Drug-coated balloons for coronary artery disease: An updated review with future perspectives.

Since the advent of coronary stents, two of the most common long-term complications after percutaneous coronary intervention (PCI) are in-stent restenosis (ISR) and stent thrombosis (ST). Although the rates of ST have been nearly abolished and ISR rates have declined with the current gold-standard second-generation drug-eluting stents (DES), late ISR of DES remains a valid concern in the field of interventional cardiology. The drug-coated balloon (DCB) is a non-stent technology that relies on the concept of targeted homogeneous drug delivery from an inflated balloon to restore luminal vascularity, treat atherosclerosis, and overcome some limitations of PCI, including ISR and prolonged dual antiplatelet therapy to prevent ST by leaving nothing behind. Most clinical evidence on coronary DCBs predominantly comes from small, randomized data and registries using paclitaxel DCBs for ISR and de novo lesions in the coronary space. Since 2014, outside the United States, DCBs have been approved for the treatment of ISR, with a class I recommendation by the European Society of Cardiology. The Food and Drug Administration very recently approved the Agent DCB to treat ISR in patients with coronary artery disease in the US. Additionally, recent randomized clinical data also showed DCB's safety and efficacy for the treatment of de novo small-vessel disease and high-bleeding-risk patients, while their role for other clinical situations including acute coronary syndrome, large-vessel disease, bifurcation lesions, and long-diffuse distal lesions is currently under investigation. Herein, we review the evidence-based role of DCBs in the treatment of coronary lesions and offer future perspectives.

Factorial validity and measurement invariance of the Athlete Burnout Questionnaire (ABQ).

The Athlete Burnout Questionnaire (ABQ) is the gold standard measure for burnout in athletes. However, previous assessments of factorial validity have: (a) tested overly restrictive measurement models; (b) provided mixed support for factorial validity; and (c) not been applied to assess measurement invariance across gender, sport type, or age. To address these issues, we used ABQ data provided by 914 athletes (Mage = 21.75 years, SD = 8.79) and examined factorial validity using confirmatory factor analysis (CFA) and exploratory structural equation modelling (ESEM) techniques. We also examined measurement invariance of the ABQ data across reported gender (female, male), sport type (individual, team), and age (≤18 years, >18 years) groups. The analyses revealed that an ESEM model provided superior fit over the corresponding CFA model. In terms of measurement invariance, support was provided for the equivalence of the ABQ across each group. This means that researchers using the ABQ can collect data across these groups and examine potential differences with confidence that the ABQ is approximately invariant. In all, we provide evidence that the majority of ABQ items are key target construct indicators and the burnout construct (as measured by the ABQ) has the same structure and meaning to different athlete groups.

From chest pain to coronary functional testing: Clinical and economic impact of coronary microvascular dysfunction.

BACKGROUND: Coronary functional testing to formally diagnose coronary microvascular dysfunction (CMD) reduces cardiovascular events and alleviates angina. This study aims to investigate the extensive and complex journey that patients with CMD undergo, from the onset of chest pain to eventual diagnosis. METHODS: Data from the Coronary Microvascular Disease Registry (CMDR) were analyzed, including information on the date of first documentation of chest pain, number of non-invasive and invasive tests the patient underwent, emergency department visits, and hospitalizations. In addition, we estimated the total cost per patient. A total of 61 patients with CMD diagnosis were included in this analysis. RESULTS: Most patients in our cohort were older than 50 years of age. The median time from initial chest pain symptoms to diagnosis was 0.62 (interquartile range [IQR]: 0.06-2.96) years. During this period, patients visited the emergency department a median of 1.0 (IQR: 0.0-2.0) times. Diagnostic tests included 3.0 (IQR: 2.0-6.0) electrocardiograms, 3.0 (IQR: 0.0-6.0) high-sensitivity troponin tests, and 1.0 (IQR: 1.0-2.0) echocardiograms. Prior to diagnosis of CMD, 13 (21.3 %) patients had left heart catheterization without coronary functional testing. Non-invasive testing for ischemia was conducted in 43 (70.5 %) patients. Alternative non-cardiac diagnoses were given to 11 (18.0 %) patients during the diagnostic process, with referrals made to gastroenterology for 16 (26.2 %) and pulmonology for 10 (16.4 %) patients. The cost was almost $2000/patient. CONCLUSION: Timely identification of CMD offers promising opportunities for prompt symptom alleviation, accompanied by reduced visits to the emergency department, cardiovascular testing, invasive medical procedures, and consequently reduced healthcare expenses.

Perfectionism and performance in sport: Exploring non-linear relationships with track and field athletes.

The relationship between perfectionism - perfectionistic strivings and perfectionistic concerns - and athletic performance is contested and inconsistent. The present study explored the possibility that one explanation for this inconsistency is the assumption that the relationship is linear. In two samples, we tested alternative non-linear relationships between perfectionism and real-world competitive athletic performance. Sample one comprised 165 Swedish track and field athletes (57 % competing in female category, 42 % in male category; Mage = 16.93 years) and sample two comprised 157 British track and field athletes (55 % competing in female category, 43 % in male category; Mage = 18.42 years). Testing for linear and non-linear relationships, we found a quadratic effect whereby higher perfectionistic strivings had both positive increasing (i.e., U-shape; sample 1) and positive decreasing (i.e., inverted U-shape; sample 2) relationships with performance. We conclude that there may be circumstances when perfectionistic strivings contribute to better and worse sport performance, and that this relationship can be curvilinear.

Comparisons and Conversions: A Methodological Note and Caution for Meta-Analysis in Sport and Exercise Psychology.

Meta-analysis is a powerful tool in sport and exercise psychology. However, it has a number of pitfalls, and some lead to ill-advised comparisons and overestimation of effects. The impetus for this research note is provided by a recent systematic review of meta-analyses that examined the correlates of sport performance and has fallen foul of some of the pitfalls. Although the systematic review potentially has great value for researchers and practitioners alike, it treats effects from correlational and intervention studies as yielding equivalent information, double-counts multiple studies, and uses an effect size for correlational studies (Cohen's d) that provides an extreme contrast of unclear practical relevance. These issues impact interpretability, bias, and usefulness of the findings. This methodological note explains each pitfall and illustrates use of an appropriate equivalent effect size for correlational studies (Mathur and VanderWeele's d) to help researchers avoid similar issues in future work.

A test of the 2 × 2 Model of Perfectionistic Pressure in youth sport.

Perfectionistic pressure from coaches and parents is likely to contribute to the development of perfectionism in youth athletes. However, if and how perfectionistic pressure from coaches and parents interact to predict the development of perfectionism is unknown. With this in mind, the present study tested a new model - the 2 × 2 Model of Perfectionistic Pressure - that focuses on the different combinations of perfectionistic pressure youth athletes can experience. Four within-person combinations of perfectionistic pressure are identified and compared: Pure coach pressure (high coach pressure/low parental pressure), pure parental pressure (low coach pressure/high parental pressure), mixed pressure (high coach pressure/high parental pressure), and low pressure (low coach pressure/low parental pressure). To test the model, a sample of 210 youth athletes (M age = 14.68 years) completed measures of perfectionistic strivings, perfectionistic concerns, coach pressure to be perfect, and parental pressure to be perfect. Moderated hierarchical regression and simple slopes analyses revealed that mixed pressure was related to the highest levels of both perfectionistic strivings and perfectionistic concerns. The findings provide initial evidence for the new model and suggests it will be useful in studying the development of perfectionism and other outcomes in sport.

A conditional process model of perfectionism, goal-realization, and post-competition mood.

Research has recently begun to examine the relationship between multidimensional perfectionism and athletes' post-competition mood. However, to date, there have been few attempts to examine the interaction between dimensions of perfectionism or model possible explanatory processes. To address these limitations, in the current study we tested a novel conditional process model whereby the relationship between perfectionistic strivings and post-competition affect was mediated by the degree to which goals were considered to have been met (goal-realization) and that this indirect effect was, in turn, moderated by levels of perfectionistic concerns. We tested this model in a sample of 251 athletes who took part in a "Runmageddon" event - a cross-country obstacle race. Athletes completed measures of perfectionism (perfectionistic strivings and perfectionistic concerns) before the race and measures of goal-realization and mood (tense arousal, energetic arousal, and hedonic tone) between 24 and 48 h after the race. Analyses revealed that perfectionistic strivings were indirectly linked to a more unpleasant post-competition mood (higher tense arousal and lower hedonic tone) via perceptions of lower goal-realization. In addition, these two indirect effects were statistically significant only when perfectionistic concerns were medium and high. The results support the proposed conditional model and suggest the interplay between dimensions of perfectionism is important for athletes' post-competition mood, and the level of perfectionistic concerns, especially.

A longitudinal study of perfectionism and orthorexia in exercisers.

Research suggests that trait perfectionism and perfectionistic self-presentation are related to orthorexia - a pathological obsession with correct nutrition. However, no studies have examined these relationships over time or compared the influence of the two aspects of perfectionism on orthorexia. In the present study we sought to address these two issues. Gym members who engaged in high degrees of exercise were recruited via social media platforms. They completed an online questionnaire that included the Multidimensional Perfectionism Scale-Short Form, Perfectionistic Self-Presentation Scale, and the Eating Habits Questionnaire on two occasions: 177 participants (Mean age = 31.6 years) initially completed the questionnaire and 82 completed the questionnaire six weeks later. A series of multiple regression analyses revealed that (i) trait perfectionism predicted an increase in orthorexia symptomatology over time with socially prescribed perfectionism and other-oriented perfectionism unique predictors of orthorexia, (ii) perfectionistic self-presentation predicted orthorexia over time with nondisplay of imperfection a unique predictor of orthorexia, and (iii) when considered alongside each other, only trait dimensions of perfectionism were unique predictors of orthorexia. The present study provides further evidence that perfectionism is related to orthorexia. In addition, the study also provides preliminary evidence that more engrained trait aspects of perfectionism are more predictive of orthorexia over time than the self-presentational aspects of perfectionism.

COVID-19 Vaccine Hesitancy, Medical Mistrust, and Mattering in Ethnically Diverse Communities.

OBJECTIVES: Uptake of the COVID-19 vaccine continues to be lower in ethnically diverse communities in the UK even though they are disproportionally affected by the negative effects of the virus. To better understand why uptake is lower, we explored factors that may underpin vaccine hesitancy and intention to vaccinate in these communities with an emphasis on medical mistrust and feelings of mattering. DESIGN: One hundred and sixty-one adults from ethnically diverse backgrounds who had not had a COVID-19 vaccination completed an online questionnaire that contained closed (quantitative) and open (qualitative) questions. RESULTS: Analyses of quantitative questions revealed that medical mistrust, but not feelings of mattering, was related to COVID-19 hesitancy and likelihood of getting a COVID-19 vaccination. Of the three components of medical mistrust, suspicion was the only unique predictor and was related to higher hesitancy towards the COVID-19 vaccine and lower likelihood of getting a COVID-19 vaccine. Analyses of the responses to the qualitative questions were organised into four themes: (1) Beliefs that taking the vaccine is an important social responsibility; (2) Experiences of pressure to take the vaccine and limited choice; (3) General mistrust linked to personal experiences and the health system; (4) Being concerned about social/medical restrictions if not vaccinated. CONCLUSION: The findings suggest that medical mistrust may partly explain why uptake of the COVID-19 vaccine is lower in ethnically diverse communities in the UK and appears to play a role in how people weigh a sense of responsibility and pressure against health and social concerns in making the decision to be vaccinated.

Young people's perceptions of their parents' expectations and criticism are increasing over time: Implications for perfectionism.

Recent evidence demonstrates rising self-oriented, other-oriented, and socially prescribed perfectionism among young people from the United States, United Kingdom, and Canada (Curran & Hill, 2019). One reason why perfectionism is increasing may be that rising competitiveness and individualism are requiring parents to engage in anxious, overly involved, and/or overly controlling forms of parenting. Yet, data to support this claim are limited and contested. In two meta-analyses, we expanded upon and tested this claim by examining whether excessive parental expectations and harsh parental criticism are correlated with perfectionism (Study 1) and whether these perceived practices are changing over time among American, Canadian, and British college students (Study 2). In Study 1, meta-analyses found small-to-moderate positive mean weighted effects of parental expectations and parental criticism on self-oriented and other-oriented perfectionism, and large positive mean weighted effects of parental expectations and parental criticism on socially prescribed perfectionism. In Study 2, using cross-temporal meta-analysis, we found that mean levels of parental expectations and parental criticism had linearly increased between 1989 and 2019 among college students. With rising competitiveness, individualism, economic inequality, and pressure to excel at school and college as the societal background, increases in parental expectations and parental criticism offer the most plausible explanation for rising perfectionism to date. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Postoperative Myocardial Injury and Outcomes in Liver and Kidney Transplant Patients.

BACKGROUND/PURPOSE: Myocardial injury after noncardiac surgery (MINS) is associated with major adverse cardiac events (MACE), but its significance post-liver and post-kidney transplantation is not well-defined. METHODS/MATERIALS: We retrospectively studied consecutive patients undergoing single-organ liver or kidney transplantation at a large tertiary transplant center. Liver and kidney transplant patients with troponins drawn within 30 days of transplantation were included. The primary exposure was MINS, defined as troponin elevation above the 99th percentile of the upper reference limit within 30 days of transplantation. The primary outcome was MACE, defined as death, myocardial infarction, revascularization, stroke, or heart failure hospitalization. RESULTS: Overall, 112 patients were included: 58 (51.7%) were liver transplant recipients, and 54 (48.3%) were kidney transplant recipients. Patients with MINS were significantly older (mean age 59 vs. 54 years, p = 0.01) and more likely to have diabetes (35% vs. 17%, p = 0.03). Other baseline characteristics were similar. Sixteen patients (14.2%) developed MACE, including 11 (9.8%) with 1-year MACE. MINS patients were significantly more likely to develop 1-year MACE (adjusted hazard ratio, 10.4; 95% confidence interval, 1.8-198). Kaplan-Meier cumulative MACE was significantly higher in the MINS group (p = 0.03). CONCLUSIONS: Liver and kidney transplant recipients with MINS are significantly more likely to develop 1-year MACE compared to those without MINS. Future prospective studies are needed to further delineate the cardiac risk and outcomes in transplanted patients.

Athlete Burnout Symptoms Are Increasing: A Cross-Temporal Meta-Analysis of Average Levels From 1997 to 2019.

With the increasing prevalence of mental health difficulties in sport, athletes may be at greater risk of burnout than ever before. In the present study, we tested this possibility by examining whether average athlete burnout levels have changed over the past 2 decades, from 1997 to 2019. A literature search returned 91 studies (N = 21,012) and 396 effect sizes. Findings from cross-temporal meta-analysis suggested that burnout symptoms have increased over the past 2 decades. Specifically, we found that athletes' mean levels of reduced sense of athletic accomplishment and sport devaluation have increased. As burnout symptoms are now typically higher among athletes than in the past, we can expect more athletes to be prone to the negative effects of burnout. Sport is therefore in urgent need of prevention and intervention strategies to stop and reverse this trend.

Do Athlete and Coach Performance Perfectionism Predict Athlete Burnout?

Research has illustrated that athlete perfectionism predicts athlete burnout. The present study sought to build on existing research in two ways. First, we provide the first test of the relationship between performance perfectionism and athlete burnout. That is, whether the degree to which athlete's expect their own or others' sport performances to be perfect, predicts burnout. Second, we broaden the examination of the perfectionism-burnout relationship to include coaches by testing the incremental predictive ability of perceptions of coach other-oriented performance perfectionism (the degree to which coaches were perceived to expect perfect performances from others). A sample of 190 competitive adult athletes (M age = 20.54) completed measures of their own performance perfectionism (self-oriented, socially prescribed, and other-oriented performance perfectionism), perceived coach other-oriented performance perfectionism, and burnout symptoms. Regression analyses indicated that both athlete self-oriented and socially prescribed performance perfectionism positively predicted athlete burnout. In addition, after controlling for all dimensions of athlete performance perfectionism, perceived coach other-oriented performance perfectionism positively predicted athlete burnout. The findings suggest that, in addition to their own perfectionism, when athletes perceive their coaches to be more perfectionistic towards others, they are more likely to experience burnout.

Perfectionistic self-presentation and orthorexia in exercisers.

PURPOSE: The present study aimed to provide the first examination of whether perfectionistic self-presentation-an interpersonal expression of perfectionism-is related to orthorexia. METHODS: We recruited a sample of 150 exercisers (Mean age = 27.7 years). Participants completed the Perfectionistic Self-Presentation Scale and the ORTO-15 on a single occasion. RESULTS: Two dimensions of perfectionistic self-presentation-perfectionistic self-promotion and nondisplay of imperfection-showed significant positive correlations with orthorexia. In addition, in multiple regression analyses controlling for the overlap between dimensions, perfectionistic self-promotion emerged as the strongest and only significant predictor of orthorexia. CONCLUSION: Perfectionistic self-presentation is positively associated with orthorexia in exercisers. Perfectionistic self-promotion-a need to portray an image of perfection to others-is primarily responsible for this relationship. LEVEL OF EVIDENCE: Cross-sectional study, Level V.

Development of perfectionism in junior athletes: Examination of actual and perceived parental perfectionism.

Initial research suggests that parental perfectionism is central to the development of athlete perfectionism. However, it is unclear whether perceived or actual parental perfectionism is most important. The present study aimed to address this issue in two ways. First, we re-examined the predictive ability of actual versus perceived parental perfectionism on athlete perfectionism. Second, for the first time, we tested whether perceived parental perfectionism mediated the relationship between actual parental perfectionism and athlete perfectionism. A sample of 150 junior athletes and their parents completed measures of perfectionism (perfectionistic strivings and perfectionistic concerns). Junior athletes completed two measures, one of their own perfectionism and one of perceptions of their parents' perfectionism. Parents completed one measure of their own perfectionism. Regression analyses showed that perceived parental perfectionism predicted athlete perfectionism over and above actual parental perfectionism. Mediation analyses provided support for our proposed model. Overall, the findings suggest that both actual and perceived parental perfectionism are important in the development of perfectionism in junior athletes.

Perfectionism and attitudes towards doping in athletes: A continuously cumulating meta-analysis and test of the 2 × 2 model.

Perfectionism may promote engagement in illegal and unacceptable behaviours such as doping. To examine this idea, in the present study, we had two aims. First, we re-examined the relationship between perfectionism and attitudes towards doping and, in doing so, conducted a continuously cumulating meta-analysis. Second, we extended our understanding of this relationship by providing the first test of the 2 × 2 model of perfectionism in context of doping. A sample of 181 university athletes (mean age 18.5 years) completed measures of perfectionism (evaluative concerns perfectionism [ECP] and personal standards perfectionism [PSP]) and attitudes toward doping. A continuously cumulating meta-analysis based on five studies (including the present study; N = 952) indicated that ECP showed a significant small-to-medium positive relationship with attitudes towards doping (r + = .21), whereas PSP showed a nonsignificant small positive relationship with attitudes towards doping (r + = .07). In addition, moderated regression analysis provided support for two hypotheses of the 2 × 2 model. Specifically, pure ECP (high ECP, low PSP) was associated with more favourable attitudes towards doping than mixed perfectionism (high ECP, high PSP) and non-perfectionism (low ECP, low PSP). The present findings suggest that ECP is a significant positive predictor of attitudes towards doping and that athletes who exhibit a combination of high ECP and low PSP are the most likely to be at risk of doping. Consequently, a focus on reducing ECP may be a valuable addition to anti-doping education programmes.

Perfectionism and Precompetition Emotions in Youth Footballers: A Three-Wave Longitudinal Test of the Mediating Role of Perfectionistic Cognitions.

Perfectionism is related to precompetition emotions in athletes. However, it is unclear why this is the case. In the present study, the authors sought to determine whether perfectionistic cognitions explain this relationship and mediate the relationships between self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), and general precompetition emotions and multidimensional anxiety and anger. The authors adopted a three-wave longitudinal design and examined between- and within-person effects in a sample of 352 youth footballers (Mage = 14.03 years, SD = 2.30). At the between-person level, perfectionistic cognitions mediated the relationships between SOP, SPP, and all general precompetition emotions plus multidimensional anxiety and anger. At the within-person level, perfectionistic cognitions mediated the relationships between SOP, SPP, and general anxiety and anger plus multidimensional anxiety and anger. Our findings imply that athletes higher in SOP and SPP experience more anxiety and anger when the frequency of perfectionistic cognitions increases in the lead-up to competition.

Development of Perfectionism in Junior Athletes: A Three-Sample Study of Coach and Parental Pressure.

Perfectionism predicts cognitions, emotions, and behaviors in sport. Nonetheless, our understanding of the factors that influence its development is limited. The authors sought to address this issue by examining the role of coach and parental pressure in the development of perfectionism in sport. Using 3 samples of junior athletes (16-19 years; cross-sectional n = 212, 3-month longitudinal n = 101, and 6-month longitudinal n = 110), the authors examined relations between coach pressure to be perfect, parental pressure to be perfect, perfectionistic strivings, and perfectionistic concerns. Mini meta-analysis of the combined cross-sectional data (N = 423) showed that both coach pressure and parental pressure were positively correlated with perfectionistic strivings and perfectionistic concerns. In contrast, longitudinal analyses showed that only coach pressure predicted increased perfectionistic strivings and perfectionistic concerns over time. Overall, our findings provide preliminary evidence that coaches may play a more important role in the development of junior athletes' perfectionism than parents.