Background: Emerging evidence suggests that elevated circulating levels of HDL-C (high-density lipoprotein cholesterol) could be linked to an increased mortality risk. However, to the best of our knowledge, the relationship between HDL-C and specific cardiovascular events has never been investigated in patients with hypertension. Methods: To fill this knowledge gap, we analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Campania Salute Network in Southern Italy. Results: We studied 11 987 patients with hypertension, who were followed for 25 534 person-years. Our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C<40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/dL (medium HDL-C); and HDL-C>80 mg/dL (high HDL-C). At the follow-up analysis, adjusting for potential confounders, we observed a total of 245 cardiovascular events with a significantly increased risk of cardiovascular events in the low HDL-C group and in the high HDL-C arm compared with the medium HDL-C group. The spline analysis revealed a nonlinear U-shaped association between HDL-C levels and cardiovascular outcomes. Interestingly, the increased cardiovascular risk associated with high HDL-C was not confirmed in female patients. Conclusions: Our data demonstrate that there is a U-shaped association between HDL-C and the risk of cardiovascular events in male patients with hypertension.
Background: Clinical and radiographic criteria are traditionally used to determine the need for surfactant therapy in preterm infants. Lung ultrasound is a bedside test that offers a rapid, radiation-free, alternative to this approach.Objective: To conduct a systematic review and meta-analysis to determine the accuracy of a lung ultrasound score (LUS) in identifying infants who would receive at least one surfactant dose. Secondary aims were to evaluate the predictive accuracy for ≥2 doses and the accuracy of a different image classification system based on three lung ultrasound profiles.Methods: PubMed, SCOPUS, Biomed Central, and the Cochrane library between January 2011 and December 2021 were searched. Full articles enrolling preterm neonates who underwent lung ultrasound to predict surfactant administration were assessed and analyzed following Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and QUADAS-2 guidelines.Results: Seven prospective studies recruiting 697 infants met the inclusion criteria.Risk of bias was generally low. Oxygen requirement, clinical and radiographic signs of respiratory distress syndrome were used as reference standards for surfactant replacement. The summary receiver operator characteristic (sROC) curve for LUS predicting first surfactant dose showed an area under the curve (AUC) = 0.88 (95% confidence interval [CI]: 0.82-0.91); optimal specificity and sensitivity (Youden index) were 0.83 and 0.81 respectively. Pooled estimates of sensitivity, specificity, diagnostic odds ratio, negative predictive value, and positive predictive value for LUS predicting the first surfactant dose were 0.
Interpersonal emotion regulation entails a wide array of strategies aimed at influencing others' emotions. Despite its importance for successful social interactions, only a few studies have evaluated interpersonal emotion regulation in children. In detail, the study of developmental changes in the use of emotion regulation strategies overlooked age, gender and cultural differences across different emotions. To address this gap, the present study used the serious game Emodiscovery, a simulation game targeted at 8-10 year-olds, which measures the strategies selected by children to improve the emotions of anger, sadness, and fear displayed by 3D virtual characters. One-hundred British (M = 9.10 years; 39% girls) and 108 Spanish (M = 9.04, 44% girls) 8-10 year-olds played three different levels or scenarios of the game. In each level, the character displayed a negative emotion (i.e., sadness, anger, and fear, respectively) and children were first asked to indicate what emotion the character was feeling and afterwards to interact three times with the character to improve his/her mood. In each interaction, four possible regulation strategies (two adaptive and two maladaptive) were displayed for children to select. Results showed that in the scenario where the character was displaying sadness, 8-year-olds chose significantly less adaptive strategies than 10-years-olds. In the scenario where the character was angry, boys who accurately recognized the emotion of anger chose more adaptive strategies than those who did not recognize the emotion. For the scenario depicting fear, boys chose less adaptive strategies than girls. The obtained results highlight the importance of looking at specific emotions when researching interpersonal emotion regulation.
Emotion regulation (ER) is key for children's development and it has recently been considered in many serious games and e-learning technologies. However, these tools have focused on children's efforts to change their own emotions (intrapersonal ER), overlooking how children may engage in modifying the emotions of others (interpersonal ER). To address this gap, we have developed a multiplatform online serious game, Emodiscovery, which evaluates whether children (8-11 year-olds) tend to use different adaptive and maladaptive regulation strategies to change others' negative emotions with the use of 3D animated characters. The game is organized into levels, each representing a different scenario, where the child is asked to interact with the character three times choosing an appropriate regulation strategy to cheer him or her up from four possible options, being two adaptive and two maladaptive strategies. To test the effectiveness of the game, a sample of English children played three scenarios depicting a character feeling sadness, anger, and fear, respectively. Results showed that most children chose adaptive strategies to improve the character's emotion across the different emotion scenarios. Furthermore, emotion recognition was not positively related to children's choices of regulation strategies. The implications and applications of the games are discussed.
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