critical stenosis with minimal myocardial histological changes and normal baseline myocardial perfusion (microsphere techniques). In this setting, PC-MRI CFR was correlated with microsphere measures of perfusion reserve. Collateral dependence was confirmed by Evan's blue dye injection. This study provides angiographic, myocardial perfusion, and histological correlates associated with PC-MRI epicardial CFR changes during chronic, progressive coronary artery constriction. It also demonstrates the disparity between epicardial and myocardial measures of coronary flow reserve with collateral dependence and the caveats for PC-MRI use in models of progressive coronary constriction.

Relationship between resilience and quality of life in diabetics.

OBJECTIVE: To determine the relationship between resilience and quality of life of diabetes patients controlling the effect of personal level (i.e., gender, age, and income) and disease-specific (i.e., duration of disease, and current glucose level) demographics. STUDY DESIGN: Analytical study. PLACE AND DURATION OF STUDY: Outpatient Departments of various hospitals in Islamabad and Rawalpindi, from October to November 2012. METHODOLOGY: Patients diagnosed with diabetes taking treatment in an outdoor patients' facility were included. Patients with a major diabetes complications causing or coexistent with a physical disability, medical condition or psychiatric comorbidity were excluded. Informed consent was taken from patients before administration of questionnaires. The patients were asked to respond to a demographic sheet, State-Trait resilience inventory, and WHO-Quality of Life BREF. Statistical testing was conducting using bivariate correlation, Mann-Whitney U-test, and multiple linear regression analysis for moderation testing. RESULTS: There were 242 patients including (n=108, 44% females; and n=134, 56% males) aged 17 - 85 years with mean of 44.56 ± 16.56 years. Trait resilience predicted all aspects of quality of life of diabetic patients (b range = 0.30 to 0.42, p < .01) and explained 17% variance in physical functioning, 29% in psychological functioning, 17% in environmental functioning, 30% in social dimension, and 29% in overall quality of life. Duration of diabetes moderated effect of state resilience on all aspects of quality of life (b interaction range = 0.20 to 0.26, p < .05) and explained an additional 4% variance in physical functioning, 5% in psychological functioning, 3% in environmental functioning, 5% in social dimension, and 4% in overall quality of life of diabetics. CONCLUSION: Trait resilience has unconditional positive effect on all aspect of quality of life. Long standing diabetics may benefit from intervention addressing state resilience.

A review of anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) impact on major adverse cardiovascular events based on coronary computerized tomography angiography: a 6-year single center review.

BACKGROUND: Anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) is a rare finding that is typically found on autopsy in a person with sudden cardiac death or during routine cardiovascular testing. The true prevalence is unknown for this reason. There is also question to the specific anatomy of the anomalies themselves and how best to correct them. METHODS: We performed a retrospective chart review of all coronary computed tomography angiography (CCTA) studies to evaluate the incidence of all-cause mortality, nonfatal myocardial infarction, stroke and late revascularization (>90 days following CCTA) from January 2005 until July 2012. We describe the origin of the artery, its course, slit-like appearance and treatment in this population. RESULTS: We reviewed 1518 CCTA reports and identified 22 patients with ACAOS with an incidence of 1.4% of our original study population over a review period of 6 years with a resultant median follow-up period of 25 months [interquartile range (IQR)25,75 12-34 months]. The indication for CCTA was for chest pain in the majority of patients (73%). We had one patient undergo surgical repair and one with coronary bypass grafting for unrelated symptomatic coronary artery disease. CONCLUSION: ACAOS continues to be a rare but presumed fatal condition in subsets identified to carry high risk features. As the characteristics of the anomalous vessels that increase risk are still debated, over an intermediate to long follow up in a single large center, none of the different anomalous findings with varying degrees of high risk findings were associated with sudden death.

Open versus Endovascular Repair of Abdominal Aortic Aneurysm in the Elective and Emergent Setting in a Pooled Population of 37,781 Patients: A Systematic Review and Meta-Analysis.

Background. We evaluated the incidence of mortality and myocardial infarction (MI) in endovascular repair (EVAR) as compared to open aneurysm repair (OAR) in both elective and ruptured abdominal aortic aneurysm (AAA ) setting. Methods. We analyzed the rates of 30-day mortality, 30-day MI, and hospital length of stay (LOS) based on comparative observation and randomized control trials involving EVAR and OAR. Results. 41 trials compared EVAR to OAR with a total pooled population of 37,781 patients. Analysis of elective and ruptured AAA repair favored EVAR with respect to 30-day mortality with a pooled odds ratio of 0.19 (95% CI 0.17-0.20; I (2) = 88.9%; P < 0.001). There were a total of 1,835 30-day MI events reported in the EVAR group as compared to 2,483 events in the OAR group. The pooled odds ratio for elective AAA was 0.74 (95% CI 0.58-0.96; P = 0.02) in favor of EVAR. The average LOS was reduced by 296.75 hrs (95% CI 156.68-436.82 hrs; P < 0.001) in the EVAR population. Conclusions. EVAR has lower rates of 30-day mortality, 30-day MI, and LOS in both elective and ruptured AAA repair.

Anomalous left main coronary artery: case series of different courses and literature review.

Background. Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains the main focus of debate. Case Series. We present three cases, all presenting to our facility within one week's time, of patients with newly discovered anomalous origination of the left coronary artery from the right sinus of Valsalva (L-ACAOS). All patients underwent cardiac computed tomography for evaluation of coronary anatomy along with other forms of functional testing. Despite the high risk nature of two of the anomalies, the patients are being treated medically without recurrence of symptoms. Summary. After review of the literature, we have found that the risk of sudden cardiac death in patients with congenital coronary anomalies, even among variants considered the highest risk, may be overestimated. In addition, the exact prevalence of coronary anomalies in the general population is currently underestimated. A national coronary artery anomaly registry based on cardiac computed tomography and invasive coronary angiography data would be helpful in advancing our understanding of these cardiac peculiarities. The true prevalence of congenital coronary anomalies and overall risk of sudden cardiac death in this population are not well known. Surgical intervention remains the mainstay of therapy in certain patients though recent investigations into the pathophysiology of these abnormalities have shown that the risk of surgery may outweigh the minimal reduction in risk of sudden cardiac death.

Explaining the adjustment of adolescents with type 1 diabetes: role of diabetes-specific and psychosocial factors.

OBJECTIVE: The aim of this study was to explain adjustment (diabetes-related quality of life, general well-being, and psychopathology) in adolescents with type 1 diabetes by testing the direct, mediating, and moderating effects of diabetes-specific and psychosocial factors, using an adapted version of the Disability-Stress-Coping model of Wallander and Varni. RESEARCH DESIGN AND METHODS: A total of 437 adolescents (54.5% girls; age range 11-19 years) with type 1 diabetes (mean +/- SD diabetes duration 6.13 +/- 3.78 years) were recruited from 25 hospitals in the Netherlands. Questionnaires were completed by the adolescents and their family members. Metabolic control was assessed by measuring A1C in all participants in one laboratory. RESULTS: Diabetes stress mediated between A1C and adjustment, after controlling for protective factors, and explained an additional 16% variance in quality of life and a 15% variance in general well-being, whereas a 19% additional variance in psychopathology was explained by both diabetes-related and general stress. No moderating effects were identified after controlling for the main effects of all risk and protective factors in the model. CONCLUSIONS: Both diabetes-related and general stress are critical predictors of the adjustment of adolescents with type 1 diabetes. Protective factors such as self-worth and social support may mediate the effects of generic stress and thus should be encouraged. Diabetes-related stress has the potential to displace the effects of protective factors and thus may play a critical role in the development of maladjustment in adolescents with type 1 diabetes.