Progression of coronary calcification in healthy postmenopausal women

BACKGROUND: Coronary artery calcium score incrementally improves coronary risk prediction beyond that provided by conventional risk factors. Limited information is available regarding rates of progression of coronary calcification in women, particularly those with baseline scores above zero. Further, determinants of progression of coronary artery calcification in women are not well understood. This study prospectively evaluated rates and determinants of progression of coronary artery calcium score in a group of healthy postmenopausal women. METHODS: We determined coronary calcium score by computed tomography and recorded demographic, lifestyle and health characteristics of 914 postmenopausal women, a subset of those enrolled in the Women's Health Initiative Observational Study. The 305 women with calcium score ≥10 Agatston units at baseline were invited for repeat scan. This analysis includes the 94 women who underwent second scans. RESULTS: Mean age of study participants was 65 ± 9 years (mean ± SD), body mass index was 26.1 ± 6.1 kg/m(2), and baseline calcium score was 162 ± 220 Agatston units. Mean interval between scans was 3.3 ± 0.7 years. A wide range of changes in coronary calcium score was observed, from -53 to +452 Agatston units/year. Women with lower scores at baseline had smaller annual increases in absolute calcium score. Coronary calcium scores increased 11, 31 and 79 Agatston units/year among women with baseline calcium score in the lowest, middle and highest tertiles. In multivariate analysis, age was not an independent predictor of absolute change in coronary calcium score. Hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) use at baseline was a negative predictor (p = 0.015), whereas baseline calcium score was a strong, positive predictor (p < 0.0001) of progression of coronary calcification. CONCLUSION: Among postmenopausal women with coronary calcium score ≥ 10 Agatston units, rates of change of coronary calcium score varied widely. In multivariate analysis, statin use was a negative independent determinant, whereas baseline calcium score was a strong positive predictor of annual change in coronary calcium score

Results of the Outcome Evaluation of Kids ACT! Youth Advocacy Program

Problem/Objective: Kids Act to Control Tobacco (Kids ACT!), a youth advocacy program for middle school youth, empowers youth to act as advocates for a tobacco-free society. The NEA Health Information Network developed a curriculum that employs a four step advocacy model. The Robert Wood Johnson Foundation funded evaluators from the George Washington University to conduct an outcome evaluation of program effectiveness. Outcomes of interest were increases in advocacy action and support for social norms for tobacco-free environments as well as delayed onset of use or experimentation with tobacco products. Methods: A group-randomized design was used in which 31 participating schools in five states were randomly assigned to intervention or control conditions. Evaluators constructed, pre-tested and revised an advocacy questionnaire. Results: Students in 6th, 7th and 8th grades completed questionnaires at pre-test (n=4,526), post-test (n=4,285) and six month follow-up (n=4,111). Reliability analysis indicated that questionnaire subscales were reliable at or above .88. Results indicate that attitudes, perceived incentive value, self-efficacy for advocacy, smoking status, and behavioral expectancies for action predict advocacy action. At post-test, effect sizes were small for attitudes (.14), perceived incentive value (.19), and self-efficacy (.26) and larger for behavioral expectancies (.36) and advocacy action (.35). Further analysis and follow-up effects will be completed by spring. Conclusions: This first large scale trial of a school-based advocacy program in the U.S. indicated that schools were receptive to advocacy education and that this intervention had a moderate impact on students\u27 becoming public advocates for a tobacco-free society

Institutional outbreak and control of a multidrug-resistant clone of Acinetobacter baumannii

Multidrug-resistant Acinetobacter baumannii has been recently recognized as a major cause of nosocomial infections. During an outbreak of a multidrug-resistant strain, all isolates of A. baumannii were analyzed by pulsed-field gel electrophoresis, and a retrospective review was conducted to identify risk factors for acquisition. Of the 65 patients, the unique outbreak clone (clone I) was isolated from 43 (group A), whereas 19 different strains were grown from 22 other patients (group B). Clone I was predominantly isolated from pleuropulmonary sources (63%; P \u3c 0.0001). Imipenem resistance was nearly universal in clone I, and amikacin resistance was common. In univariate analysis, admission to the medical/surgical intensive care unit and use of mechanical ventilation and fluoroquinolone antibiotics were associated with clone I. Only admission to the medical/surgical intensive care unit was significant by multivariate analysis. The institution of an infection control program controlled but did not eliminate the outbreak. © 2009 Lippincott Williams & Wilkins, Inc

Coronary artery calcification in black women and white women

Background Coronary calcification is a potent independent predictor of coronary risk. Sex-specific risk categories based on calcium scores have been established, but ethnic differences in coronary calcification have been little studied. This prospective cohort study compares coronary calcification, assessed by computed tomography, in postmenopausal black women and white women. Methods and Results Computed tomographic scans were performed on 128 black women and 733 white women without known coronary artery disease (mean age 63 +/- 8 years). Although coronary risk factors were more prevalent among black women (P < .0001), total calcium scores were similar to those in white women. By use of the Framingham algorithm, higher calcium scores were associated with higher 10-year risk of myocardial infarction or coronary death. In multiple regression analysis, age was independently associated with higher calcium scores in both ethnic groups (P = .002 for black women, P < .0001 for white women). Diabetes mellitus and not exercising at least 3 times per week were independently associated with higher calcium scores in white women but not black women. Educational level, body mass index, current hormone replacement therapy, hysterectomy, dietary fat consumption, family history of premature coronary disease, hypertension, self-reported high cholesterol, and current smoking were not independently associated with coronary calcium score in black women, white women, or the combined cohort; neither was ethnicity an independent predictor of coronary calcification. Conclusions Despite higher dietary fat consumption, higher body mass index, and greater prevalence of hypertension, diabetes, and smoking, black women had coronary calcium scores similar to those of white women. Ethnicity was not an independent predictor of coronary calcification