Characteristics and Outcomes of Young Patients With ST-Elevation Myocardial Infarction Without Standard Modifiable Risk Factors.

Patients with ST-elevation myocardial infarction (STEMI) with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have worse short-term mortality than those with SMuRFs. Whether this association extends to younger patients is unclear. A retrospective cohort study was performed of patients aged 18 to 45 years with STEMI at 3 Australian hospitals between 2010 and 2020. Nonatherosclerotic causes of STEMI were excluded. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 1 and 2-year mortality. Cox proportional hazards analysis was used. Of 597 patients, the median age was 42 (interquartile range 38 to 44) years, 85.1% were men and 8.4% were SMuRF-less. Patients who are SMuRF-less were >2 times more likely to have cardiac arrest (28.0% vs 12.6%, p = 0.003); require vasopressors (16.0% vs 6.8%, p = 0.018), mechanical support (10.0% vs 2.3%, p = 0.046), or intensive care admission (20.0% vs 5.7%, p <0.001); and have higher rate of left anterior descending artery infarcts than those with SMuRFs (62.0% vs 47.2%, p = 0.045). No significant differences in thrombolysis or percutaneous intervention were observed. Guideline-directed medical therapy at discharge was high (>90%), and not different in the SMuRF-less. 30-day mortality was almost fivefold higher in the SMuRF-less (hazard ratio 4.70, 95% confidence interval 1.66 to 13.35, p = 0.004), remaining significant at 1 and 2 years. In conclusion, young patients who are SMuRF-less have a higher 30-day mortality after STEMI than their counterparts with SMuRFs. This may be partially mediated by higher rates of cardiac arrest and left anterior descending artery territory events. These findings further highlight the need for improved prevention and management of SMuRF-less STEMI.

Ketamine Treatment for Alcohol Use Disorder: A Systematic Review.

Alcohol use disorder (AUD) is a chronic, recurrent condition that demonstrates significant heterogeneity in treatment response to first-line agents. Ketamine may have a therapeutic role in substance use disorders; however, research on this topic is limited. The objective of this systematic review is to qualitatively synthesize the current evidence of ketamine treatment for alcohol use disorder and evaluate its efficacy. A systematic review of Medline, PsycINFO, CINAHL, the Cochrane Library, and Google Scholar was performed to identify completed human studies in English or Spanish (from inception to July 2022) that assess the effectiveness of ketamine therapy for alcohol use disorder. This review was registered on the Open Science Framework. Data were descriptively summarized and presented in tables and tested via narrative synthesis methodology. The risk of bias was measured with Cochrane Collaboration tools and a case series quality assessment tool. A total of 11 studies with 854 adult patients in three different countries (the USA, the UK, and Russia) were analyzed. Sample sizes ranged from 5 to 211 people. Seven studies included patients with alcohol use disorder, one study focused on heavy drinkers, and three studies elaborated extensively on alcohol withdrawal. The overall proportion of patients achieving abstinence and reduced consumption was most favorable in people receiving combination ketamine and psychotherapy treatment. The results were mixed with respect to relapse, craving, and withdrawal. Ketamine may be an effective therapeutic modality for people with alcohol use disorders who fail to respond to FDA-approved first-line agents. More robust clinical trials are necessary to provide a more accurate assessment of efficacy, safety profile, and dosing strategies for ketamine utilization in alcohol use disorder.

Scaling Up a Peer-Mediated Program Statewide: Lessons Learned Through Peer to Peer.

Peer-mediated interventions are a powerful and practical way of promoting the social relationships, learning, and inclusion of students with disabilities. In this article, we describe one state's efforts to scale up a research-based, peer-mediated program called Peer to Peer throughout Michigan. Among the more than 700 schools that now offer this program, as many as 18,000 peers are involved in supporting nearly 5,000 schoolmates with autism and other developmental disabilities in their learning and relationships. We share our perspectives on eight key factors that have contributed to the growth and widespread adoption of Peer to Peer over the last 20 years. We discuss enduring challenges in this long-haul work and conclude with recommendations for future research focused on schoolwide peer-mediated programs.

A morphological and molecular revision of lizards of the genus Marisora Hedges amp; Conn (Squamata: Mabuyidae) from Central America and Mexico, with descriptions of four new species.

The skink genus Marisora ranges from Mexico to northern South America and occurs on some islands in the Caribbean Sea. We conducted a revision of the genus Marisora from Mexico and Central America, using new morphological and molecular data, and find support for the five previously described species (Marisora alliacea, M.aurulae, M. brachypoda, M. magnacornae, and M. roatanae) and describe four new species: Marisora lineola sp. nov., M. aquilonaria sp. nov., M. syntoma sp. nov., and M. urtica sp. nov. We show that two species previously known only from Central American islands, M. magnacornae and M. roatanae, also occur on the adjacent mainland and that two species recently placed in Alinea belong to this evolutionary clade: Marisora berengerae n. comb. and Marisora pergravis n. comb. Together with M. falconensis and M. unimarginata, these 13 species of Marisora arose mostly in the Pliocene and are largely allopatric but are sympatric and nearly sympatric at several locations in Central America where they maintain their morphological and genetic distinctiveness.

Fostering cultural competency, clinical reasoning, and leadership through international outreach.

ABSTRACT The Centennial Vision of the American Occupational Therapy Association (AOTA) has called for occupational therapy to be globally connected. Students can gain cultural competency, clinical reasoning, and leadership from attending didactic coursework and participating in discussions and clinical simulations. Immersing oneself in international settings, however, tends to have a greater impact on learning. The authors describe the outcomes of two international outreach programs: China Honors Immersion Program (CHIP) and Institute for Latin American Concern (ILAC). The outcomes of these programs indicate that students believe that such international experiences greatly affect their development, both professionally and personally. Implications of the program outcomes to current professional education are discussed. Future research directions are also proposed.

Recurrent concussion and risk of depression in retired professional football players.

PURPOSE: The purpose of our study was to investigate the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players with prior head injury exposure. METHODS: A general health questionnaire, including information about prior injuries, the SF-36 (Short Form 36), and other markers for depression, was completed by 2552 retired professional football players with an average age of 53.8 (+/-13.4) yr and an average professional football-playing career of 6.6 (+/-3.6) yr. A second questionnaire focusing on mild cognitive impairment (MCI)-related issues was completed by a subset of 758 retired professional football players (50 yr and older). RESULTS: Two hundred sixty-nine (11.1%) of all respondents reported having prior or current diagnosis of clinical depression. There was an association between recurrent concussion and diagnosis of lifetime depression (chi2=71.21, df=2, P<0.005), suggesting that the prevalence increases with increasing concussion history. Compared with retired players with no history of concussion, retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. The analyses controlled for age, number of years since retirement, number of years played, physical component score on the SF-36, and diagnosed comorbidities such as osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. CONCLUSION: Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential neurological consequences of recurrent concussion.

Oral contraceptive use by teenage women does not affect body composition.

OBJECTIVE: To assess the effect of oral contraceptive (OC) use during adolescence on body composition parameters and cardiovascular disease risk factors. METHODS: We used 9 years of longitudinal data from 66 non-Hispanic white females who were 12 years old at study entry in 1990, and who were subsequently classified either as OC users or nonusers. The OC users (n = 39) used OCs for a minimum of 6 months, were still using at age 21, and had used OCs, on average, for 28 months. The nonusers (n = 27) never used OCs. Individuals who started and then stopped using OCs before age 21 or used OCs for less than 6 months were excluded from these analyses. Cardiolipoprotein profiles were obtained from fasting blood samples (from age 16 to 21), and body composition measurements were made by dual energy x-ray absorptiometry (from age 12.5 to 21). Longitudinal models were used to examine changes in body composition patterns and in cardiolipoprotein patterns. RESULTS: Between ages 12.5 and 21, gains by OC users and nonusers in height, weight, body mass index (BMI), and percent body fat were not significantly different. However, between ages 16 and 21, the OC users had significantly greater increases in total serum cholesterol, serum low-density cholesterol, and serum triglycerides than did the nonusers. CONCLUSION: The use of OCs in young women is associated with less favorable blood lipid patterns, but is not associated with weight gain or increased body fat. The long-term effects of the alteration in the lipid profiles are unknown.