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PubMed2004

Socioeconomic position and hormone replacement therapy use: explaining the discrepancy in evidence from observational and randomized controlled trials.

OBJECTIVES: We assessed the association between life-course socioeconomic status or position (SEP) and hormone replacement therapy (HRT). METHODS: We conducted a cross-sectional analysis of 4286 women aged 60 to 79 years. RESULTS: Women experiencing adverse socioeconomic circumstances across the life course were less likely to have used HRT. The associations of childhood socioeconomic measures with HRT use were independent of adult SEP, behavioral risk factors, and physiological risk factors for heart disease. CONCLUSIONS: SEP from across the life course is associated with HRT use. Because the association between early life SEP and HRT is not fully explained by adult risk factors, residual confounding (which is not captured by adjustment for adult variables only) may explain some of the disparity between observational studies and randomized controlled trials in this area.

Aged↗

PubMed2005

Factors explaining disability-free life expectancy in Japan: the proportion of older workers, self-reported health status, and the number of public health nurses.

BACKGROUND: Disability-free life expectancy (DFLE) data for 47 prefectures in Japan were reported in 1999; however, few studies have identified the factors associated with the length of the DFLE. The objective of this study was to elucidate the primary factors that explain differences in DFLEs in Japan. METHODS: In our ecological study, 47 prefectures in Japan were used as units of analysis. The DFLEs for men and women at 65 years of age (DFLE65), calculated by Hashimoto et al using Sullivan's method, were set as dependent variables. From various national surveys, 181 factors associated with demographics, socioeconomic status, health status and health behaviors, medical environment, social relationships, climate, and other areas were gathered as independent variables. Pearson's or Spearman's correlation coefficients were calculated to screen independent variables potentially associated with the DFLE65s. Then, multivariate linear regression analyses were conducted for the selected 24 independent variables after adjusting for the proportion of older people (65 years or more) and population density. RESULTS: Multivariate linear regression analyses revealed that the large number of public health nurses per 100,000 population, a good self-reported health status, and a high proportion of older workers were significantly associated with long DFLE65s for both genders. CONCLUSIONS: These three factors could potentially explain the differences in DFLE of the older population in Japan.

Aged↗

PubMed2002

Comorbidities and impairments explaining the association between diabetes and lower extremity disability: The Women's Health and Aging Study.

OBJECTIVE: To elucidate the role of diabetes-related impairments and comorbidities in the association between diabetes and physical disability, this study examined the association between diabetes and lower extremity function in a sample of disabled older women. RESEARCH DESIGN AND METHODS: Cross-sectional analysis of 1,002 women (aged >or=65 years) enrolled in the Women's Health and Aging Study (one-third most disabled of the total community-dwelling population). Diabetes and other medical conditions were ascertained by standard criteria that used multiple sources of information. Functional status was assessed using self-reported and objective performance measures. RESULTS: Women with diabetes were significantly more likely to have cardiovascular diseases, peripheral nerve dysfunction, visual impairment, obesity, and depression. After adjustment for age, women with diabetes had a greater prevalence of mobility disability (odds ratio [OR] 1.85, 95% CI 1.12-3.06), activities of daily living disability (1.61, 1.06-2.43), and severe walking limitation (2.34, 1.56-3.50), and their summary mobility performance score (0-12 scale based on balance, gait speed, chair stands) was 1.4 points lower than in nondiabetic women (P < 0.001). Peripheral artery disease, peripheral nerve dysfunction, and depression were the main individual contributing factors; however, none of these conditions alone fully explained the association between diabetes and disability. Conversely, only after adjusting for all potential mediators was the relationship between diabetes and disability reduced to a large degree. CONCLUSIONS: Even among physically impaired older women, diabetes is associated with a major burden of disability. A wide range of impairments and comorbidities explains the diabetes-disability relationship, suggesting that the mechanism for such an association is multifactorial.

Age of Onset↗

PubMed2004

Increased diabetes incidence in Greek and Italian migrants to Australia: how much can be explained by known risk factors?

OBJECTIVE: The aims of the study were to determine whether Greek or Italian migrants to Australia have an elevated incidence of type 2 diabetes compared with Australian-born individuals and to what extent any differences can be explained by known risk factors. RESEARCH DESIGN AND METHODS: This was a prospective study of 34,097 men and women aged 40-69 years born in Greece, Italy, Australia, or New Zealand who were free from diabetes at baseline. For all self-reported cases of diabetes at the 4-year follow-up, a confirmation of diagnosis was sought from medical practitioners. Of these, anyone for whom there was no evidence against a diagnosis of type 2 diabetes was considered a case subject. RESULTS: Follow-up was completed by 29,331 (86%) participants, and 334 case subjects were identified. The cumulative incidence of type 2 diabetes among Greek (2.6%) and Italian (2.4%) migrants was more than three times that in Australian-born (0.7%) individuals. After adjusting for age only, the odds ratios (ORs) for being of Greek and Italian origin compared with Australian origin were 3.8 (95% CI 2.9-5.0) and 3.3 (2.6-4.3), respectively. The only known risk factor for type 2 diabetes that materially affected these ORs was BMI. After adjusting for BMI and age, the ORs for being of Greek and Italian origin, respectively, were 2.4 (1.8-3.2) and 2.0 (1.5-2.6). CONCLUSIONS: Greek and Italian migrants to Australia have a more than three times greater incidence of type 2 diabetes than Australian-born individuals, and this is only partly explained by BMI. Although weight control will remain important for these high-risk groups, identification of other risk factors is required.

Adult↗

PubMed2000

Hypothesis testing and anomaly explaining.

An experimenter who tests a hypothesis and observes an anomaly that conflicts with his knowledge and views, normally reacts by suspecting some sort of mistake. When he has excluded this possibility, his second sensible reaction is to find an ad hoc interpretation to explain the anomaly. When his favorite interpretation is interesting, probable, simple, elegant and testable enough, he can experiment to verify this explanation as a new hypothesis, independently from the anomaly. This article describes how a scientific investigation walks on two legs: one leg of hypothesis testing and a second leg of anomaly explaining.

Bias↗

PubMed1998

Role of known risk factors in explaining the difference in the risk of coronary heart disease between eastern and southwestern Finland.

We analysed to what extent cardiovascular risk factors may explain the observed difference in the risk of coronary heart disease (CHD) between two areas with markedly different CHD incidence. The study included 7049 men aged 25-64 years who had participated in a baseline survey in 1982 or in 1987 in the Kuopio and North Karelia provinces of eastern Finland and in the Turku-Loimaa region of southwestern Finland. During the baseline surveys the following factors were determined: smoking, blood pressure, cholesterol, high-density lipoprotein cholesterol, diabetes, height, body mass index, family history of CHD and socioeconomic status. The cohorts were followed for coronary events until the end of 1994. CHD risk was about 40% higher in eastern than in southwestern Finland. The levels of most of the measured risk factors were also higher in eastern Finland. Differences in risk factor levels explained about 40% of the excess CHD risk in eastern Finland. The impact of the classical risk factors, such as smoking, cholesterol and blood pressure, on the regional difference was smaller than expected. Single risk factor measurements in our population surveys, however, may not have correctly reflected the long-term exposure of individuals to these risk factors, particularly because the surveys were carried out within a period during which these risk factors were undergoing favourable changes in the Finnish population. In addition to the classical risk factors, regional differences in body height and socioeconomic status were associated with the regional differences in CHD risk.

Adult↗

PubMed1992

The stroke preventive effect in elderly hypertensives cannot fully be explained by the reduction in office blood pressure--insights from the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension).

OBJECTIVE: To study whether the cardiovascular preventive effect of antihypertensive therapy can be explained solely by the reduction in office blood pressure, and to what extent the risk of stroke and cardiac events is associated with in-study diastolic blood pressure (DBP) and systolic blood pressure (SBP). DESIGN: The Swedish Trial in Old Patients with Hypertension (STOP-Hypertension) was a prospective, randomized, double-blind, multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70-84 years. The study group comprised 1,627 elderly patients (mean blood pressure 195/102 mm Hg; mean age 75.7, SD 3.7; 63% females). The average follow-up was 25 months (range 6-65 months). No patient was lost to follow-up. METHOD: We applied a Poisson model taking current age, sex, treatment, DBP and SBP into account for all patients in the study. The constants of the model were estimated by the maximum likelihood method. RESULTS: The risk of stroke was significantly lower (42%, p = 0.0402) for a patient on active therapy than for a patient on placebo having the same blood pressure level, age, and sex. There was a corresponding, non-significant, reduction in cardiac events of 21%. In the whole study group the risk of stroke increased by 3% per mmHg (p = 0.0247) with increasing diastolic blood pressure for a given systolic pressure. The corresponding value for cardiac events was 2% per mmHg (p = 0.0376). CONCLUSION: In STOP-Hypertension we found a substantial risk reduction in stroke in actively treated patients, which was not solely explained by the blood pressure reduction obtained by treatment with beta-blockers and a potassium-sparing diuretic combination.

Aged↗

PubMed1994

Low mitochondrial free radical production per unit O2 consumption can explain the simultaneous presence of high longevity and high aerobic metabolic rate in birds.

Birds are unique since they can combine a high rate of oxygen consumption at rest with a high maximum life span (MLSP). The reasons for this capacity are unknown. A similar situation is present in primates including humans which show MLSPs higher than predicted from their rates of O2 consumption. In this work rates of oxygen radical production and O2 consumption by mitochondria were compared between adult male rats (MLSP = 4 years) and adult pigeons (MLSP = 35 years), animals of similar body size. Both the O2 consumption of the whole animal at rest and the O2 consumption of brain, lung and liver mitochondria were higher in the pigeon than in the rat. Nevertheless, mitochondrial free radical production was 2-4 times lower in pigeon than in rat tissues. This is possible because pigeon mitochondria show a rate of free radical production per unit O2 consumed one order of magnitude lower than rat mitochondria: bird mitochondria show a lower free radical leak at the respiratory chain. This result, described here for the first time, can possibly explain the capacity of birds to simultaneously increase maximum longevity and basal metabolic rate. It also suggests that the main factor relating oxidative stress to aging and longevity is not the rate of oxygen consumption but the rate of oxygen radical production. Previous inconsistencies of the rate of living theory of aging can be explained by a free radical theory of aging which focuses on the rate of oxygen radical production and on local damage to targets relevant for aging situated near the places where free radicals are continuously generated.

Aerobiosis↗

PubMed1995

The Internet and World Wide Web explained.

Most people have by now heard of the Internet. Its presence is advertised via newspapers, magazines, television and radio. The Internet offers exciting new opportunities for information exchange and medical photographers and illustrators should be exploiting the potential of these services. This article seeks to explain what the Internet is and how the World Wide Web makes access to the Internet comparatively simple. It also attempts to demystify the jargon and explain how you can connect to the services on offer.

Computer Communication Networks↗

PubMed2006

The role of illness beliefs, treatment beliefs, and perceived severity of symptoms in explaining distress in cancer patients during chemotherapy treatment.

The authors investigated cancer patients' interpretations of their physical symptoms and their illness beliefs with the objective of establishing the importance of these variables in predicting distress during chemotherapy treatment. Past researchers have suggested that causal attributions of physical symptoms and beliefs about illness progression and its consequences may serve as important mediators between number and perceived severity of symptoms and psychological adjustment in cancer patients during the treatment phase. Our aim in this study was to further these findings using the Self-Regulation Model as a theoretical framework. The study was cross-sectional in design, testing 72 patients with cancer receiving intravenous chemotherapy as outpatients in the United Kingdom. The participants completed questionnaires measuring number and perceived severity of symptoms, the causal attributions of these, illness and treatment beliefs, anxiety, and depression. The results showed that consequence beliefs serve as important mediators between number of symptoms and distress, explaining 15% of the variance in anxious mood and 5% of the variance in depressed mood. The authors found perceived severity of symptoms to be an independent predictor of anxious mood, explaining 7% of the variance. Its role in predicting depressed mood was not significant.

Adult↗

PubMed2005

Development of a structural model explaining medication compliance of persons with schizophrenia.

The purpose of this study was to develop and test a structural model explaining medication compliance of schizophrenia. From a review of the literature, a hypothetical model was developed based on the conceptual framework of the Health Belief Model with medication knowledge, symptom severity and social support as the exogenous variables, and perceived benefits, perceived barriers, substance use and medication compliance as the endogenous variables. Data was collected at various mental health facilities, including psychiatric outpatient clinics of general hospitals and community mental health centers, between March and May, 2001. A structured questionnaire was used by one- on- one interviews to collect data on 208 schizophrenic patients. Well established measurement instruments, with confirmed reliability, were used to assess each method variable. As a result of covariance structural analysis, the hypothetical model was found not to fit the empirical data well, so a parsimonious model was adopted after modifying the model. The final model was able to explain the 33 % medication compliance. Medication knowledge, social support and perceived benefits had significant effects on medication compliance. The findings of this study address the importance of medication education and social support to promote medication compliance. It is also suggested that various education programs and support groups are needed to enhance medication compliance.

Adult↗

PubMed2003

A context-dependent representation model for explaining text repetition effects.

The purpose of this article is to review abstract and episodic models of text repetition effects, describe the research supporting these types of models, and propose a new model called the context-dependent representation model, which can explain both abstract-like and episodic-like repetition effects. The basic assumptions of the model are that the surface form and textbase are represented in a context-independent manner, and a coherent situation model binds together the surface features and the textbase and leads to context-dependent representation. When the situation model is well developed, it limits repetition benefits to semantically or contextually similar texts. This produces context-dependent repetition effects, which are functionally similar to episodic repetition effects. When the situation model is not well developed or not task relevant, repetition benefits are not limited to contextually similar texts. This produces context-independent repetition effects, which are functionally similar to abstract repetition effects. The context-dependent representation model provides a theoretical basis for explaining past research, and it can serve as a guide for future research aimed at understanding text repetition effects as well as text comprehension and memory.

Attention↗

PubMed2000

The ability of familiarity, disruption, and the relative strength of nonenvironmental context cues to explain unreliable environmental-context-dependent memory effects in free recall.

The ability of environmental-context (EC) familiarity, movement disruption, and the relative strength of memory cues to explain unreliable EC-dependent free-recall memory effects was examined in two experiments. Experiment 1 replicated Smith's (1979, Experiment 1) results confirming that familiarity and disruption cannot account for free-recall EC-reinstatement effects. In Experiment 2, a level of processing manipulation varied stimulus item memory cue strengths, and memory was again assessed by free recall. Contrary to Murnane and Phelps's (1995) and Dougal and Rotello's (1999) recognition findings, an EC-reinstatement effect was observed with low, but not high, levels of processing. However, comparisons across the two experiments revealed inconsistencies with the relative cue strength hypothesis. Consequently, a variant of the relative cue strength hypothesis that highlights the role of retrieval processes was proposed to explain the interaction between the levels of processing and the EC-reinstatement effect.

Adult↗

PubMed2000

John Watson's paradoxical struggle to explain Freud.

John Watson was fascinated by the discoveries of psychoanalysis, but he rejected Freud's central concept of the unconscious as incompatible with behaviorism. After failing to explain psychoanalysis in terms of William James's concept of habit, Watson borrowed concepts from classical conditioning to explain Freud's discoveries. Watson's famous experiment with Little Albert is interpreted not only in the context of Pavlovian conditioning but also as a psychoanalytically inspired attempt to capture simplified analogues of adult phobic behavior, including the "transference" of emotion in an infant. Watson used his behavioristic concept of conditioned emotional responses to compete with Freud's concepts of displacement and the unconscious transference of emotion. Behind a mask of anti-Freudian bias, Watson surprisingly emerges as a psychologist who popularized Freud and pioneered the scientific appraisal of his ideas in the laboratory.

Adult↗

PubMed2000

How the challenge of explaining learning influenced the origins and development of John B. Watson's behaviorism.

Before he invented behaviorism, John B. Watson considered learning one of the most important topics in psychology. Watson conducted excellent empirical research on animal learning. He developed behaviorism in part to promote research and elevate the status of learning in psychology. Watson was much less successful in the adequacy and originality of the mechanisms he proposed to explain learning. By assimilating the method of classical conditioning and adopting Pavlov's theory of stimulus substitution, Watson linked behaviorism with a new method that could compete with both Titchener's method of introspection and Freud's methods of psychoanalysis. Watson's interest in explaining psychopathology led to the discovery of conditioned emotional responses and a behavioristic explanation for the learning of phobic behavior. Watson established learning as a central topic for basic research and application in American psychology.

Behaviorism↗

PubMedDate not supplied

Explaining demographic trends in teenage fertility, 1980-1995.

CONTEXT: The teenage birthrate rose sharply in the late 1980s and early 1990s, and then declined in the 1990s. Attempts to explain these changes have failed to account for the changing environment in which adolescents live. METHODS: Data from the 1995 cycle of the National Survey of Family Growth are used to compare the experiences of three cohorts of teenage females in the 1980s and 1990s. A life-course framework is used to examine trends in characteristics of adolescents and adolescent mothers over time, and event-history analyses are conducted to determine which characteristics are associated with the risk of a teenage birth in each cohort. A comparison of the predicted probabilities from hazard analyses shows how changes in the context of adolescence across the cohorts help explain changes in the probability of a teenage birth over time. RESULTS: Factors associated with the increase in the teenage birthrate in the 1980s include negative changes in family environments (such as increases in family disruption) and an increase in the proportion of teenagers having sex at an early age. Factors associated with the recent decline in the teenage birthrate include positive changes in family environments (such as improvements in maternal education), formal sex education programs and discussions with parents about sex, stabilization in the proportion of teenagers having sex at an early age and improved contraceptive use at first sex. Sexually experienced teenagers in the mid- 1990s were younger, on average, at first sex than were their counterparts in the 1980s, and thus are at an increased risk of a teenage birth. Partner factors, including nonvoluntary first sexual experiences, were not associated with the risk of a adolescent birth in any cohort. CONCLUSIONS: Programs to further reduce the teenage birthrate should take into account the role of family stability, parent-child communication, sex education programs and engagement in school, as well as attempt to reduce the proportion of adolescents having sex at an early age and to improve contraceptive use. The increasing risk levels among sexually experienced teenagers suggest that current programs may be reducing sexual activity among adolescents already at a low risk of a teenage birth, without addressing the needs of those at highest risk.

Adolescent↗

PubMed2001

[Cancer treatment in Skane and in Sjaelland. Do differences concerning examination and treatment explain reduced survival among Danish cancer patients?].

INTRODUCTION: Danish cancer patients generally have a poorer survival than Swedish cancer patients. The difference is most pronounced for certain tumour types, e.g. common types such as lung, breast, colorectal, and prostate cancer. The reasons are not clear. The present article examines if differences in the diagnostic workup and treatment can explain some of this variation. MATERIAL AND METHODS: Aspects of the diagnostic workup and treatment of the above mentioned four cancer types are examined using data from cancer registry analyses and official reports. These data are seen in the context of counts of trained personnel and equipment in cancer diagnostics and treatment in the two countries. RESULTS: With regard to lung and breast cancer, the data seem to indicate that Danish patients are diagnosed later, and that Denmark lags behind in treatment capacity. With regard to rectal cancer, the data seem to indicate that concentrating operations in fewer hospitals, and improvements in operation technique have been introduced earlier in Sweden than in Denmark. With regard to prostate cancer, however, the data seem to indicate that many more indolent cases that do not need treatment are diagnosed in Sweden than in Denmark. The total capacity for oncologic treatment, both in terms of trained personnel and equipment, seen in relation to the size of the population, is considerably larger in Southern Sweden than in Eastern Denmark. DISCUSSION: The data for some of the common cancer types seem to indicate that problems in the areas of sufficient capacity for diagnostic workup and treatment may explain some of the difference in survival between Danish and Swedish cancer patients.

Breast Neoplasms↗

PubMed2001

[Can blood homocysteine explain the family history of vascular diseases?].

INTRODUCTION AND AIMS: Family history of vascular disease is an important risk factor for vascular disease, independent of conventional risk factors. Homocysteinemia, a newly defined risk factor, is caused by genetics, such as cystathionine beta synthase deficiencies, and metabolic deficiencies. With the present work we intend to study the influence of family history of vascular disease in homocysteinemia. METHODS: We studied 204 normal persons (153 males), average age 38.7 +/- 10.9 years, in terms of family history of vascular disease (death due to myocardial infarction or a stroke), conventional risk factors, routine laboratory tests, fasting homocysteinemia and after oral methionine loading (0.1 g/Kg body weight). We compared laboratory results, conventional risk factors and homocysteinemia levels in persons with and without a family history of vascular disease. We performed covariance analysis to evaluate, in a multivariate model, factors that were related to basal or after methionine loading homocysteinemia. RESULTS: 35% of persons presented a family history of vascular disease (FHVD). Persons with FHVD presented higher age (45.6 +/- 8.9 versus 35.0 +/- 10.1, p < 0.001), and higher prevalence of hypertension (p = 0.002), dyslipidemia (p = 0.001), obesity (p = 0.03), and physical inactivity (p = 0.03). They presented a tendency, without statistical significance, to have a higher prevalence of diabetes and of hyperhomocysteinemia, and to present higher levels of basal and afterload homocysteinemia. Performing covariance analysis, basal homocysteinemia did not present any relation to FHVD. After methionine load homocysteinemia was strongly influenced by basal homocysteinemia (p = 0.0000), and significantly related to FHVD (p = 0.039). CONCLUSIONS: Homocysteinemia cannot explain most of the risk of family history of vascular disease, not explained by conventional risk factors. The only significant relationship between homocysteinemia and FHVD was observed with afterload homocysteinemia in the multivariate model. FHVD is clearly related to conventional risk factors.

Adult↗