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Biomedical subjects

Deborah M Kado

Publications and source records attributed to Deborah M Kado.

9 recordsLinked to original sources
PubMed2006

Comparing a supine radiologic versus standing clinical measurement of kyphosis in older women: the Fracture Intervention Trial.

STUDY DESIGN: A study of agreement between different measures of kyphosis, a clinical standing measure (Debrunner kyphometer; Protek AG, Bern, Switzerland) versus a supine radiologic measure (Cobb angle). OBJECTIVES: To determine whether a supine radiologic measure of kyphosis in older women is a reasonable estimate of clinical kyphosis determined in the standing position, and to investigate a computerized assessment of the Cobb angle. SUMMARY OF BACKGROUND DATA: Few studies have investigated kyphosis measurement agreement involving older adults. METHODS: Using data from the Fracture Intervention Trial, we randomly selected 120 women, aged 55-80 years, who had a Debrunner kyphometer measure of kyphosis and supine lateral spine radiographs from which we measured the Cobb angle (either manually or by digitization). We calculated the intraclass correlation coefficient (ICC) from repeated measures analysis of variance to assess the agreement among the: (1) manual Cobb angle and Debrunner kyphometer, (2) digitized Cobb angle and Debrunner kyphometer, and (3) manual and digitized Cobb angle. RESULTS: The mean of both the manual and digitized Cobb angle was 45 degrees (range 18 degrees-83 degrees), and the mean Debrunner kyphometer reading was 48 degrees (range 17 degrees-83 degrees). The ICC between either of the 2 measures of the Cobb angle and Debrunner measurement was 0.68, indicating reasonable agreement. The ICC between the manual and digitized Cobb angle was 0.99, indicating excellent agreement. CONCLUSIONS: There is reasonable agreement between a supine radiologic and standing clinical measurement of kyphosis in older women.

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PubMed2006

Sex steroid hormone gene polymorphisms and depressive symptoms in women at midlife.

Single nucleotide polymorphism (SNP) genotype frequencies were examined to determine whether variation in 6 estrogen-related genes was associated with differences in self-reported depressive symptoms in women. In this substudy of the Study of Women's Health Across the Nation (SWAN), DNA from a multiracial/multiethnic sample of 1,538 African American, Caucasian, Chinese, and Japanese women aged 42 to 52 years participating in SWAN was genotyped. Depressive symptoms were measured with the Center for Epidemiologic Studies-Depression (CES-D) scale. After excluding data from women taking antidepressants (n=103), statistical models were fit using multivariate logistic regression to predict the association of estrogen-related polymorphisms with the dichotomized CES-D score. Among Caucasian women, those with the CYP1A1 rs2606345 CC and AC genotypes had approximately 2-fold greater odds of having depressive symptoms than did those with the AA genotype (95% confidence intervals [CIs], 1.33 to 4.66 and 1.25 to 3.14, respectively). African American women with the CC genotype of the same SNP had 10-fold greater odds of having more depressive symptoms than did women with the AA genotype (95% CI, 1.20 to 86.20). In Japanese women, the odds of depressive symptoms were nearly 5-fold higher among those with CYP 19 rs936306 TT genotype (95% CI, 1.10 to 22.17) than in women with the CC genotype and 9.6-fold higher (95% CI, 2.01 to 45.81) than in women with the CT genotype. The odds of depressive symptoms among Chinese women with the 17HSD rs615942 TT genotype were nearly 11-fold higher than in those with the GT genotype (95% CI, 1.94 to 60.84) and >7-fold higher than in those with the GG genotype (95% CI, 1.13 to 51.82). These data provide evidence that selected genes involved in estrogen synthesis and metabolism increase the odds of more depressive symptoms in women who are premenopausal or perimenopausal.

17-Hydroxysteroid Dehydrogenases↗
PubMed2005

Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study.

UNLABELLED: It is unknown whether kyphosis of the thoracic spine is an independent risk factor for future osteoporotic fractures. In 596 community-dwelling women, we found that with increasing kyphosis, there was a significant trend of increasing fracture risk that was independent of previous history of fractures or BMD. INTRODUCTION: It is unknown whether kyphosis of the thoracic spine is an independent risk factor for future osteoporotic fractures. MATERIALS AND METHODS: We conducted a prospective cohort study of 596 community-dwelling women, 47-92 years of age. Between 1988 and 1991, BMD of the hip and spine and kyphosis were measured. Kyphosis was measured by counting the number of 1.7-cm blocks necessary to place under the occiput so participants could lie flat without neck hyperextension. New fractures were reported over an average follow-up of 4 years. RESULTS: Using a cut-off of at least one block, 18% of the participants had hyperkyphotic posture (range, one to nine blocks). There were 107 women who reported at least one new fracture (hip, spine, wrist, clavicle, shoulder, arm, hand, rib, pelvis, leg, or ankle). In logistic regression analyses, older women with hyperkyphotic posture (defined as at least one block) had a 1.7-fold increased risk of having a future fracture independent of age, prior fracture, and spine or hip BMD (95% CI: 1.00-2.97; p = 0.049). There was a significant trend of increasing fracture risk with increasing number of blocks, with ORs ranging from 1.5 to 2.6 as the number of blocks increased from one to at least three blocks compared with those with zero blocks (trend p = 0.03; models adjusted for age, baseline fracture, spine or hip BMD). Stratification by baseline fracture status and controlling for other possible confounders or past year falls did not change the results. CONCLUSIONS: Whereas hyperkyphosis may often result from vertebral fractures, our study findings suggest that hyperkyphotic posture itself may be an important risk factor for future fractures, independent of low BMD or fracture history.

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PubMed2005

Homocysteine versus the vitamins folate, B6, and B12 as predictors of cognitive function and decline in older high-functioning adults: MacArthur Studies of Successful Aging.

BACKGROUND: Elevated plasma total homocysteine concentration may be a risk factor for cognitive decline and Alzheimer disease, but data from prospective studies are limited. Further, high homocysteine levels are associated with low vitamin status, and it is unknown whether it is homocysteine toxicity or vitamin insufficiency that is responsible for the observed cognitive dysfunction. METHODS: We performed cross-sectional and longitudinal analyses of a cohort of 499 high-functioning community-dwelling persons aged 70 to 79 years to determine the effect of homocysteine and related vitamin plasma concentrations on cognitive function and cognitive decline. Nonfasting plasma concentrations of homocysteine, folate, vitamin B(6), and vitamin B(12) were measured at baseline. Summary measures of cognitive function were created from tests of multiple cognitive domains administered at baseline and again after 7 years. RESULTS: In cross-sectional analyses investigating each variable separately, subjects with elevated homocysteine levels, or low levels of folate or vitamin B(6), demonstrated worse baseline cognitive function. In longitudinal analyses, after adjusting for multiple covariates, including homocysteine, those in the bottom quartile of folate had a 1.6-fold increased risk (95% confidence interval: 1.01 to 2.31; P =0.04) of being in the worst quartile of 7-year cognitive decline. Low folate levels largely accounted for a trend towards greater cognitive decline with elevated homocysteine level. CONCLUSION: In high-functioning older adults, low folate levels appear to be a risk factor for cognitive decline. The risk of developing cognitive decline might be reduced through dietary folate intake.

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PubMed2005

Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study.

BACKGROUND: Physical functional decline is often the determining factor that leads to loss of independence in older persons. Identifying risk factors for physical disability may lead to interventions that may prevent or delay the onset of functional decline. Our study objective was to determine the association between hyperkyphotic posture and physical functional limitations. METHODS: Participants were 1578 older men and women from the Rancho Bernardo Study who had kyphotic posture measured as the distance from the occiput to table (units = 1.7-cm blocks, placed under the participant's head when lying supine on a radiology table). Self-reported difficulty in bending, walking, and climbing was assessed by standard questionnaires. Physical performance was assessed by measuring grip strength and ability to rise from a chair without the use of the arms. RESULTS: Men were more likely to be hyperkyphotic than were women (p <.0001). In multiply adjusted comparisons, there was a graded stepwise increase in difficulty in bending, walking and climbing, measured grip strength, and ability to rise from a chair. For example, the odds ratio (OR) of having to use the arms to stand up from a chair increased from 1.6 (95% confidence interval [CI]: 0.9-3.0) for individuals defined as hyperkyphotic by 1 block to 2.9 (95% CI: 1.7-5.1) for individuals defined as hyperkyphotic by 2 blocks to 3.7 (95% CI: 2.1-6.3) for individuals defined as hyperkyphotic by > or = 3 blocks compared to those who were not hyperkyphotic (p for trend < .0001). CONCLUSIONS: Older persons with hyperkyphotic posture are more likely to have physical functional difficulties.

Activities of Daily Living↗
PubMed2004

Hyperkyphotic posture predicts mortality in older community-dwelling men and women: a prospective study.

OBJECTIVES: To determine the association between hyperkyphotic posture and rate of mortality and cause-specific mortality in older persons. DESIGN: Prospective cohort study. SETTING: Rancho Bernardo, California. PARTICIPANTS: Subjects were 1,353 participants from the Rancho Bernardo Study who had measurements of kyphotic posture made at an osteoporosis visit between 1988 and 1991. MEASURES: Kyphotic posture was measured as the number of 1.7-cm blocks that needed to be placed under the participant's head to achieve a neutral head position when lying supine on a radiology table. Demographic and clinical characteristics and health behaviors were assessed at a clinic visit using standard questionnaires. Participants were followed for an average of 4.2 years, with mortality and cause of death confirmed using review of death certificates. RESULTS: Hyperkyphotic posture, defined as requiring one or more blocks under the occiput to achieve a neutral head position while lying supine, was more common in men than women (44% in men, 22% of women, P<.0001). In age- and sex-adjusted analyses, persons with hyperkyphotic posture had a 1.44 greater rate of mortality (95% confidence interval (CI)=1.12-1.86, P=.005). In multiply adjusted models, the increased rate of death associated with hyperkyphotic posture remained significant (relative hazard=1.40, 95% CI=1.08-1.81, P=.012). In cause-specific mortality analyses, hyperkyphotic posture was specifically associated with an increased rate of death due to atherosclerosis. CONCLUSION: Older men and women with hyperkyphotic posture have higher mortality rates.

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PubMed2002

Homocysteine levels and decline in physical function: MacArthur Studies of Successful Aging.

PURPOSE: To test whether elevated homocysteine levels are associated with an increased risk of decline in physical function in older persons. METHODS: We performed a prospective cohort study of 499 highly functioning men and women aged 70 to 79 years who were enrolled in the MacArthur Studies of Successful Aging. We measured total homocysteine levels and performance-based physical function at baseline; physical function measures were repeated an average of 28 months later. A summary measure of physical performance from tests of balance, gait, lower body strength and coordination, and manual dexterity was developed, and a change score was calculated as the difference in scores from 1988 to 1991. RESULTS: The mean (+/-SD) homocysteine level was 11.6 +/- 4.3 micromol/L. With each SD increase in homocysteine, there was an increased risk of being in the worst quartile of decline in physical function (odds ratio = 1.5; 95% confidence interval: 1.2 to 1.9) in analyses that adjusted for age, sex, baseline physical performance, smoking status, vitamin B(12) levels, and incident stroke. Similar results were seen when change in physical performance was treated as a continuous variable. CONCLUSION: Older persons with elevated plasma homocysteine levels are at an increased risk of decline in physical function.

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PubMed2002

Rapid resting heart rate: a simple and powerful predictor of osteoporotic fractures and mortality in older women.

OBJECTIVES: To determine whether resting heart rate is associated with several types of osteoporotic fractures, mortality, and cause-specific mortality in older women. DESIGN: A prospective cohort study. SETTING: Four communities across the United States. PARTICIPANTS: We prospectively assessed resting pulse rate in 9,702 women aged 65 and older enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Resting pulse was measured in the supine position. Hip, humerus, pelvis, rib, ankle, and wrist fractures were identified by self-report and validated by radiographs. Incident vertebral fractures were assessed by quantitative morphometry. Cause-specific mortality was assessed from death certificates and hospital discharge summaries. RESULTS: Women with resting heart rates of greater than 80 beats per minute (bpm) (n = 1,140 (12%)) had an adjusted 1.6-fold (95% confidence interval (CI) = 1.2-2.0) increased risk of either a hip, pelvis, or rib fracture and a 1.9-fold (95% CI = 1.4-2.5) increased risk of vertebral fracture. A heart rate of 80 bpm or greater was also associated with 1.4-fold (95% Cl = 1.2-1.5) increased all-cause mortality and 1.5-fold (95% CI = 1.2-2.1) increased coronary heart disease mortality. Investigating resting heart rate as a continuous variable, we detected a general pattern of increasing risks with higher heart rate that could not be explained by age, weight, poor health, physical activity, hyperthyroidism, or smoking. CONCLUSIONS: Older women with resting heart rates of 80 bpm or more have an increased risk of several osteoporotic fractures and of mortality that is not explained by other risk factors. Heart rate may be a simple tool for assessing risk of fracture and of death from coronary heart disease in older women.

Age Factors↗