The frequency and severity of cardiovascular toxicity in advanced renal cell carcinoma patients treated with targeted cancer therapies are high.

BACKGROUND Reproductive factors reflective of endogenous sex hormone exposure might have an effect on cardiac remodeling and the development of heart failure (HF). OBJECTIVES This study examined the association between key reproductive factors and the incidence of HF. METHODS Women from a cohort of the Women’s Health Initiative were systematically evaluated for the incidence of HF hospitalization from study enrollment through 2014. Reproductive factors (number of live births, age at first pregnancy, and total reproductive duration [time from menarche to menopause]) were self-reported at study baseline in 1993 to 1998. We employed Cox proportional hazards regression analysis in age- and multivariable-adjusted models. RESULTS Among 28,516 women, with an average age of 62.7 ± 7.1 years at baseline, 1,494 (5.2%) had an adjudicated incident HF hospitalization during an average follow-up of 13.1 years. After adjusting for covariates, total reproductive duration in years was inversely associated with incident HF: hazard ratios (HRs) of 0.99 per year (95% confidence interval [CI]: 0.98 to 0.99 per year) and 0.95 per 5 years (95% CI: 0.91 to 0.99 per 5 years). Conversely, early age at first pregnancy and nulliparity were significantly associated with incident HF in age-adjusted models, but not after multivariable adjustment. Notably, nulliparity was associated with incident HF with preserved ejection fraction in the fully adjusted model (HR: 2.75; 95% CI: 1.16 to 6.52). CONCLUSIONS In postmenopausal women, shorter total reproductive duration was associated with higher risk of incident HF, and nulliparity was associated with higher risk for incident HF with preserved ejection fraction. Whether exposure to endogenous sex hormones underlies this relationship should be investigated in future studies.

Women with history of pregnancy loss (PL) have higher burden of cardiovascular disease (CVD) later in life, yet it is unclear whether this is attributable to an association with established CVD risk factors (RFs). We examined whether PL is associated with CVD RFs and biomarkers among parous postmenopausal women in the Women's Health Initiative, and whether the association between PL and CVD RFs accounted for the association between PL and incident CVD. Linear and logistic regressions were used to estimate associations between baseline history of PL and CVD RFs. Cox proportional hazards regression models were used to estimate the associations between baseline history of PL and incident CVD after adjustment for baseline RFs. Of 79,121 women, 27,272 (35%) had experienced PL. History of PL was associated with higher BMI (p<0.0001), hypertension (p<0.0001), diabetes (p=0.003), depression (p<0.0001), and lower income (p<0.0001), physical activity (p=0.01), poorer diet (p<0.0001), smoking (p<0.0001) and alcohol use (p<0.0001). After adjustment for CVD RFs, PL was significantly associated with incident CVD over mean follow up of 16 years (HR 1.11, 95% CI 1.06-1.16). In conclusion, several CVD RFs are associated with PL, but they do not entirely account for the association between PL and incident CVD.

Recruiting and retaining direct-care staff has long been a challenge for administrators of programs that serve persons with disabilities. A literature review revealed that beginning in 1950, researchers set out to develop a paper-and-pencil test that would identify good employees. Regardless of how they defined good, employers were unable to identify tests that selected promising job applicants. Efforts to develop research-based selection tools decreased in the early 1970s with the transition from state institutions to community programs. However, the growth of community programs did not mitigate the turnover problem, and the need remains for a reliable hiring tool. Whereas recent researchers have identified practices that can reduce turnover, these practices should be more widely implemented and their efficacy examined.

Applied Humanism (AH) is an approach to behavior programming based on six relationship principles that can be inculcated into all of an agency's service delivery components. It uses normalizing methods to manage inappropriate behavior while fostering the development of equitable relations.