Heart rate increment analysis is not effective for sleep-disordered breathing screening in patients with chronic heart failure

Frequency domain analysis of heart rate variation has been suggested as an effective screening tool for sleep-disordered breathing (SDB) in the general population. The aim of this study was to assess this method in patients with chronic congestive heart failure (CHF). We included prospectively 84 patients with stable CHF, left ventricular ejection fraction (LVEF) <45% and sinus rhythm. The patients underwent polygraphy to measure the apnoea/hypopnoea index (AHI) and simultaneous Holter electrocardiogram monitoring to measure the power spectral density of the very low frequency component of the heart rate increment, expressed as the percentage of total power spectral density [% very low frequency increment (%VLFI)]. %VLFI could be determined in 54 patients (mean age, 52.8 ± 12.3 years; LVEF, 33.5 ± 9.8%). SDB defined as AHI ≥15 h⁻¹ was diagnosed in 57.4% of patients. Percent VLFI was not correlated with AHI ( r  =   0.12). Receiver-operating characteristic curves constructed using various AHI cut-offs (5–30 h⁻¹) failed to identify a %VLFI cut-off associated with SDB. The 2.4% VLFI cut-off recommended for the general population of patients with suspected SDB had low specificity (35%) and low positive and negative predictive values (35% and 54%, respectively). Heart rate increment analysis has several limitations in CHF patients and cannot be recommended as an SDB screening tool in the CHF population.     

Rotational Atherectomy for Left Main Coronary Artery Disease in Octogenarians: Transradial Approach in a Tertiary Center and Literature Review

Objectives

The aim of this study was to appreciate the safety and effectiveness of transradial percutaneous coronary intervention (PCI) with rotational atherectomy for highly calcified left main coronary artery (LMCA) disease in octogenarians.

Background

Conventional surgery is still considered the preferred management for LMCA disease; but, when the lesion is severely calcified, and the patient is unsuitable for surgery, the interventional cardiologist faces a complex PCI traditionally approached by femoral access.

Methods

Between June 2004 and December 2010, octogenarians with calcified LMCA disease who were primary denied for surgical revascularization were enrolled. Procedural success and major adverse cerebral and cardiovascular events (MACCE) including death, nonfatal myocardial infarction, target lesion revascularization (TLR), or stroke during long‐term follow‐up were evaluated.

Results

Forty‐two consecutive patients≥80 years had undergone stenting for calcified LMCA disease (13 with rotational atherectomy, the “Rota” group, and 29 without rotational atherectomy, the “without Rota” group). Procedural success was good (92.3% vs. 96.6%, respectively, p = NS). Mean follow‐up time was 25.7 ± 21.4 and 28 ± 32.3 months, respectively. There was a TLR in 25% and 11.1%, respectively; p = NS. No difference was detected in terms of overall in‐hospital or long‐term mortality or MACCE.

Conclusion

Rotational atherectomy followed by stent implantation by transradial approach, when applied to heavily calcified lesions, appeared to be a safe and effective strategy for the treatment of LMCA disease in octogenarians who were refused for surgery. (J Interven Cardiol 2013;26:173–182)

     

Congenital anomalies in children with cerebral palsy: a population‐based record linkage study

Aim Our aim was to determine the proportion of children with cerebral palsy (CP) who have a congenital anomaly (CA) in three regions (Isère Region, French Alps; Funen County, Denmark; Northern Region, England) where population‐based CP and CA registries exist, and to classify the children according to CA subtype. Method Data for children born between 1991 and 1999 were linked using electronic matching of cases. All potential matches were checked manually by each centre and verified as true matches. Results A total of 1104 children with CP were born during the study period (663 males, 441 females). Of these, 166 (15%; 95% Confidence Interval [CI] 13.0–17.3) children with CP had a CA: 8.8% had a cerebral anomaly, 4.8% had a non‐cerebral anomaly, and 1.4% had a non‐cerebral‐related syndrome or a chromosomal/genetic anomaly. Interpretation The prevalence of cerebral anomaly was highest in children with ataxic CP (41.7%) and lowest in those with dyskinetic CP (2.1%). Cerebral anomalies were found in 8.4% and 7% of children with bilateral and unilateral spastic CP respectively. The most frequent cerebral anomalies were primary microcephaly (26.5%) and congenital hydrocephalus (17.3%). The most common non‐cerebral anomalies recorded were cardiac (12.6% of children with CP and CA), urinary (5.4%), and musculoskeletal (5.4%). The prevalence of cerebral anomalies was higher among children born at term (13%) than among those born preterm (3.8%). Associated sensorineural or intellectual impairments occurred more often in children with CP and cerebral anomalies. We concluded that cerebral and non‐cerebral CA prevalence was higher among the CP population than in the general population of live births.     

Improving attitudes towards children with disabilities in a school context: a cluster randomized intervention study

Aim Although inclusive education of disabled children is now an accepted practice, it is often challenged by negative peer attitudes. We undertook an interventional study aimed at improving students’ attitudes towards their disabled peers. Method The participants were students from the 7th grade of twelve paired schools (1509 students from 62 classes; age 12–13y), randomly allocated to an intervention group (205 males, 285 females) or a control group (132 males, 165 females). The intervention consisted of a mandatory comprehensive educational project on disability. The Chedoke‐McMaster Attitudes Towards Children with Handicaps Scale (CATCH) was used to assess children’s attitudes before (T0) and after (T1) intervention. The hierarchical structure of the data was taken into account by adjusting standard deviations and using linear multilevel models. Results Seven hundred and eighty‐four students had at least one score on the three domains (cognitive, affective, behavioural) of the CATCH at T0 and T1. The final scores were higher than baseline scores (total scores, intervention group: baseline score 25.6 (SD=5.4), final score 26.8 (5.9), p<0.001; Control group: baseline 25.2 (5.4), final 26.0 (5.7), p<0.009) with no significant difference between the intervention and control groups. Individual score changes over time were associated with baseline score (p<0.001 for total and all sub‐scores). Lower improvement in attitudes was found in students from schools with special units for their peers with cognitive impairment for total (p=0.013), affective (p<0.001), and behavioural (p=0.001) scores, while higher improvement existed for the cognitive domain (p=0.029). Interpretation Although we found no effect of our intervention, we found an improvement in attitudes in the intervention and control groups that could be a result of the nature of the scales and questionnaires the students had to complete before the intervention.     

Cross-European mental health indicators: A dream or a reality?

Background: Life expectancy has increased in most European countries,but the value of this additional lifespan in terms of mentaland physical health is unclear. To afford cross-national researchinto this area the Euro-REVES project was set up to promoteharmonization of health expectancy calculations. One part ofthe project's work was to ascertain the current level of harmonizationof mental health indicators. Methods: A census was conductedof studies undertaken since 1980 which included a mental healthcomponent, using a cascade approach and advertisements in Europeanjournals. Information for each study included size, age range,design (cross-sectional or longitudinal), Indicators and scalesused. Responders were also asked to identify the major mentalhealth priorities in their country. Results: To date informationhas been received on 60 studies from 12 European countries.Dementia and depression were consistently identified as commonmental health priorities. Over half (39) of the studies werelongitudinal in design, with sizes ranging from 15 to 25,000.The Mini Mental State Examination (MMSE) was included in 53%(32) of studies, with 25% (15) including the Geriatric MentalState Schedule (GMS) and 20% (12) the Cambridge Mental Disordersof the Elderly Examination (CAMDEX) schedule. A large proportion(50%) of studies were of older people, reflecting the priorityof dementia. Conclusion: This study demonstrated that harmonizationof mental health indicators across Europe is more advanced thanfor other health indicators. Recommendations are made for furtherimprovements in the collection of cross-European comparativeinformation for mental health.     

Individual Variability of the Cutaneous Larva Migrans (CLM) Incubation Period

Abstract: Whether the high variable incubation period of cutaneous larva migrans depends on the parasite or other host factors remains unknown. Two brothers were contaminated simultaneously, but had 15‐ and 165‐day incubation periods, respectively, suggesting a possible influence of host factors. A long incubation period does not rule out cutaneous larva migrans in patients with creeping eruption.     

Drug Injecting, AIDS, and Risk Behaviour: potential for change and intervention strategies

The sharing of unsterile needles and syringes is a primary means by which drug users who inject put themselves at risk of HIV infection. This paper examines a sample of 127 regular illicit drug users (both in and out of treatment) in terms of injecting and needle sharing patterns, and investigates the impact of concern about AIDS upon these behaviours. Amongst those that had ever injected, it was found that 54% had substantially reduced their risk behaviour, in that they either no longer injected, or else no longer shared injecting equipment. A further 32% had to some extent reduced their risk behaviour, and only 14% staled that they had been unaffected by concern about AIDS. Those who were in contact with agencies were more likely to have substantially reduced their risk behaviour than those not in contact with agencies. Regarding the impact of HIV testing, the data suggest that it may be associated with reduced rather than increased risk behaviours, though the differences only approach significance. In two consecutive time periods, similar proportions reported that they were still sharing; but by the second time period almost all reported some attempt at change. In general, the results confirm other studies, from the USA and Britain, that have shown that drug users are not inherently irrational, and are capable of modifying their risk behaviour. Availability of clean injecting equipment was given as the prime reason for sharing, and the free supply of needles and syringes is advocated as a complement to effective health education. Aggressive outreach work is to be encouraged so as to reach those individuals unlikely to use established schemes.