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PubMed2006

13C urea breath test for (Helicobacter pylori): determination of the optimal cut-off point in a Canadian community population.

AIM: To determine the test characteristics and the optimal cut-off point for the (13)C urea breath test ((13)C UBT) in a Canadian community laboratory setting. METHODS: Of 2232 patients (mean age +/- SD: 51+/-21 years, 56% female) who completed a (13)C UBT, 1209 were tested to evaluate the primary diagnosis of (Helicobacter pylori) infection and 1023 were tested for confirmation of eradication following treatment. Cluster analysis was performed on the (13)C UBT data to determine the optimal cut-off point and the risk of false-positive and false-negative results. Additionally, 176 patients underwent endoscopic biopsy to allow validation of the sensitivity and specificity of the (13)C UBT against histology and microbiology using the calculated cut-off point. RESULTS: The calculated cut-off points were 3.09 delta/1000 for the whole study population (n=2232), 3.09 delta/1000 for the diagnosis group (n=1209) and 2.88 delta/1000 for the post-treatment group (n=1023). When replacing the calculated cut-off points by a practical cut-off point of 3.0 delta/1000, the risk of false-positive and false-negative results was lower than 2.3%. The (13)C UBT showed 100% sensitivity and 98.5% specificity compared with histology and microbiology (n=176) for the diagnosis of active (H pylori) infection. CONCLUSIONS: The (13)C UBT is an accurate, noninvasive test for the diagnosis of (H pylori) infection and for confirmation of cure after eradication therapy. The present study confirms the validity of a cut-off point of 3.0 delta/1000 for the (13)C UBT when used in a large Canadian community population according to a standard protocol.

Biopsy↗

PubMed2002

Periodic limb movement in a community population detected by a new actigraphy technique.

BACKGROUND: Periodic limb movements (PLMs) have been studied in both community and sleep clinic populations using polysomnography. An alternative detection method is actigraphy. Our aims were to determine the frequency of PLMs, measured by actigraphy in a community sample, and to assess the relationships of PLMs with age, gender, and reported sleep-related symptoms. METHODS: Volunteers had bilateral foot actigraphy (Cambridge Neurotechnology) at home and completed sleep questionnaires. Actigraphy was scored for PLMs per hour in bed (PLMI) and statistical analysis performed to assess possible associations. RESULTS: PLMI (mean of two nights) ranged from 0 to 60.3 and 37% of the sample had a PLMI> or =5. Men had significantly higher PLMIs than females (P=0.003) but PLMI was not correlated with age. There was a modest but significant correlation between subjectively reported restless leg severity and PLMI (r=0.238; P=0.003), but none with reported sleepiness. CONCLUSIONS: This actigraphy technique is a practical and reliable tool for community studies. A large proportion of this community sample, particularly men, had PLMs. PLMI was not correlated with age or Epworth Sleepiness Score.

Journal Article↗

PubMed1979

The impact of urinary schistosomiasis on the health of two community populations living in endemic areas in Tanzania.

Two populations living in separate areas in Tanzania known to be endemic for S. haematobium were investigated for the effects of the infection on community health. Both populations, each of about 450 examinees, had similar infection prevalences of 54-57% with peaks of 66-67% among the 5 to 19 year olds. Over 90% of the infections from either population were symptomatic showing mostly manifestations of vesical lesions. Radiological examinations of a random sample of 100 infected subjects from the population with the lower infection intensity revealed a high prevalence of 28% for bilateral uretero-renal lesions. The prevalence of urological lesions, including the potentially fatal uretero-renal lesions, was higher than hitherto reported from Tanzania. Urinary schistosomiasis was therefore considered to be of more serious public health importance in the country than has been accepted in the past.

Adolescent↗

PubMed2005

Systolic time intervals revisited: correlations with N-terminal pro-brain natriuretic peptide in a community population.

The usefulness of automated measurements of the systolic time intervals in community screening deserves investigation. The systolic time intervals, including pre-ejection period (PEP), the left ventricular ejection time (LVET), and PEP/LVET were automatically and rapidly determined from signals of electrocardiography, phonocardiography, and pulse volume recording in 1087 residents aged > or = 40 years in a community of homogeneous Chinese. Receiver operating characteristics analysis was performed to determine the cutoff values for PEP, ET, and PEP/LVET in predicting high N-terminal pro-brain natriuretic peptide (NT-proBNP). The prevalence of high NT-proBNP was 12.3% in men and 8.3% in women. NT-proBNP was linearly related to both PEP and PEP/LVET, while there was a U-shaped relationship between NT-proBNP and LVET. In men, the sensitivity and specificity in predicting high NT-proBNP levels were 60% and 60%, respectively, for PEP > or = 89 ms; 60% and 62% for PEP/LVET > or = 0.31; and 63% and 60% for LVET < 272 ms or LVET > or = 310 ms. Various combinations of the criteria further improved either sensitivity or specificity. Women had slightly different cutoff values and performance for the various criteria of abnormal systolic time intervals and their combinations. Automated systolic time intervals appear to be useful in the screening of subjects with high NT-proBNP in a community.

Adult↗

PubMedDate not supplied

Age and sex distribution of DSM-III personality cluster traits in a community population.

DSM-III pathological personality cluster traits were measured on a community sample of 235 people. Traits in the schizoid cluster (schizoid, schizotypal, and paranoid) showed no change with age while traits in the dramatic cluster (antisocial, narcissistic, borderline, and histrionic) and to some extent the anxious cluster (avoidant, dependent, compulsive, and passive/aggressive) showed similar significant associations with age. This pattern was a reverse "J" shaped curve, with mean number of traits declining from younger to older groups and a slight upturn in the oldest age group (60 years plus). Women aged 31 to 40 years had a higher mean number of traits than their male counterparts, with a corresponding increase in impairment. The highest levels of personality traits in men were found at ages 18 to 30, while in women the 31 to 40 year group was highest.

Adolescent↗

PubMed2000

Comparison of informal caregiving by black and white older adults in a community population.

OBJECTIVES: To examine the prevalence of informal caregiving and demographic factors associated with caregiving time in older community residents and compare caregiving prevalence and time spent providing care by black and white residents. DESIGN: A cross-sectional, population-based study. SETTING: The study was conducted as part of the Chicago Health and Aging Project (CHAP) in a geographically defined community of black and white residents aged 65 and older. PARTICIPANTS: Participants were 5,924 community residents (61.4% black; 38.6% white) who answered questions about informal caregiving responsibilities during a structured interview about a broad range of health and social factors. METHODS: Data were collected during an in-home interview. Multiple logistic and linear regression models were used to examine the association between caregiving and race, gender, age, marital status, and education. RESULTS: More than 16% of residents had provided care to others during the previous 12 months, and 10.3% were currently providing care. Compared with whites, blacks were 30% more likely to be caregivers, spent almost 13 more hours each week in caregiving activities, and were more likely to assist friends. The probability of caregiving increased significantly with age for married persons, decreased with age for unmarried persons, and was lower for men compared with women. The time spent providing care each week increased significantly with age for married persons and did not differ between men and women. CONCLUSIONS: Although physicians and other healthcare providers typically view older people as the recipients of informal care, individuals older than age 65 provide a substantial amount of care to others with health problems and disability. Most research has focused on the needs of young and middle-aged caregivers, and little is known about the needs of these older caregivers. Future research should use sampling strategies that provide adequate numbers of white and non-white participants for meaningful comparisons. This will permit identification of racial and cultural differences in caregiving so that interventions can be tailored to specific groups.

Black or African American↗

PubMed2005

Survey nonresponse is associated with increased mortality in patients with rheumatoid arthritis and in a community population.

OBJECTIVE: To determine whether nonresponse to a mailed health survey predicts mortality in patients with rheumatoid arthritis (RA) and in a community sample in Finland. METHODS: A 5-page health questionnaire was administered in 2000. Two years later the vital status of the subjects was ascertained from the Population Registry. RESULTS: A total of 1095 (73%) patients with RA and 1530 (77%) community control subjects returned a completed questionnaire. Over the 2-year period, the number of deaths was 57 (5.2%) in RA responders and 37 (9.3%) in RA nonresponders (p = 0.004). The corresponding figures in community controls were 34 (2.2%) and 23 (4.9%) (p = 0.002). In a Cox regression model adjusted for age and sex, RA patient and community control nonresponders were respectively 1.65 (95% CI 1.07 to 2.55) and 2.89 (95% CI 1.69 to 4.94) times more likely to die over the 2 years compared to the responders. CONCLUSION: Nonresponders to a mailed health survey were more likely to die over 2 years compared to responders. The possible nonresponse bias should be kept in mind in the interpretation of the results of studies that are based on mail questionnaires only.

Adult↗

PubMedDate not supplied

The factor structure of the Reiss Screen for Maladaptive Behaviors in institutional and community populations.

The Reiss Screen for Maladaptive Behavior was factor analyzed in two institutional samples and one community sample of persons with mental retardation. In Sample I a general factor was found. In Samples 2 and 3 a three-factor structure was found. These three factors were named Intra-personal Maladaptive Behavior, Psychotic Behavior, and Extra-personal Maladaptive Behavior. None of the factor solutions bore any close resemblance to a factor structure implied by the seven scales on the Reiss Screen. The implications for the future development of assessments of dual diagnosis are discussed.

Activities of Daily Living↗

PubMed1996

Hopelessness in a community population in Japan.

The Japanese version of the Beck Hopelessness Scale was administered to a total of 154 community residents. The internal consistency (KR-20) was .86. The mean BHS score was 8.6 (SD = 3.9), approximately one standard deviation higher than the reported mean for an Irish general population. The BHS scores were found to be significantly correlated with the age and the number of people living together. Significant negative correlations were found with subjective physical fitness, self-confidence, satisfaction with accommodation and marital state, and adjustment in the work place. The mean BHS score was significantly higher among those individuals who had experienced early maternal or paternal death than those who had not.

Adult↗

PubMed1999

A decade of spontaneous long-term course of psychogenic impairment in a community population sample.

BACKGROUND: Our epidemiological study demonstrates the spontaneous long-term course of predominantly psychosocially influenced ("psychogenic") disorders (neurotic spectrum disorders, personality disorders, stress reactions and somatoform disorders) in a representative community sample of the normal adult population of Mannheim, an industrial and university town in Germany. The natural spontaneous course of these disorders in a population sample over a long period remains largely unknown. METHOD: Beginning in 1979 (nt1 = 600) a random population sample was investigated three times over a mean period of approximately 11 years. The last follow-up study ended in 1994 (nt3 = 301). The follow-up sample was representative of the t1 sample. Psychodynamically trained and clinically experienced interviewers used a semi-structured interview and standardized clinical and psychometric instruments. Psychogenic impairment was assessed using a standardized expert rating (Impairment Score, IS). RESULTS: The mean sum-score of psychogenic impairment after 11 years exceeded the value at t1. The case rate (point prevalence, ICD diagnosis + clinical cut-off/IS) increased from 21.6% at t1 to 26.2% at t3 in the investigated follow-up sample. Intra-individual correlation of psychogenic impairment between t1 and t3 was high (r = 0.55). We found strong evidence for an unfavorable long-term course of psychogenic impairment and only a weak tendency (23.1%) for spontaneous remission of clinically relevant psychogenic impairment. Within a regression model clinical variables, childhood development conditions and personality traits at t1 predicted psychogenic impairment at t3. CONCLUSION: All clinical variables conclusively indicate an unfavorable spontaneous long-term course of psychogenic impairment. Together with the well-known high prevalence of psychogenic disorders in the normal population, this underlines the need for early therapeutic and preventive intervention.

Adult↗

PubMed2003

Social engagement and disability in a community population of older adults: the New Haven EPESE.

This paper examines the effect of social engagement on disability among community-dwelling older adults in 1982-1991. Data were collected from the New Haven, Connecticut, site of the Established Populations for Epidemiologic Studies of the Elderly. Baseline social engagement was measured by using 11 items related to social and productive activity. Disability data consisted of a six-item measure of activities of daily living, a three-item measure of gross mobility, and a four-item measure of basic physical functions. Nine waves of yearly disability data were analyzed by using generalized estimating equations models. After adjustment for age, gender, race, and physical activity, significant cross-sectional associations (p's < 0.001) were found between social engagement and all three measures of disability, with more socially engaged older adults reporting less disability. Social engagement also showed small, but negative interaction effects with follow-up-time outcomes (p's < 0.01), indicating that the protective effect of social engagement decreased slightly during follow-up. Results suggest a strong, but not necessarily causal association of social engagement with disability. Promotion of social engagement may still be important for the prevention of disability.

Activities of Daily Living↗

PubMed2002

Depressive disorders and alcohol dependence in a community population.

This cross-sectional study examines sociodemographic, clinical and func tional correlates of comorbid depression in a community sample of 268 individuals with alcohol dependence. Results of analyses comparing drinkers with either current or past depression to never-depressed drinkers showed that respondents in the former two groups were more likely to be female and report more comorbid drug use disorders. In addition to marked functional impairment for currently depressed drinkers, we also found that respondents with past depression were significantly less likely to have health insurance coverage. This lack of insurance for previously depressed persons calls for future work examining the potential influence of this barrier to access care on both clinical and functional outcomes.

Alcoholism↗

PubMed2003

Functional disability in rheumatoid arthritis patients compared with a community population in Finland.

OBJECTIVE: To compare Health Assessment Questionnaire (HAQ) scores of patients with rheumatoid arthritis (RA) with HAQ scores from a sex- and age-adjusted population. METHODS: Patients with RA (n = 1,095) and control subjects (n = 1,530) completed a mailed questionnaire that comprised the HAQ, pain and global health scores, education level, and comorbidities, as well as height, weight, and lifestyle attitudes, including smoking and exercise habits. RESULTS: The HAQ scores increased (indicating declining function) with older age in patients and controls. The HAQ scores were above the reference values (>95th percentile of the HAQ scores of the age- and sex-matched population) in 17-45% of women with RA and in 7-32% of men with RA ages 30-79 years, while the HAQ scores of the patients > or =80 years were similar to those of the age- and sex-matched population. In a logistic regression model, the odds ratio for disability (HAQ score > or =1; at least some difficulties in most activities of daily living) was 7.7 (95% confidence interval 5.3-11.1; P < 0.001) among patients with RA compared with community controls, when adjusted for age, sex, education, smoking, exercise, body mass index, number of comorbidities, and pain. CONCLUSION: RA is associated with a >7-fold risk of disability compared with that in a general population of adults in the same community. The impact of disability due to RA appears to be greater in younger and middle-age people than in elderly patients.

Activities of Daily Living↗

PubMed2003

Child and adolescent predictors for eating disorders in a community population of young adult women.

OBJECTIVE: This study investigated early predictors for developing eating disorders by young adulthood in a community sample of women participating in a 22-year longitudinal study. METHOD: Twenty-one women were identified at age 27 with lifetime full or partial eating disorders. These women were compared with 47 women with no history of eating disorders on predictive factors from three broad domains. RESULTS: The women with eating disorders had more serious health problems before age 5 and mother-reported anxiety-depression at age 9. At 15, mothers described them as having more behavior problems. Before age 15, families of the eating disorder group had more histories of depression, eating problems and changes in family financial circumstances. DISCUSSION: This study identifies early predictors distinguishing girls who develop eating disorders. Findings point to the need for continued research in the area of early health to comprehensively examine the biologic, behavioral, and environmental risks for eating disorders.

Adolescent↗

PubMed2003

Soil microbial populations, community composition, and activity as affected by repeated applications of hog and cattle manure in eastern Saskatchewan.

A field site near Humboldt, Saskatchewan, was annually treated with hog or cattle manure and cropped to canola, spring wheat, barley, and canola from 1997 to 2000. During each growing season, soil was analyzed for microbial populations in terms of activity and community structure, and crops were assessed for root rot and foliar diseases. Microbial activity in soils treated with cattle manure was higher than in soils treated with hog manure or urea. Similarly, nitrous oxide emissions from soil increased with increasing rates of hog and cattle manure. Potential human pathogens, including Rahnella, Serratia, Proteus, Leclercia, and Salmonella species, were identified in soils that received cattle manure, whereas pseudomonads were the dominant species in the hog-manure-treated soil. Fecal coliforms were confirmed in soils that received hog or cattle manure. However, Enterobacteriaceae populations were 10-fold higher in soils receiving cattle manure than in soils receiving the other treatments. Increasing cattle manure rates increased fecal coliform population, but there was no indication that increased hog manure rates increased fecal coliform populations. Addition of urea, hog manure, or cattle manure to the soil did not increase foliar disease in wheat, barley, and canola and had variable effects on root rot incidence in cereals.

Agriculture↗

PubMed1998

Blood pressure reduction, cardiovascular diseases, and cognitive decline in the mini-mental state examination in a community population of normal very old people: a three-year follow-up.

We observed the decline in cognitive functioning in a community cohort of 924 persons aged > or =75 years with initially good cognition. Cognitive performance was indexed with the Mini-Mental State Examination (MMSE) on two occasions, 3 years apart. The average decline in MMSE score was 0.4 points per year. However, 23.4% of the participants lost more than 10% of their baseline MMSE scores. Women declined more rapidly than men. Baseline advanced age, lower education, and stroke predicted the greater decline in women. It appears that the relation of lower education and stroke with cognitive decline was more pronounced in men, but age did not predict cognitive decline in men. In addition, there was a correlation between systolic pressure reduction and cognitive decline in women, which was not accounted for by other factors. In summary, although the cognitive ability is generally spared longitudinally, in terms of the entire population, a considerable proportion of individuals show substantial decline that is related to several factors such as advanced age, female gender, lower education, stroke, and systolic pressure reduction.

Aged↗

PubMed1997

Apolipoprotein E epsilon4 and incidence of Alzheimer disease in a community population of older persons.

OBJECTIVE: To examine the relation between apolipoprotein E status and risk of Alzheimer disease (AD) in a defined population and estimate the fraction of incident AD attributable to the epsilon4 allele. DESIGN: Community-based cohort study. SETTING: East Boston, Mass. PARTICIPANTS: A random sample of 578 community residents aged 65 years and older free of AD. MAIN OUTCOME MEASURE: Clinical diagnosis of AD by uniform, structured evaluation. RESULTS: The increased risk of AD associated with the presence of the epsilon4 allele was less than that found in most family and case-control studies. Persons with the epsilon4/epsilon4 or epsilon3/epsilon4 genotypes had 2.27 (95% confidence interval, 1.06-4.89) times the risk of incident disease compared with those with the epsilon3/epsilon3 genotype. The epsilon4 allele accounted for a fairly small fraction of the incidence of AD; if the allele did not exist or had no effect on disease risk, the incidence would be reduced by only 13.7%. The effect of the epsilon4 allele on risk of AD did not appear to vary with age. CONCLUSIONS: The apolipoprotein E epsilon4 allele is an important genetic risk factor for AD but accounts for a fairly small fraction of disease occurrence in this population-based study. Continued efforts to identify other environmental and genetic risk factors are warranted.

Aged↗

PubMed1992

Health measures correlates in a French elderly community population: the PAQUID study.

PAQUID is an epidemiologic prospective study of mental and functional aging. A sample of 4,050 community-dwelling individuals, aged 65 and over, was randomly selected from electoral lists of 37 parishes of Gironde after stratification by age, sex, and size of urban unit; 68.9 percent agreed to participate. Baseline information was obtained from a one-hour home interview. Health measures included ADL, IADL, mobility, Rosow scale, and two subjective health assessments. Depressive symptomatology was assessed by the CES-D scale and cognitive functioning by Folstein's MMS. Dependence rates vary from 9.7 percent to 71.9 percent according to the indicator under consideration. Cross-sectional correlations with dependence are significant for age, sex, education, rural setting, joint pain, dyspnea, hearing and visual impairment, MMS score, and depression. In logistic regressions, only dyspnea, MMS score, and depression are always significantly correlated with dependence, whichever the indicator.

Activities of Daily Living↗