There is insufficient to low strength of evidence that any non-pharmacologic intervention improves sleep quality or quantity of general inpatients. Further studies are needed in this area to guide clinicians.

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BackgroundThe degree to which genetic or environmental factors are associated with early kidney damage among African Americans (AAs) is unknown.MethodsAmong 462 AAs in the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study, we examined the cross-sectional association between apolipoprotein L1 (APOL1) risk variants and income with: 1) mildly reduced eGFR (<75 mL/min/1.73 m2, creatinine-cystatin C equation) and 2) elevated urine albumin-to-creatinine ratio (ACR) (≥17 in men and ≥25 mg/g in women). High risk APOL1 status was defined by 2 copies of high-risk variants; low risk if 0 or 1 copy. Income groups were dichotomized as < $14,000/year (lowest income group) or ≥ $14,000/year. Logistic regression models were adjusted for age, sex, and % European ancestry.ResultsOverall, participants’ mean age was 47 years and 16% (n = 73) had high risk APOL1 status. Mean eGFR was 99 mL/min/1.73 m2. Mildly reduced eGFR was prevalent among 11% (n = 51). The lowest income group had higher adjusted odds (aOR) of mildly reduced eGFR than the higher income group (aOR 1.8, 95% CI 1.2-2.7). High-risk APOL1 was not significantly associated with reduced eGFR (aOR 1.5, 95% CI 0.9-2.5). Among 301 participants with ACR data, 7% (n = 21) had elevated ACR. Compared to low-risk, persons with high-risk APOL1 had higher odds of elevated ACR (aOR 3.8, 95% CI 2.0-7.3). Income was not significantly associated with elevated ACR (aOR 1.8, 95% CI 0.7-4.5). There were no significant interactions between APOL1 and income.ConclusionsBoth genetic and socioeconomic factors may be important determinants of early kidney damage among AAs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0008-6) contains supplementary material, which is available to authorized users.

We report a case series of six women with peripartum cardiomyopathy (PPCM) who incidentally underwent echocardiography prior to the clinical presentation of PPCM. For comparison, we identified controls, matched 2:1 on age, race, body mass index, gestational age, and hypertensive disorder. Among the six cases, all were diagnosed with PPCM during the post-partum period. Pre-PPCM echocardiograms were performed between 17.7 weeks of gestation and 13 days post-partum. Baseline left ventricular ejection fraction and size were normal and similar to the 12 matched controls (60% ± 6.6% vs. 61.4% ± 6.3%, P = 0.63) or left ventricular end-diastolic dimension (4.6 cm ± 0.2 cm vs. 4.5 cm ± 0.4 cm, P = 0.689). There was a trend towards a less negative (more abnormal) mean global longitudinal strain in cases compared with controls (À14% ± 4% vs. À18.3% ± 4.5%, P = 0.0658). Mean global circumferential strain was significantly less negative (more abnormal) in cases compared with controls (À21.5% ± 5% vs. À29.3% ± 7.6%, P = 0.0329). We conclude that women who develop PPCM have normal left ventricular ejection fraction during gestation preceding PPCM, indicating that the disease develops acutely in the peripartum period. Abnormal strain can be detected, however, suggesting that strain imaging could represent a screening method in populations at high risk for PPCM if confirmed in future studies.

ObjectiveVisually estimated coronary artery calcium (VECAC) from chest CT or attenuation correction (AC)/CT obtained during positron emission tomography (PET)–myocardial perfusion imaging (MPI) is feasible. Our aim was to determine the prognostic value of VECAC beyond conventional risk factors and PET imaging parameters, including coronary flow reserve (CFR).MethodsWe analysed 608 patients without known coronary artery disease who underwent PET–MPI between 2012 and 2016 and had AC/CT and/or chest CT images. We used Cox regression to estimate the association of VECAC categories (≤10, 11–400, >400 Agatston units (AU)) with the primary outcome of all-cause death, acute coronary syndrome or stroke (mean follow-up 4.3±1.8 years). C-statistics assessed the relationship between PET parameters and VECAC with the primary outcome.ResultsMean age was 58±11 years, 65% were women and 67% were black. VECAC ≤10, 11–400 and >400 AU was observed in 68%, 12% and 20% of subjects, respectively. Compared with VECAC ≤10, VECAC categories 11–400 (HR 2.25, 95% CI 1.24 to 4.08) and >400 AU (HR 3.05, 95% CI 1.87 to 4.98) were associated with the primary outcome after adjusting for traditional risk factors, MPI findings and CFR. Adding VECAC to a model that included PET–MPI, CFR and clinical risk factors improved the prognostic value for the primary outcomes (c-statistic 0.71 to 0.75 with VECAC, p=0.01).ConclusionsVECAC is a potent predictor of events beyond traditional risk factors and PET imaging markers, including CFR. These data further support the importance for routine VECAC implementation.

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Introduction: Several studies have reported that up to 25% of patients hospitalized for heart failure (HF) are readmitted within 30 days of discharge. This confirms the need for patient education and innovative programs to promote adherence to physicians' directives and self-reliant care. The objective of the SHIP (Student Heart Failure Intervention Project) quality improvement pilot was to identify high-risk patients in a local population and implement a "constant contact" program to improve chronic HF patients' follow-through on independent self-care. Increased compliance with post-discharge and clinic instructions may ultimately reduce further hospitalizations. Methods: One hundred and ninety-eight systolic and diastolic HF patients were treated in our clinic between 06/2012 and 09/2014. Their charts were cross-referenced with hospital admission records. High-risk patients (n580) were defined by severity of HF symptoms and more than 15 clinic visits during the study period. Twelve patients (15%) were enrolled in SHIP. Medical students made weekly calls over 8 weeks (minimum 3 attempts weekly) to record the patients' health statuses and reiterate the importance of adherence and maintenance of self-care. Each patient was given the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at the beginning and end of the study with a response rate of 44%. Results: MLHFQ responses indicated overall symptom improvement. Most patients (83%) had increased knowledge of their conditions; 87% reported symptom improvement. Three patients were lost to follow-up. No participants reported continuous compliance with physicians' directives (recording weight and blood pressure daily; smoking cessation). Average call time decreased during the study. Table 1 summarizes other results. Conclusion:In this outcome-driven age of health care, traditional health care is increasingly being supplemented with innovative programs. Our constant contact program benefited high-risk HF patients and offered medical students greater exposure to population analytics and chronic disease management. An improvement was seen in most measured outcomes (symptoms, patients' understanding and compliance, and admission rates), but the data were not statistically significant. Further project scaling will allow enough power for statistical analysis that was not possible for the measured outcomes. Once initial lifestyle changes are made, patients may need further motivational support to achieve long-term positive lifestyle changes.

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