Carotid Intima‐Media Thickness and the Risk of Sudden Cardiac Death: The ARIC Study and the CHS

Background: Sudden cardiac death (SCD) is associated with severe coronary heart disease in the great majority of cases. Whether carotid intima-media thickness (C-IMT), a known surrogate marker of subclinical atherosclerosis, is associated with risk of SCD in a general population remains unknown. The objective of this study was to investigate the association between C-IMT and risk of SCD. Methods and Results We examined a total of 20 862 participants: 15 307 participants of the ARIC (Atherosclerosis Risk in Communities) study and 5555 participants of the CHS (Cardiovascular Health Study). C-IMT and common carotid artery intima-media thickness was measured at baseline by ultrasound. Presence of plaque was judged by trained readers. Over a median of 23.5 years of follow-up, 569 participants had SCD (1.81 cases per 1000 person-years) in the ARIC study. Mean C-IMT and common carotid artery intima-media thickness were associated with risk of SCD after adjustment for traditional risk factors and time-varying adjustors: hazard ratios (HRs) with 95% CIs for fourth versus first quartile were 1.64 (1.15-2.63) and 1.49 (1.05-2.11), respectively. In CHS, 302 participants developed SCD (4.64 cases per 1000 person-years) over 13.1 years. Maximum C-IMT was associated with risk of SCD after adjustment: HR (95% CI) for fourth versus first quartile was 1.75 (1.22-2.51). Presence of plaque was associated with 35% increased risk of SCD: HR (95% CI) of 1.37 (1.13-1.67) in the ARIC study and 1.32 (1.04-1.68) in CHS. Conclusions C-IMT was associated with risk of SCD in 2 biracial community-based cohorts. C-IMT may be used as a marker of SCD risk and potentially to initiate early therapeutic interventions to mitigate the risk

Participation as Post-Fordist Politics: Demos, New Labour, and Science Policy

In recent years, British science policy has seen a significant shift ‘from deficit to dialogue’ in conceptualizing the relationship between science and the public. Academics in the interdisciplinary field of Science and Technology Studies (STS) have been influential as advocates of the new public engagement agenda. However, this participatory agenda has deeper roots in the political ideology of the Third Way. A framing of participation as a politics suited to post-Fordist conditions was put forward in the magazine Marxism Today in the late 1980s, developed in the Demos thinktank in the 1990s, and influenced policy of the New Labour government. The encouragement of public participation and deliberation in relation to science and technology has been part of a broader implementation of participatory mechanisms under New Labour. This participatory program has been explicitly oriented toward producing forms of social consciousness and activity seen as essential to a viable knowledge economy and consumer society. STS arguments for public engagement in science have gained influence insofar as they have intersected with the Third Way politics of post-Fordism

Replicating A Teen Hiv/Std Preventive Intervention In A Multicultural City

Although there are now several adolescent HIV and STD preventive interventions of demonstrated efficacy in the literature, little is understood about the portability of these interventions. This study replicated Stanton\u27s Focus on Kids intervention, developed for inner city African American adolescents, in a different population, transferring it to a multicultural city. Despite careful replication of the original study\u27s procedures, youth in the preventive intervention condition of the replication study did not improve in attitudes, perceived norms, self-efficacy, or intentions toward sexual initiation, condom use, or abstinence compared with a carefully matched control condition. We discuss several possible reasons for this failure to replicate, concluding that the most likely reason is the lower rates of sexual activity among youth in the replication city

Disability and Recovery of Independent Function in Obstructive Lung Disease: The Cardiovascular Health Study

BACKGROUND: Chronic obstructive lung disease frequently leads to disability. Older patients may transition between disability and independence over time. OBJECTIVE: To identify factors associated with transitions between disability and independent function in obstructive lung disease. METHODS: We analyzed data for 4,394 participants in the Cardiovascular Health Study who completed pre-bronchodilator spirometry. We calculated the 1-year probability of developing and resolving impairment in ≥1 Instrumental Activity of Daily Living (IADL) or ≥1 Activity of Daily Living (ADL) using transition probability analysis. We identified factors associated with resolving disability using relative risk regression. RESULTS: The prevalence of IADL impairment was higher among moderate (23.9%) and severe (36.9%) airflow obstruction compared to normal spirometry (22.5%; p<0.001). Among participants with severe airflow obstruction, 23.5% recovered independence in IADLs and 40.5% recovered independence in ADLs. In adjusted analyses, airflow obstruction predicted development of IADL, but not ADL impairment. Participants with severe airflow obstruction were less likely to resolve IADL impairment (RR 0.67, 95% CI 0.49-0.94). Compared to the most active persons (≥28 blocks walked per week), walking less was associated with decreased likelihood of resolving IADL impairment (7-27 blocks: RR 0.81, 0.69-0.86, and < 7 blocks: RR 0.73, 0.61 -0.86). Increased strength (RR 1.16, 1.05-1.29) was associated with resolving IADL impairment. CONCLUSIONS: Disability is common in older persons, especially those with severe airflow obstruction. Increased physical activity and muscle strength are associated with recovery. Research on interventions to improve these factors among patients with obstructive lung disease and disability is needed

Bidirectional relationship between cognitive function and pneumonia.

RationaleRelationships between chronic health conditions and acute infections remain poorly understood. Preclinical studies suggest crosstalk between nervous and immune systems.ObjectivesTo determine bidirectional relationships between cognition and pneumonia.MethodsWe conducted longitudinal analyses of a population-based cohort over 10 years. We determined whether changes in cognition increase risk of pneumonia hospitalization by trajectory analyses and joint modeling. We then determined whether pneumonia hospitalization increased risk of subsequent dementia using a Cox model with pneumonia as a time-varying covariate.Measurements and main resultsOf the 5,888 participants, 639 (10.9%) were hospitalized with pneumonia at least once. Most participants had normal cognition before pneumonia. Three cognition trajectories were identified: no, minimal, and severe rapid decline. A greater proportion of participants hospitalized with pneumonia were on trajectories of minimal or severe decline before occurrence of pneumonia compared with those never hospitalized with pneumonia (proportion with no, minimal, and severe decline were 67.1%, 22.8%, and 10.0% vs. 76.0%, 19.3%, and 4.6% for participants with and without pneumonia, respectively; P &lt; 0.001). Small subclinical changes in cognition increased risk of pneumonia, even in those with normal cognition and physical function before pneumonia (β = -0.02; P &lt; 0.001). Participants with pneumonia were subsequently at an increased risk of dementia (hazard ratio, 2.24 [95% confidence interval, 1.62-3.11]; P = 0.01). Associations were independent of demographics, health behaviors, other chronic conditions, and physical function. Bidirectional relationship did not vary based on severity of disease, and similar associations were noted for those with severe sepsis and other infections.ConclusionsA bidirectional relationship exists between pneumonia and cognition and may explain how a single episode of infection in well-appearing older individuals accelerates decline in chronic health conditions and loss of functional independence