Heart Foundation

This study examines cultural interference in Indonesian folktale writing in Japanese produced by university-level learners of Japanese as a foreign language. The research aims to identify patterns of cultural interference and to describe how Indonesian cultural concepts are transferred, adapted, or inadequately represented in Japanese narrative texts. Employing a qualitative descriptive approach, the study analyzes 39 folktales written by Indonesian students at intermediate to upper-intermediate proficiency levels. The data were analyzed at lexical, grammatical, and discourse levels using contrastive analysis, error analysis, interlanguage analysis, and contrastive rhetoric. The findings reveal that cultural interference occurs consistently across all texts. Lexical interference is reflected in inappropriate word choice and the use of culturally bound terms without adequate adaptation. Grammatical interference appears in inconsistent sentence-final forms, inaccurate tense and aspect marking, and frequent misuse or omission of particles. At the discourse level, interference manifests through abrupt subject shifts, non-natural sentence structures, and insufficient contextual introduction of characters and settings, which disrupt narrative coherence. The study demonstrates that cultural interference in foreign language writing extends beyond linguistic error and represents learners’ ongoing intercultural negotiation. The findings highlight the importance of integrating cultural discourse awareness into Japanese language writing instruction, particularly in narrative-based learning contexts.

Takotsubo Cardiomyopathy (TTC) is an acute heart condition in which physical or emotional stress causes left ventricular dysfunction. Psychiatric comorbidities have been linked to the precipitation of this condition, but large-scale data are limited. The goal of this study was to analyze the associations between TTC and various psychiatric conditions using nationally representative data. A retrospective observational cohort study was conducted using the Nationwide Inpatient Sample (NIS) database from 2016-2022. ICD-10 code I51.81 was used to identify hospitalized patients ≥18 years with a primary diagnosis of TTC. In addition, ICD-10 codes were used to identify patients diagnosed with various psychiatric comorbidities. A total of 291,600 patients had a primary diagnosis of TTC. The mean age was 67.1 ± 14.26 years and 82.04% of the population was female. The following four psychiatric comorbidities were found to have significant associations with TTC: nicotine dependence (17.48% of patients; p<0.001; OR 1.08; 95% CI, 1.06-1.11), depressive disorders (19.20% of patients; p<0.001; OR 1.46; CI 95%, 1.43-1.49), anxiety (24.25% of patients; p<0.001; OR 1.83; CI 95%, 1.80-1.87), and PTSD (2.91% of patients; p<0.001; 1.25 OR; CI 95%, 1.18-1.31). No significant associations were found for dementia, alcohol related disorders, substance use other than tobacco and alcohol, manic disorders, or schizophrenia. In this large, nationally representative sample, nicotine dependence, anxiety, depression, and PTSD were significantly associated with TTC. These findings highlight the importance of incorporating psychiatric health practices into the field of cardiology.

HEARTS is a whole-school, prevention and intervention approach that addresses trauma and chronic stress at the student, staff, and school organizational levels. HEARTS is guided by six core evidence-grounded principles: 1) understanding stress and trauma; 2) cultural humility and equity; 3) safety and predictability; 4) compassion and dependability; 5) empowerment and collaboration; and 6) resilience and social-emotional wellness. One feature that distinguishes *MASKED* from other school-based trauma-informed approaches is the centrality of cultural humility and equity, emphasizing that if an approach or intervention is not socially and racially just, then it is not trauma-informed. Since 2008, HEARTS has integrated culturally responsive and anti-oppressive approaches across a variety of implementation models. This paper describes practice-based lessons learned and insights across these various implementation models with respect to moving the needle on anti-racist, socially just, trauma-informed practices.

There is a paucity of data regarding the longer-term durability of transcatheter heart valves. This analysis aimed to describe the 5-year clinical outcomes and valve durability for patients treated with the Portico transcatheter heart valves across 3 studies harmonized in their prospective enrollment, inclusion/exclusion criteria, centralized independent core laboratory echocardiographic analysis, and independent clinical events committee adjudication. Patient-level data from the PORTICO IDE randomized controlled trial, the PORTICO I postmarket study, and the PORTICO continued access protocol were pooled using a random-effects meta-analysis model. All 3 studies collected follow-up data at discharge, 30 days, and annually through 5 years. Adverse events and pooled echocardiographic data were assessed using Valve Academic Research Consortium-2 definitions. Durability definitions were adapted from Valve Academic Research Consortium-3 and European Association of Percutaneous Cardiovascular Interventions/European Society of Cardiology/European Association for Cardio-Thoracic Surgery consensus guidelines. A total of 1464 patients with severe symptomatic aortic stenosis and high or extreme surgical risk were included. Median age was 83 years, 61.7% were women, and the median Society of Thoracic Surgeons score was 4.9%. At 5 years, all-cause mortality and stroke rates were 49.4% and 12.3%, respectively. Transvalvular gradient and effective orifice area at 5 years were 6.2 mm Hg and 1.83 cm2, respectively, with paravalvular leak ≥moderate severity occurring in 1.9%. The 5-year bioprosthetic valve failure rate was 2.7%, including a 0.7% valve-related death rate and a 2.0% valve reintervention rate, but no patients with severe hemodynamic structural valve deterioration. Moderate hemodynamic structural valve deterioration occurred in 0.9% of the patients at 5 years. Hemodynamic performance and transcatheter heart valve durability remained stable irrespective of annular size. The use of the Portico transcatheter heart valve system in patients at high or extreme surgical risk demonstrated favorable clinical outcomes and hemodynamic performance with low transvalvular gradients and greater than mild paravalvular leak. Furthermore, bioprosthetic valve failure rates were low with no incidence of severe hemodynamic structural valve deterioration at 5 years, irrespective of annular size. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02000115 and NCT01802788.

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of mortality worldwide. Survival following OHCA largely depends on whether the initial heart rhythm is shockable or non-shockable. Previous research has suggested that drugs with an off-target effect of blocking cardiac depolarization (non-cardiac depolarization-blocking (DB) drugs) may be associated with a higher likelihood of having a non-shockable rhythm. In this study, we examined whether the use of non-cardiac DB-drugs affects the initial rhythm and survival in OHCA. We identified all patients with OHCA of medical causes from the nationwide Danish Cardiac Arrest Registry (2001-2020). Non-cardiac DB-drug use was defined by prescriptions within 90days prior to OHCA. Multiple logistic regression models with adjustments for relevant confounders were employed to estimate the odds ratio (OR) for the association between non-cardiac DB-drugs and initial heart rhythm and 30-day survival following OHCA. Additionally, stratified analyses were performed based on sex, age, cardiovascular and psychiatric comorbidities, and the year of OHCA occurrence. We included 54,370 OHCA patients (63.1% male, median age 74years). Non-cardiac DB-drugs was used by 6284 (11.6%) OHCA patients and was associated with increased odds of non-shockable rhythm compared with non-users after adjustment for relevant confounders (OR 1.62, 95% CI: 1.48-1.79). This increased odds of non-shockable rhythm was consistent in men and women (ORmen: 1.72, 95% CI: 1.53-1.95, ORwomen 1.46, 95% CI: 1.26-1.70), in all age categories (OR<60 years 1.91, 95% CI: 1.54-2.39, OR>60 years 1.57, 95% CI: 1.41-1.74), in the absence of pre-existing psychiatric or non-cardiovascular disease, or when stratified by the year of OHCA occurrence. Finally, we found that users of non-cardiac DB-drugs had lower 30-day survival chances following OHCA when compared to non-users (OR 0.81, 95% CI: 0.69-0.95). Use of non-cardiac DB-drugs was associated with increased odds of non-shockable rhythm in OHCA and with lower 30-day survival following OHCA.

BackgroundFalls are the second leading cause of unintentional injury-related deaths globally, causing approximately 684,000 deaths annually, with over 80% occurring in low- and middle-income countries. In rural Thailand, older adults are especially vulnerable due to limited access to healthcare, rehabilitation services, and safe home environments. Despite their impact, falls are often overlooked in injury prevention, particularly in resource-limited settings.ObjectivesThis initiative aimed to reduce fall-related risks among older adults in rural Thailand through: (1) training Village Health Volunteers (VHVs) in the use of the CDC’s STEADI tool for fall risk screening and early intervention; (2) equipping VHVs to conduct home safety assessments and implement personalized fall prevention strategies; and (3) promoting social connection and health literacy through community activities, including intergenerational fall prevention fairs.ResultsTwelve VHVs completed online STEADI-based training adapted to the local context. Over one month, they conducted 439 home visits across rural Chiang Mai, identifying risks and delivering targeted interventions. Two fall prevention fairs, held in collaboration with international high school students, encouraged intergenerational engagement and public awareness. The program improved perceptions of safety, increased health knowledge, and reinforced VHVs’ roles as trusted public health agents.ConclusionTraining VHVs in evidence-based fall prevention is a scalable, cost-effective strategy to reduce injuries and promote healthy aging in low-resource communities. This model highlights the value of early intervention, local leadership, and social connection in strengthening community resilience.Key messages• Empowering Village Health Volunteers with fall prevention training and tools like STEADI enables early intervention, home safety assessments, and injury reduction among older adults in limited-resource rural communities.• Community engagement through intergenerational activities and fall prevention fairs fosters social connection, combats isolation, and promotes emotional well-being among older adults in resource-limited settings.TopicFall prevention, healthy aging, social connection

Stressor-associated atrial fibrillation (AF), defined as newly diagnosed AF in the setting of a reversible physiological stressor, is common. However, risk factors, outcomes, and current management practices remain poorly understood. We analyzed data from VITAL-AF, a pragmatic, cluster-randomized AF screening trial conducted in 2018 and 2019 comprising adults ≥65 years of age across 16 primary care practices affiliated with Massachusetts General Hospital. All participants had longitudinal follow-up for adjudicated incident AF (including whether stressor-associated versus nonstressor-associated ["primary"]) and clinical outcomes. We compared associations between clinical AF risk factors and incident AF group (stressor-associated versus primary) using Fine-Gray models handling death and each AF group as competing risks. We also quantified oral anticoagulant initiation rates after AF diagnosis. We then fit Cox proportional hazards models to quantify associations between incident AF group (as a time-varying covariate) and a composite end point of major bleeding, stroke, and all-cause mortality, with adjustment for CHA₂DS₂-VASc (congestive heart failure, hypertension, age >74, diabetes, stroke or transient ischemic attack or thromboembolism, vascular disease, age 65-74, sex category; stroke) and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation; bleeding) scores and time-varying oral anticoagulant exposure. We analyzed 30 265 patients (41% men, 83% White, and mean age 74 years). Of 988 incident AF events, 290 (29%) were stressor associated. Clinical risk factors, including age, hypertension, and heart failure, showed similar associations with both primary and stressor-associated AF. Oral anticoagulant initiation within 90 days of new AF diagnosis was lower for stressor-associated versus primary AF (56% versus 75%, P<0.001). The incidence of the composite end point was 2.30 per 100 person-years (95% CI, 2.17-2.44) for no AF, 15.09 (95% CI, 12.22-18.42) for primary AF, and 22.71 (95% CI, 16.91-29.87) for stressor-associated AF. In adjusted models and using no AF as the referent, both primary AF (hazard ratio [HR], 3.91 [95% CI, 2.89-5.28]) and stressor-associated AF (HR, 6.13 [95% CI, 4.31-8.72]) were associated with substantially higher risk of the composite end point. Among >30 000 primary care patients with adjudicated AF events, nearly one-third of incident AF cases were stressor associated. Despite similar risk factor profiles and comparably high rates of adverse outcomes, oral anticoagulant initiation is lower when AF is stressor associated. Future work is needed to define optimal approaches to prevention, surveillance, and management of stressor-associated AF.