Q-Score Complements the Time in Range in the Evaluation of Short-Term Glycemic Control.

BACKGROUND AND AIMS: The Q-Score is a single-number composite metric that is constructed based on the following components: central glycemic tendency, hyperglycemia, hypoglycemia, and intra- and interday variability. Herein, we refined the Q-Score for the screening and analysis of short-term glycemic control using continuous glucose monitoring (CGM) profiles. METHODS: Continuous glucose monitoring profiles were obtained from noninterventional, retrospective cross-sectional studies. The upper limit of the Q-Score component hyperglycemia' that is, the time above target range (TAR), was adjusted from 8.9 to 10 mmol/L (n = 1562 three-day-sensor profiles). A total of 302 people with diabetes mellitus treated with intermittent CGM for ≥14 days were enrolled. The time to stability was determined via correlation-based analysis. RESULTS: There was a strong correlation between the Q-Scores of the two TARs, that is, 8.9 and 10 mmol/L (Q-ScoreTAR10 = -0.03 + 1.00 Q-ScoreTAR8.9, r = .997, p < .001). The times to stability of the Q-Score and TIR were 10 and 12 days, respectively. The Q-Score was correlated with fructosamine concentrations, the glucose management indicator (GMI), the time in range (TIR), and the glycemic risk index (GRI) (r = .698, .887, -.874, and .941), respectively. The number of Q-Score components above the target increased as the TIR decreased, from two (1.7 ± 0.9) in CGM profiles with a TIR between 70% and 80% to four (3.9 ± 0.5) in the majority of the CGM profiles with a TIR below 50%. A conversion matrix between the Q-Score and glycemic indices was developed. CONCLUSIONS: The Q-Score is a tool for assessing short-term glycemic control. The Q-Score can be translated into clinician opinion using the GRI.

Risk factors for COVID-19 hospitalization and mortality in patients with chronic kidney disease: a nationwide cohort study.

Background: Several studies have demonstrated an increased risk of severe coronavirus disease 2019 (COVID-19) in chronic kidney disease (CKD) patients. However, few have investigated the impact of CKD stage and dialysis modality. The primary aim of this study was to investigate the association between CKD stage, dialysis modality and risk of severe COVID-19. Secondly, we aimed to study the impact of comorbidities and drugs on the risk of severe COVID-19 in the CKD population. Methods: This nationwide observational study was based on data from the Swedish Renal Registry and three other national registries. Patients with non-dialysis CKD stage 3b-5 or dialysis on 1 January 2020 were included and followed until 31 December 2021. The primary outcome was COVID-19 hospitalization; the secondary outcome was COVID-19 mortality. Associations were investigated using logistic regression models, adjusting for confounders. Results: The study population comprised 7856 non-dialysis CKD patients and 4018 dialysis patients. The adjusted odds ratios (aOR) for COVID-19 hospitalization and mortality were highest in the dialysis group [aOR 2.24, 95% confidence interval (CI) 1.79-2.81; aOR 3.10, Cl 95% 2.03-4.74], followed by CKD 4 (aOR 1.33, 95% CI 1.05-1.68; aOR 1.66, Cl 95% 1.07-2.57), as compared with CKD 3b. No difference in COVID-19 outcomes was observed between patients on hemodialysis and peritoneal dialysis. Overall comorbidity burden was one of the strongest risk factors for severe COVID-19 and the risk was also increased in patients prescribed insulin, proton pump inhibitors, diuretics, antiplatelets or immunosuppressants. Conclusions: Worsening CKD stage and comorbidity are independent risk factors for severe COVID-19 in the Swedish CKD population.

Results of the first nationwide cohort study of outcomes in dialysis and kidney transplant patients before and after vaccination for COVID-19.

BACKGROUND: Patients on kidney replacement therapy (KRT) have been identified as a vulnerable group during the coronavirus disease 2019 (COVID-19) pandemic. This study reports the outcomes of COVID-19 in KRT patients in Sweden, a country where patients on KRT were prioritized early in the vaccination campaign. METHODS: Patients on KRT between January 2019 and December 2021 in the Swedish Renal Registry were included. Data were linked to national healthcare registries. The primary outcome was monthly all-cause mortality over 3 years of follow-up. The secondary outcomes were monthly COVID-19-related deaths and hospitalizations. The results were compared with the general population using standardized mortality ratios. The difference in risk for COVID-19-related outcomes between dialysis and kidney transplant recipients (KTRs) was assessed in multivariable logistic regression models before and after vaccinations started. RESULTS: On 1 January 2020, there were 4097 patients on dialysis (median age 70 years) and 5905 KTRs (median age 58 years). Between March 2020 and February 2021, mean all-cause mortality rates increased by 10% (from 720 to 804 deaths) and 22% (from 158 to 206 deaths) in dialysis and KTRs, respectively, compared with the same period in 2019. After vaccinations started, all-cause mortality rates during the third wave (April 2021) returned to pre-COVID-19 mortality rates among dialysis patients, while mortality rates remained increased among transplant recipients. Dialysis patients had a higher risk for COVID-19 hospitalizations and death before vaccinations started {adjusted odds ratio [aOR] 2.1 [95% confidence interval (CI) 1.7-2.5]} but a lower risk after vaccination [aOR 0.5 (95% CI 0.4-0.7)] compared with KTRs. CONCLUSIONS: The COVID-19 pandemic in Sweden resulted in increased mortality and hospitalization rates among KRT patients. After vaccinations started, a distinct reduction in hospitalization and mortality rates was observed among dialysis patients, but not in KTRs. Early and prioritized vaccinations of KRT patients in Sweden probably saved many lives.

Epigenetic Implications of Neighborhood Disorder and Psychological Distress among Pregnant Black Women.

Background: In the United States, Black women experience preterm birth (PTB; <37 weeks gestation) at more than 1.5 times the rate of non-Hispanic White women. Social determinants of health including the neighborhood environment have been recognized as contributing to the risk of PTB. Due to historical segregation, Black women are more likely to live in neighborhoods with higher levels of neighborhood disorder compared with White women. Perceived neighborhood disorder appears to be a risk factor for maternal psychological distress in Black women and psychological distress has mediated the association between neighborhood disorder and the risk for PTB. However, the biological pathways underpinning these associations are not clear. Objective: We examined the associations among neighborhood disorder; psychological distress; DNA methylation of six stress-related, glucocorticoid candidate genes (AVP, CRH, CRHBP, FKBP5, HSD11B2, NR3C1); and gestational age at birth among 44 Black pregnant women. Methods: Women who were 18-45 years old and 8-18 weeks gestation had blood drawn and completed questionnaires measuring perceived neighborhood disorder, neighborhood crime, and psychological distress. Results: Three CpG sites were associated with neighborhood disorder (cg03405789 [CRH], cg14939152 and cg15910486 [NR3C1]). One CpG site, cg03098337 (FKBP5) was associated with psychological distress. Three of the identified CpG sites were located within gene CpG islands or shores-areas at which DNA methylation is known to affect gene transcription. Conclusion: These findings warrant further research to clarify intermediate biological pathways and potential biomarkers to identify women at risk for PTB. Identification of PTB risk early in pregnancy would allow for interventions to prevent PTB.

PhD student perspectives on maintaining and formalizing peer mentorship during the COVID-19 pandemic.

Mentorship is important for doctoral education and development. Students in Doctor of Philosophy (PhD) in Nursing programs traditionally receive formal mentorship from more experienced faculty mentors, creating a top-down, mentor-mentee relationship. Peer mentorship, characterized by a mentor-mentee relationship between peers in similar career stages, provides unique opportunities for career development and socialization. The emergence of the COVID-19 pandemic limited in-person interactions and introduced new, complex challenges to peer mentorship. The authors, current and recently graduated PhD in Nursing students, were forced to create new ways of connecting with peers and sought to explore how other PhD in Nursing students experienced and maintained peer mentorship in their respective programs during the pandemic. In this article, the authors share their personal experiences with peer mentorship during the pandemic, their process of creating a formal peer mentor model, and findings from a national, cross-sectional survey on COVID-related, peer mentorship experiences among PhD in Nursing students from other academic institutions. Most respondents were able to maintain peer mentorship throughout the pandemic, however, less than half reported receiving faculty support to do so. Recommendations for PhD in Nursing program administrators are provided, based on the experiences of the authors and survey results from PhD in Nursing students across the United States.

DNA Methylation Patterns of Glucocorticoid Pathway Genes in Preterm Birth Among Black Women.

Preterm birth (PTB; <37 weeks gestation) rates have increased for 5 of the last 6 consecutive years in the United States. These rates are particularly alarming for U.S. non-Hispanic Black women who give birth prematurely at 1.5 times the rate of non-Hispanic White women. Previous research suggests that psychological stress is associated with PTB in Black women. However, the biological pathways by which stress alters birth timing are not clear. We examined DNA methylation (DNAm) in peripheral blood leukocytes in 6 glucocorticoid, stress-related genes in 44 (22 PTB; 22 term birth) pregnant Black women. Four cytosine-phosphate-guanine (CpG) sites were identified as differentially methylated (p < 0.05) between women with PTB and women with term births. The ability to identify stress-related biological markers that are associated with PTB among Black women would provide a critical step toward decreasing the PTB disparity among these women. Future studies should include larger sample sizes and gene expression analyses of the stress-related biological pathways to PTB.

Loneliness and Depressive Symptoms among Pregnant Black Women during the COVID-19 Pandemic.

We explored the associations among perceived stress, depressive symptoms, loneliness, and social support during the COVID-19 pandemic; and differences in perceived stress, depressive symptoms, and social support prior to the pandemic and during the pandemic among pregnant Black women. A sample of 33 pregnant Black women who participated in the Biosocial Impact on Black Births (BIBB) and were still pregnant in May-June 2020 were invited to complete an online survey about their experiences during the pandemic. Fifteen women responded very much or somewhat to experiencing stress and anxiety because of the COVID-19 pandemic. Eight women had CES-D scores ≥23, which have been correlated with depression diagnosis. Women who reported higher levels of loneliness during the COVID-19 pandemic also reported higher levels of perceived stress and depressive symptoms and lower levels of social support during the pandemic. Women who reported lower levels of social support during the pandemic also reported higher levels of perceived stress and depressive symptoms during the pandemic. There were no changes in perceived stress, depressive symptoms, or social support prior to the pandemic and during the pandemic. Clinicians should assess for signs of loneliness and depressive symptoms for pregnant women and offer recommendations for therapy and support groups.

Methodologic Considerations for Epigenomic Investigation of Preterm Birth in African American Women.

Epigenetic modifications are chemical changes that can modify gene expression without changing the sequence of the gene. These modifications are potentially identifiable and reversible, making the epigenome an important area of research for discovering biomarkers to identify those who may be at risk and providing therapeutic interventions to prevent adverse health outcomes. African Americans bear a disproportionate risk of adverse health outcomes (e.g., hypertension, cancer). Indeed, African American women experience preterm birth (PTB; <37 completed weeks gestation) at more than twice the rate of non-Hispanic White women. Research suggests that environmental influences may play a significant role in PTB outcomes for this population. However, the biological pathways by which these influences contribute to PTB are poorly understood. This paper describes research methods and ethical considerations for the collection and analysis of biological samples based on our study examining the epigenetic regulation of stress pathways in PTB in pregnant African American women.

Timing of Prenatal Care Initiation and Psychological Wellbeing in Black Women.

PURPOSE: The purpose of this study was to see if timing of prenatal care initiation was related to psychological wellbeing of Black women. STUDY DESIGN AND METHODS: Using a cross-sectional design, a sample of 197 pregnant Black women completed a self-reported survey between 8 weeks and less than 30 weeks gestation as part of the Biosocial Impact on Black Births study. The questions asked about the initiation of prenatal care, perceived stress, depressive symptoms, and psychological wellbeing. Multiple linear regression was used to examine if timing of prenatal care initiation was related to psychological variables. RESULTS: Sixty-three women (32%) reported they were not able to initiate their first prenatal care visit as early as they wanted due to various barriers. After adjusting for cofounders, not initiating prenatal care as early as women wanted predicted lower levels of psychological wellbeing. CLINICAL IMPLICATIONS: Perinatal nurses should assess psychological wellbeing in Black women throughout pregnancy; advocate for Black women who report high levels of stress, psychological distress, or depressive symptoms for further mental health evaluation by their health care provider; and provide resources and education (e.g., support groups, counseling) for these women.

Stress During Pregnancy and Epigenetic Modifications to Offspring DNA: A Systematic Review of Associations and Implications for Preterm Birth.

Offspring born preterm (ie, before 37 weeks of gestation) are more likely to die or experience long-standing illness than full-term offspring. Maternal genetic variants (ie, heritable, stable variations in the genetic code) and epigenetic modifications (ie, chemical modifications to the genetic code that can affect which genes are turned on or off) in response to stress have been implicated in preterm birth. Fetal genetic variants have been linked to preterm birth though the role of offspring epigenetics in preterm birth remains understudied. This systematic review synthesizes the literature examining associations among stress during pregnancy and epigenetic modifications to offspring DNA, with 25 reports identified. Ten reports examined DNA methylation (ie, addition/removal of methyl groups to/from DNA) across the epigenome. The remainder examined DNA methylation near genes of interest, primarily genes linked to hypothalamic-pituitary-adrenal axis function (NR3C1, FKBP51), growth/immune function (IGF2), and socioemotional regulation (SLC6A4, OXTR). The majority of reports noted associations among stress and offspring DNA methylation, primarily when perceived stress, anxiety, or depression served as the predictor. Findings suggest that differences in offspring epigenetic patterns may play a role in stress-associated preterm birth and serve as targets for novel interventions.

How Depressive Symptoms among African American Women Relate to Measures of Social Disorder in Her Childhood and Pregnancy Neighborhood.

Pregnant African American women who report higher levels of social disorder (e.g., vacant housing, drug dealing) in their neighborhoods also report higher levels of depressive symptoms. The effects of social disorder in the neighborhood during childhood on depressive symptoms during pregnancy are not known. Also unknown is the interaction between social disorders in the neighborhood during childhood and during pregnancy regarding depressive symptoms during pregnancy. The purpose of this study was to examine whether higher levels of social disorder in the neighborhood during pregnancy buffered the association of social disorder in the neighborhood during childhood (at age 10 as reference) with depressive symptoms during pregnancy among African American women. We conducted a secondary data analysis of 1383 African American women from the Life-course Influences on Fetal Environments (LIFE) Study (Detroit, Michigan, 2009-2011). Women were interviewed in the hospital 24-72 h after the births. The Center for Epidemiological Studies-Depression (CES-D) scale measured depressive symptoms. Scales measuring social disorder in the neighborhood both during childhood and during pregnancy were also included in the interviews. Women with CES-D scores ≥ 16 were younger, were more likely to be single, and had lower levels of education and household income compared with women with CES-D < 16. There was a significant association between women who report social disorder in their neighborhoods during childhood and depressive symptoms during pregnancy. This effect was moderated by measures of social disorder in the neighborhood during pregnancy (p = .037). Women who reported both low levels of social disorder in their neighborhoods during childhood and during pregnancy had the lowest CES-D scores after controlling for maternal age, marital status, years of education, and family income. The model had a good fit to the data (χ2(6) = 6.36, p = .38). Health care providers should inquire about neighborhood conditions during childhood and during pregnancy and provide referrals for appropriate professional and community support for women who report social disorder in their neighborhoods and depressive symptoms.

Efficacy of Routine Fecal Microbiota Transplantation for Treatment of Recurrent Clostridium difficile Infection: A Retrospective Cohort Study.

BACKGROUND: Patients with recurrent Clostridium difficile infections (CDIs) constitute an increasing treatment problem. Fecal microbiota transplantation (FMT) has shown promising results of treating recurrent CDI, where treatment with antibiotics fails repeatedly. Our study describes retrospective cohort treated with FMT at two major hospitals in Stockholm. METHODS: Medical records of all patients with recurrent CDI treated with FMT during the period 2013-2017 were reviewed. We evaluated cure of CDI-related diarrhea without relapse 10 weeks after FMT. RESULTS: 47 patients were included. One treatment cured 25 patients (53%), and more than one treatment cured 32 patients (68%). Treatment outcome did not vary significantly with treatment with fresh donor feces or frozen fecal culture, days of use of antibiotics or days of hospitalization prior to CDI, and renal function or time from the first CDI to therapy. Treatment failure was associated with a significantly lower Karnofsky performance status score (70 points vs 90, p=0.02). CONCLUSION: Fecal instillation, for the treatment of relapsing CDI, is a promising approach, with 68% success rate reported in this study. The success rate of FMT is high, regardless of multiple comorbidities, extended use of antibiotics, or long time hospitalization. Although generally FMT is performed with fresh donor feces, our data show that the usage of frozen fecal culture could be an effective treatment alternative in recurrent CDI.

Efficacy of Platelet-Rich Plasma for the Treatment of Interstitial Supraspinatus Tears: A Double-Blinded, Randomized Controlled Trial.

BACKGROUND: The benefits of platelet-rich plasma (PRP) for the treatment of rotator cuff tears remain inconclusive, as it is administered either as an adjuvant to surgical repair or as a primary infiltration without targeting the index lesion, which could dilute its effect. PURPOSE: To determine whether PRP infiltrations are superior to saline solution infiltrations (placebo) at improving healing, pain, and function when injected under ultrasound guidance within isolated interstitial supraspinatus tears. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: In this single-center, double-blinded, randomized controlled trial, 80 adults with symptomatic isolated interstitial tears of the supraspinatus, confirmed by magnetic resonance arthrography, were randomized to PRP or saline injections. Each patient received 2 injections with a 1-month interval. The primary outcome was the change in lesion volume, calculated on magnetic resonance arthrography, at 7 months. The secondary outcomes were improvements in shoulder pain and the Single Assessment Numerical Evaluation (SANE) score at >12 months. RESULTS: Preoperative patient characteristics did not differ between the 2 groups. At 7 months, there were no significant differences between the PRP and control groups in terms of a decrease in lesion size (-0.3 ± 23.6 mm3 vs -8.1 ± 84.7 mm3, respectively; P = .175); reduction of pain on a visual analog scale (VAS) (-2.3 ± 3.0 vs -2.0 ± 3.0, respectively; P = .586); and improvement in SANE (16.7 ± 20.0 vs 14.9 ± 29.0, respectively; P = .650), Constant (8.6 ± 13.0 vs 10.7 ± 19.0, respectively; P = .596), and American Shoulder and Elbow Surgeons (19.5 ± 20.0 vs 21.9 ± 28.0, respectively; P = .665) scores. At >12 months, there were no significant differences between the PRP and control groups in terms of a reduction of pain on a VAS (-3.3 ± 2.6 vs -2.3 ± 3.2, respectively; P = .087) or improvement in the SANE score (24.4 ± 27.5 vs 23.4 ± 24.9, respectively; P = .846). At 19.5 ± 5.3 months, the incidence of adverse effects (pain >48 hours, frozen shoulder, extension of lesion) was significantly higher in the PRP group than the control group (54% vs 26%, respectively; P = .020). CONCLUSION: PRP injections within interstitial supraspinatus tears did not improve tendon healing or clinical scores compared with saline injections and were associated with more adverse events. REGISTRATION: NCT02672085 (ClinicalTrials.gov identifier).

Postoperative Mobilization After Superior Rotator Cuff Repair: Sling Versus No Sling: A Randomized Prospective Study.

BACKGROUND: Patients are commonly advised to wear a sling for 4 to 6 weeks after rotator cuff repair despite negative effects of early immobilization and benefits of motion rehabilitation. The aim of this study was to compare clinical and radiographic outcomes up to 6 months following rotator cuff repair with and without postoperative sling immobilization. METHODS: We randomized 80 patients scheduled for arthroscopic repair of a small or medium superior rotator cuff tear into sling and no-sling groups (40 patients each). Passive mobilization was performed in both groups during the first 4 postoperative weeks, and this was followed by progressive active mobilization. Patients were evaluated clinically at 10 days and 1.5, 3, and 6 months and using ultrasound at 6 months. Univariable and multivariable analyses were performed to determine if postoperative scores were associated with sex, age at surgery, immobilization, arm dominance, a biceps procedure, resection of the distal part of the clavicle, or preoperative scores. RESULTS: The sling and no-sling groups had similar preoperative patient characteristics, function, and adjuvant procedures. At 10 days, there was no difference in pain between the 2 groups (mean pain score [and standard deviation], 5.2 ± 2.3 versus 5.2 ± 1.9, p = 0.996). In comparison with the sling group, the no-sling group showed greater mean external rotation (23.5° ± 15.6° versus 15.3° ± 14.6°, p = 0.017) and active elevation (110.9° ± 31.9° versus 97.0° ± 25.0°, p = 0.038) at 1.5 months as well as better mean active elevation (139.0° ± 24.7° versus 125.8° ± 24.4°, p = 0.015) and internal rotation (T12 or above in 50% versus 28%, p = 0.011) at 3 months. Ultrasound evaluation revealed no significant differences at 6 months in tendon thickness anteriorly (p = 0.472) or posteriorly (p = 0.639), bursitis (p = 1.000), echogenicity (p = 0.422), or repair integrity (p = 0.902). Multivariable analyses confirmed that the mean American Shoulder and Elbow Surgeons (ASES) score increased with patient age (beta, 0.60; p = 0.009), the Single Assessment Numeric Evaluation (SANE) decreased with sling immobilization (beta, -6.33; p = 0.014), and pain increased with sling immobilization (beta, 0.77; p = 0.022). CONCLUSIONS: No immobilization after rotator cuff repair is associated with better early mobility and functional scores in comparison with sling immobilization. Postoperative immobilization with a sling may therefore not be required for patients treated for a small or medium tendon tear. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Social Integration and Quality of Social Relationships as Protective Factors for Inflammation in a Nationally Representative Sample of Black Women.

Social integration and supportive relationships protect against cardiovascular disease (CVD). However, prior studies have examined heterogeneous samples which may obscure unique relationships within groups. We investigate the association between social relationships and inflammation-a known CVD risk factor-in Black women, a population with higher rates of CVD and CVD mortality. Secondary data from wave 4 of the National Longitudinal Study of Adolescent to Adult Health (Add Health) were analyzed. The sample was comprised of 1829 Black women aged 24-34 years. Social integration was a z-score standardized measure of four items (marital/cohabitation status, church attendance, volunteerism, close friendships). Data on the quality of three relationship types was available: perceived happiness with a romantic relationship and perceived closeness to mother and father figure. Inflammation was measured via high-sensitivity C-reactive protein (hs-CRP) in which levels were categorized based on clinical cut-points for risk of CVD (< 1 mg/L = low risk-reference, 1-3 mg/L = moderate risk, > 3-10 mg/L = high risk, > 10 mg/L = very high risk). Multivariable logistic regression was conducted accounting for the complex survey design and wave 4 control measures (e.g., body mass index, smoking, medications, acute illness, overall health, sociodemographic factors). No significant associations were found between level of social integration and hs-CRP levels. With respect to relationship quality, women who reported they were very happy with their romantic relationship were less likely than those who were only fairly happy or unhappy to have hs-CRP levels in the moderate- (AOR = 0.36, 95% CI = 0.17, 0.75), high (AOR = 0.20, 95% CI = 0.08, 0.49), or very high CVD-risk category (AOR = 0.36, 95% CI = 0.16, 0.80). Women who reported they were somewhat/quite/very close to their mother figure (AOR = 0.48, 95% CI = 0.25, 0.92) and those who reported having no mother figure (AOR = 0.25, 95% CI = 0.08, 0.77) were less likely than women reporting being not very close/not close at all with their mother figure to have hs-CRP levels in the moderate- vs. low-risk category. No statistically significant associations were found between father-figure relationship and hs-CRP CVD risk category. In summary, social integration and the quality of specific social relationships were significantly associated with inflammation in young adult Black women. Thus, interventions designed to enhance social connectedness and positive social relationships among Black women may have the potential to be protective for CVD risk. Further researches with the longitudinal social relationship and inflammatory measures are needed to better understand how changes in social relationships may influence CVD risk over the life course.

Neighborhood Environment and DNA Methylation: Implications for Cardiovascular Disease Risk.

Exposure to chronic stress such as living in disadvantaged neighborhoods has been related to cardiovascular disease (CVD). Chronic stress may increase the risk for CVD by increasing levels of systemic inflammation (e.g., higher levels of pro-inflammatory cytokines). Differential DNA methylation of inflammation-related candidate genes is also related to higher risk for CVD. Thus, the purpose of this review was to examine the association of neighborhood disadvantage with DNA methylation. A search of literature was conducted using Scopus, CINAHL, PubMed, Medline, and Embase databases. The keywords neighborhood, neighborhood disorder, neighborhood crime, neighborhood violence, neighborhood safety, built environment, and housing vacancy were combined with the keywords DNA methylation and epigenetics. Five studies were included in this review (n = 3 adult blood samples and n = 2 fetal blood samples). Four of the five studies reported an association of neighborhood socioeconomic status, social environment, and crime with either global or gene-specific DNA methylation. Only two studies examined the association of neighborhood disadvantage with inflammation-related candidate genes. One of these studies found a significant association of neighborhood socioeconomic disadvantage and social environment with DNA methylation in inflammation-related candidate genes. Thus, data are limited on the association between neighborhood disadvantage and DNA methylation of inflammation-related candidate genes, as well as genes in other potential mechanistic pathways including psychosocial stress, toxin response, and adiposity. Future studies should examine these associations and the potential epigenetic mechanisms by which neighborhood disadvantage increases the risk for CVD.

Can support from the father of the baby buffer the adverse effects of depressive symptoms on risk of preterm birth in Black families?

BACKGROUND: While maternal depressive symptoms during pregnancy have been linked to preterm birth (PTB; birth before 37 completed weeks of gestation), little has been reported on potential buffering factors, particularly specific to Black women who are at much higher risk. We examined the association between depressive symptoms and PTB in pregnant Black women, with father of the baby (FOB) support as a potential buffering factor. METHODS: Data were obtained from the life-course influences on fetal environments study (2009-2011), a cohort of 1,410 Black women in metropolitan Detroit, Michigan (71% response rate) using maternal interviews and medical record abstraction collected during the postpartum hospitalization. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to measure depressive symptoms. The 14-item social networks in adult relations questionnaire was used to assess the mother's relationship with the FOB. Logistic regression was used to explore the interaction between CES-D and FOB support with regard to PTB risk. We adjusted for maternal advanced age, income, education level, smoking status, hypertension, prenatal care and BMI. RESULTS: The PTB rate in this cohort was 17.7%. Among women with FOB scale < 60 (less support), the odd ratio (OR) of PTB for women with CES-D scores ≥ 23 (severe depressive symptoms) as compared to CES-D scores < 23 (no severe depressive symptoms) was 2.57 [95% confidence interval (CI): 1.68, 3.94; p < 0.001]. Among women with FOB scores ≥ 60 (more support), the odds of PTB in women with CES-D scores ≥ 23 did not significantly differ from the odds of PTB in women with CES-D scores < 23 (OR = 1.34; 95% CI: 0.74, 2.44; p = 0.3). After adjustment for covariates, among women with FOB scores < 60, the OR of PTB for women with CES-D scores ≥ 23 compared to < 23 was 2.79 (95% CI: 1.75, 4.45; p < 0.001). Among women with FOB scores ≥ 60, the odds of PTB in women with CES-D scores ≥ 23 was not statistically significantly different compared to the odds of PTB in women with CES-D scores < 23 (OR = 1.21; 95% CI: 0.62, 2.35; p = 0.6). The interaction term was statistically significant (p = 0.04). DISCUSSION/CONCLUSIONS: The adverse effect of depressive symptoms on risk of PTB may be buffered by factors such as a supportive relationship with the FOB.

Standard versus bony increased-offset reverse shoulder arthroplasty: a retrospective comparative cohort study.

BACKGROUND: To date, only a few comparative studies with small sample sizes have compared a traditional reverse shoulder arthroplasty (tRSA) to a bony increased-offset RSA (BIO-RSA). We hypothesized that the BIO-RSA would lead to lower notching rates and improved range of motion (ROM) compared with a tRSA. METHODS: A retrospective review was performed of 69 tRSAs and 61 BIO-RSAs performed by a single surgeon. At 2 years postoperative, ROM and Constant scores were compared. Radiographs were examined for scapular notching, scapular spurring or ossification, and graft healing. RESULTS: At the 2-year follow-up, the BIO-RSA group demonstrated improved anterior forward flexion compared with the tRSA group (145° ± 20° vs. 138° ± 20°, respectively; P = .017). There was no difference in external or internal rotation between the 2 groups. The BIO-RSA group had a higher Constant score than the tRSA group (69 ± 9 vs. 61 ± 13; P < .001). The radiographs showed no difference between the 2 groups, including scapular notching (P = .150). CONCLUSION: At the 2-year follow-up, BIO-RSA does not lead to a clinically significantly improvement in ROM, Constant scores, or change in scapular notching compared with a tRSA.