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Prospective Population (prospective + population)
Selected AbstractsOverweight and Obesity in Old Age Are Not Associated with Greater Dementia RiskJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008(See editorial comments by Dr. David S. Knodman, 2350), pp 234 OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons. DESIGN: Prospective population-based study, with 8 years of follow-up. SETTING: The municipality of Lieto, Finland, 1990/91 and 1998/99. PARTICIPANTS: Six hundred five men and women without dementia aged 65 to 92 at baseline (mean age 70.8). MEASUREMENTS: Weight and height were measured at baseline and at the 8-year follow-up. Dementia was clinically assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. RESULTS: Eighty-six persons were diagnosed with dementia. Cox regression analyses, adjusted for age, sex, education, cardiovascular diseases, smoking, and alcohol use, indicated that, for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio (HR)=0.92, 95% confidence interval (CI)=0.87,0.97). This association remained significant when individuals who developed dementia early during the first 4 years of follow-up were excluded from the analyses (HR=0.93, 95% CI=0.86,0.99). Women with high BMI scores had a lower dementia risk (HR=0.90, 95% CI=0.84,0.96). Men with high BMI scores also tended to have a lower dementia risk, although the association did not reach significance (HR=0.95, 95% CI=0.84,1.07). CONCLUSION: Older persons with higher BMI scores have less dementia risk than their counterparts with lower BMI scores. High BMI scores in late life should not necessarily be considered to be a risk factor for dementia. [source] Walking and Talking as Predictors of Falls in the General Population: The Leiden 85-Plus StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2003Annetje Bootsma-van der Wiel MD Objectives: To compare the value of dual tasking in predicting falling in the general population of oldest old with that of easy-to-administer single tasks. Design: Prospective population-based follow-up study. Setting: Municipality of Leiden, the Netherlands. Participants: Representative cohort of 380 individuals, all aged 85 at baseline. Measurements: During enrollment, walking time over a 12-meter distance was measured, as well as the verbal fluency to recite names of animals or professions during a 30-second period. In the dual task, performance was assessed when participants combined walking with reciting names. Incidence of falls and fractures was assessed by interviewing participants and checking their medical histories. Results: After 1 year of follow-up, 42% of the participants reported one or more falls, and 4% suffered a fracture. Total walking time, number of steps, and verbal fluency were all strongly related to incident falls (P for trend for all <.01), but dual-task performance was not a better predictor for incident falls than single-task performance. Conclusion: The dual-task test in this study had no predictive value above that of a single-task test to predict falling. Dual tasks with more-sensitive measures of impaired dual-task execution might have better test characteristics. In this study, history of falls and performance on an easy-to-administer single walking task identified old persons at higher risk for falling who could benefit from fall preventive strategies. [source] Musculoskeletal Pain and Risk for Falls in Older Disabled Women Living in the CommunityJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2002Suzanne G. Leveille PhD OBJECTIVES: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities. DESIGN: Prospective population-based cohort study. SETTING: The city and county of the eastern area of Baltimore. PARTICIPANTS: One thousand two women aged 65 and older, participants in the Women's Health and Aging Study, representing the one-third of older women who were living at home with disabilities, followed semiannually for 3 years beginning in 1991. MEASUREMENTS: Pain was categorized into four groups according to severity and location. Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region, with moderate to severe pain in at least one region (, 4 on a 10-point numeric rating scale, 10 = excruciating pain). Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category. The reference category was no pain or mild pain in one site. The additional category of "other pain" was pain that did not fit into the other three groups. The occurrence of falls and fall-related injuries were assessed at each interview. RESULTS: Of the 940 women who participated in at least one follow-up examination, 39% fell in first year; of the survivors, 36% fell in Year 2, and 39% in Year 3. After adjusting for several major risk factors for falls, women with widespread pain had an increased likelihood of falling during follow-up (adjusted odds ratio (AOR) = 1.66, 95% confidence interval (CI) = 1.25,2.21) compared with those with no or mild pain in only one musculoskeletal site. Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls (AOR = 1.36, 95% CI = 1.02,1.82). Among women with musculoskeletal pain, risk for falls was lower in those who used daily analgesic medication. Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain, most consistently in women with widespread pain. CONCLUSIONS: Musculoskeletal pain, particularly widespread pain, is a substantial risk factor for falls in older women with disabilities. These findings add an important dimension to our understanding of the multifactorial processes leading to falls in older persons. J Am Geriatr Soc 50:671,678, 2002. [source] Binge drinking and depressive symptoms: a 5-year population-based cohort studyADDICTION, Issue 7 2009Tapio Paljärvi ABSTRACT Background Only few prospective population studies have been able so far to investigate depression and drinking patterns in detail. Therefore, little is known about what aspect of alcohol consumption best predicts symptoms of depression in the general population. Participants and design In this prospective population-based two-wave cohort study, a cohort of alcohol-drinking men and women (n = 15 926) were followed-up after 5 years. A postal questionnaire was sent in 1998 (response proportion 40%) and again in 2003 (response proportion 80% of the baseline participants) to Finnish adults aged 20,54 years at baseline. Measurements Alcohol consumption was measured by average intake (g/week) and by measures of binge drinking (intoxications, hangovers and alcohol-induced pass-outs). Depressive symptoms were assessed with the 21-item Beck Depression Inventory. In addition, information from hospital discharge register for depression and alcohol abuse were linked to the data. Findings This study found a positive association between baseline binge drinking and depressive symptoms 5 years later. Adjustment for several possible confounders attenuated the observed relationships only slightly, suggesting that binge drinking contributes independently to the occurrence of depressive symptoms. Binge drinking was related to symptoms of depression independently of average intake. Conclusions This study supports the hypothesis that heavy drinking, and in particular a binge pattern involving intoxications, hangovers or pass-outs, produces depressive symptoms in the general population. The frequency of hangovers was the best predictor for depressive symptoms. [source] Physical activity in adolescence and smoking in young adulthood: a prospective twin cohort studyADDICTION, Issue 7 2007Urho M. Kujala ABSTRACT Aims To control for familial confounds, we studied the association between adolescent physical activity and later smoking in twin siblings discordant for their baseline physical activity. Design and measurements In this prospective population-based twin study, we asked whether persistent physical activity/inactivity in adolescence (assessed at 16, 17 and 18.5 years) predicted questionnaire-reported daily smoking at ages 22,27. Twins who, on the three baseline questionnaires, consistently reported frequent leisure physical activity (more than three times weekly) were classified as persistent exercisers, those who exercised less than three times monthly were called persistently inactive, others were occasional exercisers. Setting Finland. Participants A total of 4240 individuals, including 1870 twin pairs. Findings In analyses of individual twins, compared to persistent activity, persistent physical inactivity predicted increased risk of daily smoking (age- and sex-adjusted odds ratio 5.53, 95% confidence interval 3.88,7.88, P < 0.001). The risk remained elevated even after excluding all those who had smoked 50 cigarettes or more life-time at baseline and adjusted for educational level in adolescence. In within-pair analyses compared to the active members of discordant twin pairs, the physically inactive co-twins had increased risk of future daily smoking (sex-adjusted odds ratio 3.39, 95% confidence interval 1.56,7.39, P = 0.002). Conclusions Persistent physical inactivity in adolescence relates to adult smoking, even after familial factors are taken into account. [source] Signs and symptoms at diagnosis of amyotrophic lateral sclerosis: a population-based study in southern ItalyEUROPEAN JOURNAL OF NEUROLOGY, Issue 7 2006S. Zoccolella Amyotrophic lateral sclerosis (ALS) diagnostic criteria are used to select patients for clinical trials based on different levels of diagnostic certainty, according to the spread of upper (UMN) and lower motoneuron (LMN) signs in different anatomic regions. However, the clinical presentation of ALS patients is extremely variable and this can delay the time to diagnosis and decrease the likelihood for trial entry. The aims of the study were to describe the signs and symptoms of diagnosis in a population-based incident cohort of ALS cases, using the El Escorial (EEC) and the Revised Airlie Diagnostic Criteria (AHC). The source of the study was a prospective population-based registry established in Puglia, southern Italy, in 1997. The diagnosis and the classification of the cases were based on EEC and AHC. All incident ALS cases during the period 1998,1999 were enrolled and followed up. During the surveillance period, we identified 130 ALS incident cases, and bulbar-ALS represented 20% of our cohort. The highest risk for bulbar onset was among subjects aged >75 years [RR: 20.1, 95% confidence interval (CI) 3.4,118.0] compared with subjects aged <55 years and among females compared with males (Relative risk (RR): 2.75, 95% CI: 1,7.3). The vast majority of patients (72%) referred progressive muscle weakness in the limbs as the presenting symptom. Eighty percent of cases presented contemporary bulbar or spinal involvement; UMN signs in the bulbar region were present in 24% of cases and any motoneuronal sign in thoracic region in only 15% of the cases. In this population-based series, progressive muscle weakness was the most common presenting sign; bulbar onset was associated with advanced age and female sex. UMN signs in the bulbar region and any motoneuronal sign in the thoracic region were observed in 20% of our case series. This may represent the main limitation to show the spread of signs during diagnostic assessment for inclusion in epidemiological studies and clinical trials. [source] The evolution of problem and social competence behaviors during toddlerhood: A prospective population-based cohort surveyINFANT MENTAL HEALTH JOURNAL, Issue 1 2007Raymond H. Baillargeon Research in developmental psychopathology has long been preoccupied with rather broad categories of behavior, but we know little about the specific behaviors that comprise these categories. The objective of this study was to: (a) estimate the prevalence of problem and social competence behaviors in the general population of children at 17 months of age, and (b) describe the continuity and discontinuity in the degree to which children exhibit these behaviors between 17 and 29 months of age. The results show that frequent problem behaviors are not typical of children under two years of age. Further, the results suggest that it is possible to distinguish between different types of problem behaviors before two years of age. In addition, the results show that gender differences in some problem behaviors are already present before two years of age, and increase in magnitude during toddlerhood. Finally, the results show that interindividual differences in problem behaviors observed before two years of age are stable. The predictive accuracy of frequent problem behaviors in children at 17 months of age was limited, however, with often a majority of toddlers not behaving this way a year later. Overall, our results suggest that toddlerhood represents a critical period when behavioral and emotional problems of potentially clinical significance emerge. Pediatricians should routinely ask parents to report the frequency of their young children's problem behaviors during child health supervision visits so that children whose frequent problem behaviors persist over time can be identified and possibly referred for treatment. [source] Alcoholic beverage consumption and gastric cancer risk: A prospective population-based study in womenINTERNATIONAL JOURNAL OF CANCER, Issue 2 2007Susanna C. Larsson Abstract The association between alcohol consumption and risk of gastric cancer remains controversial. Moreover, prospective data on the role of alcoholic beverage type are sparse. We prospectively investigated the association between total alcohol (ethanol) intake as well as specific alcoholic beverages and risk of gastric cancer in the Swedish Mammography Cohort, a population-based cohort of 61,433 women. Alcohol intake and other dietary exposures were assessed at baseline (1987,1990) and again in 1997 using a food-frequency questionnaire. Incident gastric cancer cases were ascertained through the Swedish Cancer Register. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 966,807 person-years of follow-up, through June 2005, 160 incident cases of gastric cancer occurred. Total alcohol intake was not significantly associated with risk of gastric cancer. Compared with nondrinkers, the multivariate HR of gastric cancer for women with an alcohol intake of 40 g or more per week was 1.33 (95% CI, 0.79,2.25). Consumption of medium-strong/strong beer was associated with a statistically significant increased risk of gastric cancer; the multivariate HR for women who consumed more than one serving of medium-strong/strong beer per week (median, 2.5 drinks/week) was 2.09 (95% CI, 1.11,3.93; p -trend = 0.02) compared with no consumption. Consumption of light beer, wine, and hard liquor was not significantly associated with gastric cancer risk. Our findings suggest that constituents of beer other than alcohol may be associated with an increased risk of gastric cancer. © 2006 Wiley-Liss, Inc. [source] Evidence for an age-related influence of microsatellite instability on colorectal cancer survivalINTERNATIONAL JOURNAL OF CANCER, Issue 6 2002Susan M. Farrington Abstract It is well established that microsatellite instability (MSI), the hallmark of defective DNA mismatch repair (MMR), is associated with prolonged survival in colorectal cancer compared with tumours that are microsatellite stable (MSS). MSI in sporadic colorectal tumours is primarily due to epigenetic silencing of MLH1. However, there are no prospective population-based studies of survival in patients with germline MMR gene mutations who develop cancer. Although MSI is almost universal in tumours from HNPCC family members, there is a potential confounding effect of ascertainment and other biases that could explain the apparent survival benefit in HNPCC families. Resolving whether germline MMR gene mutations impact on survival is important because it potentially undermines the rationale for surveillance of mutation carriers. Here, we report an investigation of the influence of MSI on survival in cohorts of cancer patients (aged < 30 years at diagnosis, n = 118; non-age-selected, n = 181) in the context of clinicopathologic variables. There was a substantial age-related influence of tumour MSI status on survival. In young patients with tumour MSI, 65% of patients with MSI tumours had germline MSH2 or MLH1 mutations. Clinicopathologic variables and tumour MSI of the cohort were studied with respect to survival and compared with control groups. Young patients had excess MSI tumours (p < 0.000001), mucinous tumours (p < 0.01), advanced disease (p , 0.001) and poorer 5-year survival compared with older cases. Cox proportional hazard analysis identified Dukes' stage, age at diagnosis and calendar year of treatment as independent predictors of survival. There was no detectable association between tumour MSI and survival in young patients, although we confirmed previous observations that MSI is associated with better prognosis in later onset cohorts. These findings underscore the rationale for surveillance and early identification of tumours in MMR gene carriers as well as refining understanding of the influence of MSI on cancer progression. © 2002 Wiley-Liss, Inc. [source] Attitudes toward weight gain during pregnancy: Results from the Norwegian mother and child cohort study (MoBa)INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 5 2009MSPH, Rebecca A. Swann BS Abstract Objective To explore attitudes toward weight gain during pregnancy in women with and without eating disorders and across eating disorder subtypes, and to examine associations among weight-gain attitudes and actual gestational weight gain, infant birth weight, and infant size-for-gestational-age. Method Pregnant women (35,929) enrolled in the prospective population-based Norwegian mother and child cohort study (MoBa) provided information at approximately week 18 of gestation regarding eating disorders and weight gain attitudes. We explored these variables in women with anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, purging type, and binge eating disorder (BED). Results The presence of an eating disorderly was associated with greater worry over gestational weight gain. In women without eating disorders, greater worry was associated with higher gestational weight gain, higher infant weights, greater likelihood of a large-for-gestational-age infant, and reduced likelihood of a small-for-gestational-age infant. Women with BED who reported greater worry also experienced higher weight gains during pregnancy. Discussion Women with eating disorders tend to experience weight-gain-related worry during pregnancy. Early worry about gestational weight-gain may be a harbinger of high gestational gain. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord, 2009 [source] Reviews: A review of hereditary and acquired coagulation disorders in the aetiology of ischaemic strokeINTERNATIONAL JOURNAL OF STROKE, Issue 5 2010Lonneke M. L. De Lau The diagnostic workup in patients with ischaemic stroke often includes testing for prothrombotic conditions. However, the clinical relevance of coagulation abnormalities in ischaemic stroke is uncertain. Therefore, we reviewed what is presently known about the association between inherited and acquired coagulation disorders and ischaemic stroke, with a special emphasis on the methodological aspects. Good-quality data in this field are scarce, and most studies fall short on epidemiological criteria for causal inference. While inherited coagulation disorders are recognised risk factors for venous thrombosis, there is no substantial evidence for an association with arterial ischaemic stroke. Possible exceptions are the prothrombin G20210A mutation in adults and protein C deficiency in children. There is proof of an association between the antiphospholipid syndrome and ischaemic stroke, but the clinical significance of isolated mildly elevated antiphospholipid antibody titres is unclear. Evidence also suggests significant associations of increased homocysteine and fibrinogen concentrations with ischaemic stroke, but whether these associations are causal is still debated. Data on other acquired coagulation abnormalities are insufficient to allow conclusions regarding causality. For most coagulation disorders, a causal relation with ischaemic stroke has not been definitely established. Hence, at present, there is no valid indication for testing all patients with ischaemic stroke for these conditions. Large prospective population-based studies allowing the evaluation of interactive and subgroup effects are required to appreciate the role of coagulation disorders in the pathophysiology of arterial ischaemic stroke and to guide the management of individual patients. [source] Association Between Changes in Habitual Physical Activity and Changes in Bone Density, Muscle Strength, and Functional Performance in Elderly Men and WomenJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2008Robin M. Daly PhD OBJECTIVES: To investigate the long-term effects of habitual physical activity on changes in musculoskeletal health, functional performance, and fracture risk in elderly men and women. DESIGN: Ten-year prospective population-based study. SETTING: Malmö-Sjöbo Prospective Study, Sweden. PARTICIPANTS: Participants were 152 men and 206 women aged 50, 60, 70, and 80 who were followed for 10 years. MEASUREMENTS: Distal radius bone mineral density (BMD) (single photon absorptiometry), upper limb muscle (grip) strength, balance, gait velocity, occupational and leisure-time activity, and fractures (interview-administered questionnaire) were reassessed after 10 years. Annual changes for all measures were compared between participants with varying habitual physical activity histories at baseline and follow-up: inactive,inactive (n=202), active,inactive (n=47), inactive,active (n=49), and active,active (n=60). Data for men and women were pooled, because there were no sex-by-activity group interactions. To detect possible differences in fracture incidence between the varying habitual activity groups, participants were classified into two activity groups based on their activity classification at baseline and follow-up: inactive:less active versus active:more active. RESULTS: The annual rate of bone loss was 0.6% per year less in individuals classified as active at both time points than in those classified as inactive at both time points (P<.01). Similar results were observed for balance, but there was no effect of varying habitual activity on changes in muscle strength or gait velocity. There were also no differences in fracture incidence between individuals categorized as active:more active and those categorized as inactive:less active during the follow-up (adjusted hazard ratio=0.90, 95% confidence interval (CI)=0.42,1.90). CONCLUSION: This study showed that elderly men and women who maintained a habitually active lifestyle over 10 years had lower bone loss and retained better balance than those who remained habitually inactive. [source] Frailty in Older Mexican AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2005Kenneth J. Ottenbacher PhD Objectives: To identify sociodemographic characteristics and health performance variables associated with frailty in older Mexican Americans. Design: A prospective population-based survey. Setting: Homes of older adults living in the southwest. Participants: Six hundred twenty-one noninstitutionalized Mexican-American men and women aged 70 and older included in the Hispanic Established Populations for Epidemiologic Study of the Elderly participated in a home-based interview. Measurements: Interviews included information on sociodemographics, self-reports of medical conditions (arthritis, diabetes mellitus, heart attack, hip fracture, cancer, and stroke) and functional status. Weight and measures of lower and upper extremity muscle strength were obtained along with information on activities of daily living and instrumental activities of daily living. A summary measure of frailty was created based on weight loss, exhaustion, grip strength, and walking speed. Multivariable linear regression identified variables associated with frailty at baseline. Logistic regression examined variables predicting frailty at 1-year follow-up. Results: Sex was associated with frailty at baseline (F=4.28, P=.03). Predictors of frailty in men included upper extremity strength, disability (activities of daily living), comorbidities, and mental status scores (Nagelkerke coefficient of determination (R2)=0.37). Predictors for women included lower extremity strength, disability (activities of daily living), and body mass index (Nagelkerke R2=0.29). At 1-year follow-up, 83% of men and 79% of women were correctly classified as frail. Conclusion: Different variables were identified as statistically significant predictors of frailty in Mexican-American men and women aged 70 and older. The prevention, development, and treatment of frailty in older Mexican Americans may require consideration of the unique characteristics of this population. [source] Femoral Neck BMD Is a Strong Predictor of Hip Fracture Susceptibility in Elderly Men and Women Because It Detects Cortical Bone Instability: The Rotterdam Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 11 2007Fernando Rivadeneira Abstract We studied HSA measurements in relation to hip fracture risk in 4806 individuals (2740 women). Hip fractures (n = 147) occurred at the same absolute levels of bone instability in both sexes. Cortical instability (propensity of thinner cortices in wide diameters to buckle) explains why hip fracture risk at different BMD levels is the same across sexes. Introduction: Despite the sexual dimorphism of bone, hip fracture risk is very similar in men and women at the same absolute BMD. We aimed to elucidate the main structural properties of bone that underlie the measured BMD and that ultimately determines the risk of hip fracture in elderly men and women. Materials and Methods: This study is part of the Rotterdam Study (a large prospective population-based cohort) and included 147 incident hip fracture cases in 4806 participants with DXA-derived hip structural analysis (mean follow-up, 8.6 yr). Indices compared in relation to fracture included neck width, cortical thickness, section modulus (an index of bending strength), and buckling ratio (an index of cortical bone instability). We used a mathematical model to calculate the hip fracture distribution by femoral neck BMD, BMC, bone area, and hip structure analysis (HSA) parameters (cortical thickness, section modulus narrow neck width, and buckling ratio) and compared it with prospective data from the Rotterdam Study. Results: In the prospective data, hip fracture cases in both sexes had lower BMD, thinner cortices, greater bone width, lower strength, and higher instability at baseline. In fractured individuals, men had an average BMD that was 0.09 g/cm2 higher than women (p < 0.00001), whereas no significant difference in buckling ratios was seen. Modeled fracture distribution by BMD and buckling ratio levels were in concordance to the prospective data and showed that hip fractures seem to occur at the same absolute levels of bone instability (buckling ratio) in both men and women. No significant differences were observed between the areas under the ROC curves of BMD (0.8146 in women and 0.8048 in men) and the buckling ratio (0.8161 in women and 0.7759 in men). Conclusions: The buckling ratio (an index of bone instability) portrays in both sexes the critical balance between cortical thickness and bone width. Our findings suggest that extreme thinning of cortices in expanded bones plays a key role on local susceptibility to fracture. Even though the buckling ratio does not offer additional predictive value, these findings improve our understanding of why low BMD is a good predictor of fragility fractures. [source] ApoE Gene Polymorphisms, BMD, and Fracture Risk in Elderly Men and Women: The Rotterdam Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 9 2004Mariette WCJ Schoofs Abstract To study the association between the ApoE gene polymorphism and osteoporosis, we performed an association study in 5857 subjects from the Rotterdam Study. We did not observe an association between the ApoE polymorphism and osteoporosis in this study, which is thus far the largest study on ApoE and osteoporosis. Introduction: The E4 allele of the E2, E3, E4 protein isoform polymorphism in the gene encoding apolipoprotein E (ApoE) has previously been associated with an increased fracture risk. We investigated the association between the ApoE polymorphism and BMD, bone loss, and incident fractures as part of the Rotterdam Study a prospective population-based cohort study of diseases in the elderly. Materials and Methods: The study population consisted of 5857 subjects (2560 men; 3297 women) for whom data on ApoE genotypes, confounding variables, and follow-up of nonvertebral fractures were available. Data on femoral neck and lumbar spine BMD were available for 4814 participants. Genotype analyses for bone loss (defined as annualized percent change in BMD at the hip and lumbar spine) and BMD were performed using ANOVA. Fractures were analyzed using a Cox proportional-hazards model and logistic regression. All relative risks were adjusted for age and body mass index. Results and Conclusions: The genotype distribution of the study population was in Hardy-Weinberg equilibrium (p = 0.98) and did not differ by gender. At baseline, mean BMD of the lumbar spine and femoral neck did not differ between the ApoE genotypes of men and women. Bone loss (mean follow-up, 2.0 years) did not differ by ApoE genotype for women and men. During a mean follow-up of 6.6 years, 708 nonvertebral fractures (198 hip fractures and 179 wrist fractures) and 149 incident vertebral fractures occurred. No consistent differences in the distribution of alleles could be observed between subjects with or without these fractures. Our data do not support the hypothesis that the ApoE4 risk allele is associated with BMD, increased bone loss, or an increased risk of osteoporotic fractures. [source] The Influence of an Insulin-Like Growth Factor I Gene Promoter Polymorphism on Hip Bone Geometry and the Risk of Nonvertebral Fracture in the Elderly: The Rotterdam Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 8 2004Fernando Rivadeneira Abstract The absence of the wildtype allele of a promoter polymorphism of the IGF-I gene is associated with increased risk (1.5; 95% CI, 1.1-2.0) of fragility fracture in women (n = 4212) but not in men (n = 2799). An approximation of hip bone geometry (from DXA) suggested the polymorphism is associated with bone strength and stability in gender-specific ways. Introduction: Previously, we found a CA-repeat promoter polymorphism in the insulin-like growth factor I (IGF-I) gene associated with IGF-I levels and BMD in postmenopausal women, but the relationship with fractures is unclear. In this large population-based study of elderly men and women, we examined the association between this IGF-I promoter polymorphism with parameters of bone geometry and the occurrence of fractures. Material and Methods: Within the Rotterdam Study, a prospective population-based cohort, the IGF-I polymorphism was analyzed in relation to incident nonvertebral fractures in 2799 men and 4212 women followed on average for 8.6 years. Furthermore, we estimated structural parameters of hip bone geometry indirectly from DXA outputs of the femoral neck in 2372 men and 3114 women. We studied neck width, cortical thickness, and the cortical buckling ratio and the section modulus as indexes of bone stability and bending strength. Results: Women heterozygotes and noncarriers of the allele had, respectively, 1.2 (95% CI, 1.0-1.5) and 1.5 (95% CI, 1.1-2.0) increased risk of having a fragility fracture at older age compared with homozygotes for the 192-bp allele (p trend = 0.0007). In men, fracture risk was not influenced by the polymorphism. Compared with homozygotes for the 192-bp allele, noncarrier males had ,1% narrower femoral necks and 2.2% lower section moduli (p trend < 0.05). Noncarrier females had 1.7% thinner cortices and 1.6% higher buckling ratios (p trend < 0.05) but no significant differences in femoral neck widths and section moduli. In women with low body mass index, genotype differences in bone strength (section modulus) and fracture risk were accentuated (p interaction = 0.05). The genotype-dependent differences in hip bone geometry did not fully explain the genotype-dependent differences in fracture risk. Conclusions: The CA-repeat promoter polymorphism in the IGF-I gene is associated with the risk for fragility fracture at old age in women and with bone structure in both genders. [source] Incidence of Hip and Other Osteoporotic Fractures in Elderly Men and Women: Dubbo Osteoporosis Epidemiology Study,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 4 2004Kevin P Chang Abstract In this prospective 12-year study in men and women 60 years of age and older, there was a 4,6% per year reduction in the incidence rate of overall osteoporotic fractures, but the study was unable to exclude any change in the hip fracture incidence rate. Approximately one-half of hip fractures occurred before 80 years in men and two-thirds before 85 years in women. The age distribution of hip fractures underlines the need for earlier intervention in osteoporosis. Introduction: Although hip fracture is the major osteoporotic fracture in terms of health outcomes, quality of life, and costs, there is a paucity of long-term data on secular changes in men and women within a defined community. This long-term prospective population-based study over 12 years from 1989 to 2000 specifically examined the age distribution and secular changes in the incidence rates of hip and other osteoporotic fractures in men and women 60 years of age and older in a predominantly white population in Dubbo, Australia. Materials and Methods: Hip and all other clinical fractures were ascertained by reviewing all radiography reports from the two area radiology services, ensuring complete ascertainment of all clinical osteoporotic fractures. Results and Conclusion: Among the 1055 symptomatic atraumatic fractures (after excluding pathological fractures), there was a significant reduction in the overall fracture incidence rate in women (4% per year; p = 0.0003) and men (6% per year; p = 0.0004) over the 12 years. There were 229 hip fractures (175 in women and 54 in men) within 39,357 person-years of observation. The overall rate ± SE of hip fracture was 759 ± 57 per 100,000 person-years in women and 329 ± 45 per 100,000 person-years in men, with an exponential increase with age. With advancing age, the incidence rate of hip fractures in men approached that in women; the female:male ratio fell from 4.5 (95% CI: 1.3,15.7) to 1.5 (0.9,2.5) and 1.9 (1.2,2.8) in the 60,69, 70,79, and 80+ year age groups, respectively. In women, the absolute number of fractures and incidence rate continuously increased with age; however, in men, the absolute number of hip fractures peaked at 80,84 years of age and then decreased. Most importantly, despite the continuing increase with age, almost one-half (48%) of the hip fractures occurred before the age of 80 years in men, and 66% of hip fractures occurred before the age of 85 years in women. The overall hip fracture incidence is comparable with other white (except Sweden) and Asian groups as well as two other Australian studies. This study could not exclude a change in hip fracture incidence rate, even in those 80 years of age and over among whom the incidence of hip fractures was the highest. The incidence data highlight the fact that a large proportion of hip fractures occurs in those under 80 years of age, particularly in men. This age distribution underlines the need for earlier intervention in osteoporosis in women and particularly in men to achieve the most cost-effective outcomes. [source] Prehospital management of diabetic emergencies , a population-based intervention studyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2003A. Holstein Background: Diabetes-related emergencies are frequent and potentially life-threatening. A study was performed to obtain reliable data about the prevalence of diabetic emergencies and to improve the quality of prehospital care of patients with diabetes-related emergencies. Methods: A prospective population-based study in a German emergency medical service district in the period from 1997 to 2000 was conducted. After initial diabetes training for the entire emergency team, a standardized protocol was introduced for prehospital emergency therapy of severe hypoglycaemia (SH) and severe hyperglycaemic disorders. A rapid blood glucose test was performed on all emergency patients with the exception of resuscitations and deaths. Indicators of treatment quality before and after these interventions were compared. Results: A rapid blood glucose test was performed in 6631 (85%) of the 7804 emergencies that occurred during the period investigated. The prevalence of acute diabetic complications was 3.1%, and 213 cases of SH and 29 severe hyperglycaemic disorders were recorded. Education of the emergency team led to a significant improvement in the quality of treatment. Larger volumes of iv 40% glucose solution (50 ± 20 ml (1997,2000) vs. 25 ± 17 ml (1993,96); P < 0.0001) were administered to patients with SH. Insulin-treated patients who were well educated about their diabetes were more often treated only at the emergency scene, after SH (25% vs. 8%; P = 0.007), and without complications. In 50 patients who experienced sulfonylurea-induced SH, the mandatory additional glucose infusions and hospitalization for further observation reduced mortality from 4.9% to 0% (P = 0.2). Conclusion: Training of the emergency team is an effective and efficient intervention to improve quality of treatment and prognosis outcome for patients with diabetic emergencies. Treatment of SH at the emergency scene only was demonstrated to be safe in type 1 diabetic patients who had previously received structured patient education. [source] Higher 25-hydroxyvitamin D is associated with lower relapse risk in multiple sclerosis,ANNALS OF NEUROLOGY, Issue 2 2010Steve Simpson Jr. MPH Objective A protective association between higher vitamin D levels and the onset of multiple sclerosis (MS) has been demonstrated; however, its role in modulating MS clinical course has been little studied. We investigated whether higher levels of serum 25-hydroxyvitamin D (25-OH-D) were associated with a lower risk of relapses in people with MS. Methods We conducted a prospective cohort study of 145 participants with relapsing-remitting MS from 2002 to 2005. Serum 25-OH-D levels were measured biannually, and the hazard of relapse was assessed using survival analysis. Results There was an inverse linear relationship between 25-OH-D levels and the hazard of relapse over the subsequent 6 months, with hazard ratio (HR) 0.91 (95% confidence interval [CI]: 0.85,0.97) per 10nmol/l increase in 25-OH-D level (p = 0.006). When variation due to timing of blood collection was removed by estimating 25-OH-D at the start of each season, this association persisted, with HR 0.90 (95% CI, 0.83,0.98) per 10nmol/l increase (p = 0.016). Taking into account the biological half-life of 25-OH-D, we estimated 25-OH-D at monthly intervals, resulting in a slightly enhanced association, with HR 0.88 (95% CI, 0.82,0.95) per 10nmol/l increase (p = 0.001). Adjusting for potential confounders did not alter these findings. Interpretation In this prospective population-based cohort study, in a cohort largely on immunomodulatory therapy, higher 25-OH-D levels were associated with a reduced hazard of relapse. This occurred in a dose-dependent linear fashion, with each 10nmol/l increase in 25-OH-D resulting in up to a 12% reduction in risk of relapse. Clinically, raising 25-OH-D levels by 50nmol/l could halve the hazard of a relapse. ANN NEUROL 2010;68:193,203 [source] Interleukin-6 is a significant predictor of radiographic knee osteoarthritis: The Chingford studyARTHRITIS & RHEUMATISM, Issue 7 2009Gregory Livshits Objective There is a great need for identification of biomarkers that could improve the prediction of early osteoarthritis (OA). We undertook this study to determine whether circulating levels of interleukin-6 (IL-6), tumor necrosis factor , (TNF,), and C-reactive protein (CRP) can serve as useful markers of radiographic knee OA (RKOA) in a normal human population. Methods RKOA data were obtained from the cohort of the Chingford Study, a prospective population-based study of healthy, middle-aged British women. The RKOA-affected status of the subjects was assessed using the Kellgren/Lawrence (K/L) grade as determined on radiographs obtained at baseline (n = 908) and at 10 years and 15 years thereafter. Serum levels of CRP, IL-6, and TNF, were assayed at 5, 8, and 15 years, using high-sensitivity commercial assays. A K/L grade of ,2 in either knee was used as the outcome measure. Statistical analyses included analysis of variance for repeated measurements and logistic regression models, together with longitudinal modeling of dichotomous responses. Results During 15 years of followup, the prevalence of RKOA (K/L grade ,2) increased from 14.7% to 48.7% (P < 0.00001 versus baseline). The body mass index (BMI) and circulating levels of CRP and IL-6 were consistently and significantly higher in subjects diagnosed as having RKOA. When multiple logistic regression was applied to the data, the variables of older age (P = 3.93 × 10,5), higher BMI at baseline (P = 0.0003), and increased levels of IL-6 at year 5 (P = 0.0129) were determined to be independent predictors of the appearance of RKOA at year 10. The results were fully confirmed using longitudinal modeling of repeated measurements of the data obtained at 3 visits. The odds ratio for RKOA in subjects whose IL-6 levels were in the fourth quartile of increasing levels (versus the first quartile) was 2.74 (95% confidence interval 1.94,3.87). Conclusion This followup study showed that individuals were more likely to be diagnosed as having RKOA if they had a higher BMI and increased circulating levels of IL-6. These results should stimulate more work on IL-6 as a potential therapeutic target. [source] Hospital system costs of artificial infant feeding: estimates for the Australian Capital TerritoryAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2002Julie P. Smith Objective: To estimate the attributable ACT hospital system costs of treating selected infant and childhood illnesses having known associations with early weaning from human milk. Method: We identified relative risks of infant and childhood morbidity associated with exposure to artificial feeding in the early months of life vs breastfeeding from cohort studies cited by the American Academy of Pediatrics in 1997 as establishing the protective effect of breastfeeding. Data for ACT breastfeeding prevalence is assessed from a 1997 prospective population-based cohort study of 1,295 women. ACT Hospital Morbidity Data and DRG treatment costs were used to estimate the attributable fraction of costs of hospitalisation for gastrointestinal illness, respiratory illness and otitis media, eczema, and necrotising enterocolitis. Results: Although initiation rates were high (92%), less than one in 10 ACT infants are exclusively breastfed for the recommended six months, mainly due to supplementation or weaning on to formula within the first three months and the early introduction of solids by breastfeeding mothers. This study suggests the attributable hospitalisation costs of early weaning in the ACT are about $1 -2 million a year for the five illnesses. Conclusions and implications: Early weaning from breast milk is associated with significant hospital costs for treatment of gastrointestinal illness, respiratory illness and otitis media, eczema, and necrotising enterocolitis These costs are minimum estimates of the cost of early weaning as they exclude numerous other chronic or common illnesses and out-of-hospital health care costs. Higher rates of exclusive breastfeeding would reduce these costs. Interventions to protect and support breastfeeding are likely to be cost-effective for the public health system. [source] Pterygium in Tibetans: a population-based study in ChinaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 9 2007Peng Lu MD Abstract Purpose:, To describe the prevalence and to identify associated risk factors for pterygium in a Tibetan population at high altitude in Zeku County, China. Methods:, A prospective population-based survey was conducted from October to December 2006. A stratified, clustered, randomized sampling procedure was used to select 2632 Tibetan people aged 40 years and older. Pterygium was diagnosed and graded clinically as grade 1 (transparent), 2 (intermediate) and 3 (opaque). Risks factors associated with pterygium were evaluated with logistic regression models. Results:, From a total of 2632 eligible subjects, 2229 (84.69%) were examined. There were 323 people with pterygium, equivalent to an overall prevalence of 14.49% (95% confidence interval [CI] 13.03,15.95). Pterygium was independently associated with increasing age for persons aged 70,79 years, compared with those aged 40,49 years (odds ratio [OR] 2.0; 95% CI 1.4,2.8), female gender (OR 1.6; 95% CI 1.2,2.0), dry eye symptoms (OR 1.3; 95% CI 1.0,1.7), seldom use of sunglasses/crystal spectacles (OR 4.6; 95% CI 1.9,11.3) or hats (OR 3.6: 95% CI 2.4,5.4), lower education level (<3 years) (OR 1.6; 95% CI 1.1,2.4) and low socioeconomic status (OR 1.9; 95% CI 1.5,2.4). Conclusions:, The prevalence of pterygium in a Tibetan population at high altitude is significantly high, particularly in certain at-risk groups. The primary causative factors are related to ocular sun exposure, which are easily preventable. Public health schemes to address this serious health issue are urgently needed. [source] Cigarette smoking is an independent risk factor for type 2 diabetes: a four-year community-based prospective studyCLINICAL ENDOCRINOLOGY, Issue 5 2009Nam H. Cho Summary Objectives, We investigated the association between smoking and its additive effects with insulin resistance and ,-cell function on the incidence of type 2 diabetes in a prospective population-based cohort study. Design and method, A total of 10 038 subjects were recruited from rural and urban areas. All subjects underwent 75 g oral glucose tolerance tests and full biochemical assessments at baseline and during 4-year follow-up period. The final analysis was limited to 4041 men due to the low smoking rates in women. Results, The ex- and heavy current smokers had the highest incidence of diabetes of 12·5% and 11·1% respectively, compared with never-smokers (7·9%) during 4 years. After multivariate adjustment by Cox-proportional hazard model, ex- and current smokers reveal a relative risk of 1·60 (95% CI: 1·07,2·39), 2·06 (1·35,3·16, for <20 cigarettes/day) and 2·41 (1·48,3·93, for ,20 cigarettes/day) respectively compared with never smokers. The risk of new onset diabetes was the highest in those with low homeostasis model assessment for beta cell function (HOMA-,) and high homeostasis model assessment for insulin resistance (HOMA-IR) group in both smokers and never smokers. Conclusions, Smoking is an independent risk factor for type 2 diabetes mellitus and showed synergistic interaction with the status of low insulin secretion and high insulin resistance for developing diabetes. Given the high rates of smoking and growing burden of diabetes in the world, cessation of smoking should be considered as one of the key factors for diabetes prevention and treatment programmes. [source] Psychological aspects of adductor spasmodic dysphonia: a prospective population controlled questionnaire studyCLINICAL OTOLARYNGOLOGY, Issue 1 2010A.A. Kaptein Clin. Otolaryngol. 2010, 35, 31,38. Objective:, To examine psychosocial concomitants, illness perceptions, and treatment perceptions in patients with adductor spasmodic dysphonia. Design:, Prospective controlled cohort study. Setting:, A tertiary care facility. Participants:, Forty-nine out-patients (38 women, 11 men; average age of 52 years) with adductor spasmodic dysphonia completed a battery of reliable and validated psychometric assessment instruments. Control patients' data were derived from scores in questionnaires by samples in the formal Manuals of the questionnaires used. Main outcome measures:, Psychosocial functioning, illness perceptions, and treatment perceptions. Results:, Scores on psychosocial measures were elevated in male patients especially, indicating levels of psychological morbidity significantly above those seen in the general population. Assessments of illness perceptions and treatment perceptions indicated that patients perceive that they have a very low degree of control over the disorder, and experience a high emotional impact from it. Voice Handicap Index scores illustrated substantial degrees of perceived handicap. Conclusions:, Adductor spasmodic dysphonia is associated with significant negative psychosocial concomitants, coupled with low perceived control over the condition. Future research should elucidate the implications of illness perceptions and treatment perceptions for the biopsychosocial care of persons with adductor spasmodic dysphonia in order to improve self-management and enhance quality of life. [source] In-hospital mortality of newborn infants born before 33 weeks of gestation depends on the initial level of neonatal care: the EPIPAGE studyACTA PAEDIATRICA, Issue 3 2003JP Empana Aim: To determine the relation between the level of initial neonatal care and in-hospital mortality of infants born before 33 wk of gestation in the era of surfactant therapy. Methods: A 1 y prospective population-based survey was conducted in the north of France, as part of the EPIPAGE (Epidemiologie des Petits Ages Gestationnels) survey. Perinatal data were recorded for 585 very premature newborns transferred to a neonatal intensive care unit in 1997. The relation between the level of the neonatal unit that provided care for the first consecutive 48 h and in-hospital mortality was assessed by multivariate logistic regression, and adjusted for perinatal data and initial disease severity, estimated by the Clinical Risk Index for Babies (CRIB). Results: The average gestational age (mean ± SD) was 31.6 ± 0.62 wk in level I, 30.7 ± 0.21 in level II, 29.9 ± 0.13 in non-teaching level III, and 29.0 ± 0.15 in the level III teaching unit (p < 0.0001). The mean in-hospital mortality rate was 8.4% and did not differ by level of care (ptrend= 0.17). After adjustment for perinatal data and CRIB, however, with the teaching unit as the reference, the risk of death was significantly higher in level I,II units [adjusted odds ratio (ORa) = 7.9, 95% confidence interval (95% CI) 2.2,29.1], but not in the non-teaching level III units (ORa = 0.8, 95% CI 0.3,2.1). Conclusion: In-hospital mortality in non-teaching level III units was similar to that in a teaching unit, but significantly higher in level I-level II units. Neonatal care of newborns delivered before 33 wk of gestation should initially occur in level III units. [source] | |||||||||||||