Lynchmarcus3124

BACKGROUND The development of congenital heart disease (CHD) is multifactorial with genetic and environmental influences. We sought to determine the relationship between socioeconomic and environmental factors with the incidence of CHD among live-born infants in California and to determine whether maternal comorbidities are in the causal pathway. METHODS AND RESULTS This was a population-based cohort study in California (2007-2012). The primary outcome was having significant CHD. Predictors included socioeconomic status and environmental exposure to pollutants determined by U.S. Census data. A social deprivation index and environmental exposure index was assigned based on neighborhood socioeconomic variables, categorized into 4 quartiles. Quartile 1 was the best with the least exposure to pollutants and social deprivation, and quartile 4 was the worst. Multivariate logistic regression and mediation analyses were performed. Among 2 419 651 live-born infants, the incidence of CHD was 3.2 per 1000 live births. The incidence of CHD was significantly higher among those in quartile 4 compared with quartile 1 (social deprivation index 0.35% versus 0.29%; odds ratio [OR], 1.31; 95% CI, 1.21-1.41; environmental exposure index 0.35% versus 0.29%; OR, 1.23; 95% CI, 1.15-1.31) after adjusting for maternal race/ethnicity and age and accounting for the relationship between the 2 primary predictors. Maternal comorbidities explained 13% (95% CI, 10%-20%) of the relationship between social deprivation index and environmental exposure index with the incidence of CHD. Azacitidine CONCLUSIONS Increased social deprivation and exposure to environmental pollutants are associated with the incidence of live-born CHD in California. Maternal comorbidities explain some, but not all, of this relationship. These findings identify targets for social policy initiatives to minimize health disparities.Aims This survey aimed to explore real-world physician experiences and treatment satisfaction with fast-acting insulin aspart (faster aspart) in clinical practice across Europe and Canada.Materials and methods An online web-based survey was used for physicians treating people with type 1 or type 2 diabetes. General practitioners and specialists, with experience using faster aspart, were interviewed.Results A total of 191 physicians participated in the survey. Most of their patients (68% of those with T1D and 63% of those with T2D) were previously treated with another mealtime insulin before switching to faster aspart. At the time of initiating faster aspart, nearly half of patients had an HbA1c level between 7.5% (59 mmol/mol) and 8.5% (69 mmol/mol). The main prescription drivers for faster aspart, versus other mealtime insulins, were faster onset of action, improved postprandial glucose (PPG) control, and dosing flexibility. Most physicians were more satisfied with faster aspart than other mealtime insulins regarding at-meal (66%) and post-meal (71%) dosing flexibility, improved PPG levels (66%), and onset of action (61%). Main reasons for not prescribing faster aspart included a good response to current treatment (76%) or patient reluctance to switch (57%). Overall, 12% of patients discontinued faster aspart, for reasons including concerns of hypoglycemia (17%), poor adherence (17%), and level of patient co-pay (17%). More than half of physicians had fewer concerns regarding postprandial hyperglycemia, and were more confident in their patients reaching their HbA1c target with faster aspart than with other mealtime insulins.Limitations The findings of this survey are based heavily on physicians' experiences, and could therefore be subject to recall bias.Conclusions Reported physician and patient experiences of using faster aspart have been positive, and better PPG control and increased dosing flexibility are expected to improve glycemic management.The current study examined direct and indirect effects of a mother's history of childhood physical and sexual abuse on her child's officially reported victimization. This prospective, longitudinal study followed a community-based sample of 499 mothers and their children. Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, and 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants' target child between birth and age 3.5. Whereas both types of maternal maltreatment history doubled the child's risk of child protective services investigation, mothers' sexual abuse history conferred significantly greater risk. Pathways to child victimization varied by type of maternal maltreatment history. Mothers who had been physically abused later demonstrated interpersonal aggressive response biases, which mediated the path to child victimization. In contrast, the association between maternal history of sexual abuse and child victimization was mediated by mothers' substance use problems. Study implications center on targeting child maltreatment prevention efforts according to the mother's history and current problems.The Confluence Model of Sexual Aggression is a well-established framework for understanding factors that contribute to men's perpetration of sexual aggression against women, highlighting the roles of hostile masculinity, impersonal sex orientation, and exposure to pornography. To date, only one study has applied aspects of the Confluence Model to examine predictors of sexual aggression in adolescent males, and the study did not include pornography exposure as a predictor. The current study evaluates the Confluence Model as a framework for understanding the perpetration of both contact and noncontact sexual aggression in a sample of 935 heterosexual 10th-grade adolescent boys. Composite scores for hostile masculinity and impersonal sex orientation were generated. Nearly all the variables included in the hostile masculinity and impersonal sex constructs were associated with perpetration. Zero-inflated Poisson regression models revealed distinct combinations of salient predictors when the dependent variable was identified as boys' frequency of perpetration, compared with when the dependent variable was defined as any perpetration of sexual aggression. Impersonal sex orientation and violent pornography exposure were associated with perpetrating noncontact sexual aggression in the last 6 months, while violent pornography exposure and the interaction of hostile masculinity and impersonal sex orientation increased the frequency of recent contact sexual aggression. Results suggest that hostile masculinity, impersonal sex orientation, and violent pornography exposure are important factors to address within sexual assault prevention approaches for adolescent boys.