ABSTRACT
Evidence is accumulating about the association between strong family ties and the emotional and physical welfare of older adults, and researchers have identified negative consequences of being unmarried, being childless, and/or living alone. These associations have been recognized in multiple contexts, including in Asia where living with a spouse and/or grown children has been shown in some studies to improve elderly well-being. Social support, especially family support, is expected to continue to be important where populations are aging and social safety nets are weak. Using longitudinal data from the 2010 and 2012 waves of the China Family Panel Studies, we focus on the effects of marital status at times 1 and 2, changes in marital status between the two surveys, and other family-related indicators of social connectedness on ratings of depression, levels of life satisfaction, and self-reported physical health among those aged 50 and over. Our sample includes 9831 respondents who have valid data on wellbeing indicators for Wave 1 and Wave 2, as well as complete information on the other covariates controlled in our analysis. In analyses of the full sample, those who were married at both points in time reported lower depression scores than those who were never-married, divorced, or widowed at both time points, and those whose unions dissolved in the interval. Those who were married at both times also generally reported greater levels of life satisfaction than those who were never married at both time points and those who became divorced during the interval. Important underlying gender differences are observed both for life satisfaction and depression. In addition, those who were married at both time points reported being in better physical health than those who became widowed during the interval (significant primarily for women), and those who had never been married (significant primarily for men). Our study contributes to the literature on social ties and the wellbeing by highlighting the importance of marital status and changing marital status, net of child co-residence and proximity, in China.
ABSTRACT
OBJECTIVES: The purpose of this study was to evaluate the incidence of inaccurate stent positioning in the treatment of coronary aorto-ostial lesions. BACKGROUND: The percutaneous treatment of aorto-ostial disease is challenging, with a paucity of data describing the incidence of stent mispositioning. METHODS: We retrospectively reviewed the accuracy of stent positioning in 100 consecutive coronary aorto-ostial lesions. Using careful angiographic review, each stent placement was classified as "missed" (> 1 mm distal or proximal to the angiographically determined ostium) or "accurately" positioned. RESULTS: The true ostium was missed during stent placement in 54% of cases. In 52% of the misses, the stent was placed too proximally. This proximal miss was associated with an inability to coaxially re-engage the treated vessel in 93% of the cases. The stent was placed too distally in 48% of missed cases, resulting in a placement of one or more additional overlapping stents in 38% of those cases. Clinical follow-up (mean, 24.5 ± 12.9 months) was obtained in 98% of cases. Angiographic follow-up prompted by recurrent chest pain or ischemia was performed in 45/100 cases. There was a three-fold increase in restenosis and target lesion revascularization (TLR) among the cohort of patients with stent misplacement (26% and 23%, respectively) compared to those with accurate stent placement (9% and 6%, respectively; p = 0.02 for both restenosis and TLR). CONCLUSIONS: Angiographically-guided stenting for coronary aorto-ostial disease leads to a high incidence of proximal and distal stent misplacement. Stent mispositioning is associated with significantly higher restenosis and clinically driven TLR compared to patients with accurate stent placement.
