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Abstract Background Age-related macular degeneration (AMD) is a major cause of vision loss worldwide. This study aimed to assess risk factors for wet AMD by two methods: assessing risk factors measured in the Scottish Heart Health Extended Cohort (SHHEC), and to systematically review the literature. Methods Eighteen thousand one hundred seven volunteers were recruited to SHHEC between 1984–1995, with risk factor data collected on recruitment. Hospital records were linked to study data up to 2017 and survival analysis was used to analyse risk factors and wet AMD. Literature published between 2000–2023 was searched for studies assessing risk factors for wet AMD, resulting in 5,503 papers. Following review, 7 studies were included in the systematic review. Results Within the SHHEC data, 231 cases of wet AMD were reported. Increasing age (Hazard Ratio (HR) 10.51; 99% Confidence Interval (CI) 4.78–23.11) and smoking (HR 1.67; 99% CI 1.17–2.38) were significantly associated with an increased risk of wet AMD. Increased dietary intake of vitamin K (HR 0.56; 99% CI 0.34–0.94) was associated with a decreased risk of wet AMD. According to a systematic review, smoking, high Body mass index, heavy alcohol intake, increased systolic blood pressure, increased pulse pressure, and high levels of C-reactive protein and serum triglycerides in the blood may be associated with an increased risk of wet AMD. However, the studies provide mixed evidence and no conclusive results. Conclusion We have demonstrated that increasing age and smoking are high-risk factors for the development of wet AMD, while vitamin K is associated with a reduced risk of wet AMD.

Abstract This study, from the Tayside Pollution Research Programme (TPRP), aims to investigate the effects of air pollution on respiratory hospital admissions in adults and children < 16 y of age, over a 14-year period, in Dundee, Scotland (population circa 148,270). We conducted a case-crossover study using routinely collected healthcare records from Ninewells Hospital, Dundee, Scotland from 2004 to 2017. Respiratory hospitalisation events were linked to daily nitric oxide gases (NOx, NO2, NO) extracted from publicly available data over this period. We used distributed lag models to allow for delayed effects of air pollutants up to 14 days. A total of 34,192 hospital admissions for a respiratory condition were included in this study (children = 9,501; adults = 24,691). Respiratory admissions in children were significantly associated with cumulative 14-day exposure to NOx (RR for a 10 µg m−3 increase in concentration 1.020; 95% confidence interval 1.010–1.031), NO2 (RR 1.086; 95% CI 1.036–1.139) and NO (RR 1.033; 95% CI 1.016–1.052). Similar estimates were observed for acute respiratory infection categories in children. Effects appeared to be somewhat delayed, with the largest estimates mostly observed around lag 6. No significant association was seen for respiratory admissions in adults. This study shows that both NO and NO2 are associated with increased respiratory hospital admissions in children < 16 y of age, and that much more should be done to improve and enforce the established legal NOx pollution limits in cities for the sake of our children’s health.

In structuring and providing leadership for learning community programs, learning community coordinators must address myriad issues and situations in order to create an experience that aids student learning and success. All types of students participate in learning communities, including students with psychiatric/ psychological disabilities; however, learning community coordinators may not proactively consider ways of addressing the needs of this particular student population. This qualitative study explored the experiences of learning community coordinators working with students with psychiatric/psychological disabilities within the specific context of the learning community and sought to identify successes, challenges, and recommendations for working with these students. Participants highlighted the value of student self disclosure, the benefits of utilizing peer mentors, colleague challenges, successes they experienced working with students with psychiatric/psychological disabilities, and recommendations for other learning community coordinators.

Implementing interventions that manipulate food store environments are one potential strategy for improving dietary behaviors. The present study evaluated intervention effects, from the El Valor de Nuestra Salud (The Value of Our Health) study, on in-store environmental changes within Latino/Hispanic-focused food stores (tiendas). Sixteen tiendas were randomly assigned to either: a six-month structural and social food store intervention or a wait-list control condition. Store-level environmental measures of product availability, placement, and promotion were assessed monthly from baseline through six-months post-baseline using store audits. Linear mixed effects models tested for condition-by-time interactions in store-level environmental measures. Results demonstrated that the intervention was successful at increasing the total number of fruit and vegetable (FV) promotions (p < 0.001) and the number of FV promotions outside the produce department (p < 0.001) among tiendas in the intervention versus control condition. No changes in product availability or placement were observed. Results suggests changing the marketing mix element of promotions within small stores is measurable and feasible in an in-store intervention. Difficulties in capturing changes in product availability and placement may be due to intervention implementation methods chosen by tiendas. It is important to build upon the lessons learned from these types of interventions to disseminate evidence-based in-store interventions.

Guideline summaryChronic limb-threatening ischemia (CLTI) is associated with mortality, amputation, and impaired quality of life. These Global Vascular Guidelines (GVG) are focused on definition, evaluation, and management of CLTI with the goals of improving evidence-based care and highlighting critical research needs. The term CLTI is preferred over critical limb ischemia, as the latter implies threshold values of impaired perfusion rather than a continuum. CLTI is a clinical syndrome defined by the presence of peripheral artery disease (PAD) in combination with rest pain, gangrene, or a lower limb ulceration >2 weeks duration. Venous, traumatic, embolic, and nonatherosclerotic etiologies are excluded. All patients with suspected CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic complexity (PLAN). Average-risk and high-risk patients are defined by estimated procedural and 2-year all-cause mortality. The GVG proposes a new Global Anatomic Staging System (GLASS), which involves defining a preferred target artery path (TAP) and then estimating limb-based patency (LBP), resulting in three stages of complexity for intervention. The optimal revascularization strategy is also influenced by the availability of autogenous vein for open bypass surgery. Recommendations for EBR are based on best available data, pending level 1 evidence from ongoing trials. Vein bypass may be preferred for average-risk patients with advanced limb threat and high complexity disease, while those with less complex anatomy, intermediate severity limb threat, or high patient risk may be favored for endovascular intervention. All patients with CLTI should be afforded best medical therapy including the use of antithrombotic, lipid-lowering, antihypertensive, and glycemic control agents, as well as counseling on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative.

Background: Age-related macular degeneration (AMD) is a major cause of vision loss worldwide. This study aimed to assess risk factors for wet AMD by two methods: assessing risk factors measured in the Scottish Heart Health Extended Cohort (SHHEC), and to systematically review the literature. Methods: Eighteen thousand one hundred seven volunteers were recruited to SHHEC between 1984–1995, with risk factor data collected on recruitment. Hospital records were linked to study data up to 2017 and survival analysis was used to analyse risk factors and wet AMD. Literature published between 2000–2023 was searched for studies assessing risk factors for wet AMD, resulting in 5,503 papers. Following review, 7 studies were included in the systematic review. Results: Within the SHHEC data, 231 cases of wet AMD were reported. Increasing age (Hazard Ratio (HR) 10.51; 99% Confidence Interval (CI) 4.78–23.11) and smoking (HR 1.67; 99% CI 1.17–2.38) were significantly associated with an increased risk of wet AMD. Increased dietary intake of vitamin K (HR 0.56; 99% CI 0.34–0.94) was associated with a decreased risk of wet AMD. According to a systematic review, smoking, high Body mass index, heavy alcohol intake, increased systolic blood pressure, increased pulse pressure, and high levels of C-reactive protein and serum triglycerides in the blood may be associated with an increased risk of wet AMD. However, the studies provide mixed evidence and no conclusive results. Conclusion: We have demonstrated that increasing age and smoking are high-risk factors for the development of wet AMD, while vitamin K is associated with a reduced risk of wet AMD. [ABSTRACT FROM AUTHOR]

This study examined fruit and vegetable intake by food store type shopped among US Hispanics. Using National Health and Nutrition Examination Survey 2011-2012 data, T test and chi-square tests examined differences between Hispanic consumers by food store type. Negative binomial regression analyses estimated associations between fruit and vegetable intake and food store type. Hispanics who only purchased fruits and vegetables from convenience stores were younger and more likely US born. They reported lower intakes of fruit and vegetables than individuals who purchased these foods from supermarket/grocery stores. Those who primarily purchased fruits and vegetables from supermarkets/grocery stores consumed 0.92 (p

In the POLLUX study, daratumumab plus lenalidomide/dexamethasone significantly reduced risk of progression/death versus lenalidomide/dexamethasone alone in relapsed/refractory multiple myeloma. We provide one additional year of follow up and include the effect on minimal residual disease and in clinically relevant subgroups. After 25.4 months of follow up, daratumumab plus lenalidomide/dexamethasone prolonged progression-free survival versus lenalidomide/dexamethasone alone (median not reached vs 17.5 months; hazard ratio, 0.41; 95% confidence interval, 0.31-0.53; P12 and ≤12 months and >6 and ≤6 months. No new safety signals were observed. In relapsed/refractory multiple myeloma patients, daratumumab plus lenalidomide/dexamethasone continued to improve progression-free survival and deepen responses versus lenalidomide/dexamethasone. Trial Registration: clinicaltrials.gov identifier: 02076009.

Retail food environments have received attention for their influence on dietary behaviors and for their nutrition intervention potential. To improve diet-related behaviors, such as fruit and vegetable (FV) purchasing, it is important to examine its relationship with in-store environmental characteristics. This study used baseline data from the "El Valor de Nuestra Salud" study to examine how in-store environmental characteristics, such as product availability, placement and promotion, were associated with FV purchasing among Hispanic customers in San Diego County. Mixed linear regression models indicated that greater availability of fresh FVs was associated with a $0.36 increase in FV purchasing (p = 0.01). Placement variables, specifically each additional square foot of display space dedicated to FVs (p = 0.01) and each additional fresh FV display (p = 0.01), were associated with a $0.02 increase and $0.29 decrease, respectively, in FV purchasing. Introducing FV promotions in the final model was not related to FV purchasing. Exploratory analyses indicated that men reported spending $3.69 fewer dollars on FVs compared to women, controlling for covariates (p = 0.02). These results can help inform interventions targeting in-store environmental characteristics to encourage FV purchasing among Hispanics.

Purpose Risk factor-based models struggle to accurately predict the development of cardiovascular disease (CVD) at the level of the individual. Ways of identifying people with low predicted risk who will develop CVD would allow stratified advice and support informed treatment decisions about the initiation or adjustment of preventive medication, and this is the aim of this prospective cohort study.Participants The Tayside Screening for Cardiac Events (TASCFORCE) study recruited men and women aged≥40 years, free from known CVD, with a predicted 10-year risk of coronary heart disease

The objective of this study was to observe parent-child interactions in tiendas, limited assortment food stores catering to Latinos in the United States, and to examine the extent to which child involvement influenced these interactions and their purchase outcomes. Two confederates, one posing as a tienda employee and one posing as a customer, observed the entire shopping trip of 100 Latino parent-child (mean age = 8 years) dyads and coded the following: number and type of parent- and child-initiated request interactions, types of purchase influence attempts used by children and how parents responded, and whether the product was purchased. Level of child involvement was examined as a potential influencing factor on purchasing. The observations were relatively short (mean duration of 10 minutes), reflecting the "quick trip" nature of the observed shopping trips. From the 100 parent-child dyads, 144 request interactions were observed, and among dyads with at least 1 request interaction during the shopping trip, the average number of request interactions per dyad was 2. Children initiated most of the request interactions by asking for a product or simply placing it in the basket; parents initiated 24% of the request interactions. Child involvement in shopping and checkout were associated with spending and purchase outcomes. These results indicate that children and parents influence each other during grocery shopping, and children who are more involved have greater influence over purchases. Furthermore, this study identified a number of targets for future family/parent and consumer food environment interventions.

Abstract Background Chronic kidney disease has emerged as a strong cardiovascular risk factor, and in many current guidelines, it is already considered as a coronary heart disease (CHD) equivalent. Routinely, creatinine has been used as the main marker of renal function, but recently, cystatin C emerged as a more promising marker. The aim of this study was to assess the comparative cardiovascular and mortality risk of chronic kidney disease (CKD) using cystatin C-based and creatinine-based equations of the estimated glomerular filtration rate (eGFR) in participants of population-based and disease cohorts. Methods The present study has been conducted within the BiomarCaRE project, with harmonized data from 20 population-based cohorts (n = 76,954) from 6 European countries and 3 cardiovascular disease (CVD) cohorts (n = 4982) from Germany. Cox proportional hazards models were used to assess hazard ratios (HRs) for the various CKD definitions with adverse outcomes and mortality after adjustment for the Systematic COronary Risk Evaluation (SCORE) variables and study center. Main outcome measures were cardiovascular diseases, cardiovascular death, and all-cause mortality. Results The overall prevalence of CKD stage 3–5 by creatinine- and cystatin C-based eGFR, respectively, was 3.3% and 7.4% in the population-based cohorts and 13.9% and 14.4% in the disease cohorts. CKD was an important independent risk factor for subsequent CVD events and mortality. For example, in the population-based cohorts, the HR for CVD mortality was 1.72 (95% CI 1.53 to 1.92) with creatinine-based CKD and it was 2.14 (95% CI 1.90 to 2.40) based on cystatin-based CKD compared to participants without CKD. In general, the HRs were higher for cystatin C-based CKD compared to creatinine-based CKD, for all three outcomes and risk increased clearly below the conventional threshold for CKD, also in older adults. Net reclassification indices were larger for a cystatin-C based CKD definition. Differences in HRs (between the two CKD measures) in the disease cohorts were less pronounced than in the population-based cohorts. Conclusion CKD is an important risk factor for subsequent CVD events and total mortality. However, point estimates of creatinine- and cystatin C-based CKD differed considerably between low- and high-risk populations. Especially in low-risk settings, the use of cystatin C-based CKD may result in more accurate risk estimates and have better prognostic value.

Think teachers can post what they want on their own time? Think again. Many have lost their jobs over social networking gaffes in recent years. In this article, the author shares what he has learned about how school districts cope with teachers and online social networking sites, and offers recommendations to teachers who want to have an online social life "and" hold on to their jobs. (Contains 11 online resources.)

A qualitative inquiry designed to understand entry-level, live-in, professional staff recruitment and retention practices perceived as successful revealed a link to elements of organizational culture. Several important areas of understanding emerged: the actual recruitment and retention practices, the impact of leadership, and the role of organizational culture in the success of the department. This article addresses the impact of culture on the organization and its contribution to success in hiring and retaining entry-level staff. The discussion of findings and practical implications broadens our understanding of culture and better informs practice.