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To investigate the levels of physical activity and sedentary behavior, and the factors associated with these, in middle-aged and elderly stroke survivors who had no limitations to their physical activity.

We analyzed physical activity and sedentary behavior patterns using data from 12,986 community-dwelling adults aged ≥50 years without activity limitation 377 stroke survivors, 531 ischemic heart disease (IHD) survivors, and 12,078 healthy controls in the Korean National Health and Nutrition Examination Survey. The prevalence and associated factors of compliance to aerobic activity guidelines and prolonged sedentary time were investigated using complex-sample statistics.

Stroke survivors spent less time in transport-related activities and walking than healthy controls. Stroke survivors, despite having no restriction in daily and social activities, had lower rates of compliance with aerobic activity guidelines (32.4%) and a higher prevalence of long sedentary time (56.6%) than IHD survivors (aerobic acti physical activity and sedentary behavior.

The spouse is the ideal person for providing comprehensive and sustainable support for menopausal women. However, existing validated questionnaires to measure such support are limited. This study developed and validated a new instrument, the Menopausal Spousal Support Questionnaire (MSSQ), for measuring spouses' support for menopausal women, and validated its psychometric properties.

The MSSQ was developed and then validated using sequential exploratory mixed methods in two phases. In Phase I, the MSSQ was developed based on a literature review, in-depth interviews with 13 menopausal women and discussions within the research team. This was followed by Phase II, in which a two-step validation process was conducted to perform (a) an exploratory factor analysis (EFA) with data from 146 menopausal women and (b) a confirmatory factor analysis (CFA) with data from 431 menopausal women. The results were used to determine the psychometric properties of the newly developed MSSQ.

The final MSSQ consisted of 17 items in four domains appraisal support, intimacy support, emotional support and instrumental support. The modelling results demonstrated a good model fit root mean square of error approximation (RMSEA) = 0.075, comparative fit index (CFI) = 0.942, Tucker-Lewis Index (TLI) = 0.921, chi-square/degree of freedom (ChiSq/df) = 3.546). The scale also proved to be reliable composite reliability (CR) > 0.6, average variance extracted (AVE) > 0.5, internal reliability (IR) > 0.93.

The MSSQ is psychometrically valid for measuring spousal support for menopausal women and could also serve as a screening tool for healthcare providers.

The MSSQ is psychometrically valid for measuring spousal support for menopausal women and could also serve as a screening tool for healthcare providers.Clinical, laboratory, and autopsy findings support an association between coronavirus disease-2019 (COVID-19) and thromboembolic disease. Acute COVID-19 infection is characterized by mononuclear cell reactivity and pan-endothelialitis, contributing to a high incidence of thrombosis in large and small blood vessels, both arterial and venous. Observational studies and randomized trials have investigated whether full-dose anticoagulation may improve outcomes compared with prophylactic dose heparin. Although no benefit for therapeutic heparin has been found in patients who are critically ill hospitalized with COVID-19, some studies support a possible role for therapeutic anticoagulation in patients not yet requiring intensive care unit support. We summarize the pathology, rationale, and current evidence for use of anticoagulation in patients with COVID-19 and describe the main design elements of the ongoing FREEDOM COVID-19 Anticoagulation trial, in which 3,600 hospitalized patients with COVID-19 not requiring intensive care unit level of care are being randomized to prophylactic-dose enoxaparin vs therapeutic-dose enoxaparin vs therapeutic-dose apixaban. (FREEDOM COVID-19 Anticoagulation Strategy [FREEDOM COVID]; NCT04512079).

The 2018 U.S. heart allocation system offers an accelerated pathway for heart transplantation to the most urgent patients.

This study sought to determine whether the new allocation system resulted in lower likelihood of candidate recovery.

Adult patients waitlisted for heart transplantation with temporary mechanical circulatory support at the time of initial listing between 2010 and 2020 in the United Network for Organ Sharing registry were included. Competing events of heart transplantation, waitlist death or delisting for deteriorating condition, and delisting for improved condition (candidate recovery) were analyzed in the new vs old heart allocation system.

A total of 688 patients were waitlisted with venoarterial extracorporeal membrane oxygenation or a surgical nondischargeable biventricular assist device (status 1 or old 1A). Overall, 2,237 patients were waitlisted with an intra-aortic balloon pump, a percutaneous left ventricular assist device (LVAD), or a surgical nondischargeable LVAD (statugy.

Current practice of the new allocation system may not offer select temporary mechanical circulatory support patients the opportunity and adequate time to recover to the point of waitlist removal. Further research will determine which patients would benefit from urgent transplantation vs recovery strategy.

The Evolut Low Risk Trial (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients) showed that transcatheter aortic valve replacement (TAVR) with a supra-annular, self-expanding valve was noninferior to surgery for the primary endpoint of all-cause mortality or disabling stroke at 2 years. This finding was based on a Bayesian analysis performed after 850 patients had reached 1 year of follow-up.

The goal of this study was to report the full 2-year clinical and echocardiographic outcomes for patients enrolled in the Evolut Low Risk Trial.

A total of 1,414 low-surgical risk patients with severe aortic stenosis were randomized to receive TAVR or surgical AVR. An independent clinical events committee adjudicated adverse events, and a central echocardiographic core laboratory assessed hemodynamic endpoints.

An attempted implant was performed in 730 TAVR and 684 surgical patients from March 2016 to May 2019. The Kaplan-Meier rates for the complete 2-year primary endpoint of death or dites that were slightly better than those predicted by using the Bayesian analysis. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients [Evolut Low Risk Trial]; NCT02701283).

Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), limited data suggest symptomatic severe AS remains undertreated.

This study sought to investigate temporal trends in AVR utilization among patients with a clinical indication for AVR.

Patients with severe AS (aortic valve area<1cm

) on transthoracic echocardiograms from 2000 to 2017 at 2 large academic medical centers were classified based on clinical guideline indications for AVR and divided into 4 AS subgroups high gradient with normal left ventricular ejection fraction (LVEF) (HG-NEF), high gradient with low LVEF (HG-LEF), low gradient with normal LVEF (LG-NEF), and low gradient with low LVEF (LG-LEF). Utilization of AVR was examined and predictors identified.

Of 10,795 patients, 6,150 (57%) had an indication or potential indication for AVR, of whom 2,977 (48%) received AVR. The frequency of AVR varied by AS subtype with LG groups less likely to receive an AVR (HG-NEF 70%, HG-LEF 53%, LG-NEF 32%, LG-LEF 38%, P< 0.001). AVR volumes grew over the 18-year study period but were paralleled by comparable growth in the number of patients with an indication for AVR. In patients with a Class I indication, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index transthoracic echocardiogram, and LVEF≥0.5 were independently associated with an increased likelihood of receiving an AVR. AVR was associated with improved survival in each AS-subgroup.

Over an 18-year period, the proportion of patients with an indication for AVR who did not receive AVR has remained substantial despite the rapid growth of AVR volumes.

Over an 18-year period, the proportion of patients with an indication for AVR who did not receive AVR has remained substantial despite the rapid growth of AVR volumes.

Coronary artery disease (CAD) is the most common cause of new-onset heart failure (HF). Although guidelines recommend ischemic evaluation in this population, testing has historically been underutilized.

This study aimed to identify contemporary trends in CAD testing for patients with new-onset HF, particularly after publication of the STICHES (Surgical Treatment for Ischemic HeartFailure Extension Study), and to characterize geographic and clinician-level variability in testing patterns.

We determined the proportion of patients with incident HF who received CAD testing from 2004 to 2019 using an administrative claims database covering commercial insurance and Medicare. We identified demographic and clinical predictors of CAD testing during the 90days before and after initial diagnosis. Patients were grouped by their county of residence to assess national variation. Patients were then linked to their primary care physician and/or cardiologist to evaluate variation across clinicians.

Among 558,322 patients with new-onset HF, 34.8% underwent CAD testing and 9.3% underwent revascularization. After multivariable adjustment, patients who underwent CAD testing were more likely to be younger, male, diagnosed in an acute care setting, and have systolic dysfunction or recent cardiogenic shock. Incidence of CAD testing remained flat without significant change post-STICHES. Covariate-adjusted testing rates varied from 20% to 45% across counties. The likelihood of testing was higher among patients co-managed by a cardiologist (adjusted OR 5.12; 95% CI 4.98-5.27) but varied substantially across cardiologists (IQR 50.9%-62.4%).

Most patients with new-onset HF across inpatient and outpatient settings did not receive timely testing for CAD. Substantial variability in testing persists across regions and clinicians.

Most patients with new-onset HF across inpatient and outpatient settings did not receive timely testing for CAD. Substantial variability in testing persists across regions and clinicians.

Kissing may be a risk factor for gonorrhoea. Past studies have focused on male kissing partners among men who have sex with men (MSM). This study aimed to examine the kissing practices of MSM who kiss male and female partners.

We conducted a cross-sectional survey at the Melbourne Sexual Health Centre (MSHC) between March and April 2019. Men attending the MSHC, aged ≥16years who reported any sexual contact with another man in the previous 12months were invited to participate in the survey. Data about the number of kissing-only (kissing without sex), kissing-with-sex, and sex-only (having sex without kissing) partners in the previous 3months were collected. Men were asked to report the number of male and female partners separately.

There were 357 MSM included in the survey. selleck chemicals Most men (97.2%, n =347) had kissed or had sex with another man, whereas 16.0% (n =57) had kissed or had sex with a female partner in the previous 3months. Of the 57 men, 26.3% (n =15) had only kissed a female partner without having sex.