Children are at high risk for negative COVID-19 related outcomes. The present longitudinal study assessed (1) changes in child internalizing and externalizing problems from before to during the pandemic and (2) whether parent mental health (depression, anxiety, stress) or parenting behavior during COVID-19 were associated with changes in child mental health problems. Sixty eight mother-child dyads participated in this study. Children were approximately five years-old at the time of enrollment and were between the ages of 7–9 years old at the time of the follow-up survey. Parenting behavior, parental depression, anxiety, perceived stress and child internalizing and externalizing problems were measured using validated questionnaires. Children experienced greater internalizing (t = 6.46, p < 0.001) and externalizing (t = 6.13, p < 0.001) problems during the pandemic compared to before the pandemic. After taking into account child gender and COVID-related stressors, parental hostility was uniquely associated with greater changes in externalizing problems (β = 0.355, SE = 0.178, p < 0.05), while maternal anxiety was associated with greater increases in internalizing problems (β = 0.513, SE = 0.208, p < 0.05). Findings highlight the need for mental health supports for families to limit the impact of the COVID-19 pandemic on child and parent mental health.
Background
Sodium‐glucose co‐transporter (SGLT) inhibitors reduce cardiovascular outcomes including mortality in several populations; however, their effect on atrial fibrillation/flutter (AF) remains unclear. Our objective was to determine whether SGLT inhibitors reduce AF and whether a history of AF modifies the effect of SGLT inhibitors on the composite of heart failure hospitalization or cardiovascular death.
Methods and Results
We searched MEDLINE, Embase, and CENTRAL to March 2021. Pairs of reviewers identified randomized controlled trials that compared an SGLT inhibitor with placebo or no therapy. We pooled data using RevMan 5.4.1, assessed risk of bias using the Cochrane tool, and determined the overall quality of evidence using Grades of Recommendation, Assessment, Development and Evaluation. Thirty‐one eligible trials reported on AF events (75 279 participants, mean age 62 years, 35.0% women). Moderate quality evidence supported a lower risk of serious AF events with SGLT inhibitors (1.1% versus 1.5%; risk ratio 0.75 [95% CI, 0.66–0.86]; I
2
=0%). A similar reduction in total AF events was also noted with SGLT inhibitors. Three trials reported on heart failure hospitalization/cardiovascular death stratified by a baseline history of AF (18 832 participants, mean age 66 years, 38.1% women); in patients with a history of AF, SGLT inhibitors resulted in a lower risk in the composite of heart failure hospitalization or cardiovascular death (hazard ratio, 0.70 [95% CI, 0.57–0.85]; I
2
=0%)—similar to the effect estimate for patients without AF,
P
value for interaction: 1.00.
Conclusions
SGLT inhibitors may reduce AF events and likely reduce heart failure hospitalization/cardiovascular death to a similar extent in patients with and without AF.
Cardiovascular disease (CVD) is the leading cause of death worldwide. The effects of testosterone, the primary male sex hormone, on cardiovascular risk have been of special interest due to the increased risk of CVD in men. Although it is well established that testosterone levels decline and cardiovascular mortality increases with age, the association between testosterone and CVD remains unclear. Observational and randomized studies on the effects of endogenous and exogenous testosterone have produced conflicting data, and meta-analyses have been inconclusive, suggesting significant study heterogeneity. Despite a lack of adequately powered randomized controlled trials, large observational studies in the early 2010s led to advisories on the use of testosterone replacement therapy. Similar advisories have been mandated for certain types of androgen deprivation therapy. Additional research suggests that testosterone shortens the heart-rate–corrected QT interval, improves glycemic control, induces vasodilation, is prothrombotic, and has anti-obesity effects, whereas associations with atherosclerosis and inflammation are less clear. Despite inconclusive evidence on cardiovascular risk and inconsistencies among clinical practice guidelines, millions of men continue to use testosterone replacement and androgen deprivation therapy. In addition to summarizing clinical and preclinical data, this review provides insight on potential mechanisms of action of testosterone on CVD, applications of this knowledge to clinical settings, and avenues for future research.
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