A perverse predicament

Background Educational attainment is an indicator of socioeconomic status and is inversely associated with cardiovascular risk factors and risk for incident coronary artery disease (CAD). Whether the level of educational attainment (EL) in patients with CAD influences outcomes remains understudied. Purpose To ascertain the relationship between EL and adverse outcomes in patients with CAD. We hypothesize that EL will be inversely associated with adverse outcomes in this high-risk patient population. Methods Subjects undergoing cardiac catheterization for known or suspected CAD were recruited in a cardiovascular biobank and had their highest level of educational attainment assessed using predefined options of elementary/middle school, high school, college, or graduate education. The primary outcome of interest was all-cause mortality and secondary outcomes included a composite of cardiovascular deaths and nonfatal myocardial infarction (MI) events, and nonfatal MI events during follow-up. Cox proportional hazards regression models were used to analyze the association between EL and adverse outcomes after adjustment for demographic characteristics, cardiovascular risk factors, cardiovascular medication use, and estimated zip code-based annual family income. Results Among the 6,318 subjects (mean age 64 years, 63% male, 23% black) enrolled, 998 (16%) had received graduate or a higher qualification, 2,689 (43%) had received a college education, 2,403 (38%) had received a high school education, and 228 (3%) had received elementary/middle school education. During a median follow-up of 3 years,there were 1,110 deaths from all causes, 851 cardiovascular deaths/nonfatal MI, and 286 nonfatal MI events. After adjusting for covariates and compared to patients with graduate education or higher, those with lower EL (elementary/middle school, high school, or college education) had a higher risk of all-cause mortality [hazard ratio 1.66, (95% CI 1.08, 2.54), 1.58 (95% CI 1.22, 2.04), and 1.45 (95% CI 1.13, 1.57), respectively]. Similar findings were observed for secondary outcomes. EL dichotomized at graduate education was associated with all-cause mortality (hazard ratio 1.48, 95% CI 1.16, 1.88), but this relationship was significantly modified by sex (p-interaction 0.023) and the association was attenuated among male patients (hazard ratio 1.23, 95% CI 0.94, 1.61) but not female patients (hazard ratio 2.70, 95% CI 1.53, 4.77). Conclusions Lower educational attainment is an independent predictor of adverse outcomes in patients with CAD. The causal link between low education level and increased CV risk needs further investigation. Acknowledgement/Funding Dr. Quyyumi is supported by NIH grants 5P01HL101398-02, 1P20HL113451-01, 1R56HL126558-01, 1RF1AG051633-01, R01 NS064162-01, R01 HL89650-01, HL095479-0

BackgroundEducational attainment is an indicator of socioeconomic status and is inversely associated with coronary artery disease risk. Whether educational attainment level (EAL) among patients with coronary artery disease influences outcomes remains understudied.Methods and ResultsPatients undergoing cardiac catheterization had their highest EAL assessed using options of elementary/middle school, high school, college, or graduate education. Primary outcome was all‐cause mortality and secondary outcomes were a composite of cardiovascular death/non‐fatal myocardial infarction and non‐fatal myocardial infarction during follow‐up. Cox models adjusted for clinically relevant confounders were used to analyze the association of EAL with outcomes. Among 6318 patients (63.5 years, 63% men, 23% black) enrolled, 16%, 42%, 38%, and 4% had received graduate or higher, college, high school, and elementary/middle school education, respectively. During 4.2 median years of follow‐up, there were 1066 all‐cause deaths, 812 cardiovascular deaths/non‐fatal myocardial infarction, and 276 non‐fatal myocardial infarction. Compared with patients with graduate education, those in lower EAL categories (elementary/middle school, high school, or college education) had a higher risk of all‐cause mortality (hazard ratios 1.52 [95% CI 1.11–2.09]; 1.43 [95% CI 1.17–1.73]; and 95% CI 1.26 [1.03–1.53], respectively). Similar findings were observed for secondary outcomes.ConclusionsLow educational attainment is an independent predictor of adverse outcomes in patients undergoing angiographic coronary artery disease evaluation. The utility of incorporating EAL into risk assessment algorithms and the causal link between low EAL and adverse outcomes in this high‐risk patient population need further investigation.

Educational attainment is related to improved health and longevity. We investigated the relationship between educational attainment and cardiovascular risk factors, subclinical atherosclerosis, and incidence of coronary artery disease. The Reykjavik REFINE study is a population-based study recruiting 6616 subjects, 25-69 years of age from the greater Reykjavik area in 2005-2011. Baseline measurements of cardiovascular risk factors were performed, and all participants had a carotid ultrasound examination to detect subclinical atherosclerotic lesions. Clinical follow-up of cardiovascular disease during a ten-year period was performed. Educational attainment was related to clinical outcome measures. The study population comprised of 3251 men and 3365 women. The proportion of the study population with primary school education only was 20.1%, 31.2% had vocational training, 12.3% had high school education and 36.4% were university graduates. Traditional cardiovascular risk factors were generally higher among subjects with primary school education only. Compared to subjects with university education, the odds ratio of having severe atherosclerotic plaque was 1.84 (95% CI 1.40-2.43) among those with primary school education only and 1.49 (95% CI 1.16-1.91) among subjects with vocational training. The subjects with high school or university education were less likely to develop significant cardiovascular disease during the 10-year follow-up period. Primary school and vocational training compared to university education are associated with risk factors of atherosclerotic disease, subclinical carotid plaque, and incidence of cardiovascular disease. The reason for this disparity remains to be clarified but socioeconomic inequality related to less educational attainment might be involved.

Introduction: Education, a key modifiable social determinant of health, plays a significant role in shaping outcomes related to ischemic stroke. Higher educational attainment has been linked to improved management of risk factors and greater adherence to medical treatments. However, the impact of education on patients suffering from intracerebral hemorrhage (ICH) remains underexplored. Methods: We conducted a post-hoc analysis of the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study to examine the impact of educational attainment on good functional outcome (modified Rankin Scale score of 0-3 at 90 days after ICH). A logistic regression model was adjusted for age, sex, race/ethnicity, insurance status, mechanical ventilation, systolic blood pressure, smoking status, diabetes mellitus, atrial fibrillation, hypertension, congestive heart failure, Glasgow Coma Scale, ICH location (side and deep), ICH volume on CT, and presence of intraventricular hemorrhage. Results: Among 1894 individuals included in this study, 584 patients (30.8%) had less than a high school (HS) education, 539 patients (28.5%) had a HS education, 641 patients (33.8%) had more than HS or a college education, and 130 patients (6.9%) had postgraduate education. See Table 1 for demographics by education group. The predicted probability of good outcome by education level was significantly different (Figure 1). Compared to those with <HS education, the odds ratio for good outcome in those with more than a HS or college education was 1.42 (95%CI 1.04-1.94, p=0.028) and for those with postgraduate education was 2.27 (95%CI 1.34-3.85, p=0.002). Conclusion: Our study demonstrated that higher educational attainment was associated with a greater likelihood of favorable outcome (mRS 0-3 at 90 days) in ICH patients, with the most significant effect observed in those with postgraduate education. Further study is needed to understand the mediators of this observation (i.e. socioeconomic status, medication adherence, etc.).

596: The effectiveness of enhanced teachable moments (Charlas) on prenatal vitamin knowledge among disadvantaged women in the Dominican Republic

Purpose The purpose of this paper is to study the effects of a variety of levels of education, namely, high school, vocational and university education, on the probability of being employed in Eastern Europe and the former Soviet Union. Design/methodology/approach The data are from two waves of the Life-in-Transition Survey that covers 29 post-communist transitional countries. The number of binary logistic models is estimated to quantify the effects of different types of education on the likelihood of being employed, while controlling for different sets of covariates. Findings The findings reveal that the effect of employment associated with university education is higher than that of vocational education, which in turn is higher than that of high school education. However, the differences between the effects of the various levels of education are not considerable. Any specific level of education is always associated with a higher effect in Eastern Europe as compared to the former Soviet Union. The effect of education is also found to be higher for females than for males. In the former Soviet Union, the positive effect of university and vocational education on employment is found to go down with age. Originality/value This is the first study which compares effect of different types of education on probability of being employed on a diverse sample of 29 post-communist countries over the period of five years.

Uspostavljanje modela filmske edukacije u srednjoj školi

Potential modifiable risk factors for macrosomia in patients with gestational diabetes mellitus

BACKGROUND AND AIM: The environmental injustice of beauty framework links intersectional systems of oppression (e.g. racism, sexism, classism) to racialized beauty practices and poor health outcomes. Historical and ongoing discrimination around vaginal odors especially among women of color can influence menstrual and other vaginal product use, which are a source of exposure to harmful chemical mixtures. The aim of this analysis is to examine differences in vaginal product use by race/ethnicity and socioeconomic status. METHODS: We combined survey data on vaginal product use from the following two studies focused on the health of Black and Latina reproductive-aged women: a hospital-based study in the Washington, DC area (FORGE) and a community-based study in California (Taking Stock). Vaginal product use was examined at the intersections of race/ethnicity (Black (N=185), Latina (N=156), White (N=71), and Other (N=84) and socioeconomic status (≦High School (HS) education (N=99) versus HS (N=391)). RESULTS:Significant differences exist in the type of vaginal care products used by racial/ethnicity as well as by educational attainment. Tampon and menstrual cup use were more common among White women than Black or Latina women (p.001). Among women of color, tampon and menstrual cup use were greater among more highly educated women. Conversely, less educated women were more likely to use douches, feminine sprays, and scented tampons and pads (p.01). The highest prevalence of most fragranced product use was among Black women with HS education or less. CONCLUSIONS:White women with some college education have significantly different vaginal product use patterns than Black and Latina women without a college education. Racial/ethnic and socioeconomic patterns in product use may contribute to inequities in environmental exposures and health outcomes. In future analyses, we will examine intersectional patterns across multiple product categories. KEYWORDS: Environmental disparities, Female, Environmental epidemiology, Chemical exposures

ObjectiveTo assess if the educational level of patients in Southwestern China will affect the functional recovery after total knee arthroplasty (TKA).MethodsThis retrospective study included a total of 334 patients (48 males, 286 females, with an average age of 68 years, range from 51 to 84 years) who had undergone primary unilateral TKA from March 2017 to April 2018. Patients were screened for enrollment and classified into four groups (illiterate group, the primary school group, high school group, and university group) according to their educational attainment. All patients were monitored for at least 2 years after TKA. The primary outcome was determined using the Hospital for Special Surgery knee (HSS) score at the time of follow‐up. The secondary outcomes were determined using the 12‐Item Short Form Health Survey (SF‐12) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, the satisfaction level, and complications of the surgery.ResultsThree hundred and thirty‐four patients were divided into four groups based on their highest educational level: 83 patients in the illiteracy group, 84 in the primary school group, 91 in the high school group, and 76 in the university group. They were followed up for at least 2 years. For the primary outcome, patients with high school and university education had noteworthy better HSS scores on the surgical‐side knee than those in the primary school and illiterate groups (illiteracy group 86.71 ± 5.94 vs primary school group 85.36 ± 5.88 vs high school group 89.48 ± 3.66 vs university group 88.95 ± 3.55; P < 0.05). For secondary outcomes, the mental component summary (MCS) in the university group was significantly lower than the other three groups (P < 0.05). The results of WOMAC scores were consistent with the results of the HSS score: patients in the university group and the high school group had better results when compared with the other two groups (P < 0.05). There were no statistical differences in the comparison of additional indicators and complications among the four groups, but more patients (12 peoples, 15.8%) in the university group were dissatisfied with knee function after TKA.ConclusionIn Southwest China, patients with high school education or above can achieve better joint function after TKA but do not get better postoperative satisfaction, which may be related to the patients' higher surgical expectations for social and mental needs.

IntroductionMultiple epidemiological studies have investigated the association between stroke clinical outcomes and education level. However, the relationship between the level of education in patients who underwent mechanical thrombectomy (MT) is limited. We aim to assess if the level of education is associated with poor functional outcome, defined as a modified Rankin Scale (mRS) score of ≥3, in patients following MT.MethodsWe reviewed 257 patients with large vessel occlusion (LVO) who underwent MT between 2018 and June 2023, education levels were available on 106 patients. Education level was defined as “less than high school” (n=15, 14.2%), “high school” (n=54, 50.9%), and “college or higher” (n=36, 34%), 1 of these with “other” education level was excluded from the analysis. Chi‐square and Kruskal Wallis tests were used to examine potential differences in education level and outcomes. All analyses were conducted in IBM SPSS Statistics version 29.ResultsCompared to those with a college or higher education, those with a less than high school education were more likely to have a poor functional outcome (mRS ≥3) at 90 days. (p=0.03). Black patients were more likely to have a less than high school education than white patients (30.0% vs 4.8%) p<0.001. There were no significant differences in mortality, length of hospitalization, comorbid conditions, Alberta stroke program early CT score (ASPECTS), or initial National Institutes of Health Stroke Scale (NIHSS).ConclusionIn our cohort, patients with less than a high school education are more likely to have poorer functional outcomes 90 days post‐MT compared with patients with a college education or higher. Interestingly, there was no significant statistical difference noted in initial NIHSS, ASPECTS, and length of hospitalization between these cohorts. Larger post‐thrombectomy cohorts should be used to further investigate these initial results. In addition, it is important to note that education and race are intertwined in this study, though our relatively small sample of post‐thrombectomy patients limited our analyses. Future research should evaluate this relationship further.

Prevalence and Correlates of Erectile Dysfunction by Race and Ethnicity Among Men Aged 40 or Older in the United States: From the Male Attitudes Regarding Sexual Health Survey

BackgroundDecisions about limitations of life sustaining treatments (LST) are made for end-of-life patients in intensive care units (ICUs). The aim of this research was to explore the professional and ethical attitudes and experiences of medical professionals on treatment of end-of-life patients in ICUs in the Republic of Croatia.MethodsA cross-sectional study was conducted among physicians and nurses working in surgical, medical, neurological, and multidisciplinary ICUs in the total of 9 hospitals throughout Croatia using a questionnaire with closed and open type questions. Exploratory factor analysis was conducted to reduce data to a smaller set of summary variables. Mann–Whitney U test was used to analyse the differences between two groups and Kruskal–Wallis tests were used to analyse the differences between more than two groups.ResultsLess than third of participants (29.2%) stated they were included in the decision-making process, and physicians are much more included than nurses (p < 0.001). Sixty two percent of participants stated that the decision-making process took place between physicians. Eighteen percent of participants stated that ‘do-not-attempt cardiopulmonary resuscitations’ orders were frequently made in their ICUs. A decision to withdraw inotropes and antibiotics was frequently made as stated by 22.4% and 19.9% of participants, respectively. Withholding/withdrawing of LST were ethically acceptable to 64.2% of participants. Thirty seven percent of participants thought there was a significant difference between withholding and withdrawing LST from an ethical standpoint. Seventy-nine percent of participants stated that a verbal or written decision made by a capable patient should be respected. Physicians were more inclined to respect patient’s wishes then nurses with high school education (p = 0.038). Nurses were more included in the decision-making process in neurological than in surgical, medical, or multidisciplinary ICUs (p < 0.001, p = 0.005, p = 0.023 respectively). Male participants in comparison to female (p = 0.002), and physicians in comparison to nurses with high school and college education (p < 0.001) displayed more liberal attitudes about LST limitation.ConclusionsDNACPR orders are not commonly made in Croatian ICUs, even though limitations of LST were found ethically acceptable by most of the participants. Attitudes of paternalistic and conservative nature were expected considering Croatia’s geographical location in Southern Europe.

PURPOSE: The isometric grip test is a simple measure of muscle strength that was recently added to the National Health and Nutrition Examination Survey (NHANES). Previous research has shown an inverse relationship between grip strength and cardiovascular mortality. Since grip strength in an American population-based study has never been reported, this study describes grip strength in American adults by demographics, obesity category, and physical activity (PA) level. METHODS: Adults (n= 4252) completed the 2011-2012 NHANES’ body measure, grip test, demographic and physical activity questionnaires. Data were analyzed via SAS 9.4 SURVEY procedures using NHANES analytic guidelines. RESULTS: Over 35% of American adults were obese (body mass index > 30 kg/m2); 55.07% were viscerally obese (sagittal abdominal diameter >22 cm for male, and >20 cm for female). Males (42.73 ± 0.36 kg) demonstrated significantly stronger grip strength than females (26.83 ± 0.17 kg) (p<0.0001). Adults 20-39y had significantly stronger grip strength than those 40-59y (p=0.0008) and 60+ y (p<0.0001), and adults 40-59y had stronger grip strength than those 60+y (p<0.0001). Non-Hispanic Blacks (NHB) had stronger grip strength than non-Hispanic Whites (NHW, p=0.003), Hispanics (H; p<0.0024) and Non-Hispanic Asians (NHA, p<0.0001), and both NHW and H had stronger grip strength than NHA (p<0.0001). There was no difference between grip strength of NHW and H (p=0.99). High income adults had significantly stronger grip strength than those classified as low (p=0.01) or middle income (p=0.038). Adults with less than high school education had weaker grip strength than those with high school (p=0.043) or college education (p=0.004). Obese adults had stronger grip strength than non-obese adults (p=0.0004), and viscerally obese adults had stronger grip strength than those not viscerally obese (p=0.016). Adults who reported no moderate-to-vigorous leisure-time physical activity (MVLTPA) participation had significantly weaker grip strength than those who reported MVLTPA participation (p=0.0006). CONCLUSIONS: Grip strength varies by demographics, obesity category, and PA level. Future research is needed to link grip strength to other risk factors (e.g., dietary patterns) and health conditions in American adult population.

Estimating county-level demand for educational attainment