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PubMed2000

Which aspects of breathing during sleep influence the overnight fall of blood pressure in a community population?

BACKGROUND: Obstructive sleep apnoea (OSA) causes recurrent rises in blood pressure during sleep, and recent community surveys have suggested a link between mild OSA and diurnal hypertension. The fact that OSA and hypertension share some risk factors, as well as problems accurately quantifying OSA severity, have diluted the power of such studies. This study tries to circumvent some of these problems by measuring the overnight change in blood pressure and relating it to relevant measures of the severity of upper airway obstruction on the same night. METHODS: Men born between 1930 and 1960 and their wives living in a market town north of Oxford were identified from a GP practice register. Enough couples were recruited to provide approximately 10 (20 individuals) per year of birth. Subjects were visited at home where a questionnaire was administered, anthropometric measurements made, blood pressures taken (including by the subject), and sensors applied for a subsequent overnight sleep study. The sleep study measured indices of hypoxia, snoring, autonomic arousal, degree of respiratory effort; the last two of these derived from measurements of pulse transit time (indirect beat to beat blood pressure). After waking the following morning, the subjects took their own blood pressures again. RESULTS: Data were available from 224 couples (448 subjects). On average, systolic BP fell 8 mm Hg from evening to morning. Only hypoxic dips (>4% SaO(2) dips/h) and the measure of degree of respiratory effort were significant independent predictors of this overnight change in systolic BP, together accounting for 7-10% of the variation (p<0.0001). Dividing the subjects into quartiles according to the respiratory effort overnight showed a progressive reduction in the fall of systolic BP overnight: 13.6, 10.8, 7.3, and 5.6 mm Hg, lowest to highest quartiles. CONCLUSIONS: This study suggests that increased respiratory effort during sleep (seen in OSA and related syndromes of increased upper airway resistance during sleep) offsets the normal fall in BP that occurs overnight, even within this community population. This may be one of the mechanisms by which hypertension is carried over into the waking hours in patients with OSA.

Adult↗

PubMed1998

Prevalence of chronic fatigue syndrome in a community population in Japan.

In order to know the prevalence of chronic fatigue syndrome (CFS) in a community population in Japan, we analyzed data from a population-based interview survey. Two cases out of 137 respondents experienced chronic fatigue during a period of nine months, suffered from 50% or more reduction of daily activity due to fatigue and had no other physical or psychiatric diagnosis. Both of the two cases fulfilled the 1994 Centers for Disease Control (CDC) criteria and the British criteria. The point and nine-month prevalence rates of CFS were both 1.5% (95% confidence intervals, 0.4-5.2%). None fulfilled the 1989 CDC criteria for CFS. The prevalence rate of CFS was higher than those in previous studies in the Western countries, suggesting a need for future research on cross-cultural differences in the definition, prevalence and symptomatology of CFS.

Adolescent↗

PubMed1999

Change in cognitive function in older persons from a community population: relation to age and Alzheimer disease.

OBJECTIVE: To examine change in cognitive function in older persons sampled from a community population, and its relation to age and Alzheimer disease. DESIGN: Prospective cohort study with an average of 3.5 years of follow-up. SETTING: East Boston, Mass--a geographically defined, urban, working-class community. PARTICIPANTS: A stratified, random sample of persons 65 years and older underwent uniform, structured clinical evaluation for Alzheimer disease. The 388 persons (89.2% of those eligible) who completed at least 1 annual follow-up evaluation were studied: 97 had Alzheimer disease at baseline; 95 developed Alzheimer disease during the study; and 196 were unaffected. OUTCOME MEASURES: Eight cognitive performance tests were administered, then converted to population-weighted z scores and averaged to create a composite summary measure of cognitive function. Initial level of and change in this score were the outcome measures. RESULTS: In the population as a whole, many persons experienced a decline in cognitive performance, and age was related to both initial level and rate of decline. Analyses were conducted in 3 subgroups: persons with Alzheimer disease at baseline, those who developed Alzheimer disease during the study, and those who remained unaffected. In both Alzheimer disease subgroups, substantial cognitive decline was observed, but neither initial level nor rate of decline was related to age. In unaffected persons, little cognitive decline was evident, and there was a small, inverse association of age with initial level of cognitive function. CONCLUSION: In a general population sample, there was little evidence of cognitive decline during a 3.5-year period among persons who remained free of Alzheimer disease.

Aged↗

PubMed1976

Presence and persistence of depressive symptoms in patient and community populations.

The authors used a questionnaire to assess presence and persistence of 16 depression-associated symptoms in two inpatient groups and a random community sample. Nondepressed inpatients were more likely than the community population to experience psychological symptoms of depression, but persistence of the symptoms was the same for both groups. In contrast, significantly more depressed patients than community respondents indicated presence for all but 2 symptoms and persistence for all but 1. Thus persistence of symptoms may be more specific to depression than mere presence.

Depression↗

PubMed2005

Physical activity, cognitive activity, and cognitive decline in a biracial community population.

BACKGROUND: Findings from studies investigating whether physical activity reduces the risk of cognitive decline in old age have been inconsistent. OBJECTIVE: To examine whether participation in physical activity by older adults reduces the rate of cognitive decline after accounting for participation in cognitively stimulating activities. DESIGN: A prospective population study conducted from August 1993 to January 2003, with an average follow-up of 6.4 years. SETTING: A biracial community population on the south side of Chicago. PARTICIPANTS: Participants were 4055 community-dwelling adults 65 years and older who were able to walk across a small room and had participated in at least 2 of the 3 follow-up assessments. MAIN OUTCOME MEASURE: Annual rate of cognitive change as measured by a global cognitive score, which consisted of averaged standardized scores from 4 cognitive tests. RESULTS: In a mixed model adjusted for age, sex, race, and education, each additional physical activity hour per week was associated with a slower rate of cognitive decline by 0.0007 U/y (P = .04). However, with further adjustments (1) for participation in cognitive activities (beta = .0006, P = .10), (2) for depression and vascular diseases (beta = .0005, P = .19), and (3) by excluding participants whose global cognitive score at baseline was at or below the 10th percentile (beta = .0002, P = .45), the coefficients were smaller and no longer statistically significant. CONCLUSION: These data do not support the hypothesis that physical activity alone protects against cognitive decline among older adults.

Aged↗

PubMed2000

The prevalence of dizziness and its association with functional disability in a biracial community population.

BACKGROUND: Information regarding the prevalence of dizziness and its association with functional disability among African American and white residents from defined community populations is limited. METHODS: A total of 6,158 persons 65 years and older (78.8% of age-eligible persons) completed in-home interviews that included three common measures of self-reported disability: the Katz Activities of Daily Living (ADL) Scale, the Rosow-Breslau Functional Health Scale, and the Nagi Physical Disability Scale. A stratified random sample of 729 persons underwent a detailed evaluation that included questions on the frequency and severity of dizziness, which was defined as having an episode of dizziness or lightheadedness at least once a month. RESULTS: The overall prevalence of dizziness in this population was 9.6% (95% confidence interval [CI] 7.2-12.0). It increased with age, from 6.6% in those 65-74 years old, to 11.6% in those 75-84 years old, and to 18.4% in those persons > or =85 years old. It was more common in women (odds ratio [OR] 2.03, 95% CI 0.99-4.19) but was not associated with race. After adjusting for age, sex, and race, dizziness was associated with greater disability on the Rosow-Breslau (OR 2.29, 95% CI 1.18-4.46) and Nagi (OR 2.54, 95% CI 1.48-4.36) measures but not on the Katz ADL Scale (OR 1.18, 95% CI 0.64-2.20). CONCLUSIONS: Dizziness is common among older persons and is associated with functional disability.

Activities of Daily Living↗

PubMed1989

Prevalence of Alzheimer's disease in a community population of older persons. Higher than previously reported.

Clinically diagnosed Alzheimer's disease and other dementing illnesses were assessed in a geographically defined US community. Of 3623 persons (80.8% of all community residents over 65 years of age) who had brief memory testing in their homes, a stratified sample of 467 persons underwent neurological, neuropsychological, and laboratory examination. Prevalence rates of Alzheimer's disease were calculated for the community population from the sample undergoing clinical evaluation. Of those over the age of 65 years, an estimated 10.3% (95% confidence limits, 8.1% and 12.5%) had probable Alzheimer's disease. This prevalence rate was strongly associated with age. Of those 65 to 74 years old, 3.0% (95% confidence limits, 0.8 and 5.2) had probable Alzheimer's disease, compared with 18.7% (95% confidence limits, 13.2 and 24.2) of those 75 to 84 years old and 47.2% (95% confidence limits, 37.0 and 63.2) of those over 85 years. Other dementing conditions were uncommon. Of community residents with moderate or severe cognitive impairment, 84.1% had clinically diagnosed Alzheimer's disease as the only probable diagnosis. These data suggest that clinically diagnosed Alzheimer's disease is a common condition and that its public health impact will continue to increase with increasing longevity of the population.

Age Factors↗

PubMed1974

Surface-surface associations in microbial communities populating epithelial habitats in the murine gastrointestinal ecosystem: scanning electron microscopy.

Scanning electron microscopy has been used to visualize the residents of microbial communities populating habitats on epithelial surfaces in the gastrointestinal tracts of mice. In the stomach, bacteria form a dense layer on the stratified squamous epithelium of the nonsecreting area. Microbes of at least three morphological types can be seen in this layer, including short rods with round ends, rods in chains, and tapering filaments composed of repeating units of rod- or coccal-shaped elements varying in size from large at one end of the filament to small at the other end. These three forms all attach by one end to the epithelium. The latter two forms can be found only so attached; in both cases, the end is inserted into a hole or depression in the keratinized epithelium. In the small intestine, a microbe of morphology similar to that of the tapering filaments found in the stomach can be seen attached end-on to the epithelium. Again each filament has one end inserted into a hole in the epithelium. In this case, however, the repeating elements of each filament are all about the same size. In the cecum and colon, predominantly fusiform- and spiral-shaped microbes can be seen mixed together in layers on the epithelium. At least three types of fusiform-shaped microbes can be distinguished on the basis of surface texture, and one type of spiral-shaped microbe can be found. These microorganisms appear to be attached to each other and to the epithelium by weblike filaments. The numerous microbial types present in the various epithelial habitats associate intimately surface-to-surface with each other and with the epithelium. Such surface-surface association may be an important autogenic factor contributing to the stability of the murine gastrointestinal ecosystem.

Animals↗

PubMed1981

Allergen skin-test reactivity in a community population sample: correlation with age, histamine skin reactions and total serum immunoglobulin E.

Allergen skin reactivity to 14 common local antigens was studied in a community population sample. Differences in the prevalence of positive reactions were related to both the specific antigen itself and the age of the subjects. For most allergens, peak prevalence occurred in the 20- to 34-yr age group, falling thereafter with increasing age. The frequency distribution of reactions revealed a bimodal curve, peaks occurring among nonreactors and those with eight positive reactions out of the 14 tests that were applied. The major contributor to this age--skin test relationship was the level of total serum IgE that was highest in young people and decreased progressively with age. Histamine skin reactions, which were smallest in younger subjects compared with all three older age groups, also contributed to the age-related prevalence of allergen skin-test reactions.

Adolescent↗

PubMed2000

Rationality/antiemotionality personality and selected chronic diseases in a community population in Japan.

OBJECTIVE: To clarify the relationships of the rationality/antiemotionality (R/A) personality with past histories of seven chronic diseases and current smoking habits in a community population in Japan. METHODS: A questionnaire survey was conducted of all residents aged 35 years old or over (n = 37,287) in Takayama city, Gifu prefecture, Japan; the response rate was 90.3%. Data from 13,091 males and 14,061 females who completed all relevant questions were analyzed. The subjects were asked to complete an 11-item R/A personality scale developed by Grossarth-Maticek et al. (1985). Past histories of seven major chronic diseases and current smoking habit were also asked in the questionnaire. RESULTS: Among males, the R/A scale score was significantly lower in those who had stroke, diabetes or allergy than in those who did not. Among females, the R/A scale score was significantly lower in those who had stroke, allergy or stomach cancer than in those who did not. Among females, current smokers had significantly lower R/A scores than non-smokers. After controlling for age, smoking and drinking, the R/A score was significantly and negatively associated with stroke among males and females; it was significantly and negatively associated with diabetes and allergy among males. CONCLUSION: Our findings are contrary to those observed in Yugoslavia and West Germany, and suggest a cultural difference in the relationship between the R/A personality and disease occurrence.

Adult↗

PubMed2001

Hypochondriacal concerns in a community population.

BACKGROUND: Hypochondriasis is recognized as an important disorder in clinical populations, associated with increased health care utilization, disability and psychiatric co-morbidity. Few studies have investigated hypochondriasis in the community. We report on the broader concept of illness worry in a community population. METHODS: Five hundred and seventy-six subjects from an ethnically diverse urban setting were surveyed. Information was gathered on sociodemographic variables, medical and psychiatric status, health care utilization and disability. Bivariate and multivariate regression analyses were used to compare groups with illness worry (with and without the medical condition) to those without illness worry. RESULTS: Only one subject of 533 (0.2%) met criteria for hypochondriasis and seven (1.3%) fulfilled abridged criteria. However, 33 (6%) of the sample had illness worry. Of these, 17 had the illness about which they worried. Compared with controls, both illness worry groups had elevated levels of medical illness, psychiatric symptoms, help-seeking, health care use and disability. In multiple regression analyses, illness worry was an independent predictor of somatic symptoms, help-seeking, and disability, when sociodemographic and medical variables were controlled. CONCLUSIONS: Hypochondriasis appears to be a rare disorder in the community while illness worry is relatively common. Illness worry was present in equal numbers of subjects with the illness of concern, as those without. Illness worry was an independent factor contributing to increased levels of distress, health care utilization, and disability, even when medical status was controlled, suggesting that it is an important issue for further research.

Adult↗

PubMed1995

Traumas and posttraumatic stress disorder in a community population of older adolescents.

OBJECTIVE: The prevalence of DSM-III-R traumas and posttraumatic stress disorder (PTSD) and their impact on psychosocial functioning were examined in a community population of older adolescents. METHODS: Subjects were 384 adolescents participating in an ongoing longitudinal study. When subjects were aged 18 years, the NIMH Diagnostic Interview Schedule, Version IIIR, was used to identify lifetime traumatic events and diagnoses of PTSD, major depression, phobias, and substance dependence. Behavioral, emotional, and academic functioning in later adolescence was evaluated through self-report measures and school records. RESULTS: More than two fifths of adolescents experienced at least one DSM-III-R trauma by age 18 years; PTSD developed in 14.5% of these affected youths or 6.3% of the total sample. Youths with PTSD demonstrated widespread impairment at age 18, including more overall behavioral-emotional problems, interpersonal problems, academic failure, suicidal behavior, and health problems, as well as an increased risk for additional disorders. An equally striking finding was that youths who experienced traumas but did not develop PTSD also showed deficits in many of these areas when compared with their peers who had not experienced traumas. CONCLUSIONS: The substantial risk faced by youths in community settings for experiencing traumas and PTSD, along with associated impairments in later adolescence, underscores the need for programs of prompt intervention.

Achievement↗

PubMed1987

A study of somatization disorder in a community population utilizing grade of membership analysis.

A new multivariate analytical technique for the analysis of medical classification, Grade of Membership analysis, is utilized to examine somatization disorder in a community population. The authors examine whether somatic symptoms will cluster into a clinical syndrome resembling somatization disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), if no prior assumptions are made about the inter-relationship of somatic symptoms or their clustering into clinical syndromes. Using respondents in the US National Institute of Mental Health Epidemiologic Catchment Area project of the Piedmont Region of North Carolina, Grade of Membership analysis was applied to all respondents reporting 3 or more somatic symptoms from the somatization disorder section of the Diagnostic Interview Schedule. Seven 'pure' types, roughly analogous to clusters in cluster analysis emerged from the analysis. One 'pure' type in the analysis is nearly identical to DSM-III somatization disorder and is associated with demographic characteristics found among patients with DSM-III somatization disorder. The results indicate that symptoms associated with somatization disorder cluster in a highly predictable fashion and represent a strong validation of the natural occurrence of an entity resembling somatization disorder.

Adult↗

PubMed1984

The usefulness of the Denver Developmental Screening Test to predict kindergarten problems in a general community population.

The Denver Developmental Screening Test (DDST) was administered to 2,569 children five to seven months prior to starting kindergarten in September 1980 in a geographically well-defined community. The test was administered by trained public health nurses. At the end of the 1980-1981 school year, all 163 kindergarten teachers in the area completed a rating form for each child in their class. The rating form determined global ratings of: 1) learning abilities; 2) classroom behavior; 3) amount of special attention required; and 4) referrals to special education services outside the classroom. The specificity of the DDST in predicting kindergarten teacher ratings was 99 per cent for all areas. Test sensitivity varied from 5 per cent to 10 per cent in detecting problems in the four areas. The predictive values of an positive test varied from 31 per cent for behavior problems to 62 per cent for extra attention required in the classroom. Negative test predictive values varied from 79 per cent to 93 per cent. These results based on kindergarten teacher ratings suggest that, because of the low sensitivity and modest predictive value, the DDST may be relatively inefficient to use in a school entry screening program in a general community population of children.

Child, Preschool↗

PubMed1981

Distribution of IgE in a community population sample: correlations with age, sex, and allergen skin test reactivity.

The distribution of total serum IgE determined by the paper radioimmunosorbent test (PRIST) is examined in a large random stratified community population. Prior to logarithmic conversion the distribution of this immunoglobulin is not normal, with almost 40% of values below 20 IU/ml. A normal distribution occurs following such conversion, with a geometric mean value of 32.1 IU/ml. Both age and sex, in addition to atopic status, relate to IgE level. In both sexes highest levels occur among 6- to 14-year-olds, and males have higher levels than females at any given age. Women over age 75 yr have the lowest levels (geometric mean 9.2 IU/ml). Subjects with positive skin test results have several times the concentration of IgE as their nonatopic counterparts.

Adolescent↗

PubMed1997

Dental status, quality of life, and mortality in an older community population: a multivariate approach.

OBJECTIVE: To evaluate the relationships between a functional measure of dental status (FDS), several variables belonging to a quality of life (QOL) profile, and mortality in an older community population. DESIGN: Cross-sectional analysis for FDS and QOL; 10-year prospective study for mortality. SETTING: The historical and central district of the city of Brescia, northern Italy. PARTICIPANTS: The entire cohort of 70 to 75-year-old people living in the above-mentioned district (n = 1303): 1201 subjects were eligible for interview at baseline; 11 refused the physical examination; 52 were lost to follow-up; data are presented for the remaining sample of 1137 subjects. MEASUREMENTS: FDS examination was used to classify the subjects into three groups: naturally adequate (ADS) (25.2%), naturally inadequate (IDS) (14.3%) dental status, and denture wearers (DW) (60.4%). Various QOL domains were assessed: mood level, cognitive status, instrumental activities of daily living (IADL), social relationships, indexes of somatic health, and health behaviors. The demographic and socioeconomic parameters were used as covariates. RESULTS: Univariate analysis showed that both the ADS and the DW groups had a better QOL profile than the IDS group. Multiple logistic regression indicated that ADS and DW conditions were predicted independently by better educational and financial conditions, higher social relationships and a better IADL level in comparison with IDS. Moreover, compared with IDS, DS was a significant predictor of a better level at the SELF, IADL, and HCU scales whereas DW predicted only a better IADL level. Crude survival analysis showed that ADS was associated with a lower mortality risk compared with both DW and IDS, which did not differ from each other. FDS also remained a significant and independent predictor of mortality in a more general Cox's regression model. CONCLUSIONS: Within this cohort of 70 to 75-year-old urban residents, FDS is associated with several QOL domains and with long-term survival. A hierarchy of reciprocal relationships exists among these parameters. The present study provides a basis for encouraging more extensive use of dentures. Longitudinal studies using oral health outcomes are warranted before clinical recommendations can be made.

Aged↗

PubMed1986

Somatization disorder in a community population.

The data recently collected in the Piedmont region of North Carolina as part of the National Institute of Mental Health Epidemiologic Catchment Area Program were used to examine somatization disorder in a community population. The authors found an adjusted prevalence of 0.38% for somatization disorder diagnosed according to the Diagnostic Interview Schedule and DSM-III. Respondents with somatization disorder demonstrated demographic characteristics (female, unmarried, nonwhite, from a rural area, less educated) that are consistent with findings from past clinical and epidemiologic studies of somatization disorder. The adjusted prevalence is higher than that of other Epidemiologic Catchment Area sites, and possible explanations for this findings are discussed.

Adolescent↗

PubMed2004

A longitudinal study of parkinsonism and disability in a community population of older people.

BACKGROUND: Parkinsonian signs in patients without Parkinson's disease are often undetected but occur frequently in older people, and are often considered benign. We measured the association between parkinsonism and subsequent disability. METHODS: We conducted a prospective, longitudinal, community-based population study in East Boston, Massachusetts, using a stratified random sample of 455 community residents, aged 65 years and older. Four categories of parkinsonian signs were measured at baseline: bradykinesia, gait disturbance, rigidity, and tremor. Parkinsonism was defined as the presence of two or more categories of parkinsonian signs, and cases of Parkinson's disease were excluded from analyses. Disability was assessed annually over a mean of 4.7 years using the Katz, Rosow-Breslau, and Nagi disability measures. RESULTS: Parkinsonism at baseline strongly predicted subsequent disability as assessed with the three disability measures (on the Katz measure, beta = -1.30, p < .001). On average, a person with parkinsonism had a disability level at follow-up equal to that of a comparable person approximately 16.7 years for men and 8 years for women. The rate of developing disability for persons with parkinsonism increased each year; on the Katz measure, participants with parkinsonism declined on average 16.4% faster than those without. Gait impairment and bradykinesia strongly predicted subsequent disability; tremor and rigidity did not. The effect of parkinsonism was attenuated but still persistent in persons with coexistent moderate-to-severe cognitive impairment or stroke. CONCLUSIONS: Parkinsonism strongly predicts progressive disability in the older community population and has a marked aging effect on disability level.

Aged↗