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This document is a response to a letter regarding the impact of prehospital care and door-to-computed tomography scan time on stroke outcomes. The authors address the issues raised by the letter and provide information about the prehospital assessment and care of stroke patients in Ireland. They explain that Ireland has a standardized training protocol for paramedics, and all hospitals can receive pre-notification of suspected strokes from ambulances. They also mention that technical solutions like mobile stroke units have not been extensively assessed in remote areas due to cost and low frequency of use. The authors conclude that optimizing prehospital and emergency care for stroke patients is important, but there is no evidence that patients attending remote hospitals in Ireland receive poorer care in these respects. [Extracted from the article]

Cardiovascular disease (CVD)-related mortality has declined substantially in the United Kingdom (UK) in recent decades, but the continued relevance of conventional risk factors for prediction of CVD mortality throughout the life-course is uncertain. We compared the 10-year risks and lifetime risks of CVD mortality associated with conventional risk factors recorded in middle and old age. The Whitehall study was a prospective study of 19,019 male London civil servants (mean age 52 years) when enrolled in 1967–1970 and followed-up for 50 years for cause-specific mortality. In 1997, 7044 (83%) survivors (mean age 77 years) were re-surveyed. The 10-year and lifetime risks of CVD mortality were estimated by levels of CVD risk factors recorded in middle-age and old-age, respectively. By July 2020, 97% had died (22%, 51% and 80% before age 70, 80 and 90 years, respectively) and 7944 of 17,673 deaths (45%) were from CVD. The 10-year and lifetime risks of CVD death increased linearly with higher levels of CVD risk factors recorded in middle-age and in old-age. Individuals in the top versus bottom 5% of CVD risk scores in middle age had a 10.3% (95% CI:7.2–13.4) vs 0.6% (0.1–1.2) 10-year risk of CVD mortality, a 61.4% (59.4–65.3) vs 31.3% (24.1–34.5) lifetime risk of CVD mortality and a 12-year difference in life expectancy from age 50 years. The corresponding differences using a CVD risk score in old-age were 11.0% (4.4–17.5) vs 0.8% (0.0–2.2) for 10-year risk and 42.1% (28.2–50.0) vs 30.3% (6.0–38.0) for lifetime risk of CVD mortality and a 6-year difference in life expectancy from age 70 years. Conventional risk factors remained highly predictive of CVD mortality and life expectancy through the life-course. The findings highlight the relevance of estimation of both lifetime risks of CVD and 10-year risks of CVD for primary prevention of CVD. [ABSTRACT FROM AUTHOR]

AbstractThis paper explores the definition of, and perceived community attitudes, toward kudanga, a Swahili street term for a type of transactional sex practised in Dar es Salaam, Tanzania. Rooted in economic and gender disparity, transactional sex increases adolescent girls’ and young women’s vulnerability to HIV and gender-based violence. We sought to understand perceived community attitudes about kudanga, and how the internalisation of norms surrounding gender-based violence relate to the experiences of young women who practise kudanga. Using qualitative data from focus group discussions with 37 young women, we found that community perceptions of kudanga were largely negative, and those who engaged in it were looked down upon and despised. Violence and lack of sexual agency were normalised when doing kudanga. However, young women understood kudanga to often be their best option to obtain economic stability and felt strongly that those who practised kudanga should not be stigmatised. Our research provides further evidence that transactional sex exists on a continuum and highlights the importance of reducing community stigma surrounding transactional sex as a means of decreasing risk of HIV and gender-based violence for young women. To our knowledge, this article is the first to explore kudanga. [ABSTRACT FROM AUTHOR]

Objective: Cardiovascular abnormalities are common in patients with Williams syndrome and frequently require surgical intervention necessitating analgesia and sedation in a population with a unique neuropsychiatric profile, potentially increasing the risk of adverse cardiac events during the perioperative period. Despite this risk, the overall postoperative analgosedative requirements in patients with WS in the cardiac intensive care unit have not yet been investigated. Our primary aim was to examine the analgosedative requirement in patients with WS after cardiac surgery compared to a control group. Our secondary aim was to compare the frequency of major ACE and mortality between the two groups. Design: Matched case–control study. Setting: Pediatric CICU at a Tertiary Children's Hospital. Patients: Patients with WS and age-matched controls who underwent cardiac surgery and were admitted to the CICU after cardiac surgery between July 2014 and January 2021. Interventions: None. Measurements and Main Results: Postoperative outcomes and total doses of analgosedative medications were collected in the first six days after surgery for the study groups. Median age was 29.8 (12.4–70.8) months for WS and 23.5 (11.2–42.3) months for controls. Across all study intervals (48 h and first 6 postoperative days), there were no differences between groups in total doses of morphine equivalents (5.0 mg/kg vs 5.6 mg/kg, p = 0.7 and 8.2 mg/kg vs 10.0 mg/kg, p = 0.7), midazolam equivalents (1.8 mg/kg vs 1.5 mg/kg, p = 0.4 and 3.4 mg/kg vs 3.8 mg/kg, p = 0.4), or dexmedetomidine (20.5 mcg/kg vs 24.4 mcg/kg, p = 0.5 and 42.3 mcg/kg vs 39.1 mcg/kg, p = 0.3). There was no difference in frequency of major ACE or mortality. Conclusions: Patients with WS received similar analgosedative medication doses compared with controls. There was no significant difference in the frequency of major ACE (including cardiac arrest, extracorporeal membrane oxygenation, and surgical re-intervention) or mortality between the two groups, though these findings must be interpreted with caution. Further investigation is necessary to elucidate the adequacy of pain/sedation control, factors that might affect analgosedative needs in this unique population, and the impact on clinical outcomes. [ABSTRACT FROM AUTHOR]

• Conducted latent profile analyses of emerging adults' social media use. • Distinguished screen time from engagement and general from alcohol-related. • Various forms of engagement seem to matter more than screen time. • The highest active engagers online might be the most at-risk for alcohol misuse. Nearly all U.S. emerging adults use social media at least daily, and most discuss their offline activities online, including their alcohol misuse. As a result, developing evidence finds a correlation between social media use and offline alcohol drinking, suggesting that social media may be a novel risk factor for alcohol misuse. However, there are conflicting findings about what specific function of social media use is risker – does the amount of time spent online or the types of online activities matter more? Our multidisciplinary team of human–computer interactionists, social workers, and public health scholars aimed to refine our understanding of the association between emerging adult social media use and alcohol misuse. To do so, we conceptualized social media use as a multidimensional construct, examining how much time emerging adults spend online (i.e., screen time) and their different online activities (i.e., social media engagement , such as posting pictures or reacting to posted content [e.g., liking shared pictures]). Taking this conceptualization a step further, we distinguished general online activities (i.e., general social media engagement , such as sharing pictures of food) from those explicitly related to offline alcohol consumption (i.e., alcohol-related social media engagement , such as sharing a video of someone drinking alcohol at a party). Finally, we examined if different levels of these three conceptualizations of social media use were risk factors for alcohol misuse and related negative consequences. We collected survey data from 249 emerging adults on Amazon Mechanical Turk. Using latent profile analyses, we attempted to distinguish the different ways we conceptualized social media use (i.e., screen time from general social media engagement and alcohol-related social media engagement.) We then examined whether significant differences existed between identified profiles and various alcohol-related outcomes in a typical and heavy drinking week. We identified 3-profile solutions for both screen time (low, medium, and high) and general social media engagement (minimum, moderate, and high) and a 2-profile solution for alcohol-related social media engagement (minimal and moderate). When we assessed for alcohol risk, screen time was not related to drinking at all (neither frequency nor quantity), not even for emerging adults who reported using social media almost constantly. However, during a heavy drinking week, those who moderately post alcohol-related content online drank more heavily and had more binge drinking days. Notably, and contrary to previous research, emerging adults who reported high general social media engagement were most at risk for binge drinking and experiencing more alcohol-related negative consequences. Findings underscore the importance of considering various forms of social media engagement – and not screen time – when studying the harms associated with using social media, including offline risk-taking behaviors like alcohol misuse. Results indicate that research, interventions, and clinical practice that target and treat emerging adult alcohol misuse should assess their social media behavior, concentrating on their engagement. This is especially true for the highest general engaging emerging adults who almost constantly post, respond, and react while online; these individuals might be the most at-risk and need support. [ABSTRACT FROM AUTHOR]

Left ventricular systolic dysfunction (LVSD) is frequently observed following repair of ventricular septal defects (VSD), although little is known about its incidence, time course, or risk factors. Among infants undergoing VSD repair, for postoperative LVSD, we sought to determine (1) incidence, (2) predictors, and (3) time to resolution. We queried our institution’s surgical database for infants who underwent repair of isolated VSDs from November 2001 through January 2019. The primary outcome was postoperative LVSD, which was defined as a shortening fraction (SF) of <26% by M-mode. Postoperative echocardiograms were reviewed, and measurements were made using standard methods. Receiver operating characteristic analysis was generated to determine the preoperative left ventricular internal dimension (LVIDd) z-score most predictive of LVSD. Multivariable analysis was conducted to determine associations with LVSD; covariates in the model were weight percentile, genetic syndrome, preoperative diuretic, VSD type, and preoperative LVIDd z-score. Of the 164 patients who met inclusion criteria, 62 (38%) had postoperative LVSD. Fifty-eight (94%) of patients had resolution of LVSD within 9 months of surgery. Preoperative LVIDd z-score of >3.1 was associated with both an increased incidence of postoperative LVSD and prolonged time to resolution. Multivariable logistic regression analysis showed only preoperative LVIDd z-score was independently associated with postoperative LVSD. LVSD following VSD closure is common, but nearly all cases resolve by 9 months postoperatively. Elevated LVIDd prior to surgery is associated with postoperative LVSD. These data suggest VSD closure should be considered prior to the development of significant left ventricular dilation. [ABSTRACT FROM AUTHOR]