Association of NAD(P)H:Quinone Oxidoreductase 1 Polymorphism and Alzheimer’s Disease in Chinese

Several lines of evidence support a role of oxidative stress in the pathology of Alzheimer’s disease (AD). NAD(P)H:quinone oxidoreductase 1 (NQO1) catalyzes the two-electron reduction of quinones, preventing their participation in redox cycling and subsequent generation of reactive oxygen species. We examined association between the NQO1 C609T gene polymorphism and sporadic AD in a Chinese population comprising 311 AD patients and 330 controls. Our results showed a higher T-allele frequency in the AD cases compared with the controls. The difference was close to but did not reach statistically significant level [p = 0.059; odds ratio (OR) T versus C = 1.236; 95% confidence interval (95% CI), 0.992–1.540]. A significantly low C/C genotype frequency in the AD cases compared with the controls was detected (p = 0.025; OR C/C versus C/T + T/T = 0.674; 95% CI, 1.049–2.098) and APOE ε4 status analysis revealed significant difference in the APOE ε4 non-carriers (p = 0.036; OR = 0.633; 95% CI, 1.027–2.427). In the ≥65 years samples, significantly low C/C frequency in the AD cases in comparison with the controls was observed in the APOE ε4 non-carriers (p = 0.045; OR = 0.595; 95% CI, 1.010–2.794). These results indicated that the C/C genotype had a possible protective effect against AD development, and the T allele might be a weak risk factor for late onset AD. J-T Bian and H-L Zhao contributed equally to the work.     

Factors associated with time delay to carotid stenting in patients with a symptomatic carotid artery stenosis

Treatment of a symptomatic stenosis is known to be most beneficial within 14 days after the presenting event but this can frequently not be achieved in daily practice. The aim of this study was the assessment of factors responsible for this time delay to treatment. A retrospective analysis of a prospective two-center CAS database was carried out to investigate the potential factors that influence a delayed CAS treatment. Of 374 patients with a symptomatic carotid stenosis, 59.1% were treated beyond ≥14 days. A retinal TIA event (OR = 3.59, 95% CI 1.47–8.74, p < 0.01) was found to be a predictor for a delayed treatment, whereas the year of the intervention (OR = 0.32, 95% CI 0.20–0.50, p < 0.01) and a contralateral carotid occlusion (OR = 0.42, 95% CI 0.21–0.86, p = 0.02) were predictive of an early treatment. Similarly, within the subgroup of patients with transient symptoms, the year of the intervention (OR = 0.28, 95% CI 0.14–0.59, p < 0.01) was associated with an early treatment, whereas a retinal TIA as the qualifying event (OR = 6.96, 95% CI 2.37–20.47, p < 0.01) was associated with a delayed treatment. Treatment delay was most pronounced in patients with an amaurosis fugax, whereas a contralateral carotid occlusion led to an early intervention. Although CAS is increasingly performed faster in the last years, there is still scope for an even more accelerated treatment strategy, which might prevent future recurrent strokes prior to treatment.     

<Emphasis Type="Italic">PEMT</Emphasis> G523A (V175M) Is Associated with Sporadic Alzheimer's Disease in a Chinese Population

There is evidence that increased concentrations of circulating homocysteine are associated with Alzheimer's disease (AD). Phosphatidylethanolamine N-methyltransferase (PEMT) is an important catalyst involved in the production of homocysteine. We investigated the association of a functional single nucleotide polymorphism (rs7946) in PEMT with sporadic AD risk in a Han Chinese population that included 386 AD patients and 366 controls. PEMT G523A was genotyped by either sequencing or PCR-restriction fragment length polymorphism analysis. The plasma homocysteine concentrations of 210 subjects were determined by high-performance liquid chromatography. Significant higher frequency of the A allele was detected in AD cases than in controls (A vs. G, p = 0.007, OR = 1.482, 95% CI 1.114–1.972). After adjusting for gender, age/age at onset, and APOE ε4 status, logistic analysis showed rs7946 was associated with AD in a dominant model (AA + GA vs. GG, p = 0.007, OR = 1.596, 95% CI 1.138–2.240). When stratified by APOE ε4 status or gender, the significant difference was only observed in the APOE ε4 non-carriers and in the female subjects, respectively. We did not find a relationship of this polymorphism with plasma homocysteine levels. These results suggested that PEMT G523A is associated with AD and that the A allele is an APOE ε4-independent risk factor for AD among Han Chinese women.     

Analyzing Theoretical Mechanisms of Physical Activity Behavior Change in Breast Cancer Survivors: Results from the Activity Promotion (ACTION) Trial

Background We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors. Purpose To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks. Methods Breast cancer survivors (N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group. Results Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = −0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks. Conclusions Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted.     

Physical activity and sleep problems in 38 low- and middle-income countries

ObjectiveAlthough physical activity (PA) is associated with a reduction of a wide range of sleep problems, it remains uncertain whether complying with the international guidelines of 150 min of moderate to vigorous PA per week can reduce sleep problems in adults. This research investigated the relationship between compliance with the PA recommendations of the World Health Organization and sleep problems in 38 low- and middle-income countries (LMICs).MethodsCross-sectional, community-based data from the World Health Survey were analyzed. Adjusted logistic regression analyses were undertaken to explore the relationship between PA levels using the International Physical Activity Questionnaire and self-reported sleep problems (such as difficulties falling asleep, waking up frequently during the night or waking up too early in the morning) in the last 30 days.ResultsAcross 204,315 individuals (38.6 ± 16.1 years; 49.3% males), the overall prevalence (95% CI) of low PA and sleep problems were 29.9% (29.1–30.8%) and 7.5% (7.2–7.9%), respectively. After adjusting for socio-demographics, obesity, chronic physical conditions, depression, and anxiety; not complying with PA recommendations was associated with higher odds for sleep problems overall [odds ratio (OR) = 1.23, 95% CI = 1.10–1.38] as well as across the entire age range: 18–34 years (OR = 1.26; 95% CI = 1.02–1.57); 35–64 years (OR = 1.17; 95% CI = 1.01–1.35); and age ≥65 years (OR = 1.40; 95% CI = 1.11–1.76).ConclusionsNot complying with international PA recommendations is associated with higher odds of sleep problems, independently of depression and anxiety in LMICs. Future longitudinal and interventional studies are warranted to assess whether increasing PA levels may improve sleep problems in this setting.     

Maternal sleep quality during early pregnancy,risk factors and its impact on pregnancy outcomes: a prospective cohort study

ObjectivesWe aimed to assess the prevalence of poor sleep quality during early pregnancy and its risk factors, and to explore the association between sleep quality and adverse pregnancy outcomes.MethodsThis was a prospective birth cohort study that included 4352 pregnant women. Sleep quality were assessed using the Pittsburgh Sleep Quality Index (PSQI). The risk factors for poor sleep quality were analyzed by a logistic regression model. Log-binomial regression models were used to analyze the association between sleep quality and pregnancy outcomes.ResultsThe prevalence of maternal poor sleep quality during early pregnancy was 34.14%. The multivariate logistic model showed that stillbirth history (OR = 2.45; 95% CI: 1.34, 4.47), history of induced abortion (OR = 1.26; 95% CI: 1.07, 1.49), general health-related quality of life (OR = 3.98; 95% CI: 2.97, 5.34), insufficient physical activity (OR = 1.18; 95% CI: 1.03, 1.36), smoking (OR = 1.59; 95% CI: 1.18, 2.15), and vegetarian (OR = 2.18; 95% CI: 1.54, 3.08) were risk factors for poor sleep quality, while taking folic acid consistently before pregnancy (OR = 0.83; 95% CI: 0.72,0.97) was the protective factor. After controlling for all the confounders, poor sleep quality during early pregnancy increased the risk of premature rupture of membranes by 12% (95% CI: 1.00, 1.25).ConclusionPregnant women with a history of stillbirth and induced abortion, general health-related quality of life, insufficient physical activity, smoking, and a vegetarian diet tended to have poor sleep quality. More attention should be paid to healthy lifestyle of pregnant women to improve sleep quality and better pregnancy outcomes.     

Predicting the Physical Activity Intention–Behavior Profiles of Adopters and Maintainers Using Three Social Cognition Models

Background  Most of the population have positive intentions to engage in physical activity (PA) but fail to act; thus, the need to understand successful translation of intention into behavior is warranted in order to focus intervention efforts. Purpose  The objective of the study is to examine constructs of the transtheoretical model, theory of planned behavior, and protection motivation theory as predictors of physical activity intention–behavior profiles across 6 months in a Canadian workplace sample. Methods  Employees from three large organizations in the province of Alberta (n = 887) completed a baseline survey relating to their demographic and medical background, PA, and social–cognitive constructs. A total of 611 participants completed a second assessment 6 months later. Results  Participants were grouped by five profiles: nonintenders, unsuccessful adopters, successful adopters, unsuccessful maintainers, and successful maintainers. Perceived importance and concern for PA (cognitive processes, instrumental attitude, perceived severity) distinguished nonintenders from the other four profiles, self-management and self-regulation of the behavior (behavioral processes, self-efficacy) distinguished successful adopters from unsuccessful adopters, while control over constraints (cons, perceived control, self-efficacy) were the key discriminators of successful maintainers from unsuccessful maintainers. Conclusion  The results provide useful information for intervention campaigns and demonstrate a need to consider adoption and maintenance profiles.     

Mental health status and related characteristics of Chinese male rural-urban migrant workers

To explore mental health status and related characteristics in a sample of Chinese male rural–urban migrants. Subjects were 1,595 male rural–urban migrant workers selected though a multi-stage sample survey conducted in two cities (Hangzhou and Guangzhou). Data were collected by means of a self-administered questionnaire. Both life and work stressors were examined. Stress and mental health status were measured by the Chinese Perceived Stress Scale (CPSS) and the Chinese Health Questionnaire (CHQ), respectively. Unconditional logistic regression analysis was performed to identify factors associated with probable mental disorders. There are approximately 120 million rural–urban migrants in China. The prevalence of probable mental disorders in the sample population was 24.4% (95% CI: 23.3–25.5%), which was higher than among urban residents (20.2%, 95% CI: 18.8–21.7%). Logistic regression analysis revealed that five characteristics were positively associated with risk for probable mental disorders: originating in the South (OR = 2.00; 95% CI = 1.02, 4.00), higher life stress (OR = 7.63; 95% CI = 5.88, 10.00), staying in the city for 5–9 months each year (OR = 2.56; 95% CI = 1.67, 3.85), higher work stress (OR = 2.56; 95% CI = 1.96, 3.33), and separation from wife (OR = 2.43; 95% CI = 1.61, 3.57). Employment in machinery and transportation (OR = 0.54; 95% CI = 0.36, 0.81) and higher self-worth (OR = 0.42; 95% CI = 0.28, 0.62) were negatively associated. Findings support an urgent need to develop specific policies and programs to address mental health problems among Chinese rural–urban migrants.     

Effects of nighttime sleep duration and sex on the association between siesta and hypertension

ObjectiveTo examine the association between siesta and hypertension by sex and nighttime sleep duration among Chinese adults aged ≥35 years in Yinzhou, Ningbo City.MethodsAll data were obtained from physical examinations and structured questionnaires. A total of 44, 652 participants were included. Logistic regression models were applied to calculate odds ratios and 95% confidence intervals for the association between siesta and hypertension.ResultsWhen compared with no siesta, siesta durations of 60∼89 min (OR = 1.10, 95% CI:1.04–1.17) and ≥90 min (OR = 1.21, 95% CI:1.08–1.36) were associated with higher risk of hypertension in women. But no significant association was observed in men. Siesta durations of 30∼59 min (OR = 1.09, 95% CI:1.00–1.19) and 60–89 min (OR = 1.10, 95% CI:1.05–1.16) were associated with hypertension in people with 6∼8 h sleep, and this association appeared seemingly stronger with ≥90 min siesta either in short (<6 h) sleepers (OR = 1.20, 95% CI: 0.99–1.47) or in long (>8 h) sleepers (OR = 1.29, 95% CI: 1.00–1.68). However, in short sleepers, 60∼89 min siesta seemed to be associated with decreased risk of hypertension (OR = 0.95, 95% CI: 0.85–1.06); while in long sleepers, the same range of siesta seemed to be associated with increased risk of hypertension (OR = 1.11, 95% CI: 0.93–1.34).ConclusionLong siesta was associated with increased risk of hypertension in women but not in men. Not too long siesta may be related to decreased risk of hypertension in short sleepers but not in people with adequate or even long sleep. These findings warrant further examination with prospective studies and laboratory investigations.     

Cognitive disorders associated with hospitalization of COVID-19: Results from an observational cohort study

IntroductionOur understanding of risk factors for COVID‑19, including pre-existing medical conditions and genetic variations, is limited. To what extent the pre-existing clinical condition and genetic background have implications for COVID-19 still needs to be explored.MethodsOur study included 389,620 participants of European descent from the UK Biobank, of whom 3,884 received the COVID-19 test and 1,091 were tested positive for COVID-19. We examined the association of COVID-19 status with an extensive list of 974 medical conditions and 30 blood biomarkers. Additionally, we tested the association of genetic variants in two key genes related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, angiotensin-converting enzyme 2 (ACE2) and transmembrane protease serine 2 (TMPRSS2), with COVID-19 or any other phenotypes.ResultsThe most significant risk factors for COVID-19 include Alzheimer’s disease (OR = 2.29, 95% CI: 1.25–4.16), dementia (OR = 2.16, 95% CI: 1.36–3.42), and the overall category of delirium, dementia, amnestic and other cognitive disorders (OR = 1.90, 95% CI: 1.24–2.90). Evidence suggesting associations of genetic variants in SARS-CoV-2 infection-related genes with COVID-19 (rs7282236, OR = 1.33, 95% CI: 1.14–1.54, p = 2.31 × 10⁻⁴) and other phenotypes, such as an immune deficiency (p = 5.65 × 10⁻⁵) and prostate cancer (p = 1.1 × 10⁻⁵), was obtained.ConclusionsOur unbiased and extensive search identified pre-existing Alzheimer’s disease and dementia as top risk factors for hospital admission due to COVID-19, highlighting the importance of providing special protective care for patients with cognitive disorders during this pandemic. We also obtained evidence suggesting a direct association of genetic variants with COVID-19.     

El bloqueo interatrial avanzado predice recurrencia de infarto cerebral embólico de origen no determinado

BackgroundAdvanced interatrial block (IAB) is an independent risk factor for ischaemic stroke. This study aimed to analyse whether advanced IAB predicts recurrence of embolic stroke of undetermined source (ESUS).Methods104 patients with a confirmed diagnosis of ESUS were followed up for a median period of 15 months (interquartile range, 10-48). We recorded data on clinical variables, P-wave characteristics, and presence of IAB on the electrocardiogram. Electrocardiogram findings were interpreted by a blinded, centralised rater at (XXXX2). ESUS recurrence was the primary outcome variable.ResultsMedian age was 47 years (range, 19-85); 50% of patients were women. IAB was detected in 36 patients (34.6%); IAB was partial in 29 cases (27.9%) and advanced in 7 (6.7%). Sixteen patients (15.4%) presented stroke recurrence; of these, 5 had partial and 4 had advanced IAB (P = .01; odds ratio [OR] = 9.44; 95% confidence interval [CI], 1.88-47.46; relative risk [RR] = 4.62; 95% CI, 2.01-10.61). Median P-wave duration was longer in patients with stroke recurrence (P = .009). The multivariate logistic regression analysis identified the following independent risk factors for stroke recurrence: advanced IAB (P < .001; OR = 10.86; 95% CI, 3.07-38.46), male sex (P = .028; OR = 4.6; 95% CI, 1.18-17.96), and age older than 50 years (P = .039; OR = 3.84; 95% CI, 1.06-13.88). In the Cox proportional hazards model, the risk variables identified were age older than 50 years (P = .002; hazard ratio, 7.04; 95% CI, 2.06-23.8) and P-wave duration (per ms) (P = .007; hazard ratio, 1.02; 95% CI, 1.01-1.04).ConclusionsAdvanced IAB and age older than 50 years predict ESUS recurrence.     

Social class of origin and cardinal symptoms of schizophrenic disorders over the early illness course

  Background: This study describes the relationship of social class of origin to cardinal symptoms of schizophrenic disorders over the early illness course. Method: The sample of subjects was drawn from the Suffolk County Mental Health Project, a longitudinal epidemiologic study of first-hospitalized subjects with psychotic disorders; the present study focused on patients with schizophrenic disorders. At baseline, subjects were dichotomized into upper/middle and lower social class of origin groups, based on occupation of the head of the household of origin. The patients in both groups were assessed for the major symptoms of schizophrenic disorders using standard structured instruments at both baseline and 6-month follow-up. The 6-month symptom severity levels were compared between the groups, controlling for baseline symptom status and potential confounders. Results: At 6-month follow-up, the upper/middle social class of origin group, as compared to the lower social class of origin group, had lower symptom levels for hallucinations (adjusted OR = 4.88, χ² = 8.49, P = 0.004) and delusions (adjusted OR = 2.46, χ² = 4.16, P = 0.04). There were no notable group differences for any of the negative or thought disorganization symptoms. Conclusions: Social class of origin is associated with positive symptoms of schizophrenia over the early illness course. Accepted: 10 November 1999     

Correlates of Non-Concordance between Perceived and Objective Measures of Walkability

Background  Objective and self-reported physical environmental attributes have been related to physical activity. Purpose  We examined the characteristics of adults who are resident in objectively identified high walkable neighborhoods but whose perceptions of neighborhood attributes are not concordant with objective attributes relating to high walkability. Methods  Neighborhood built-environment attributes relating to walkability (dwelling density, intersection density, land use mix, and net retail area) were determined objectively, using Geographic Information System databases; data on corresponding perceptions of local environment attributes (from the Neighborhood Environment Walkability Scale) were derived from a self-completion survey of a socially diverse sample of 2,650 adults aged 19 to 65. Objective and perceived walkability attributes were categorized using median splits, and correlates of non-concordance were determined using multiple logistic regression models. Results  There was a fair overall agreement between objectively determined walkability and perceived walkability (Kappa = 0.35, 95% CI = 0.31–0.39). Among those resident in objectively assessed high walkable areas (n = 1,063), 32.1% perceived them to be low walkable; conversely, 32.7% (n = 1,021) resident in objectively determined low walkability areas perceived them to be high. For residents of objectively determined high walkable areas, the characteristics that differentiated those with perceptions of low walkability (non-concordant perceptions) from those with concordant perceptions of high walkability were: not being university-educated (OR = 1.47, 95% CI = 1.06–2.04); having lower household incomes (OR = 1.54, 95% CI = 1.09–2.17); being overweight (OR = 1.46, 95% CI = 1.03–2.07); and walking fewer days per week for transport (OR = 1.75, 95% CI = 1.11–2.70). Higher walking times and more positive cognitive variables were noted among participants who lived in a neighborhood with low walkability that was perceived as high compared to those who lived in a high walkable environment that was perceived as low walkable. Conclusion  Adults with lower educational attainment and lower incomes, who were overweight, or who were less physically active for transportation purposes, were more likely to misperceive their high walkable neighborhood as low walkable. There is the potential for physical activity promotion and persuasion strategies to address non-concordant perceptions, especially among those who live in high walkable environments but perceive them to be low and also among those who are socially disadvantaged and are less active. Perceptions of environmental attributes may be more strongly correlated with cognitive antecedents and with behavior than are objective measures.     

Efficacy and Use of an Internet-delivered Computer-tailored Lifestyle Intervention, Targeting Saturated Fat Intake, Physical Activity and Smoking Cessation: A Randomized Controlled Trial

Background Although experts claim that computer-tailored interventions provided over the Internet have great potential to promote health behavior change, few studies have tested the efficacy of computer-tailored lifestyle interventions online-delivered over the Internet. Purpose To evaluate the short-term (1 month) efficacy of an Internet-delivered, computer-tailored lifestyle intervention targeting saturated fat intake, physical activity (PA), and smoking cessation, and to evaluate exposure to the intervention. Methods A pretest–posttest randomized controlled trial with an intervention group and a no intervention waiting list control group was conducted. Self-reported behavior and determinants were assessed at baseline and 1 month follow-up. Exposure to the intervention was monitored through server registrations. The data were analyzed using multiple linear and logistic regression analysis. Results The intervention resulted in a significantly lower self-reported saturated fat intake (b = −0.76, p < 0.01) and a higher likelihood of meeting the PA guidelines among respondents who were insufficiently active at baseline (OR = 1.34, 95%CI = 1.001–1.80). No significant intervention effects were found for self-reported smoking status. Of the participants, 81% actually visited the website. Conclusions The Internet-delivered, computer-tailored lifestyle intervention was effective in reducing self-reported saturated fat intake and in increasing self-reported PA among participants who completed the study.     

Sleep habits and weight status in Brazilian children aged 4–6 years of age: the PREDI study

ObjectivesTo evaluate the association of sleep habits with the weight status of children aged 4–6 years.MethodsData were obtained from the PREDI Study, a Brazilian birth cohort study. The current study was carried out in the homes of the participants during two follow-ups: 2016/17 and 2018. The participants were submitted to anthropometric assessment and demographic, socioeconomic and sleep data were obtained. The child's sleep habits were self-reported by the mother or caregiver on the day of the visit and included information on the following sleep habits during the past week: bedtime routine, rhythmicity, and separation affect determined with the Sleep Habits Inventory for Preschool Children and the Sleep Habits Inventory. Logistic regression and gamma-log regression analyses were used to examine the association of sleep habits with excess body weight of children in the two follow-ups according to sex.ResultsOf the 217 and 185 children included in 2016/17 and 2018, respectively, 66 (30.6%) and 48 (25.9%) had a BMI >85th percentile at 4–6 years, respectively. The median rhythmicity score was higher in children with excess body weight (p = 0.05). Adjusted analysis showed that rhythmicity was associated with excess body weight of girls at ages 4–5 years (OR = 1.42, 95% CI: 1.09–1.86, p = 0.009) and 6 years (OR = 1.32, 95% CI: 1.06–1.65, p = 0.015), even after adjustment for other important covariates. Additionally, the sleep habit “separation affect” was inversely associated with the child's BMI in boys (β = −0.005, 95% CI: −0.010–0.000, p = 0.037).ConclusionsIn the present study, rhythmicity problems were associated with increased odds of girls aged 4–6 years having excess body weight. These results are important from a public health perspective since strategies aimed at preventing excess body weight in children need to consider the child's sleep quality as a potential risk factor, especially rhythmicity.     

Thrombolytic therapy in ischemic stroke patients with pre-stroke depression in the telestroke vs non-telestroke

Background and PurposeThrombolysis therapy remains the gold standard in acute ischemic stroke treatment, and rates of treatment with rtPA in ischemic stroke patients with comorbid depression has yet to be fully investigated. This study aims to examine clinical risk factors associated with inclusion or exclusion for rtPA in acute ischemic stroke populations with pre-stroke depression in the telestroke versus a non-telestroke setting.MethodsWe collected retrospective data from a regional stroke registry for pre-stroke depressed ischemic stroke patients from January 2010 to June 2016. Logistic regression was used to determine demographic and baseline clinical risk factors associated with inclusion and exclusion from rtPA.Results. In the adjusted analysis, increasing age (OR = 1.064, 95% CI, 1.006-1.125, P = 0.029), improved ambulation (OR = 3.513, 95% CI, (0.855–14.436, P = 0.018) and sleep apnea (OR = 4.458, 95% CI, 0.731–27.182, P = 0.05) were associated with inclusion for rtPA, while Caucasian race (OR = 0.119, 95% CI, 0.0168–0.908, P = 0.040), systolic blood pressure (OR = 0.945, 95% CI, 0.906–0.985, P = 0.008), and direct admission (OR = 0.028, 95% CI, 0.003–0.317, P = 0.004) were associated with exclusion from rtPA. In the telestroke setting, INR (OR = 1.016, 95% CI, 0–5.393, P = 0.163) was not significantly associated with rtPA inclusion or exclusion.ConclusionIdentifying contraindicators associated with exclusion from rtPA is significant to improve the use thrombolytic therapy in the telestroke and non telestroke settings.     

Predictors of the initiation of shift work disorder among Chinese intern nurses: a prospective study

AimIndividual vulnerability to shift work disorder (SWD) varies. The aim of the present study was to verify the individual characteristics that predicted SWD onset by following Chinese intern nurses who at baseline had not worked rotating or night shifts.MethodsA total of 706 Chinese first-year intern female nurses aged 16–24 years were recruited. At baseline (T₀), they reported demographic characteristics, insomnia symptoms and excessive sleepiness, trait neuroticism, sleep reactivity, morningness, and circadian flexibility and languidity. At the three-month (T₁) and six-month (T₂) follow-up, the SWD status was determined based on significant sleep disturbance and/or excessive sleepiness in the context of working a rotating shift schedule.Results and conclusionsThe prevalence rates of SWD were 35.2% at T₁ and 37.7% at T₂. Two bivariate logistics regressions revealed that morningness (odds ratio [OR] = 1.31, 95% confidence interval [CI] = 1.09–1.58, T₁; OR = 1.36, 95% CI = 1.12–1.65, T₂), languidity (OR = 1.56, 95% CI = 1.28–1.90, T₁), and sleep reactivity (OR = 1.29, 95% CI = 1.07–1.57, T₁; OR = 1.31, 95% CI = 1.07–1.61, T₂) predicted the onset of SWD, while flexibility (OR = 0.75, 95% CI = 0.62–0.90, T₁) decreased the odds of SWD onset. By comparing nurses with SWD and nurses without SWD across all six months, morningness (OR = 1.58, 95% CI = 1.20–2.07), sleep reactivity (OR = 1.54, 95% CI = 1.16–2.04), languidity (OR = 1.70, 95% CI = 1.30–2.22), and flexibility (OR = 0.70, 95% CI = 0.54–0.90) showed significant effects on persistent SWD.     

Study of association of severity of sleep disordered breathing and functional outcome in stroke patients

ObjectiveSleep disordered breathing (SDB) is a prevalent yet underrecognized condition that may have major adverse consequences for those affected by it. We performed a prospective observational study to seek a correlation of severity of SDB with the severity of stroke and its functional outcome.MethodsPatients with history of recent-onset stroke were recruited and underwent overnight polysomnography (PSG) after the acute phase of the stroke was over; for defining hypopneas, 3% and 4% desaturation limits were used, and the apnea−hypopnea index was respectively calculated as AHI_3% and AHI_4%. Stroke severity was graded using the Scandinavian Stroke Scale. Functional disability and neurological impairment was evaluated six weeks after the PSG using the Barthel Index (<80 = functional dependence; ≥80 = functional independence) and modified Rankins Scale (>2 = poor outcome; ≤2 = good outcome).ResultsA total of 50 patients were enrolled, 30 (60%) with ischemic stroke and 20 (40%) with hemorrhagic strokes. Of the patients, 39 (78%) had an AHI_4% of >5/h, 23 (46%) had an AHI_4% of >15/h, and 9 (18%) had an AHI_4% of >30/h. Multivariate analysis showed that body mass index (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.04–1.54, p = 0.019) and Scandinavian Stroke Scale score (stroke severity) (OR = 0.86; 95% CI = 0.76–0.96, p = 0.009) were significant risk factors for predicting SDB (AHI_4% > 15) in patients of stroke. When we looked for factors predicting outcomes, only AHI_4% (OR = 1.20; 95% CI 1.01–1.43, p value 0.041) was predictive of the functional dependence (based on Barthel Index) of the patient and AHI_4% (OR = 1.14; 95% CI 1.03–1.25, p = 0.008) and body mass index (OR = 0.75; 95% CI 0.59–0.96, p = 0.024) were found to be predictive of poor outcome (based on modified Rankins Scale). We obtained similar results, regardless of the hypopnea definition used.ConclusionIn conclusion, given the high frequency of SDB in stroke patients and its correlation with poor outcome, screening for obstructive sleep apnea in all stroke and transient ischemic attack patients may be warranted.     

Prevalence of and Associations with Waterpipe Tobacco Smoking among U.S. University Students

Background  Although waterpipe tobacco smoking seems to be increasing on U.S. university campuses, these data have come from convenience samples. Purpose  We aimed to determine the prevalence of and associations with waterpipe tobacco smoking among a random sample of students. Methods  We surveyed a random sample of graduate and undergraduate students at a large, urban university. We used multivariate modeling to determine independent associations between belief-related predictors and waterpipe tobacco smoking. Results  Of the 647 respondents, waterpipe smoking was reported in 40.5%, over the past year in 30.6%, and over the past 30 days in 9.5%. Over half of the sample (52.1%) perceived that tobacco smoking from a waterpipe was less addictive than cigarette smoking. In fully adjusted multivariate models, 1-year waterpipe smoking was associated with low perceived harm (OR = 2.54, 95% CI = 1.68, 3.83), low perceived addictiveness (OR = 4.64, 95% CI = 3.03, 7.10), perception of high social acceptability (OR = 20.00, 95% CI = 6.03, 66.30), and high perception of popularity (OR = 4.72, 95% CI = 2.85, 7.82). Conclusions  In this sample, lifetime waterpipe use was as common as lifetime cigarette use. Perception of harm, perception of addictiveness, social acceptability, and popularity were all strongly related to waterpipe smoking.