Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Measuring meaning in life in South Africa: Validation of an instrument developed in the USA

Investigations into the construct of meaning in life is an important focus area of psychological research. Research has consistently shown a sense of meaning in life to be a significant correlate of mental health and well-being. Most of this research on meaning in life is conducted worldwide with instruments developed in North America. However, inter-cultural measurement of psychological constructs is a concern, as psychometric instruments in one culture are not necessarily transferable to different cultures. In this case study, we examine whether the Life Regard Index (LRI), developed in the USA and a popular scale for measuring meaning in life, is transferable to a sample from South Africa. The results confirm the construct validity of the LRI, but indicate that the LRI's factor structure has changed and two of the original 28 items were not part of the covariance structure. From these results, we conclude that the LRI is transferable to the South African sample, but not irrespectively and without adjustments. It should be used as a one-dimensional instrument with only 26 items before applying it to the South African sample. The study provides evidence that LRI, which was developed in the USA and became a popular instrument for measuring meaning in life, cannot be transferred indiscriminately to a South African sample. This insight contributes to the quality of future research studies in South Africa, not only on the important aspect of life meaning, but also when applying other psychometric instruments developed elsewhere. © Psychological Society of South Africa. All rights reserved.Articl

Spirituality in practice : relationships between meaning in life, commitment and motivation

Increasing numbers of people are searching for meaning and spiritual significance in the workplace. Research in the field of psychiatry has consistently shown a sense of meaning in one's life to be an important correlate of mental health and well-being. In this study, we examined the relationships between a person's sense of meaning in life, with life orientation variables, biographic variables, work commitment and work motivation. Through testing six hypotheses, we found significant associations between sense of meaning in life, positive work orientations, career commitment and work motivation. Our findings point to a spiritual source of work motivation and commitment, a more fundamental source than covered in existing motivation theories - commitment and motivation can also be expressions of a sense of meaning in one's life. This study improves understanding of workplace spirituality in practice

Early complications of stenting in patients with congenital heart disease: a multicentre study.

Item does not contain fulltextAIMS: Stenting has become an established interventional cardiology procedure for congenital heart disease. Although most stent procedures are completed successfully, complications may occur. This multicentre study evaluated early complications after stenting in patients with congenital heart disease, including potential risk factors. METHODS AND RESULTS: In this combined Dutch-Belgian retrospective study, 309 consecutive patients had undergone 366 catheterizations and received 464 stents in 13 different anatomical positions (418 sites). Seventy-two stenting-related complications (19%) occurred, of which 24 (5.7%) were major. Seven procedure-related deaths were documented (2.3%). Stent malpositioning and embolization were most common (7.7%). The use of non-premounted stents tended to be associated with higher complication rates. Centre inexperience with stenting and stenting of native vs. post-surgical stenosis tended to be associated with increased major complication rates. CONCLUSION: After stenting, complications are common for congenital heart disease. The vast diversity of stenotic sites combined with relatively small patient populations makes these procedures sensitive to complications. Combining operator experience may reduce the risks of stenting in congenital heart disease. The availability of premounted stents for greater vessel diameters will likely reduce incidences of stent migration and embolization