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Chazan-Cohen R, Von Ende A, Lombardi C. Parenting and family self-sufficiency services contribute to impacts of Early Head Start for children and families. Front Psychol 2023; 14:1302687. [PMID: 38155689 PMCID: PMC10752921 DOI: 10.3389/fpsyg.2023.1302687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
Introduction There is evidence that two-generation early childhood programs, those that strive to support not only child development, but also optimal parenting and family wellbeing, help to foster resilience for young children and their families in the face of adversity. Methods Using data from a large experimental evaluation, the Early Head Start Research and Evaluation Project, this paper explores how parenting and family self-sufficiency services embedded in Early Head Start (EHS), a federally funded, nationally implemented two-generation early childhood program for low-income families lasting from pregnancy and until children are three, contribute to the impacts of the program for both the children and their families. Results Parenting support in any modality (home visiting, case management or parent education) contributed to program impacts on important child and family outcomes, but not parent employment. Somewhat surprisingly, family receipt of employment services did not lead to any of the impacts of the program, while education and job training services did. When EHS parents received education or job training services, it led to impacts not only on mother employment, but also on other important family and child outcomes. Discussion These findings validate and reinforce the two-generation approach of EHS, specifically supporting the focus on parenting and parent education and job training.
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Affiliation(s)
- Rachel Chazan-Cohen
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Adam Von Ende
- Division of Developmental Medicine, Brazelton Touchpoints Center, Boston Children’s Hospital, Boston, MA, United States
| | - Caitlin Lombardi
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
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Spartera M, Stracquadanio A, Pessoa-Amorim G, Harston G, Mazzucco S, Young V, Von Ende A, Hess AT, Ferreira VM, Kennedy J, Neubauer S, Casadei B, Wijesurendra RS. Reduced Left Atrial Rotational Flow Is Independently Associated With Embolic Brain Infarcts. JACC Cardiovasc Imaging 2023; 16:1149-1159. [PMID: 37204381 DOI: 10.1016/j.jcmg.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/22/2023] [Accepted: 03/10/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Up to 25% of embolic strokes occur in individuals without atrial fibrillation (AF) or other identifiable mechanisms. OBJECTIVES This study aims to assess whether left atrial (LA) blood flow characteristics are associated with embolic brain infarcts, independently of AF. METHODS The authors recruited 134 patients: 44 with a history of ischemic stroke and 90 with no history of stroke but CHA2DS2VASc score ≥1. Cardiac magnetic resonance (CMR) evaluated cardiac function and LA 4-dimensional flow parameters, including velocity and vorticity (a measure of rotational flow), and brain magnetic resonance imaging (MRI) was performed to detect large noncortical or cortical infarcts (LNCCIs) (likely embolic), or nonembolic lacunar infarcts. RESULTS Patients (41% female; age 70 ± 9 years) had moderate stroke risk (median CHA2DS2VASc = 3, Q1-Q3: 2-4). Sixty-eight (51%) had diagnosed AF, of whom 58 (43%) were in AF during CMR. Thirty-nine (29%) had ≥1 LNCCI, 20 (15%) had ≥1 lacunar infarct without LNCCI, and 75 (56%) had no infarct. Lower LA vorticity was significantly associated with prevalent LNCCIs after adjustment for AF during CMR, history of AF, CHA2DS2VASc score, LA emptying fraction, LA indexed maximum volume, left ventricular ejection fraction, and indexed left ventricular mass (OR: 2.06 [95% CI: 1.08-3.92 per SD]; P = 0.027). By contrast, LA flow peak velocity was not significantly associated with LNCCIs (P = 0.21). No LA parameter was associated with lacunar infarcts (all P > 0.05). CONCLUSIONS Reduced LA flow vorticity is significantly and independently associated with embolic brain infarcts. Imaging LA flow characteristics may aid identification of individuals who would benefit from anticoagulation for embolic stroke prevention, regardless of heart rhythm.
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Affiliation(s)
- Marco Spartera
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom.
| | - Antonio Stracquadanio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Guilherme Pessoa-Amorim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - George Harston
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Sara Mazzucco
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, Oxford, United Kingdom
| | - Victoria Young
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Adam Von Ende
- CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Aaron T Hess
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - James Kennedy
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom; University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom; Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom; CTSU Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Clarke R, Von Ende A, Schmidt LE, Yin X, Hill M, Hughes AD, Pechlaner R, Willeit J, Kiechl S, Watkins H, Theofilatos K, Hopewell JC, Mayr M. Apolipoprotein Proteomics for Residual Lipid-Related Risk in Coronary Heart Disease. Circ Res 2023; 132:452-464. [PMID: 36691918 PMCID: PMC9930889 DOI: 10.1161/circresaha.122.321690] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Recognition of the importance of conventional lipid measures and the advent of novel lipid-lowering medications have prompted the need for more comprehensive lipid panels to guide use of emerging treatments for the prevention of coronary heart disease (CHD). This report assessed the relevance of 13 apolipoproteins measured using a single mass-spectrometry assay for risk of CHD in the PROCARDIS case-control study of CHD (941 cases/975 controls). METHODS The associations of apolipoproteins with CHD were assessed after adjustment for established risk factors and correction for statin use. Apolipoproteins were grouped into 4 lipid-related classes [lipoprotein(a), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides] and their associations with CHD were adjusted for established CHD risk factors and conventional lipids. Analyses of these apolipoproteins in a subset of the ASCOT trial (Anglo-Scandinavian Cardiac Outcomes Trial) were used to assess their within-person variability and to estimate a correction for statin use. The findings in the PROCARDIS study were compared with those for incident cardiovascular disease in the Bruneck prospective study (n=688), including new measurements of Apo(a). RESULTS Triglyceride-carrying apolipoproteins (ApoC1, ApoC3, and ApoE) were most strongly associated with the risk of CHD (2- to 3-fold higher odds ratios for top versus bottom quintile) independent of conventional lipid measures. Likewise, ApoB was independently associated with a 2-fold higher odds ratios of CHD. Lipoprotein(a) was measured using peptides from the Apo(a)-kringle repeat and Apo(a)-constant regions, but neither of these associations differed from the association with conventionally measured lipoprotein(a). Among HDL-related apolipoproteins, ApoA4 and ApoM were inversely related to CHD, independent of conventional lipid measures. The disease associations with all apolipoproteins were directionally consistent in the PROCARDIS and Bruneck studies, with the exception of ApoM. CONCLUSIONS Apolipoproteins were associated with CHD independent of conventional risk factors and lipids, suggesting apolipoproteins could help to identify patients with residual lipid-related risk and guide personalized approaches to CHD risk reduction.
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Affiliation(s)
- Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (R.C., A.V.E., M.H., J.C.H.)
| | - Adam Von Ende
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (R.C., A.V.E., M.H., J.C.H.)
| | - Lukas E. Schmidt
- King’s British Heart Foundation Centre, School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, United Kingdom (L.E.S., X.Y., K.T., M.M.)
| | - Xiaoke Yin
- King’s British Heart Foundation Centre, School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, United Kingdom (L.E.S., X.Y., K.T., M.M.)
| | - Michael Hill
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (R.C., A.V.E., M.H., J.C.H.)
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, Department of Population Science and Experimental Medicine, Institute of Cardiovascular Science, University College London, United Kingdom (A.D.H.)
| | - Raimund Pechlaner
- Department of Neurology, Medical University of Innsbruck, Austria (R.P., J.W., S.K.)
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Austria (R.P., J.W., S.K.)
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Austria (R.P., J.W., S.K.)
- Research Centre on Vascular Ageing and Stroke, Innsbruck, Austria (S.K.)
| | - Hugh Watkins
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom (H.W.)
| | - Konstantinos Theofilatos
- King’s British Heart Foundation Centre, School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, United Kingdom (L.E.S., X.Y., K.T., M.M.)
| | - Jemma C. Hopewell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, United Kingdom (R.C., A.V.E., M.H., J.C.H.)
| | - Manuel Mayr
- King’s British Heart Foundation Centre, School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, United Kingdom (L.E.S., X.Y., K.T., M.M.)
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Camm CF, Lacey B, Massa MS, Von Ende A, Gajendragadkar P, Stiby A, Valdes-Marquez E, Lewington S, Wijesurendra R, Parish S, Casadei B, Hopewell JC. Independent effects of adiposity measures on risk of atrial fibrillation in men and women: a study of 0.5 million individuals. Int J Epidemiol 2022; 51:984-995. [PMID: 34562082 PMCID: PMC9189979 DOI: 10.1093/ije/dyab184] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) has a higher prevalence in men than in women and is associated with measures of adiposity and lean mass (LM). However, it remains uncertain whether the risks of AF associated with these measures vary by sex. METHODS Among 477 904 UK Biobank participants aged 40-69 without prior AF, 23 134 incident AF cases were identified (14 400 men, 8734 women; median follow-up 11.1 years). Cox proportional hazards models were used to estimate the covariate adjusted hazard ratios (HRs) describing the association of AF with weight, measures of adiposity [fat mass (FM), waist circumference (WC)] and LM, and their independent relevance, by sex. RESULTS Weight and WC were independently associated with risk of AF [HR: 1.25 (1.23-1.27) per 10 kg, HR: 1.11 (1.09-1.14) per 10 cm, respectively], with comparable effects in both sexes. The association with weight was principally driven by LM, which, per 5 kg, conferred double the risk of AF compared with FM when mutually adjusted [HR: 1.20 (1.19-1.21), HR: 1.10 (1.09-1.11), respectively]; however, the effect of LM was weaker in men than in women (p-interaction = 4.3 x 10-9). Comparing the relative effects of LM, FM and WC identified different patterns within each sex; LM was the strongest predictor for both, whereas WC was stronger than FM in men but not in women. CONCLUSIONS LM and FM (as constituents of weight) and WC are risk factors for AF. However, the independent relevance of general adiposity for AF was more limited in men than in women. The relevance of both WC and LM suggests a potentially important role for visceral adiposity and muscle mass in AF development.
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Affiliation(s)
- C Fielder Camm
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ben Lacey
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M Sofia Massa
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Adam Von Ende
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Alexander Stiby
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Sarah Lewington
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rohan Wijesurendra
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Sarah Parish
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Jemma C Hopewell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Spartera M, Stracquadanio A, Pessoa-Amorim G, Von Ende A, Fletcher A, Manley P, Ferreira VM, Hess AT, Hopewell JC, Neubauer S, Wijesurendra RS, Casadei B. The impact of atrial fibrillation and stroke risk factors on left atrial blood flow characteristics. Eur Heart J Cardiovasc Imaging 2021; 23:115-123. [PMID: 34687541 PMCID: PMC8685601 DOI: 10.1093/ehjci/jeab213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/06/2021] [Indexed: 12/03/2022] Open
Abstract
AIMS Altered left atrial (LA) blood flow characteristics account for an increase in cardioembolic stroke risk in atrial fibrillation (AF). Here, we aimed to assess whether exposure to stroke risk factors is sufficient to alter LA blood flow even in the presence of sinus rhythm (SR). METHODS AND RESULTS We investigated 95 individuals: 37 patients with persistent AF, who were studied before and after cardioversion [Group 1; median CHA2DS2-VASc = 2.0 (1.5-3.5)]; 35 individuals with no history of AF but similar stroke risk to Group 1 [Group 2; median CHA2DS2-VASc = 3.0 (2.0-4.0)]; and 23 low-risk individuals in SR [Group 3; median CHA2DS2-VASc = 0.0 (0.0-0.0)]. Cardiac function and LA flow characteristics were evaluated using cardiac magnetic resonance. Before cardioversion, Group 1 displayed impaired left ventricular (LV) and LA function, reduced LA flow velocities and vorticity, and a higher normalized vortex volume (all P < 0.001 vs. Groups 2 and 3). After restoration of SR at ≥4-week post-cardioversion, LV systolic function and LA flow parameters improved significantly (all P < 0.001 vs. pre-cardioversion) and were no longer different from those in Group 2. However, in the presence of SR, LA flow peak and mean velocity, and vorticity were lower in Groups 1 and 2 vs. Group 3 (all P < 0.01), and were associated with impaired LA emptying fraction (LAEF) and LV diastolic dysfunction. CONCLUSION Patients at moderate-to-high stroke risk display altered LA flow characteristics in SR in association with an LA myopathic phenotype and LV diastolic dysfunction, regardless of a history of AF.
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Affiliation(s)
- Marco Spartera
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Antonio Stracquadanio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Guilherme Pessoa-Amorim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
| | - Adam Von Ende
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison Fletcher
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Peter Manley
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Aaron T Hess
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Jemma C Hopewell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, Headley Way, Oxford OX3 9DU, UK
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Gajendragadkar PR, Von Ende A, Ibrahim M, Valdes-Marquez E, Camm CF, Murgia F, Stiby A, Casadei B, Hopewell JC. Assessment of the causal relevance of ECG parameters for risk of atrial fibrillation: A mendelian randomisation study. PLoS Med 2021; 18:e1003572. [PMID: 33983917 PMCID: PMC8118296 DOI: 10.1371/journal.pmed.1003572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Atrial electrical and structural remodelling in older individuals with cardiovascular risk factors has been associated with changes in surface electrocardiographic (ECG) parameters (e.g., prolongation of the PR interval) and higher risks of atrial fibrillation (AF). However, it has been difficult to establish whether altered ECG parameters are the cause or a consequence of the myocardial substrate leading to AF. This study aimed to examine the potential causal relevance of ECG parameters on risk of AF using mendelian randomisation (MR). METHODS AND FINDINGS Weighted genetic scores explaining lifelong differences in P-wave duration, PR interval, and QT interval were constructed, and associations between these ECG scores and risk of AF were estimated among 278,792 UK Biobank participants (mean age: 57 years at recruitment; 19,132 AF cases). The independent genetic variants contributing to each of the separate ECG scores, and their corresponding weights, were based on published genome-wide association studies. In UK Biobank, genetic scores representing a 5 ms longer P-wave duration or PR interval were significantly associated with lower risks of AF (odds ratio [OR] 0.91; 95% confidence interval [CI]: 0.87-0.96, P = 2 × 10-4 and OR 0.94; 95% CI: 0.93-0.96, P = 2 × 10-19, respectively), while longer QT interval was not significantly associated with AF. These effects were independently replicated among a further 17,931 AF cases from the AFGen Consortium. Investigation of potential mechanistic pathways showed that differences in ECG parameters associated with specific ion channel genes had effects on risk of AF consistent with the overall scores, while the overall scores were not associated with changes in left atrial size. Limitations of the study included the inherent assumptions of MR, restriction to individuals of European ancestry, and possible restriction of results to the normal ECG ranges represented in UK Biobank. CONCLUSIONS In UK Biobank, we observed evidence suggesting a causal relationship between lifelong differences in ECG parameters (particularly PR interval) that reflect longer atrial conduction times and a lower risk of AF. These findings, which appear to be independent of atrial size and concomitant cardiovascular comorbidity, support the relevance of varying mechanisms underpinning AF and indicate that more individualised treatment strategies warrant consideration.
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Affiliation(s)
- Parag Ravindra Gajendragadkar
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Adam Von Ende
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Maysson Ibrahim
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Elsa Valdes-Marquez
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Christian Fielder Camm
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Federico Murgia
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Alexander Stiby
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Barbara Casadei
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Jemma C. Hopewell
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
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Spartera M, Pessoa-Amorim G, Stracquadanio A, Von Ende A, Fletcher A, Manley P, Neubauer S, Ferreira VM, Casadei B, Hess AT, Wijesurendra RS. Left atrial 4D flow cardiovascular magnetic resonance: a reproducibility study in sinus rhythm and atrial fibrillation. J Cardiovasc Magn Reson 2021; 23:29. [PMID: 33745457 PMCID: PMC7983287 DOI: 10.1186/s12968-021-00729-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/03/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) allows sophisticated quantification of left atrial (LA) blood flow, and could yield novel biomarkers of propensity for intra-cardiac thrombus formation and embolic stroke. As reproducibility is critically important to diagnostic performance, we systematically investigated technical and temporal variation of LA 4D flow in atrial fibrillation (AF) and sinus rhythm (SR). METHODS Eighty-six subjects (SR, n = 64; AF, n = 22) with wide-ranging stroke risk (CHA2DS2VASc 0-6) underwent LA 4D flow assessment of peak and mean velocity, vorticity, vortex volume, and stasis. Eighty-five (99%) underwent a second acquisition within the same session, and 74 (86%) also returned at 30 (27-35) days for an interval scan. We assessed variability attributable to manual contouring (intra- and inter-observer), and subject repositioning and reacquisition of data, both within the same session (same-day scan-rescan), and over time (interval scan). Within-subject coefficients of variation (CV) and bootstrapped 95% CIs were calculated and compared. RESULTS Same-day scan-rescan CVs were 6% for peak velocity, 5% for mean velocity, 7% for vorticity, 9% for vortex volume, and 10% for stasis, and were similar between SR and AF subjects (all p > 0.05). Interval-scan variability was similar to same-day scan-rescan variability for peak velocity, vorticity, and vortex volume (all p > 0.05), and higher for stasis and mean velocity (interval scan CVs of 14% and 8%, respectively, both p < 0.05). Longitudinal changes in heart rate and blood pressure at the interval scan in the same subjects were associated with significantly higher variability for LA stasis (p = 0.024), but not for the remaining flow parameters (all p > 0.05). SR subjects showed significantly greater interval-scan variability than AF patients for mean velocity, vortex volume, and stasis (all p < 0.05), but not peak velocity or vorticity (both p > 0.05). CONCLUSIONS LA peak velocity and vorticity are the most reproducible and temporally stable novel LA 4D flow biomarkers, and are robust to changes in heart rate, blood pressure, and differences in heart rhythm.
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Affiliation(s)
- Marco Spartera
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK.
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK.
| | - Guilherme Pessoa-Amorim
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Antonio Stracquadanio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Adam Von Ende
- Department of Population Health, CTSU Nuffield University of Oxford, Oxford, UK
| | - Alison Fletcher
- The University of Oxford Acute Vascular Imaging Centre (AVIC), Oxford, UK
| | - Peter Manley
- The University of Oxford Acute Vascular Imaging Centre (AVIC), Oxford, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Vanessa M Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
| | - Aaron T Hess
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
| | - Rohan S Wijesurendra
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, University of Oxford, West Wing, Headley Way, Oxford, UK
- The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Oxford, UK
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Barto B, Bartlett JD, Von Ende A, Bodian R, Noroña CR, Griffin J, Fraser JG, Kinniburgh K, Spinazzola J, Montagna C, Todd M. The impact of a statewide trauma-informed child welfare initiative on children's permanency and maltreatment outcomes. Child Abuse Negl 2018; 81:149-160. [PMID: 29739000 DOI: 10.1016/j.chiabu.2018.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 04/12/2018] [Accepted: 04/27/2018] [Indexed: 05/16/2023]
Abstract
This article presents findings of a state-wide trauma informed child-welfare initiative with the goal of improving well-being, permanency and maltreatment outcomes for traumatized children. The Massachuetts Child Trauma Project (MCTP), funded by the Administration of Children and Families, Children's Bureau was a multi-year project implementing trauma-informed care into child welfare service delivery. The project's implementation design included training and consultation for mental health providers in three evidence-based treatments and training of the child-welfare workforce in trauma-informed case work practice. The learning was integrated between child-welfare and mental health with Trauma Informed Leadership Teams which included leaders from both systems and the greater community. These teams developed incremental steps toward trauma-informed system improvement. This study evaluated whether MCTP was associated with reductions in child abuse and neglect, improvements in placement stability, and higher rates of permanency during the first year of implementation. Children in the intervention group had fewer total substantiated reports of maltreatment, including less physical abuse and neglect than the comparison group by the end of the intervention year. However, children in the intervention group had more maltreatment reports (substantiated or not) and total out-of-home placements than did their counterparts in the comparison group. Assignment to MCTP, however, was not associated with an increase in kinship care or adoption. Overall, the results are promising in reinforcing the importance of mobilizing communities toward improvements in child-welfare service delivery.
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Affiliation(s)
- Beth Barto
- LUK, Inc., 545 Westminster St., Fitchburg, MA, 01420, United States.
| | | | - Adam Von Ende
- Brazelton Touchpoints Center, Division of Developmental Medicine, Boston Children's Hospital, 1295 Boylston St., Suite 320, Boston, MA, 02215, United States
| | - Ruth Bodian
- Massachusetts Department of Children & Families, 600 Washington St., Boston, MA, 02111, United States
| | - Carmen Rosa Noroña
- Child Witness to Violence Project, Boston Medical Center, One Boston Medical Center Pl, Boston, MA, 02118, United States
| | - Jessica Griffin
- University of Massachusetts Medical School, 55 N Lake Ave., Worcester, MA, 01655, United States
| | | | - Kristine Kinniburgh
- Trauma Center at Justice Resource Institute, 1269 Beacon St., Brookline, MA, 02446, United States
| | - Joseph Spinazzola
- The Foundation Trust, P.O. Box 760995, Melrose, MA, 02176, United States
| | - Crystaltina Montagna
- University of Massachusetts Medical School, 55 N Lake Ave., Worcester, MA, 01655, United States
| | - Marybeth Todd
- Child Trends, 56 Robbins St., Acton, MA, 01720, United States
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Green BL, Ayoub C, Dym Bartlett J, Furrer C, Von Ende A, Chazan-Cohen R, Klevens J, Nygren P. It's not as simple as it sounds: Problems and solutions in accessing and using administrative child welfare data for evaluating the impact of early childhood interventions. Child Youth Serv Rev 2015; 57:40-49. [PMID: 26744551 PMCID: PMC4699440 DOI: 10.1016/j.childyouth.2015.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
In recent years, there has been increasing interest in using administrative data collected by state child welfare agencies as a source of information for research and evaluation. The challenges of obtaining access to and using these data, however, have not been well documented. This study describes the processes used to access child welfare records in six different states and the approach to combining and using the information gathered to evaluate the impact of the Early Head Start program on children's involvement with the child welfare system from birth through age eleven. We provide "lessons learned" for researchers who are attempting to use this information, including being prepared for long delays in access to information, the need for deep understanding of how child welfare agencies record and code information, and for considerable data management work for translating agency records into analysis-ready datasets. While accessing and using this information is not easy, and the data have a number of limitations, we suggest that the benefits can outweigh the challenges and that these records can be a useful source of information for policy-relevant child welfare research.
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Affiliation(s)
- Beth L Green
- Center for the Improvement of Child and Family Studies, Portland State University, P.O. Box 751, Portland, OR 97207-07541, United States
| | - Catherine Ayoub
- Brazelton Touchpoints Center - BCH3111, Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, 1295 Boylston, Suite 320, Boston, MA 02215, United States
| | - Jessica Dym Bartlett
- Brazelton Touchpoints Center - BCH3111, Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, 1295 Boylston, Suite 320, Boston, MA 02215, United States
| | - Carrie Furrer
- Center for the Improvement of Child and Family Studies, Portland State University, P.O. Box 751, Portland, OR 97207-07541, United States
| | - Adam Von Ende
- Brazelton Touchpoints Center - BCH3111, Division of Developmental Medicine, Boston Children's Hospital, Harvard Medical School, 1295 Boylston, Suite 320, Boston, MA 02215, United States
| | - Rachel Chazan-Cohen
- College of Education and Human Development, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125, United States
| | - Joanne Klevens
- Division of Violence Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-63, Atlanta, GA 30341, United States
| | - Peggy Nygren
- Center for the Improvement of Child and Family Studies, Portland State University, P.O. Box 751, Portland, OR 97207-07541, United States
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Green BL, Ayoub C, Bartlett JD, Von Ende A, Furrer C, Chazan-Cohen R, Vallotton C, Klevens J. The effect of Early Head Start on child welfare system involvement: A first look at longitudinal child maltreatment outcomes. Child Youth Serv Rev 2014; 42:127-135. [PMID: 26744550 PMCID: PMC4700883 DOI: 10.1016/j.childyouth.2014.03.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
The high societal and personal costs of child maltreatment make identification of effective early prevention programs a high research priority. Early Head Start (EHS), a dual generational program serving low-income families with children prenatally through age three years, is one of the largest federally funded programs for infants and toddlers in the United States. A national randomized trial found EHS to be effective in improving parent and child outcomes, but its effectiveness in reducing child maltreatment was not assessed. The current study used administrative data from state child welfare agencies to examine the impact of EHS on documented abuse and neglect among children from seven of the original seventeen programs in the national EHS randomized controlled trial. Results indicated that children in EHS had significantly fewer child welfare encounters between the ages of five and nine years than did children in the control group, and that EHS slowed the rate of subsequent encounters. Additionally, compared to children in the control group, children in EHS were less likely to have a substantiated report of physical or sexual abuse, but more likely to have a substantiated report of neglect. These findings suggest that EHS may be effective in reducing child maltreatment among low-income children, in particular, physical and sexual abuse.
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Affiliation(s)
- Beth L. Green
- Center for the Improvement of Child and Family Studies, Portland State University, P.O. Box 751, Portland, OR 97207-07541, United States
| | - Catherine Ayoub
- Harvard Medical School and Brazelton Touchpoints Center, Touchpoints Center, Division of Developmental Medicine, Boston Children's Hospital, 1295 Boylston Street, Suite 320, Boston, MA 02215, United States
| | - Jessica Dym Bartlett
- Brazelton Touchpoints Center, Division of Developmental Medicine, Boston Children's Hospital, 1295 Boylston Street, Suite 320, Boston, MA 02215, United States
| | - Adam Von Ende
- Brazelton Touchpoints Center, Division of Developmental Medicine, Boston Children's Hospital, 1295 Boylston Street, Suite 320, Boston, MA 02215, United States
| | - Carrie Furrer
- Center for the Improvement of Child and Family Studies, Portland State University, P.O. Box 751, Portland, OR 97207-07541, United States
| | - Rachel Chazan-Cohen
- George Mason University, Department of Psychology, MSN 3F5, 4400 University Drive, Fairfax, VA 22030, United States
| | - Claire Vallotton
- Human Development & Family Studies, Michigan State University, 552 W. Circle Drive, 2G Human Ecology, East Lansing, MI 48824, United States
| | - Joanne Klevens
- Division of Violence Prevention, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-64, Atlanta, GA 30341, United States
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Houben MH, Hensen EF, Rauws EA, Hulst RW, Hoff BW, Ende AV, Kate FJ, Tytgat GN. Randomized trial of omeprazole and clarithromycin combined with either metronidazole or amoxycillin in patients with metronidazole-resistant or -susceptible Helicobacter pylori strains. Aliment Pharmacol Ther 1999; 13:883-9. [PMID: 10383522 DOI: 10.1046/j.1365-2036.1999.00565.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The impact of metronidazole resistance on the efficacy of proton pump inhibitor based triple therapies remains unclear. AIM To study whether metronidazole resistance affects Helicobacter pylori eradication rates in patients treated for 1 week with either omeprazole 20 mg b.d., metronidazole 400 mg b.d. and clarithromycin 250 mg b.d. (OMC), or omeprazole 20 mg b.d., amoxycillin 1000 mg b.d. and clarithromycin 500 mg b.d. (OAC). METHODS A randomized, single blind, single centre study with parallel groups was conducted. H. pylori positive patients were enrolled in a metronidazole-resistant (MR; MIC > 8 microgram/mL) or a metronidazole-susceptible group (MS; MIC < 4 microgram/mL), as determined by E-test. Within the strata patients were randomized to either OAC or OMC. RESULTS One hundred and twenty-two patients were included. The per protocol cure rate for OAC was 52 out of 57 (91%) (MS 23 out of 26 (89%); MR 29 out of 31 (94%)) and for OMC 46 out of 55 (84%) (MS 19 out of 22 (86%); MR 27 out of 33 (82%)). CONCLUSIONS One-week OAC and OMC are effective therapies. OAC and OMC were equally effective in patients with metronidazole-susceptible strains of H. pylori. Using the OMC regimen, neither equality nor significant differences in treatment outcome could be shown between patients with metronidazole-resistant or -susceptible strains of H. pylori.
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Affiliation(s)
- M H Houben
- Department of Internal Medicine, Red Cross Hospital, The Hague, The Netherlands.
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