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Adolescents with single ventricle heart disease (SVHD) show autonomic, mood, and cognitive deficits, indicating aberrations in brain areas that regulate these functions. However, the gray matter integrity in autonomic, mood, and cognitive control sites is unclear. We examined regional brain gray matter changes, using high-resolution T1-weighted images (3.0-Tesla magnetic resonance scanner) with voxel based morphometry procedures, as well as mood and cognitive functions in SVHD (n = 18; age, 15.7±1.1 years; male, 10) and controls (n = 31; age, 16.0±1.1 years; male, 17). High-resolution T1-weighted images were realigned, gray matter tissue type partitioned, normalized to a common space, smoothed, and compared between groups (analysis of covariance; covariates, age and gender). The mood and cognitive scores were compared between groups using independent samples t-tests. SVHD subjects showed significantly altered mood and cognitive functions over controls. Significantly reduced gray matter emerged in multiple brain areas, including the thalamus, caudate nuclei, putamen, insula, prefrontal, post-central and precentral gyrus, occipital gyrus, para-hippocampal gyrus, temporal gyrus, and cerebellar sites in SVHD over controls. SVHD subjects show compromised gray matter integrity in autonomic, mood and cognitive control sites. The findings indicate that frequent deficits found in SVHD subjects have a brain structural basis in the condition.

ObjectiveChildren with hypoplastic left heart syndrome are at a risk for neurodevelopmental delays. Current guidelines recommend systematic evaluation and management of neurodevelopmental outcomes with referral for early intervention services. The Single Ventricle Reconstruction Trial represents the largest cohort of children with hypoplastic left heart syndrome ever assembled. Data on life events and resource utilisation have been collected annually. We sought to determine the type and prevalence of early intervention services used from age 1 to 4 years and factors associated with utilisation of services.MethodsData from 14-month neurodevelopmental assessment and annual medical history forms were used. We assessed the impact of social risk and geographic differences. Fisher exact tests and logistic regression were used to evaluate associations.ResultsAnnual medical history forms were available for 302 of 314 children. Greater than half of the children (52–69%) were not receiving services at any age assessed, whereas 20–32% were receiving two or more therapies each year. Utilisation was significantly lower in year 4 (31%) compared with years 1–3 (with a range from 40 to 48%) (pConclusionDespite significant neurodevelopmental delays, early intervention service utilisation was low in this cohort. As survival has improved for children with hypoplastic left heart syndrome, attention must shift to strategies to optimise developmental outcomes, including enrolment in early intervention when merited.

Background We sought to characterize growth between birth and age 3 years in infants with hypoplastic left heart syndrome who underwent the Norwood procedure. Methods and Results We performed a secondary analysis using the Single Ventricle Reconstruction Trial database after excluding patients z score ( LAZ ) and weight‐for‐age z score ( WAZ ) at birth and age 3 years and change in WAZ over 4 clinically relevant time periods. We identified correlates of change in WAZ and LAZ using multivariable linear regression with bootstrapping. Mean WAZ and LAZ were below average relative to the general population at birth ( P P =0.05, respectively) and age 3 years ( P WAZ occurred between birth and Norwood discharge; the greatest gain occurred between stage II and 14 months. At age 3 years, WAZ and LAZ were WAZ differed among time periods. Shunt type was associated with change in WAZ only in the Norwood discharge to stage II period; subjects with a Blalock‐Taussig shunt had a greater decline in WAZ than those with a right ventricle‐pulmonary artery shunt ( P =0.002). Conclusions WAZ changed over time and the predictors of change in WAZ varied among time periods. By age 3 years, subjects remained small and three times as many children were short as were underweight (>2 SD below normal). Failure to find consistent risk factors supports the strategy of tailoring nutritional therapies to patient‐ and stage‐specific targets. Clinical Trial Registration URL: http://clinicaltrials.gov/ . Unique identifier: NCT00115934.

Journal of Cardiovascular Nursing Vol. 00, No. 0, pp 00Y00 x Copyright B 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Prevalence, Awareness, Treatment, and Control of Hypertension Among Arab Americans Ayman Tailakh, PhD, RN; Janet C. Mentes, PhD, APRN, BC, FGSA; Donald E. Morisky, ScD, MSPH, ScM; Nancy A. Pike, PhD, RN, CPNP-AC, FAHA; Linda R. Phillips, PhD, RN, FAAN; Lorraine S. Evangelista, PhD, RN, FAHA, FAAN Background: Hypertension (HTN) is a major risk factor for heart disease, which is the leading cause of death in the United States. Hypertension detection and blood pressure (BP) control are critically important for reducing the risk of myocardial infarction and strokes. Although there are more than 3.5 million Arab Americans in the United States, there are no national or regional data on HTN prevalence among Arab Americans. Objective: This study aims to estimate the prevalence of HTN in a community sample of Arab Americans; assess levels of awareness, treatment, and control in hypertensive patients; and describe and compare lifestyle behaviors (eg, physical activity, nutrition, and weight control). Methods: In this cross-sectional, descriptive study, 126 participants completed a self-administered questionnaire to measure physical activity, nutrition, and medical history. Height and weight were measured. Three BP measurements were obtained at 60-second intervals after resting for 5 minutes. Hypertension was defined as a mean systolic BP of 140 mm Hg or higher, or a diastolic BP 90 mm Hg or higher, and/or taking antihypertensive medications. Results: Overall, 36.5% of participants had HTN and 39.7% had pre-HTN. Among hypertensive participants, only 67.4% were aware of their high BP, and 52.2% were taking antihypertensive medication. Among those taking medication, 46% had controlled BP. The prevalence of HTN was higher in men than in women (45.9% and 23.2%, respectively; P = .029) and increased with age (P = .01). Hypertensive participants also had higher body mass index (mean, 31.55 kg/m 2 ) compared with normotensive participants (mean, 28.37 kg/m 2 ; P = .01). Conclusion: Our results indicate that HTN and pre-HTN are highly prevalent in Arab Americans. Hypertension awareness and control rates were inadequate and low compared with national data. These results emphasize the urgent need to develop public health strategies to improve the prevention, detection, and treatment of HTN among Arab Americans. KEY WORDS: adherence, Arab Americans, hypertension, prevalence Ayman Tailakh, PhD, RN Assistant Professor, College of Nursing, Sultan Qaboos University, Muscat, Oman. Janet C. Mentes, PhD, APRN, BC, FGSA Associate Professor, School of Nursing, University of California, Los Angeles. Donald E. Morisky, ScD, MSPH, ScM Professor, Department of Community Health Sciences, School of Public Health, University of California, Los Angeles. Nancy A. Pike, PhD, RN, CPNP-AC, FAHA Assistant Professor, School of Nursing, University of California, Los Angeles. Linda R. Phillips, PhD, RN, FAAN Professor, School of Nursing, University of California, Los Angeles. Lorraine S. Evangelista, PhD, RN, FAHA, FAAN Associate Professor, Program of Nursing Science, University of California, Irvine. The authors have no funding or conflicts of interest to disclose. Correspondence Ayman Tailakh, PhD, RN, College of Nursing, Sultan Qaboos University, PO Box 66 Al-Khodh, 123 Muscat, Oman (atailakh@squ.edu.om). DOI: 10.1097/JCN.0b013e31825638ae Background Hypertension (HTN) is a major risk factor for heart disease, which is the leading cause of death in the United States. 1 Hypertension is the third leading cause of death in the world, with a mortality rate of 13%. 2 Almost 30% of American adults live with HTN. 3 The estimated cost of HTN in the United States for 2010 was $174 billion. 4 Hypertension prevention and treatment have been addressed as national health goals for Healthy People 2020, which include reducing the prevalence of HTN from a baseline of 29.9% to 26.9% and increasing HTN control rate from 43.7% to 61.2%. 5 Racial/ethnic disparities in awareness and treat- ment of HTN persist in the United States; this raises a concern, as minority ethnic groups are more likely to develop HTN before the age of 50 years. 1 There are more than 3.5 million Arab Americans in the United States, 6 which represents a new minority ethnic Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

The Norwood procedure with a modified Blalock-Taussig (MBT) shunt, the first palliative stage for single-ventricle lesions with systemic outflow obstruction, is associated with high mortality. The right ventricle-pulmonary artery (RVPA) shunt may improve coronary flow but requires a ventriculotomy. We compared the two shunts in infants with hypoplastic heart syndrome or related anomalies.Infants undergoing the Norwood procedure were randomly assigned to the MBT shunt (275 infants) or the RVPA shunt (274 infants) at 15 North American centers. The primary outcome was death or cardiac transplantation 12 months after randomization. Secondary outcomes included unintended cardiovascular interventions and right ventricular size and function at 14 months and transplantation-free survival until the last subject reached 14 months of age.Transplantation-free survival 12 months after randomization was higher with the RVPA shunt than with the MBT shunt (74% vs. 64%, P=0.01). However, the RVPA shunt group had more unintended interventions (P=0.003) and complications (P=0.002). Right ventricular size and function at the age of 14 months and the rate of nonfatal serious adverse events at the age of 12 months were similar in the two groups. Data collected over a mean (+/-SD) follow-up period of 32+/-11 months showed a nonsignificant difference in transplantation-free survival between the two groups (P=0.06). On nonproportional-hazards analysis, the size of the treatment effect differed before and after 12 months (P=0.02).In children undergoing the Norwood procedure, transplantation-free survival at 12 months was better with the RVPA shunt than with the MBT shunt. After 12 months, available data showed no significant difference in transplantation-free survival between the two groups. (ClinicalTrials.gov number, NCT00115934.)