Development and validation of equation for cardiorespiratory fitness in patients with heart failure with preserved ejection fraction

Background/Aims@#Cardiorespiratory fitness (CRF), as measured by maximal oxygen consumption (VO2max), is an important independent predictive factor of cardiovascular outcomes in patients with heart failure (HF). However, it is unclear whether conventional equations for estimating CRF are applicable to patients with HF with preserved ejection fraction (HFpEF). @*Methods@#This study included 521 patients with HFpEF (EF ≥ 50%) whose CRF was directly measured by cardiopulmonary exercise test using a treadmill. We developed a new equation (Kor-HFpEF) for half of the patients in the HFpEF cohort (group A, n = 253) and validated it for the remaining half (group B, n = 268). The accuracy of the Kor-HFpEF equation was compared to that of the other equations in the validation group. @*Results@#In the total HFpEF cohort, the directly measured VO2max was significantly overestimated by the FRIEND and ACSM equations (p < 0.001) and underestimated by the FRIEND-HF equation (p <0.001) (direct 21.2 ± 5.9 mL/kg/min; FRIEND 29.1 ± 11.8 mL/kg/min; ACSM 32.5 ± 13.4 mL/kg/min; FRIEND-HF 14.1 ± 4.9 mL/kg/min). However, the VO2max estimated by the Kor-HFpEF equation (21.3 ± 4.6 mL/kg/min) was similar to the directly measured VO2max (21.7 ± 5.9 mL/kg/min, p = 0.124), whereas the VO2max estimated by the other three equations was still significantly different from the directly measured VO2max in group B (all p < 0.001). @*Conclusions@#Traditional equations used to estimate VO2max were not applicable to patients with HFpEF. We developed and validated a new Kor-HFpEF equation for these patients, which had a high accuracy.

The Effect of Neighborhood Characteristics and Friends’ Smoking Status on the Habitual Smoking Onset in Adolescents

Purpose@#The aim of this study was threefold, to longitudinally examine the risk of habitual smoking onset in adolescents, to delineate the effects of neighborhood characteristics and friends’ smoking status on the habitual smoking onset, and to investigate whether the association between friends’ smoking status and habitual smoking onset was moderated by neighborhood characteristics. @*Methods@#This study conducted multilevel discrete-time survival analysis, using cohort data from the 3rd to 6th waves of the Korean Child and Youth Panel Survey, which excluded habitual smokers, matched with 2010 census data on respondents’ residence. @*Results@#Habitual smoking onset risk increased from the 8th to the 11th grade, and then slightly decreased from the 11th to the 12th grade. Friends’ smoking status (B = 0.60, p < .001), smoking rate (B = 0.06, p = .038), and the number of tobacco outlets in the respondents’ neighborhood (B = 0.51, p = .003) were positively associated with habitual smoking onset risk. Furthermore, the association between friends’ smoking status and habitual smoking onset risk was moderated by the number of tobacco outlets in the neighborhood. Specifically, the association was stronger in neighborhoods with more tobacco outlets (B = 0.58, p = .048). @*Conclusion@#Friends’ smoking status and living in neighborhoods that are more susceptible to smoking increase the risk of habitual smoking. The number of tobacco outlets in the neighborhood enhances the peer effect of adolescent’s smoking behavior. Therefore, policies or interventions designed to reduce youth’s tobacco use should focus on not only on reducing peer smoking, but also restricting smoking by adults and the number of neighborhood tobacco outlets.

Prognostic value of routine blood tests along with clinical risk factors in predicting ischemic stroke in non‑valvular atrial fibrillation:a prospective cohort study

Background@#In patients with atrial fibrillation (AF), most biomarkers are still of limited use due to cost-effectiveness and complexity in clinical practice.Hypotheses Biomarkers from routine blood tests improve the current risk stratification in AF patients. @*Methods@#This prospective study enrolled 600 patients diagnosed with non-valvular AF, of whom 537 were analyzed. Platelet count; platelet distribution width (PDW); red cell distribution width (RDW); and creatinine, D-dimer, and troponin I levels were measured at enrollment. @*Results@#During the mean follow-up period (2.2 ± 0.6 years), 1.9% patients developed ischemic stroke. According to the optimal cutoff of each biomarker, the risk of ischemic stroke was higher in patients with RDW ≥ 13.5%, creatinine ≥ 1.11 mg/dL, or PDW ≥ 13.2% (significant biomarkers; P value: < 0.01, 0.04, or 0.07, respectively). These 3 significant biomarkers had higher information gain than clinical risk factors in predicting ischemic stroke. The cumulative incidence of ischemic stroke was 1.2%, 1.1%, 8.4%, and 40.0% in patients with 0, 1, 2, and 3 significant biomarkers, respectively (P-for-trend < 0.001). Patients with  ≥ 2 significant biomarkers had a significantly higher risk of ischemic stroke than those with  < 2 significant biomarkers (adjusted hazard ratio 11.5, 95% confidence interval 3.3–40.2, P < 0.001). The predictability for ischemic stroke was significantly improved when  ≥ 2 significant biomarkers were added to the CHA2DS2–VASc score (area under the curve 0.790 vs. 0.620, P = 0.043). @*Conclusion@#Routine blood tests can provide better risk stratification of AF along with clinical risk factors.

Clinical and Histological Response to Immunosuppressive Therapy in Giant Cell Myocarditis

No abstract available.

Analyzing Changes and Determinants of Self-rated Health during Adolescence: A Latent Growth Analysis

PURPOSE: The purpose of this study was to examine changes in the self-rated health of adolescents and to identify its predictors using longitudinal data from the KCYPS. METHODS: A sample of 2,351 adolescents who were in the first grade of middle school in 2010 was analyzed. The study employed latent growth analysis using data from 2010 to 2016. RESULTS: Results indicated that self-rated health of adolescents increased, following the form of a linear function. The analyses revealed that adolescent self-perception of health were conceptualized not only by their health-related behaviors, but also by personal, socioeconomic and psychological factors. Specifically, physical activity, passive leisure time activities, gender (initial: b=−.060, slope: b=.030), place of residence (initial: b=−.079), self-rated economic condition (b=.098), working status of mother (b=.016), monthly family income (b=−.001), aggression (b=.061), depression (initial: b=−.104, slope: b=.012), stress (initial: b=−.172, slope: b=.014, ego-resiliency (initial: b=.197, slope: b=−.021), and self-esteem (initial: b=.106, slope: b=−.017) had significant effects on the overall linear change of self-rated health (p < .05 for all estimators above). CONCLUSION: The findings of this study suggest that adolescents' self evaluation of their health is shaped by their total sense of functioning, which includes individual, health-related behavioral, socioeconomic, and psychological factors.

Attitudes of Medical Staff and Factors Related to Nutritional Support for Patient Care in a University Hospital

PURPOSE: Knowledge of nutritional support and attitudes of medical staff both affect patient care. We identified attitudes regarding nutritional support among medical staff as well as changes in attitudes when a nutritional support team is present. METHODS: Data were collected from 172 medical staff members who served at a university hospital located in Gyeongju by self-administered questionnaire from June 12~August 30, 2013. The questionnaire inquired about importance of nutritional support, self-confidence about nutritional support, consideration of nutritional support for patient care, consideration of nutritional support when a nutritional support team is present, and nutritional knowledge training during the past year. RESULTS: A total of 169 subjects (98.3%) thought that nutritional support is important for patient care. Only 19 subjects (11.0%) were highly self-confident about nutritional support. In total, 147 subjects (85.5%) considered nutritional support for some or all patients, whereas 169 (98.3%) considered nutritional support for patient care when a nutritional support team is present. Thirty-eight subjects (22.1%) received nutritional knowledge training during the past year. High self-confidence for nutritional support was related to nutritional knowledge training and service part. Positive changes regarding nutritional support when a nutritional support team is present were associated with nutritional knowledge training and high self-confidence for nutritional support. CONCLUSION: No differences in nutritional support attitudes for patient care were observed among the medical staff. Nutritional knowledge training and service part affected self-confidence of nutritional support and induced positive changes in attitudes for nutritional support.