Advancing Cardiovascular Risk Assessment with Artificial Intelligence: Opportunities and Implications in North Carolina.

Cardiovascular disease mortality is increasing in North Carolina with persistent inequality by race, income, and location. Artificial intelligence (AI) can repurpose the widely available electrocardiogram (ECG) for enhanced assessment of cardiac dysfunction. By identifying accelerated cardiac aging from the ECG, AI offers novel insights into risk assessment and prevention

Circulating ketone bodies and mortality in heart failure: a community cohort study

BackgroundThe relationship between ketone bodies (KB) and mortality in patients with heart failure (HF) syndrome has not been well established.ObjectivesThe aim of this study is to assess the distribution of KB in HF, identify clinical correlates, and examine the associations between plasma KB and all-cause mortality in a population-based HF cohort.MethodsThe plasma KB levels were measured by nuclear magnetic resonance spectroscopy. Multivariable linear regression was used to examine associations between clinical correlates and KB levels. Proportional hazard regression was employed to examine associations between KB (represented as both continuous and categorical variables) and mortality, with adjustment for several clinical covariates.ResultsAmong the 1,382 HF patients with KB measurements, the median (IQR) age was 78 (68, 84) and 52% were men. The median (IQR) KB was found to be 180 (134, 308) μM. Higher KB levels were associated with advanced HF (NYHA class III–IV) and higher NT-proBNP levels (both P < 0.001). The median follow-up was 13.9 years, and the 5-year mortality rate was 51.8% [95% confidence interval (CI): 49.1%–54.4%]. The risk of death increased when KB levels were higher (HRhigh vs. low group 1.23; 95% CI: 1.05–1.44), independently of a validated clinical risk score. The association between higher KB and mortality differed by ejection fraction (EF) and was noticeably stronger among patients with preserved EF.ConclusionsMost patients with HF exhibited KB levels that were consistent with those found in healthy adults. Elevated levels of KB were observed in patients with advanced HF. Higher KB levels were found to be associated with an increased risk of death, particularly in patients with preserved EF

Child and Family Therapy Process: Concordance of Therapist and Observational Perspectives

The objective of this study is to examine the characteristics of outpatient mental health services delivered in community-based outpatient clinics, comparing information obtained from two different sources, therapists serving children and families, and observational coders viewing tapes of the same treatment sessions. Videotaped therapy sessions were rated by therapists and independent coders regarding goals and strategies pursued during each session. Sixty-three sessions were taped of outpatient care provided to 18 children and their caregivers by 11 therapists. Children were 4–13 years old and families were receiving services at least in part due to reported child behavior problems, confirmed by ratings from the Child Behavior Checklist and Conners Parent Rating Scale—Revised. Analyses assessed the frequency, type, and intensity of goals and strategies pursued in therapy sessions from both therapist and observational coders’ perspectives. Reliability of observer ratings and correspondence between therapist and observer reports were also examined. The reliability of observational coding of goals and strategies was moderate to good, with 76% of 39 codes having ICCs of .5 or greater. Therapists reported pursuing 2.5 times more goals and strategies per session, on average, than identified by observational coders. Correspondence between therapists and coders about the occurrence of specific goals and strategies in treatment sessions was low, with 20.5% of codes having a Kappa of .4 or higher. Substantial differences exist in what therapists and independent coders report as occurring in outpatient treatment sessions. Both perspectives suggest major differences between the content of services provided in community-based outpatient clinics and the structure of evidence-based programs, which emphasize intense pursuit of a small number of goals and strategies in each treatment session. Implications of the findings for quality improvement efforts in community-based mental health care settings are discussed

Prenatal Exposure to Phthalates and Neurodevelopment in the CHAMACOS Cohort

IRETBackground: Previous studies suggest that prenatal exposure to phthalates, ubiquitous synthetic chemicals, may adversely affect neurodevelopment. However, data are limited on how phthalates affect cognition, executive function, and behavioral function into adolescence. Objective: We aimed to investigate associations of prenatal phthalate exposure with neurodevelopment in childhood and adolescence in the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study. Methods: We examined associations between maternal urinary phthalate metabolite concentrations measured twice during pregnancy and a range of neurodevelopmental outcomes from ages 7 through 16 y in the CHAMACOS birth cohort (n = 334). We used age-specific linear regression models and generalized estimating equation mpdels to assess longitudinal effects and examined differences by sex. Results: Phthalate metabolites were detected in 88%-100% of samples, depending on the metabolite. Associations of phthalates with neurodevelop- mental outcomes were largely null with some noteworthy patterns. Higher prenatal concentrations of metabolites of low-molecular weight phthalates (ΣLMW) were associated with more self-reported hyperactivity [ß = 0.8, 95% confidence interval (CI): 0.1, 1.4 per 2-fold increase in ΣLMW phtha- lates], attention problems (ß= 1.5, 95% CI: 0.7, 2.2), and anxiety (ß = 0.9, 95% CI: 0.0, 1.8) at age 16. We observed sex-specific differences for the sums of high-molecular-weight and di(2-ethylhexyl) metabolites and cognitive outcomes (e.g., ß for Full-Scale IQ for boys= —1.9, 95% CI: —4.1, 0.3 and -1.7,95% CI: -3.8, 0.3, respectively; ß for girls = 1.8, 95% CI: 0.1,3.4 and 1.6, 95% CI: 0.0, 3.2, respectively; p-int= 0.01 for both). Conclusion: We found predominantly null associations of prenatal phthalates with neurodevelopment in CHAMACOS, and weak associations of SLMW phthalates with internalizing and externalizing behaviors in adolescence. No previous studies have examined associations of prenatal phthal- ate exposure with neurodevelopment into adolescence, an important time for manifestations of effects. © 2019, Public Health Services, US Dept of Health and Human Services. All rights reserved.Estudios previos sugieren que la exposición prenatal a ftalatos, sustancias químicas sintéticas ubicuas, puede afectar negativamente el desarrollo neurológico. Sin embargo, los datos sobre cómo los ftalatos afectan la cognición, la función ejecutiva y la función conductual en la adolescencia son limitados. Objetivo: Nuestro objetivo fue investigar las asociaciones de la exposición prenatal a ftalatos con el neurodesarrollo en la niñez y la adolescencia en el estudio del Centro de Evaluación de la Salud de Madres e Hijos de Salinas (CHAMACOS). Métodos: Examinamos las asociaciones entre las concentraciones de metabolitos de ftalato urinario materno medidas dos veces durante el embarazo y una variedad de resultados del desarrollo neurológico desde los 7 hasta los 16 años en la cohorte de nacimiento CHAMACOS (n = 334). Usamos modelos de regresión lineal específicos por edad y modelos de ecuaciones de estimación generalizadas para evaluar los efectos longitudinales y examinamos las diferencias por sexo. Resultados: Se detectaron metabolitos de ftalato en 88% -100% de las muestras, dependiendo del metabolito. Las asociaciones de ftalatos con resultados del neurodesarrollo fueron en gran parte nulas con algunos patrones notables. Las concentraciones prenatales más altas de metabolitos de ftalatos de bajo peso molecular (ΣLMW) se asociaron con más hiperactividad autoinformada [ß = 0,8, intervalo de confianza (IC) del 95%: 0,1, 1,4 por aumento de 2 veces en ΣLMW ftalatos], problemas de atención (ß = 1,5, IC del 95%: 0,7, 2,2) y ansiedad (ß = 0,9, IC del 95%: 0,0, 1,8) a los 16 años. Observamos diferencias específicas por sexo para las sumas de peso molecular alto y di (2-etilhexil) metabolitos y resultados cognitivos (p. ej., ß para el coeficiente intelectual de escala completa para niños = —1,9; IC del 95%: —4,1, 0,3 y -1,7; IC del 95%: -3,8, 0,3, respectivamente; ß para niñas = 1.8, IC del 95%: 0.1,3.4 y 1.6, IC del 95%: 0.0, 3.2, respectivamente; p-int = 0.01 para ambos). Conclusión: Encontramos asociaciones predominantemente nulas de ftalatos prenatales con neurodesarrollo en CHAMACOS, y asociaciones débiles de ftalatos SLMW con conductas internalizantes y externalizantes en la adolescencia. Ningún estudio previo ha examinado las asociaciones de la exposición prenatal a los ftalatos con el desarrollo neurológico en la adolescencia, un momento importante para las manifestaciones de los efectos. © 2019, Servicios de salud pública, Departamento de Salud y Servicios Humanos de EE. UU. Reservados todos los derechos.University of California at Berkeley, USAUniversidad Nacional, Costa RicaCenters for Disease Control and Prevention, USAInstituto Regional de Estudios en Sustancias Tóxica