Intermittent Occlusion of the Superior Vena Cava to Improve Hemodynamics in Patients With Acutely Decompensated Heart Failure: The VENUS-HF Early Feasibility Study.

BACKGROUND: Reducing congestion remains a primary target of therapy for acutely decompensated heart failure. The VENUS-HF EFS (VENUS-Heart Failure Early Feasibility Study) is the first clinical trial testing intermittent occlusion of the superior vena cava with the preCARDIA system, a catheter mounted balloon and pump console, to improve decongestion in acutely decompensated heart failure. METHODS: In a multicenter, prospective, single-arm exploratory safety and feasibility trial, 30 patients with acutely decompensated heart failure were assigned to preCARDIA therapy for 12 or 24 hours. The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events through 30 days. Secondary end points included technical success defined as successful preCARDIA placement, treatment, and removal and reduction in right atrial and pulmonary capillary wedge pressure. Other efficacy measures included urine output and patient-reported symptoms. RESULTS: Thirty patients were enrolled and assigned to receive the preCARDIA system. Freedom from device- or procedure-related major adverse events was observed in 100% (n=30/30) of patients. The system was successfully placed, activated and removed after 12 (n=6) or 24 hours (n=23) in 97% (n=29/30) of patients. Compared with baseline values, right atrial pressure decreased by 34% (17±4 versus 11±5 mm Hg, P<0.001) and pulmonary capillary wedge pressure decreased by 27% (31±8 versus 22±9 mm Hg, P<0.001). Compared with pretreatment values, urine output and net fluid balance increased by 130% and 156%, respectively, with up to 24 hours of treatment (P<0.01). CONCLUSIONS: We report the first-in-human experience of intermittent superior vena cava occlusion using the preCARDIA system to reduce congestion in acutely decompensated heart failure. PreCARDIA treatment for up to 24 hours was well tolerated without device- or procedure-related serious or major adverse events and associated with reduced filling pressures and increased urine output. These results support future studies characterizing the clinical utility of the preCARDIA system. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03836079.

An analysis of the socio-demographic characteristics of sole registered births and infant deaths.

BACKGROUND: Differences in birth characteristics and infant mortality rates by marital status and birth registration type reflect complex underlying factors. In particular, births registered solely by the mother are seen as a disadvantaged group. This article analyses the socio-demographic characteristics of births by registration type and parents' marital status and explores these differences for health outcomes. METHODS: Birth notifications data from the NHS Numbers for Babies system was linked to birth registration data held by the Office for National Statistics (ONS) for births occurring in 2007 and 2008 in England and Wales. This dataset was further linked to death registration data to identify infants who died before their first birthday.Regression analysis was used to compare factors and health outcomes across marital and registration status groups. Regression models were calculated to determine the main risk factors for poor outcomes. RESULTS: The registration groups differed in the age of the mother at birth, the proportion of young mothers, ethnic group distribution and measures of deprived circumstances. The joint registered-different address and sole registered groups were similar in the proportion of young mothers and the deprivation indices. The groups also differed in the proportion of low birthweight and premature babies. The joint registered-different address and sole registered groups both had higher percentages of 'small for gestational age' babies compared with the within-marriage and joint registered-same address groups. The stillbirth rate was highest in the sole registered group. Both the joint registered-different address and sole registered groups had higher infant mortality rates compared with the within-marriage and joint registered-same address groups. Multivariate analysis indicated that low birthweight was a key factor in infant mortality. CONCLUSIONS: Births registered solely by the mother were found to be a disadvantaged group but were also similar to the joint-registered group living at different addresses in their main socio-demographic characteristics and health outcomes. The joint-registered group living at the same address was similar to the within-marriage group across the same measures. This argues that, in the 21st century, the distinction between infants with 'resident' and 'nonresident' fathers is more meaningful for health outcomes than that between births inside and outside marriage.

Resilience to adult psychopathology following childhood maltreatment: evidence from a community sample.

OBJECTIVE: Child abuse is an important risk for adult psychiatric morbidity. However, not all maltreated children experience mental health problems as adults. The aims of the present study were to address the extent of resilience to adult psychopathology in a representative community sample, and to explore predictors of a good prognosis. METHODS: Data are drawn from a follow-up of the Isle of Wight study, an epidemiological sample assessed in adolescence and at midlife. Ratings of psychiatric disorder, peer relationships and family functioning were made in adolescence; adult assessments included a lifetime psychiatric history, personality and social functioning assessments, and retrospective reports of childhood sexual and physical abuse. RESULTS: Ten percent of individuals reported repeated or severe physical or sexual abuse in childhood. Prospective measures revealed increased rates of adolescent psychiatric disorders in this group. Rates of adult psychopathology were also high. A substantial minority of abused individuals reported no mental health problems in adult life. Resilience of this kind was related to perceived parental care, adolescent peer relationships, the quality of adult love relationships, and personality style. CONCLUSION: Good quality relationships across childhood, adolescence and adulthood appear especially important for adult psychological well being in the context of childhood abuse.

Preadolescent conduct problems in girls and boys.

OBJECTIVE: To examine sex differences in correlates of disruptive behavior disorders (DBDs) in preadolescent children using indicators of a wide range of well-established risk factors for DBDs and outcomes 3 years after initial assessment. METHOD: Analyses were based on data for 5- to 10-year-olds (n = 5,913) from the British Child and Adolescent Mental Health Survey 1999, and a 3-year follow-up of selected subsamples (n = 1,440) at ages 8 through 13 years. DSM-IV diagnoses were assigned using the Developmental and Well-Being Assessment at both contacts. RESULTS: Boys and girls were equally exposed to most social and family risks for DBDs, with little evidence of differential sensitivity to these risks. Boys were exposed more to neurodevelopmental difficulties, attention-deficit/hyperactivity disorder, and peer problems and had lower rates of prosocial behaviors; together, these factors and physical punishment could account for 54% of the observed sex differences in DBDs. At follow-up, outcomes for girls and boys with DBDs were very similar. For children with subthreshold conduct problems at initial assessment, boys were more likely to go on to exhibit DBDs than were girls (25% versus 7%). CONCLUSIONS: Sex differences in the levels of a variety of child characteristics and interpersonal factors are likely to be important in understanding sex differences in risk for DBDs in preadolescent samples.

Precursors and correlates of criminal behaviour in women.

BACKGROUND: The precursors and correlates of criminal behaviour in women were examined in this longitudinal study of women in their late thirties. METHODS: The sample consisted of a high-risk group of women (n = 86) and a comparison group (n = 97): the former had been raised in institutional care. Questionnaire measures of childhood behaviour problems and detailed interview data from two time points in adulthood were obtained, along with official records of offending. RESULTS: In terms of childhood precursors, antisocial behaviour, institutional rearing, hyperactivity and adolescent conduct disorder were found to be significantly related to offending. Later adolescent factors were also found to be important: mixing with deviant peers and leaving school without any qualifications or plans for work. Correlates of offending in adulthood included difficulties in mental health, drug use, marriage and parenting. Further analysis was undertaken to clarify the associations by using ex-care status and conduct disorder as covariates. DISCUSSION: Well-established predictors of offending in male samples seem quite as important for women and girls. The findings also suggested strong links between offending and problems in parenting.

Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology.

BACKGROUND: Despite an expanding epidemiological evidence base, uncertainties remain over key aspects of the epidemiology of the 'antisocial' disorders in childhood and adolescence. METHODS: We used cross-sectional data on a nationally representative sample of 10,438 5-15-year-olds drawn from the 1999 British Child Mental Health Survey to examine age trends, gender ratios and patterns of comorbidity in DSM-IV Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). RESULTS: CD was significantly more common in boys than girls, and increased in prevalence with age. Among children who met diagnostic criteria for CD, status violations and other non-aggressive conduct problems increased with age, while aggressive symptoms became less common. Gender differences in ODD varied by reporter. Estimates of age trends in ODD depended heavily on treatment of overlaps with CD. Following DSM-IV guidelines (where ODD is not diagnosed in the presence of CD), rates of ODD fell with age; if that constraint was released, clinically significant rates of oppositionality persisted at similar levels from early childhood to middle adolescence. CD and ODD showed high levels of overlap, and both diagnoses showed substantial comorbidity with other non-antisocial disorders. CONCLUSIONS: Results from this large-scale study confirm and extend previous findings in the epidemiology of the disruptive behaviour disorders.