Background: Reduced socioeconomic status (SES) is associated with an increased risk of stroke, although the mechanism is not clear. It may be that those with lower SES have a greater burden of classic vascular risk factors. Methods: Our aim was to quantify the extent to which classic vascular risk factors explain the association between SES and stroke incidence. We conducted a systematic review and meta-analysis of studies examining the association of SES and stroke incidence, where classic vascular risk factors were considered. Searching MEDLINE, EMBASE and the Cochrane Library from 1980 onwards we identified 17 studies, 12 of these studies provided sufficient information to allow a meta-analysis. From each study the increased risk of stroke incidence, where the lowest socioeconomic category was compared with the highest, was recorded and pooled. The stroke incidence risks, adjusted for grouped classic risk factors, were also pooled. Review Manager 5 software was used for all analyses and results were analysed using hazard ratios (HR, 95% confidence interval, 95% CI) with a random effects model. Results: Those with a lower SES were more likely to have a stroke (HR 1.67; 95% CI 1.46–1.91). Additional risk was reduced, but not eliminated, when classic vascular risk factors were adjusted for (HR 1.31; 95% CI 1.16–1.48). Conclusion: Low SES is associated with an increased risk of stroke that is partly explained by known classic vascular risk factors.

The symbolic play and social participation behaviors of 6 language-impaired and 8 normal language-learning children were compared on three measures of play: (a) the Symbolic Play Test (Lowe & Costello, 1976), (b) the Brown-Lunzer Scale (Brown, Redmond, Bass, Liebergott, & Swope, 1975), and (c) the Scale of Social Participation in Play (Tizard, Philps, & Plewis, 1976). Subject groups were equated for MLU (Brown, 1973), Developmental Sentence Scoring (Lee, 1974), and performance on the Test of Auditory Comprehension of Language (Carrow, 1973). Results indicated that the language-impaired subjects demonstrated significant deficits in symbolic, adaptive, and integrative play behaviors in comparison with the linguistically equivalent normal subjects. The language-impaired group also evidenced significantly more nonplay and significantly less solitary and parallel play than their normal peers. Findings are discussed with respect to the developmental relationship between language and cognition.

Extended‐release tacrolimus for prophylaxis of allograft rejection in orthotopic heart transplant (OHT) recipients is currently not FDA‐approved. One such extended‐release formulation of tacrolimus known as LCPT allows once‐daily dosing and improves bioavailability compared to immediate‐release tacrolimus (IR‐tacrolimus). We compared the efficacy and safety of LCPT to IR‐tacrolimus applied de novo in adult OHT recipients. Twenty‐five prospective recipients on LCPT at our center from 2017 to 2019 were matched 1:2 with historical control recipients treated with IR‐tacrolimus based on age, gender, and baseline creatinine. The primary composite outcome of death, acute cellular rejection, and/or new graft dysfunction within 1 year was compared using non‐inferiority analysis. LCPT demonstrated non‐inferiority to IR‐tacrolimus, with a primary outcome risk reduction of 20% (90% CI: ‐40%, ‐.5%; non‐inferiority P = .001). Tacrolimus trough levels peaked at 2–3 months and were higher in LCPT (median 14.5 vs. 12.7 ng/ml; P = .03) with similar dose levels (LCPT vs. IR‐tacrolimus: .08 vs. .09 mg/kg/day; P = .33). Cardiovascular‐related readmissions were reduced by 62% (P = .046) in LCPT patients. The complication rate per transplant admission and all‐cause readmission rate did not differ significantly. These results suggest that LCPT is non‐inferior in efficacy to IR‐tacrolimus with a similar safety profile and improved bioavailability in OHT.

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