Distal Determinants of Cardiovascular Disease Risk Factors

Introduction: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. West Virginia (WV) has one of the highest prevalence of CVD in the United States. The first two studies examined the association between perinatal risk factors (birth weight (BTW) and breastfeeding) and subsequent childhood and maternal CVD risk factors 11 years post-partum. The purpose of the third study was to conduct a systematic review and meta-analysis to examine the evidence regarding the relationship between childhood obesity and adult CVD risk factors.;Method: We used longitudinally linked data from three cross-sectional datasets in WV for the first (N=19,583) and second study (N=10,457). The outcome variables included blood pressure for children and lipid levels for both mothers and children. The exposures were BTW of the infant (study 1) and reported history of breastfeeding obtained retrospectively when the child was in fifth grade (study 2). Mean differences, correlations, and simple regression analyses were performed to examine the unadjusted associations. Multiple regression analysis was performed adjusting for current body mass index (BMI) and additional covariates. For the third study, the search strategy included (1) electronic searches in multiple databases (PubMed (MEDLINE), Web of Science, and Scopus) on June 5, 2015, and (2) citation tracking (N=4,840 citations). Studies were included if they met the following criteria (1) longitudinal study-design, (2) childhood exposure and adult outcomes collected on the same individual over time, (3) childhood obesity, as defined by the authors, (4) English language articles, (5) studies published by June, 2015, (6) the primary outcome measures included: systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), non-high-density lipoprotein cholesterol (non-HDL), triglycerides (TG), and (7) outcome not self-reported.;Results: BTW was significantly associated with HDL (b= 0.14mg/dL; 95% CI: 0.11, 0.18), LDL (b = -0.1mg/dL; 95% CI: -0.19, -0.016), non-HDL (b = -0.18mg/dL; 95% CI: -0.28, -0.09), and log-TGs (b=-0.007 (-0.008, -0.005) per 1000 g increase in BTW in the adjusted analyses. There was a positive association between BTW and maternal TC levels, which became non-significant in the adjusted analysis [b= 0.4 mg/dL (95% CI: -0.01, 0.90) per1000 g increase in BTW]. None of the other maternal lipids were significant in the unadjusted or the adjusted analysis. For the second study, there was a significant association between reported history of breastfeeding and child\u27s TGs (beta=-0.04; 95% CI: -0.06, -0.01) when adjusted for the child\u27s current BMI and additional covariates. Maternal lipids were not significantly related to their breastfeeding history. For the third study, a total of 23 studies were included in the systematic review and 21 in the meta-analysis. The findings suggest that childhood obesity is significantly and positively associated with adult SBP (Zr = 0.11; 95% CI: 0.07, 0.14), DBP (Zr = 0.11; 95% CI: 0.07, 0.14), and TG (Zr =0.08; 95% CI: 0.03, 0.13), and inversely associated with adult HDL (Zr =-0.06; 95% CI: -0.10, -0.02). For those studies that adjusted for adult BMI, associations were reversed.;Conclusion: Low BTW was associated with poor lipid levels (LDL, HDL, non-HDL, and TG) and breastfeeding was protective for TGs in fifth grade children independent of their current BMI. As CVD risk factors persist from childhood into adulthood, the small effect sizes observed in the first two studies can have potential unfavorable consequence on lipid levels in later adulthood. The results of the systematic review with meta-analysis suggest that childhood obesity is significantly and positively associated with adult SBP, DBP, and TG and negatively associated with adult HDL. Well-designed, longitudinal studies with improved reporting as well as data analysis that include both unadjusted and adjusted associations for adult adiposity are needed before any definitive conclusions can be made

Emotional Intelligence and Teaching Satisfaction: The Mediating Role of Emotional Labor Strategies

The study examines the direct effect of four “emotional intelligence” attributes on teachers’ job satisfaction in Karachi’s private teaching institutions. The study also investigates the mediating effects of “emotional labor strategies” on teachers’ job satisfaction. We have used the questionnaire adopted from earlier studies. We distributed 550 questionnaires to respondents, of which we received 499 useable responses. The study has used Smart PLS version 3.3 for data analysis. Our results support only six hypotheses, including two direct and our indirect. This study has contributed to the body of knowledge in the following ways. First, it has measured the effects of the four attributes of emotional intelligence on job satisfaction. Second, most studies have examined the mediating effect of emotional labor strategies on emotional intelligence and other job satisfaction antecedents. Perhaps this is the first study that has examined the direct impact of the sub-factor of emotional intelligence on teachers’ job satisfaction. Additionally, it also looks at the mediating effect of emotional labor strategies on teachers’ satisfaction. There are several implications for managers. For example, the teaching institutes should provide counseling and training to teachers for enhancing their emotional intelligence. Emotional labor strategies help individuals control and monitor their emotions; therefore, educational institutions may also encourage their teachers to adopt these strategies

Genetics education in primary care residency training: satisfaction and current barriers

Background Genetics education can be integrated into general care medicine through primary care residency programs. A study of primary care residents was done to evaluate quality, satisfaction, and barriers in genetics education in residency training programs. Thus, providing more evidence for the necessity for its development and progress. Methods A cross-sectional descriptive self-administered questionnaire survey was delivered to four primary care West Virginia University (WVU) residency training programs in 2020–2021. The anonymous 14-item survey included the following questionnaire domains: general data, genetics training satisfaction, and genetics education barriers. Results The survey response rate was 52% (70/123) and 59 participants completed the survey. Overall, respondents viewed genetic education as critical to their chosen specialty (90%). Trainees at all educational levels obtained their education mostly from class based educational curricula (77% from lectures, 65% from didactic and 49% from grand rounds). The majority of survey respondents indicated insufficient experience with genetic patient care (34% ward genetic consultation, 5% clinic experience, 0% genetic department rotation). The percentage of residents who were satisfied with genetic topics were as follows: basic genetics (57%), capturing family history (82%), initiating basic genetic workup (15%), a basic understanding of the genetic report (23%), basic management surveillance in the genetic patient (18%), understanding the genetic referral and explaining it to a patient (47%). Residents reported barriers to genetic interest included complexity of the field (87%), followed by limited utility of genetics testing (41%). The most common suggestions for improving the genetic education component were to provide more lectures (61%), followed by enhanced advertisement of genetic education resources specifically rotations in the genetics department (22%). Other suggestions include the integration of genetic education in inpatient learning (20%) and providing research experience (7%). Conclusion Primary care residents were satisfied with their genetic knowledge in the classroom and stated a clear need for enhanced hands-on clinical skills and research experience in their current residency training. The survey suggestions for improvement can enhance primary care residents’ genetic training that can lead to advances in rare disease recognition, precision medicine, and improve access to genetics testing

On saturation effect for linear shape-preserving approximation in Sobolev spaces

Objectives Little is known about patterns and correlates of Complementary Health Approaches (CHAs) in chronic pain populations, particularly in rural, underserved communities. This article details the development and implementation of a new survey instrument designed to address this gap, the Complementary Health Approaches for Pain Survey (CHAPS). Design Following pilot-testing using pre-specified criteria to assess quality and comprehension in our target population, and after feedback regarding face-validity from content experts and stakeholders, the final cross-sectional self-report survey required 10–12 minutes to complete. It contained 69 demographic, lifestyle and health-related factors, and utilized a Transtheoretical Model (TTM) underpinning to assess short- and long-term use of 12 CHAs for pain management. Twenty additional items on pain severity, feelings, clinical outcomes, and activities were assessed using the Short-Form Global Pain Scale (SF-GPS); Internal reliability was assessed using Cronbach’s alpha. Settings/location Investigators conducted consecutive sampling in four West Virginia pain management and rheumatology practices. Participants 301 Appalachian adult patients seeking conventional care for pain management. Results Response rates were high (88% ± 4.1%). High quality and comprehension deemed the CHAPS an appropriate measurement tool in a rural population with pain. Missing data were unrelated to patient characteristics. Participants predominantly experienced chronic pain (93%), had five or more health conditions (56%, Mean = 5.4±3.1), were white (92%), female (57%), and middle-aged (Mean = 55.6 (SD = 13.6) years). Over 40% were disabled (43%) and/or obese (44%, Mean BMI = 33.4±31.5). Additionally, 44% used opioids, 31% used other prescription medications, and 66% used at least one CHA for pain, with 48% using CHAs for greater than 6 months. There was high internal reliability of the SF-GPS (alpha = .93) and satisfactory internal reliability for each of the five TTM stages across (all) twelve CHAs: precontemplation (0.89), contemplation (0.72), preparation (0.75), action (0.70), and maintenance (0.70). Conclusions The CHAPS is the first comprehensive measurement tool to assess CHA use specifically for pain management. Ease of administration in a population with pain support further use in population- and clinic-based studies in similar populations

Golden Proportion in Visual Dental Smile in Pakistani Population: A Pilot Study

Uvod: Oduvijek se raspravljalo o tome što čini dobru dentalnu estetiku, s obzirom na to da ona može varirati od osobe do osobe, ovisno o njezinu iskustvu i društvenom okružju. Zato se “zlatni omjer” smatra važnim kako bi se postigla estetika i skladan osmijeh. Svrha: Istraživanjem se željelo postići sljedeće: odrediti prevalenciju “zlatnog omjera” vidljive širine na odabranom uzorku pakistanske populacije; ispitati ima li spolnih razlika u stvarnim širinama gornjih prednjih zuba; ustanoviti korisnost Levinove FI zubne ljestvice kao prediktora “zlatnog omjera”. Ispitanici i postupci: Od stotinu pacijenata odabranih neprobabilističkim uzorkovanjem, samo je njih 44 bilo uključeno u istraživanje. Za mjerenje zuba stručnjaci su se koristili zubnim modelima odabranih ispitanika. Stvarna širina (meziodistalna) mjerila se pomičnom mjerkom, a vidljiva (širina maksilarnih frontalnih zuba gledano sprijeda) ljestvicom i mjerkom. Predicirana širina izračunavala se korištenjem “zlatnog omjera” za gornji bočni sjekutić i gornji očnjak. Nakon toga su podaci bili statistički analizirani (deskriptivna statistika, Pearsonov koeficijent korelacije, t-test). Rezultati: Šezdeset i tri posto (63,6 %) uzorka (22 žene i 6 muškaraca) odgovaralo je ljestvici “zlatnog omjera” kad je riječ o vidljivoj širini gornjih prednjih zuba. Gledano sprijeda, vidljiva širina gornjih bočnih sjekutića iznosila je 75 posto stvarne širine središnjih sjekutića (središnji sjekutić bio je referentni zub te je zato korištena stvarna širina), a vidljiva širina očnjaka bila je 61,3 posto (gotovo “zlatni postotak”) vidljive širine bočnih sjekutića. Nije bilo veće spolne razlike u stvarnoj širini gornjih središnjih i bočnih sjekutića te očnjaka. Zaključak: Z ubna ljestvica FI može biti korisna i dobra početna točka za predikciju “zlatnog omjera” kod 63 posto pakistanske populacije. Ipak, taj se omjer ne bi se trebao smatrati odlučujućim čimbenikom dentalne privlačnosti. To bi prije trebao biti raspon nego jedna vrijednost.Introduction: It has always been argued as to what constitutes good dental esthetics, as it can vary from person to person depending on personal experiences and social surroundings. Golden proportion has been stated to be an important tool for achieving esthetics and harmony in smile. Objectives: The aim of this study was to find out prevalence of golden proportion of the apparent width in a selected sample of Pakistani population, to examine if there is gender difference considering actual maxillary frontal teeth widths, to determine the usefulness of Levin’s Phi Dental Grid as a predictor of golden proportion. Material and Method: From one hundred patients evaluated using non-probability sampling, only 44 were included in the study. Dental casts of the selected individuals were used for teeth measurement. The actual width (measured mesiodistal width) was measured using vernier caliper, the apparent width (width of the maxillary frontal teeth when viewed from the front) was measured using the grid and the caliper, and the predicted width was calculated using the Golden proportion for the maxillary lateral incisor and the maxillary canine. Data was subjected to statistical analysis (descriptive statistics, Pearson’s coeficient of correlation, t-test). Results: Sixty three percent of the sample (22 females and 6 males) fitted the scale of golden proportion considering the apparent width of the maxillary frontal teeth. When viewed from the front, maxillary lateral incisor’s apparent width was 75% of the central incisor’s actual width (central incisor was reference tooth therefore actual width was used) and the canine’s apparent width was 61.3% (almost golden percentage) of the lateral incisor’s apparent width. There was no significant gender difference for the actual widths of the maxillary central incisors, lateral incisors and canines. Conclusion: Phi Dental Grid can be useful tool and a good starting point to predict golden proportion in 63% of the Pakistani population. However, golden proportion should not be considered as a decisive factor of determining dental attractiveness. It should be a range rather then a single value

Maternal Age and Inadequate Prenatal Care in West Virginia: A Project WATCH Study

Introduction: Adequate prenatal care (PNC) is essential to the overall health of mother and infant. Teen age and advanced maternal age (AMA) are known risk factors for poor birth outcomes. However, less is known about whether these age groups are associated with inadequate PNC. Purpose: This study sought to determine the potential association between maternal age (in groups, aged 20–24, 25–29, 30–34, 35–39, and \u3e40) and inadequate PNC (visits). Methods: West Virginia (WV) Project WATCH population-level data (May 2018–March 2022) were used for this study. Multiple logistic regressions were performed on inadequate PNC (less than 10 visits) with maternal age categories, adjusting for covariates including maternal race, smoking status, substance use status, parity, education, geographic location, and insurance status. Results: Results demonstrate that both young and AMA pregnant people are more likely to receive inadequate PNC. PNC is particularly important for these groups, as they are at increased risk of poor birth outcomes. Just over 11% of pregnant people who gave birth in WV received inadequate PNC. Participants aged 19 years and younger (aOR:1.3, CI:(1.2,1.4)), 35–39 years (aOR:1.1, CI:(1.0,1.2)), and 40 years (aOR:1.3, CI:(1.1,1.5)) were at increased odds of inadequate PNC relative to 25–29-year-olds. Implications: Results indicate that easily obtained demographics, such as a pregnant person’s age, can be utilized by policymakers and clinical interventionists to improve birth outcomes by increasing PNC outreach for these groups

Impact of foreign direct investment on economic growth: A case study of Pakistan

Purpose- This research paper aims to analyze the impact of foreign direct investment (FDI) in Pakistan for the period 1981 to 2010. It evaluated the GDP growth performance and assessed the historical trends of the FDI and CPI in Pakistan. Methodology/Sample- The link between gross domestic product (GDP,) foreign direct investment and Inflation is measured with the help of multiple regression models. GDP in this model is used as dependent variable whereas FDI and inflation (CPI) are measured as independent variables. Findings- According to the results, the model is overall significant with the positive and significant association of GDP and FDI while a negative and significant relationship found between GDP and inflation. Practical Implications- On the basis of the empirical results acquired, Policy proposals are advised to attract FDI in Pakistan. Foreign direct investment (FDI) is an essential factor for economic growth in the developing countries. FDI allows the transfer of technology, uplift competition in the domestic input market, contributes to human capital development and Profits created by FDI contribute to corporate tax revenues in the host country

Impact of foreign direct investment on economic growth: A case study of Pakistan

Purpose- This research paper aims to analyze the impact of foreign direct investment (FDI) in Pakistan for the period 1981 to 2010. It evaluated the GDP growth performance and assessed the historical trends of the FDI and CPI in Pakistan. Methodology/Sample- The link between gross domestic product (GDP,) foreign direct investment and Inflation is measured with the help of multiple regression models. GDP in this model is used as dependent variable whereas FDI and inflation (CPI) are measured as independent variables. Findings- According to the results, the model is overall significant with the positive and significant association of GDP and FDI while a negative and significant relationship found between GDP and inflation. Practical Implications- On the basis of the empirical results acquired, Policy proposals are advised to attract FDI in Pakistan. Foreign direct investment (FDI) is an essential factor for economic growth in the developing countries. FDI allows the transfer of technology, uplift competition in the domestic input market, contributes to human capital development and Profits created by FDI contribute to corporate tax revenues in the host country

Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis

Background Overweight and obesity is a major public health concern that includes associations with the development of cardiovascular disease (CVD) risk factors during childhood and adolescence as well as premature mortality in adults. Despite the high prevalence of childhood and adolescent obesity as well as adult CVD, individual studies as well as previous systematic reviews examining the relationship between childhood obesity and adult CVD have yielded conflicting results. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap. Methods Studies were included if they met the following criteria: (1) longitudinal and cohort studies (including case-cohort), (2) childhood exposure and adult outcomes collected on the same individual over time, (3) childhood obesity, as defined by the original study authors, (4) English-language articles, (5) studies published up to June, 2015, (6) one or more of the following CVD risk factors [systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), non-high-density lipoprotein cholesterol (non-HDL), and triglycerides (TG)], (7) outcome(s) not self-reported, and (8) exposure measurements (child’s adiposity) assessed by health professionals, trained investigators, or self-reported. Studies were retrieved by searching three electronic databases as well as citation tracking. Fisher’s r to z score was calculated for each study for each outcome. Pooled effect sizes were calculated using random-effects models while risk of bias was assessed using the STROBE instrument. In order to try and identify sources of heterogeneity, random-effects meta-regression was also performed. Results Of the 4840 citations reviewed, a total of 23 studies were included in the systematic review and 21 in the meta-analysis. The findings suggested that childhood obesity is significantly and positively associated with adult SBP (Zr = 0.11; 95% CI: 0.07, 0.14), DBP (Zr = 0.11; 95% CI: 0.07, 0.14), and TG (Zr =0.08; 95% CI: 0.03, 0.13), and significantly and inversely associated with adult HDL (Zr = −0.06; 95% CI: -0.10, −0.02). For those studies that adjusted for adult body mass index (BMI), associations were reversed, suggesting that adult BMI may be a potential mediator. Nine studies had more than 33% of items that placed them at an increased risk for bias. Conclusions The results of this study suggest that childhood obesity may be a risk factor for selected adult CVD risk factors. However, a need exists for additional, higher-quality studies that include, but are not limited to, both unadjusted and adjusted measures such as BMI before any definitive conclusions can be reached. Systematic review and meta-analysis PROSPERO 2015: CRD42015019763

Prevalence of alcohol use in late pregnancy

Background Prenatal alcohol exposure (PAE) can result in detrimental developmental complications. The objective of this study was to estimate the most recent PAE prevalence data for the state of West Virginia (WV) and associated factors. Method In all, 1830 newborn residual dried blood spots (DBS) in the WV Newborn Screening Repository were analyzed for phosphatidylethanol (PETH). Data were matched with Project WATCH data (94% match, N = 1729). Results The prevalence of late pregnancy PAE was 8.10% (95%CI: 6.81, 9.38) for all births, 7.61% (95%CI: 6.26, 8.97) for WV residents only, and ranged from 2.27 to 17.11% by region. The significant factors associated with PAE included smoking (OR: 2.03, 95% CI: 1.40, 2.94), preterm births (OR: 1.88; 95% CI: 1.23, 2.89), birth weight of ≤2000 g vs. \u3e3000 g (OR: 2.62, 95%CI: 1.19, 5.79), no exclusive breastfeeding intention (OR: 1.45, 95% CI: 1.02, 2.04), and not exclusively breastfeeding before discharge (OR: 1.61; 95% CI: 1.09, 2.38). Conclusion The prevalence of PAE is higher than previously shown for the state. Accurate and timely estimates are vital to inform public health workers, policymakers, researchers, and clinicians to develop and promote effective prevention strategies to lower PAE prevalence and provide targeted interventions and treatment services for infants affected by PAE