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PubMed1998

Customary physical activity and psychological wellbeing: a longitudinal study.

OBJECTIVES: to assess longitudinal relationships between habitual levels of physical activity and indices of psychological wellbeing in older people. DESIGN: baseline assessment with 4- and 8-year follow-ups. SUBJECTS: 1042 people originally aged 65 and over randomly sampled from general practitioner lists in Nottingham, UK. METHODS: logistic regression analysis of selected T1 (1985) and T2 (1989) variables, with depression at T2 as dependent; multiple regression analyses of selected T1, T2 and T3 (1993) variables, with life satisfaction at T2 (model 1) or T3 (model 2) as dependent. MAIN OUTCOME MEASURES: questionnaire-assessed levels of physical activity; 14-item Symptoms of Anxiety and Depression scale; 13-item Life Satisfaction Index; health, demographic and social activity variables. RESULTS: in the logistic regression model, depression at T2 was most strongly associated with depression [odds ratio (OR) = 7.13; 95% confidence interval (CI) = 3.25-15.64; P < 0.001] and lower physical health status (OR = 1.26 per unit change in score; 95% CI = 1.17-1.42; P < 0.001) at T1. Lower levels of outdoor/leisure activities at T1 were also associated with some increased risk of depression 4 years later (OR = 0.92 per hour of activity; 95% CI = 0.85-0.99; P < 0.05). Similar predictive patterns emerged from the multiple regression analyses where, in both models, earlier levels of life satisfaction, social engagement and health accounted for most of the explained variance in life satisfaction (R2 = 0.42 for model 1; R2 = 0.35 for model 2). Again, however, earlier levels of physical activity (as walking and housework) did contribute significantly, although modestly, to longitudinal changes in morale. CONCLUSIONS: while the results provide some support for the conclusion that physical activity contributes independently to the promotion and maintenance of psychological wellbeing in later life, this contribution is, at best, extremely modest.

Activities of Daily Living↗

PubMed1998

The Nottingham Longitudinal Study of Activity and Ageing: a methodological overview.

OBJECTIVES: first, to describe the background and methodological approach to the assessment of customary physical activity, health and psycho-social status used by the Nottingham Longitudinal Study of Activity and Ageing; second, to provide information on the sampling strategy and survey response rates for three waves of data collection; and, third, to provide information on the reliability and validity of the survey assessments. DESIGN: longitudinal study. SUBJECTS: 1042 people originally aged 65 and over, randomly sampled from general practitioner lists in Nottingham, UK. METHODS: a descriptive overview of response rates (%), instrument reliability (alpha coefficients) and intercorrelations among measured outcomes (correlation coefficients and principal components analysis). MAIN OUTCOME MEASURES: questionnaire-assessed levels of physical activity; instrumental measurements of handgrip strength, weight, demi-span and shoulder flexibility; brief assessments of depression, social engagement, life-satisfaction and cognitive impairment. RESULTS: the study achieved a baseline (TI) response rate of 80%, with re-interview rates of 88% and 73% for T2 (1989) and T3 (1993) surveys respectively. For both men and women, factor scores derived from first principal components extracted from T1 survey data showed significant (r > or = 0.4; P < 0.001) product moment correlations with instrumental measurements of handgrip strength and shoulder flexibility. All the brief assessment measures showed satisfactory levels of reliability (alpha > or = 0.7).

Activities of Daily Living↗

PubMed2007

The glomerular filtration rate in an apparently healthy population and its relation with cardiovascular mortality during 10 years.

AIMS: Moderate-to-severe chronic renal failure is an established risk factor for cardiovascular disease and mortality. However, most studies have been performed in selected populations and the impact of very small decrements of renal function on long-term cardiac morbidity and mortality has not yet been established. Also, the cut-off level of glomerular filtration rate (GFR) from which cardiovascular risk increases has not exactly been established. This study wants to address these questions. METHODS AND RESULTS: Ten year follow-up of a representative population-based cohort comprised 8913 randomly selected, apparently healthy participants. Participants were randomly drawn from Belgian voting lists. Cardiovascular risk factors were noted. Serum creatinine values were corrected to isotope dilution mass spectrometry standard, and GFR was calculated using the recently modified 'modification of diet in renal disease' equation. Participants were followed for 10 years, and cause-specific death was registered by analysis of death certificates. The probability to die from all causes or from cardiovascular causes during the 10 year follow-up period increased in each quartile of GFR, even after correction for different other comorbid conditions. CONCLUSION: Even mild renal failure is an independent risk factor for cardiovascular mortality within 10 years in an apparently healthy unselected population. This detrimental effect starts already at a relatively high GFR of 90 mL/min/1.73 m2 and remains present after correction for other established cardiovascular risk factors.

Cardiovascular Diseases↗

PubMed1991

Breast cancer in men: aspects of familial aggregation.

Familial aggregation of breast cancer in males was investigated in a population-based case-control study. Cases were ascertained from 10 Surveillance, Epidemiology, and End Results Program registries in the United States between 1983 and 1986. Controls were identified by random-digit dialing and from lists of Medicare recipients. The relative odds of developing breast cancer were similar in men with affected paternal and maternal relatives and in men with affected mothers and sisters. The risk increased with the number of affected relatives. The relative odds of developing breast cancer were greater in men with first-degree relatives who developed their mammary neoplasm before the age of 45 than in men with older first-degree affected relatives; the enhancement of risk in men with an affected sister was greater in those under age 60 than in older men. These results are similar to those observed by others in studies of breast cancer in women.

Breast Neoplasms↗

PubMed2006

A systematic review of the clinical effects of reducing dialysate fluid temperature.

BACKGROUND: Intradialytic hypotension (IDH) is a frequent complication of haemodialysis. Reducing the temperature of the dialysis fluid is a simple therapeutic strategy but is relatively underused. This may be due to concerns regarding its effects on symptoms and dialysis adequacy. We performed a systematic review of the literature to examine the effects of cool dialysis on intradialytic blood pressure, and to assess its safety in terms of thermal symptoms and small solute clearance. METHODS: We searched the Cochrane Central Register of Controlled Trials, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, databases of ongoing trials, the contents of four major renal journals as well as hand-searching reference lists. We included all prospective randomized studies that compared any technique of reducing dialysate temperature with standard bicarbonate dialysis. These techniques included an empirical, fixed reduction of dialysate temperature or use of a biofeedback temperature-control device (BTM) to deliver isothermic dialysis or programmed patient cooling. RESULTS: A total of 22 studies comprising 408 patients were included (16 studies examined a fixed empirical temperature reduction and six examined BTM). All studies were of crossover design and relatively short duration. IDH occurred 7.1 (95% CI, 5.3-8.9) times less frequently with cool dialysis (both fixed reduction and BTM). Post-dialysis mean arterial pressure was higher with cool-temperature dialysis by 11.3 mmHg (95% CI, 7.7-15.0). No studies reported that cool dialysis led to a reduction in dialysis adequacy as assessed by urea clearance. The frequency and severity of thermal-related symptoms were generally reported inadequately. CONCLUSIONS: Reducing the temperature of the dialysate is an effective intervention to reduce the frequency of IDH and does not adversely affect dialysis adequacy. This applies to the fixed reduction of dialysate temperature and BTM. It remains unclear as to what extent cool-temperature dialysis causes intolerable cold symptoms during dialysis. There are no trials comparing fixed empirical temperature reduction with BTM, and no trials examining the long-term effects of cool dialysis on patient outcomes.

Blood↗

PubMed1993

History of lactation and breast cancer risk.

A self-administered questionnaire was completed by 1,018 women diagnosed with breast cancer during 1988-1989 identified through the British Columbia Cancer Registry and by 1,025 controls selected at random from the Provincial Voters List. Parous premenopausal women who had never nursed (odds ratio (OR) = 1.3, 95% confidence interval (CI) 0.9-2.0) or who had lactated for 1 month or less (OR = 1.8, 95% CI 1.3-2.5) had an increased risk of breast cancer adjusted for age and parity, compared with women who had breast-fed 2 months or longer. The risk was particularly elevated (OR = 3.0, 95% CI 1.6-5.4) among women who reported having tried to nurse, but who were unsuccessful. Among women who nursed for at least 2 months, there was an indication of decreasing risk with increasing duration of nursing. Among postmenopausal parous women, no relation between lactation history and breast cancer risk was evident.

Adult↗

PubMed1996

Genes, hypertension, and intermediate phenotypes.

Although it has been recognized for almost 70 years that there is a substantial genetic component to the pathogenesis of hypertension, only recently have systematic efforts been made to identify the responsible genetically determined mechanisms. In the case of several rare syndromes, spectacular progress has been made in identifying the underlying molecular mechanisms responsible for the clinical expression. Glucocorticoid-suppressible aldosteronism and Liddle's syndrome, each inherited as an autosomal-dominant condition, complete the list. In the case of randomly selected patients and families with essential hypertension, inheritance involves many genes and progress has been far more modest. Probably the most promising lead has involved the genes governing the structure of angiotensinogen, the substrate in the renin reaction. Linkage has been established and confirmed. At the moment, however, neither the relation of the genetic abnormality to the underlying mechanisms, nor the contribution of this abnormality to hypertension in the individual patient, has been defined. We know less about other candidate genes, with the exception of studies that rigorously ruled out a contribution. The development of the concept of the "intermediate phenotype," a physiological feature that makes it possible to identify a homogeneous subpopulation, should help to sort out many of these issues. Unfortunately, the identification and characterization of intermediate phenotypes is substantially more difficult at the moment than are the genetic studies, and so progress is likely to be slow. The field is complicated by the reporting of claims made on the basis of small patient samples. In the case of polymorphisms in the angiotensin-converting enzyme gene as a risk factor for tissue injury, for example, substantial follow-up studies have systematically failed to confirm the original report, which was based on a small patient sample. The fact that the same DNA collection is likely to be examined many times for multiple gene candidates creates a setting in which type I errors are likely, and so we are likely to see many more examples. Caveat lector. Again, the development of relevant intermediate phenotypes will make the spurious association less likely.

Angiotensinogen↗

PubMed1993

An empirical study of a model of self-care in chronic illness.

A descriptive correlational study was conducted to test the efficacy of the Model of Self-Care in Chronic Illness. The model, an adaption and extension of the Health Belief Model, was developed to describe and relate the variables that influence effective self-care among ambulatory chronically ill adults. Participants (n = 181) were randomly selected from the waiting lists of an ambulatory care clinic of a major military medical center. The research examined general self-care, i.e., behaviors to promote health and prevent illness, and therapeutic self-care, i.e., education, diet, and other behaviors prescribed for a specific illness. Self-concept was correlated significantly with general as well as medication and dietary self-care. Psychological status and general health motivations influence general self-care. Stepwise multiple regression analyses demonstrated that costs of medication, patients' psychological status and perceptions of the seriousness of their illnesses, and vulnerability to complications were significantly related to medication self-care, while costs and perceptions of seriousness and vulnerability were significantly related to dietary self-care.

Adult↗

PubMed1986

A poll of radiation health scientists.

A sampling of 210 university-employed radiation health scientists randomly selected from the membership lists of the Health Physics Society and the Radiation Research Society was polled in a secret ballot. The results support the positions that the public's fear of radiation is substantially greater than realistic, that TV, newspapers and magazines substantially exaggerate the dangers of radiation, that the amount of money now being spent on radiation protection is sufficient, and that the openness and honesty of U.S. government agencies about dangers of radiation were below average before 1972 but have been above average since then. Respondents give very high credibility ratings to BEIR, UNSCEAR, ICRP, and NCRP and to the individual scientists associated with their reports, and very low credibility ratings to those who have disputed them.

Costs and Cost Analysis↗

PubMed2002

A survey of the incidence of single-visit endodontics.

This survey was conducted to obtain answers to some basic questions regarding the timing of root canal obturation. A questionnaire was sent via e-mail to 738 randomly chosen United States endodontists listed in the 1998 to 1999 membership roster of the American Association of Endodontists. One hundred fifty-six replies were received. In pulpectomy cases, root canal obturation at the first visit was carried out by 55.8% of the responding endodontists; in infected root canal cases, the percentage was 34.4%. Of the responding endodontists, 34.2% indicated that their patients had experienced some trouble after root canal obturation at the first visit.

Bacterial Infections↗

PubMed1999

A population study of ethnic variations in the angiotensin-converting enzyme I/D polymorphism: relationships with gender, hypertension and impaired glucose metabolism.

BACKGROUND: The presence of the deletion allele of the angiotensin-converting enzyme (ACE) I/D polymorphism is associated with an excess risk of vascular disease and diabetic nephropathy. OBJECTIVE: To examine the importance of this polymorphism as a determinant of hypertension and impaired glucose metabolism in a population-based study of three ethnic groups and assess the potential modifying effect of gender. DESIGN: Population-based cross-sectional study in South London. The population-based sample of 1577 men and women, age 40-59 years, was obtained from stratified random sampling of general practice lists where 25% of the residents were born outside the UK. The ACE I/D polymorphism was determined for 1366 individuals (86.6%): 462 whites, 462 of African descent and 442 of South Asian origin. RESULTS: The genotype frequency within each ethnic group was in Hardy-Weinberg equilibrium. The frequencies were similar in whites and those of African descent (II, ID, DD: 18.4%, 49.6%, 32.0% for whites and 18.4%, 50.5%, 30.9% for those of African descent), but there was a much higher frequency of the II genotype in those of South Asian origin (39.8%, 41.8%, 18.3%; chi2 = 77.6; P < 0.0001). There was no association between the I/D polymorphism and impaired glucose metabolism in any ethnic group. There were also no significant associations between the I/D polymorphism and hypertension in whites and in those of South Asian origin. This contrasts with a highly significant association between the D allele and hypertension in women of African descent (OR = 2.54; 95% CI 1.38-4.65; P = 0.003) but not in men of African descent (0.79; 0.36-1.72) (test for differences between sexes P = 0.023). CONCLUSIONS: These observations provide estimates of the frequency distribution of the ACE I/D polymorphism in whites, in people of African descent and in people of South Asian origin. Moreover, these results highlight the potential importance of gender-dependent interactions between genetic background and expression of hypertensive phenotype.

Adult↗

PubMed2003

Soluble CD14 and aortic stiffness in a population-based study.

OBJECTIVE: Soluble CD14 (sCD14), an effective mediator for the activation of monocytes by bacterial endotoxin is involved in the release of substances able to modify the characteristics of the arterial wall. The aim of this study was to investigate, in humans, the relationship of sCD14 with aortic stiffness and to analyse the influence of arterial structure and endothelial function on this relationship. DESIGN: Cross-sectional population-based study. PARTICIPANTS: One thousand and fifteen subjects randomly selected from the polling lists, were recruited by the Toulouse MONICA centre between 1995 and 1997. METHODS: Carotid-femoral pulse wave velocity (PWV) and blood pressure (BP) were measured in the supine position. Common carotid intima-media thickness (IMT) and the presence of plaques were assessed by ultrasonography. sCD14 was measured using an immunoenzymatic method. RESULTS: The results concern the 891 subjects with complete data for all the variables. In the bivariate analyses, PWV (P < 0.001), systolic BP (P < 0.05), pulse pressure (PP) (P < 0.01), IMT (P < 0.001), the number of plaques (P < 0.05) and von Willebrand factor activity (vWFa) (P < 0.001) were positively associated with sCD14, whereas no significant relationship was observed between sCD14 and diastolic BP. After adjustment for age and sex, no significant relationship remained between IMT, the number of plaques, SBP, PP and sCD14. A significant and positive relationship was observed between sCD14 and PWV (trend P < 0.05) after adjustment for numerous confounders. CONCLUSION: This population-based study yields first evidence that sCD14 is associated with aortic stiffness independently of age, BP and atherosclerosis in humans.

Adult↗

PubMed1995

National study of obliterative arterial disease of the lower limbs involving general practitioners in France: Artemio study.

A national survey was performed in France from May to June, 1993. The aim of this study was to evaluate general practitioners' attitudes and behaviors when diagnosing and managing patients with lower extremity arterial disease (LEAD). One thousand general practitioners, randomly drawn from an exhaustive list, were contacted to participate in a telephone interview concerning the last patient with intermittent claudication seen in their practice. Four hundred seventy-six general practitioners participated. Risk factors noted for these 476 patients with intermittent claudication were in agreement with the literature: 86% were men aged 64 +/- 10 years (mean +/- SD) and 14% were women aged 73 +/- 8 years. Sixty-two percent had a pain-free walking distance of between 100 and 500 meters at diagnosis. Forty-five percent were former smokers and 37% currently smoked; 55% had hypertension, 14% diabetes, and 56% disturbances of lipid metabolism. A majority of them were hypercholesterolemic. The diagnosis of the disease was based primarily on a clinical assessment, confirmed for 33% by Doppler or echo Doppler. The mean duration of diagnosis was 4.4 +/- 4.1 years. Management of the disease was mainly by prescription of vasodilators (91%), antiplatelet agents (59%), and anticoagulants (8%). Use of Doppler or echo Doppler was recommended once a year. Infection was observed in 27% of patients. Thirty-eight percent had had a cardiac incident (angina pectoris or myocardial infarction) and 10% a cerebrovascular accident. They differed significantly from those with LEAD alone for the following parameters: age (68.5 +/- 9.2 vs. 63.2 +/- 10.3 years; p < 0.001); duration of LEAD (5.6 +/- 4.6 vs. 3.6 +/- 3.5 years; p < 0.001); hypertension (65% vs. 50%; p < 0.01); and current smoking (29% vs. 43%; p < 0.01). This survey confirmed the feasibility of telephone interviewing, on a large sample of general practitioners in France. The high level of association with other cardiac incidents was, for these patients, a much higher risk of mortality and morbidity than LEAD alone. It would be interesting to validate the associations observed with a prospective study of comorbidity.

Adult↗

PubMedDate not supplied

Antibiotic prophylaxis among commercial sex workers in Cebu City, Philippines. Patterns of use and perceptions of efficacy.

BACKGROUND: This study describes the extent to which commercial sex workers (CSW) in Cebu City, Philippines perceive prophylactic antibiotic use to be an effective form of prevention for sexually transmitted diseases (STD) and human immunodeficiency virus (HIV), as well as the prevalence of this self-treatment practice. METHODS: A survey instrument was developed and pretested after 3 months of intensive ethnographic research on STD and acquired immune deficiency syndrome (AIDS). A multistage sampling procedure was followed to ensure that a representative sample of CSW from four distinct work environments would be interviewed. Commercial sex workers registered at the Cebu City social hygiene clinic were sampled randomly from coded work establishment lists, and a convenience sample of unregistered freelance CSW was secured. In total, 200 CSW were interviewed. Of these 200 CSW, all were sexually active, but only 160 had been engaged actively in commercial sexual exchange the month before their interviews. RESULTS: Popular use of antibiotics as prophylaxis against STD is commonplace in the Philippines among CSW, with 38% reporting routine or occasional use and 31% reporting use in the last 2 weeks. Unregistered CSW are five times more likely to use prophylactic antibiotics than registered CSW, and they are seven times less likely to use condoms with 80% or more of their customers. They also have sex with three times as many customers. CONCLUSIONS: Use of prophylactic antibiotics by CSW offers them a false sense of security in a high-risk work environment. Self-treatment with low-dose prophylactic antibiotics provides no protection against STD, impedes STD screening efforts, and contributes to antibiotic resistance. An alarming percentage of CSW consider antibiotics a potential means of protecting themselves against AIDS. Public health interventions focusing on STD and AIDS in developing countries must address current patterns of prophylactic antibiotic use.

Adolescent↗

PubMed1997

Gallstones in a community free of obesity but prone to slow intestinal transit.

OBJECTIVES: To verify anecdotal reports that gallstones were frequent in a remote community where obesity is rare and to look for possible explanations of their occurrence, including slow intestinal transit. DESIGN: Population survey of gallbladder status and stool form. SETTING: Two villages in Ladakh, a mountainous region of northern India; for comparison, a stratified random sample from general practitioners' lists in East Bristol. SUBJECTS: Women aged 25-59 years, 437 in Ladakh and 974 in Bristol. MAIN OUTCOME MEASURES: Presence of gallstones on ultrasonography and response to questionnaires about parity, the intake of dried legume seeds (pulses) and bowel function including the form or appearance of the stools on a seven-point, transit-sensitive scale. Weight, height and waist circumference were also recorded. RESULTS: Gallstone disease was at least as frequent in Ladakh as in Bristol although Ladakhi women were uniformly slim and their weight, waist size and body mass index failed to rise with age. After adjustment for age, gallstone disease was associated with higher body mass index and waist size in Bristol but not in Ladakh. It was associated with increased parity in Bristol, but not significantly so after adjusting for age and not at all in Ladakh. Gallstone disease was not directly associated with bowel function but Ladakhis often reported their stools to be lumpy (42.4 vs. 26.5% of Bristol women) and seldom as soft or loose (6.4 vs. 42.5%), implying that their intestinal transit tends to be slow. CONCLUSION: Gallstones can be common in a population free of obesity but prone to intestinal stasis.

Adult↗

PubMed2003

Evidence-based treatments in child and adolescent psychiatry: an inventory.

OBJECTIVE: To provide a list of evidence-based psychopharmacology and psychotherapy treatments for child psychiatry. METHOD: Published reviews and Medline searches were examined to generate a list of treatments supported by randomized controlled trials. RESULTS: For psychopharmacology, the best evidence to date supports the use of stimulant medications for attention-deficit/hyperactivity disorder and selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive disorder. There is also reasonable evidence addressing SSRIs for anxiety disorders and moderate to severe major depressive disorder, and risperidone for autism. The psychosocial interventions best supported by well-designed studies are cognitive-behavioral and behavioral interventions, especially for mood, anxiety, and behavioral disorders. Family-based and systems of care interventions also have been found effective. CONCLUSIONS: Although the number of evidence-based treatments for child psychiatry is growing, much of clinical practice remains based on the adult literature and traditional models of care. Challenges toward adopting evidence-based practices are discussed.

Adolescent↗

PubMed1990

Obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy.

Sleep screening was used to discover the incidence of sleep apnoea in 50 children undergoing routine adenotonsillectomy for recurrent upper respiratory tract infections, randomly selected from the waiting list. Preoperative assessment included a detailed parental history, physical examination, and lateral cephalometry, in order to identify factors that might alert the clinician to a diagnosis of obstructive sleep apnoea. There were 2 equal groups of snorers and non-snorers (grade 0); 1 patient was found to have the sleep apnoea syndrome (IV), 9 patients had obstructive snoring with apnoeic episodes (III), 3 patients had snoring with a disrupted sleep pattern (II), and 12 patients snored with no disruption of sleep (I). In identifying patients with apnoea, a history of snoring was unhelpful, whereas one of breathing irregularities was found to be highly specific. Nasal obstruction correlated poorly; however, there was a significant relationship between tonsillar position and size and sleep grade (Chi-squared P less than 0.01). Stepwise regression analysis showed a large contribution to the grading was made by the size of the oropharyngeal airway measured by lateral cephalometry. The children in grade II-IV were re-studied 3 months post-operatively and all reverted to grades 0 or I.

Adenoidectomy↗

PubMed1996

Snoring, apnoea and ENT symptoms in the paediatric community.

This study was designed to determine the prevalence of snoring and assess the extent of associated ENT symptoms in children up to 10 years of age. A questionnaire was presented to the parents of 245 children chosen at random from the General Practice list of the town of Frome, Somerset, UK. The prevalence of snoring was found to be 27%. This increased to 47% in the presence of an upper respiratory infection. Snoring was found to be significantly (P < 0.001) associated with a history of poor hearing, restless sleep, and having a cold. Less significant (P < 0.01) associations occurred with parental smoking, eczema, sleep talking, moving around the bed at night, sore throats, having a runny nose and mouth breathing. Snoring is a common symptom in children up to 10 years of age. Without evidence of other ENT disease the snoring child does not require referral to an ENT department for further investigation.

Child↗