ObjectivesWe conducted a systematic review and meta-analysis of studies that compared levels of molecular biomarkers in women with peripartum cardiomyopathy (PPCM) to those in healthy pregnant and postpartum women to: (1) assess the evidence for prolactin (PRL) metabolism in PPCM, (2) ascertain the evidence for biomarkers of iron deficiency in PPCM, (3) identify other biomarkers associated with PPCM.MethodsWe searched Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and the Global Health Library from inception without language restriction for studies that compared biomarkers levels in PPCM cases to healthy controls. Pooled standardised mean difference (SMD) was generated using a random effects model for the difference in levels of biomarkers.ResultsTwo studies assessed the association of PRL with PPCM, and reported that PPCM cases have higher levels of total PRL. No studies investigated iron metabolism in PPCM. Other biomarkers associated with PPCM included serum levels of natriuretic peptides (SMD=3.77, 95% CI 0.71 to 6.82), albumin (SMD=-0.67, 95% CI -1.01 to -0.32), C-reactive protein (SMD=1.67, 95% CI 0.22 to 3.12), selenium (SMD=-0.73, 95% CI -1.58 to 0.12), cardiac troponins (SMD=1.06, 95% CI 0.33 to 1.80), creatinine (SMD=0.51, 95% CI 0.33 to 0.69), white bloodcells (SMD=0.44, 95 % CI 0.07 to 0.82), haemoglobin (SMD=-0.45, 95% CI -0.64 to-0.26).ConclusionsMore robust molecular studies are needed to explore the association between prolactin and PPCM in human subjects and to determine the extent to which iron deficiency (with or without anaemia) contributes to the risk of PPCM.
Earlier pubertal development is only partially explained by childhood body mass index (BMI); the role of other factors like childhood infections is less understood. Using data from the LEGACY Girls Study (2011 – 2016), we prospectively examined the associations between childhood viral infections (Cytomegalovirus (CMV), Epstein Barr Virus (EBV), Herpes Simplex Virus 1 (HSV1), HSV2 and pubertal timing. We measured exposures based on seropositivity in pre-menarcheal girls (n=490). Breast and pubic hair development were classified based on mother-reported Tanner Stage (TS: TS2+ compared with TS1), adjusting for age, BMI, and sociodemographic factors. The average age at first blood draw was 9.8 years (Stdev=1.9 years). The prevalences were 31% CMV+, 37% EBV+, 14% HSV1+, 0.4% HSV2+, and 16% for both CMV+/EBV+. CMV+ infection without co-infection was associated with developing breasts an average of 7 months earlier (Hazard Ratio (HR)=2.12, 95% CI 1.32, 3.40). CMV+ infection without co-infection and HSV1+ and/or HSV2+ infection were associated with developing pubic hair 9 months later (HR 0.41, 95% CI 0.24, 0.71, HR 0.42, 95% CI 0.22, 0.81, respectively). Infection was not associated with menarche. If replicated in larger cohorts with blood collection prior to any breast development, this study supports that childhood infections may play a role in altering pubertal timing.
Social workers often are reluctant to use evidence-based practice in group work. Part of this reluctance is because of the perceived rigidity of the process and its emphasis on research. However, social workers can rely on the four cornerstones of evidence-based practice-research, clinical experience, personal views, and client's perspective-to provide an evidence-based group intervention. In this article, the authors illustrate how social workers used the four cornerstones at one alternative high school to provide an evidence-based group intervention. These cornerstones were used from the beginning of the process, which started with choosing the type of intervention, through the end of the process, which concluded with assessing the intervention. In this article, the authors show that it is possible for social workers to provide an evidence-based group intervention, while remaining flexible, thereby contributing to social workers' knowledge of how to use evidence-based practice with groups.
Results Stroke event rates for baseline and Q20 cohorts were 3.1 and 8.4 per 1000 person years respectively. At baseline, healthier levels of three LS7 -BP, physical activity and smoking were associated with reduced risk of stroke. HRs [95% Confidence Intervals] for intermediate and ideal (vs poor) were 0.62 [0.49, 0.79] and 0.41 [0.24, 0.69] for BP; 0.68 [0.49, 0.95] and 0.55 [0.39, 0.79] for physical activity; and 0.68 [0.54, 0.86] and 0.57 [0.43, 0.77] for smoking. For exposures measured at Q20, only BP maintained a protective association (HRs 0.84 [0.66, 1.06] and 0.50 [0.30, 0.84] for intermediate and ideal levels respectively). Protection from each unit increase in overall CVH scores also weakened with age. With reference to the Low-Low trajectory, all trajectories were generally associated with reduced risk. The HRs were Low-High 0.57 (0.41, 0.79); High-Low 0.85 (0.61, 1.19) and High-High 0.77 (0.58, 1.03) respectively. Conclusion Not all components of CVH individually influence stroke. While the association between CVH and stroke weakens with age, improving overall CVH may bring some benefit even in later life.
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