Sleep and mortality: a population-based 22-year follow-up study

STUDY OBJECTIVES: Long and short sleep have been associated with increased mortality. We assessed mortality and 3 aspects of sleep behavior in a large cohort with 22-year follow-up. DESIGN/SETTING: Prospective, population-based cohort study. PARTICIPANTS: 21,268 twins aged > or =18 years responding to questionnaires administered to the Finnish Twin Cohort in 1975 (response rate 89%), and 1981 (84%). INTERVENTIONS: N/A. MEASUREMENTS: Subjects were categorized as short (<7 h), average, or long (>8 h) sleepers; sleeping well, fairly well, or fairly poorly/poorly; no, infrequent, or frequent users of hypnotics and/or tranquilizers. Cox proportional hazard models were used to obtain hazard ratios (HR) for mortality during 1982-2003 by sleep variable categories and their combinations. Adjustments were done for 10 sociodemographic and lifestyle covariates known to affect risk of death. RESULTS: Significantly increased risk of mortality was observed both for short sleep in men (+26%) and in women (+21%), and for long sleep (+24% and +17%), respectively, and also frequent use of hypnotics/tranquilizers (+31% in men and +39% in women). Snoring as a covariate did not change the results. The effect of sleep on mortality varied between age groups, with strongest effects in young men. Between 1975 and 1981, sleep length and sleep quality changed in one-third of subjects. In men there was a significant increase for stable short (1.34) and stable long (1.29) sleep for natural deaths, and for external causes in stable short sleepers (1.62). CONCLUSIONS: Our results show complicated associations between sleep and mortality, with increased risk in short and long sleep.     

Blunted cardiovascular reactions are a predictor of negative health outcomes: A prospective cohort study

The study examined whether cardiovascular responses to psychological stress tests predict future anxiety and depression scores 40‐months later. Hemodynamic measures were obtained from 102 healthy adults before, during and after mental arithmetic, a speech task, and a cold pressor task. The 14‐item Hospital Anxiety and Depression Scale was administered at initial testing and at 40‐months follow‐up. At initial testing analyses revealed that high anxiety symptoms were characterized by blunted cardiovascular reactions to acute mental stress, particularly mental arithmetic. Furthermore, after adjustment for baseline blood pressure (BP ), baseline anxiety levels and traditional risk factors, attenuated systolic BP responses to mental arithmetic were associated with future anxiety levels (ΔR ² = .055). These findings suggest that blunted cardiovascular reactions to stress may be an independent risk factor for future anxiety levels.     

Temperament moderates developmental changes in vigilance to emotional faces in infants: Evidence from an eye-tracking study

Affect-biased attention reflects the prioritization of attention to stimuli that individuals deem to be motivationally and/or affectively salient. Normative affect-biased attention is early-emerging, providing an experience-expectant function for socioemotional development. Evidence is limited regarding how reactive and regulatory aspects of temperament may shape maturational changes in affect-biased attention that operate at the earliest stages of information processing. This study implemented a novel eye-tracking paradigm designed to capture attention vigilance in infants. We assessed temperamental negative affect (NA) and attention control (AC) using laboratory observations and parent-reports, respectively. Among infants (N = 161 in the final analysis) aged 4 to 24 months (Mean = 12.05, SD = 5.46; 86 males), there was a significant age effect on fixation latency to emotional versus neutral faces only in infants characterized with high NA and high AC. Specifically, in infants with these temperament traits, older infants showed shorter latency (i.e., greater vigilance) toward neutral faces, which are potentially novel and unfamiliar to infants. The age effect on vigilance toward emotional faces was not significant. The findings support the argument that the development of affect-biased attention is associated with multiple temperament processes that potentially interact over time.     

Baseline C-reactive protein level as a predictor of mortality in bacteraemia patients: a population-based cohort study

We examined the association between C-reactive protein (CRP) level at time of blood culture (BC) draw and mortality following bacteraemia. Our population-based cohort study comprised all first-time monomicrobial bacteraemia episodes in adults in a Danish county during 1996–2004 (n = 5267). CRP was measured within 24 h of the first positive BC draw. Cox regression was used to compute mortality rate ratios (MRRs) associated with CRP level quartiles (10–64 (reference), 65–143, 144–240 and 241–688 mg/L), controlling for age, gender, comorbidity, specialty, acquisition of infection, and infection focus. We also looked for a biological interaction between CRP level and high magnitude of bacteraemia (three of three culture bottles positive). Thirty-day mortality increased with higher CRP level: adjusted 0–30-day MRRs for patients in the second, third and fourth CRP quartiles were 1.38 (95% CI 1.13–1.69), 1.70 (95% CI 1.40–2.06), and 2.38 (95% CI 1.96–2.87), respectively (p for trend <10⁾⁴). In contrast, mortality associations with CRP during 31–365 days of follow-up were weak (adjusted MRRs for the second to fourth quartiles ranged from 1.18 to 1.28). A high magnitude of bacteraemia strengthened the association between high CRP level and 30-day mortality. We conclude that the CRP level, measured concurrently with the first positive BC, independently predicted 30-day mortality in adult bacteraemia patients.     

Depression and cancer mortality and morbidity: Prospective evidence from the Alameda County study

The association between the presence of depressive symptoms and cancer incidence and mortality and mortality from noncancer causes was studied in a population-based cohort of 6848 persons free of cancer who were followed from 1965 to 1982 as part of the Alameda County study. Age-adjusted and multivariate analyses involving over 111,000 person-years of follow-up demonstrated an association between high levels of depressive symptoms at baseline and deaths from noncancer causes but no association with either cancer incidence or cancer mortality. Our analyses suggest the possibility that the presence of previously diagnosed cases of cancer and the inclusion of items which tap somatic problems in depression scales may contribute to differences between these results and others in which depression has been linked to cancer mortality.This investigation was supported by PHS Grant CA37449, awarded by the National Cancer Institute, U.S. Department of Health and Human Services.     

癫痫儿童气质特点研究

目的了解癫痫儿童的气质特点,提供癫痫综合治疗的依据。方法以儿童气质测量软件为研究工具,对84例符合1981年国际抗癫痫联盟(ILAE)分类诊断标准的癫痫患儿的和168例正常儿童进行儿童气质父母问卷的调查。结果癫痫儿童组气质得分明显高于对照组的因子有活动水平(3.4±0.6/3.1±0.7,t=5.38,P<0.01)、适应性(3.3±0.5/2.8±0.6,t=5.82,P<0.01)、反应强度(3.8±0.8/3.6±1.0,t=5.64,P<0.01)、情绪本质(3.3±0.6/2.9±0.7,t=4.89,P<0.01)、坚持性等维度(3.2±0.7/2.6±0.7,t=5.63,P<0.01)。癫痫组难养型和启动缓慢型的患儿分别为(25.0%和10.7%)明显高于对照组(8.9%,3.6%,χ2=26.76,P<0.001)。结论癫痫儿童中难养型和启动缓慢型气质类型者较多。     

Prognostic factors of asthma severity: a 9-year international prospective cohort study

BACKGROUND: The natural history of asthma severity is poorly known. OBJECTIVE: To investigate prognostic factors of asthma severity. METHODS: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). RESULTS: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. CONCLUSION: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. CLINICAL IMPLICATIONS: Our results suggest that the evolution of asthma severity is to a large extent predictable.     

Severity of frailty as a significant predictor of mortality for hemodialysis patients: a prospective study in China

Background: Frailty is known to be highly prevalent in older hemodialysis (HD) patients. We studied the prevalence of frailty and its associated factors in Chinese HD patients. We further studied if frailty could predict survival in HD patients.Methods: This is a prospective study involving patients receiving maintenance HD in the dialysis center of Xuanwu Hospital, Beijing. Study subjects were enrolled from October to December, 2017 and followed up for two years. Demographic data, comorbidities and biological parameters were collected. Frailty was assessed using the Fried frailty phenotype at baseline. Cox regression analysis was performed to identify the relationship between frailty and mortality in HD patients. Kaplan-Meier was plotted using the cutoff value obtained by ROC curve to evaluate survival rates in different frailty status.Results: Total of 208 HD patients were enrolled with a mean age of 60.5±12.7 years. According to the frailty criteria, at baseline the prevalence of robust, pre-frail and frail in HD patients was 28.7%, 45.9%, and 25.4%, respectively. The two-year all-cause mortality was 18.8% (39/207) and underlying causes of death included coronary artery disease (CAD), cerebrovascular disease (CVD), hyperkalemia, severe infection, malignant tumor and others. Survival curve showed the patients with frailty score ≥4 to have significantly shorter survival time as compared to patients with frailty score ≤ 3. Frailty predicted two-year mortality when frailty score ≥4 with a sensitivity of 70% and a specificity of 83.67% with an AUC of 0.819. Frailty score was positively associated with age and ratio of ultrafiltration volume to dry weight, while negatively associated with levels of serum albumin, uric acid and diastolic blood pressure after HD.Conclusions: Our results confirm frailty to be very common among HD patients and severity of frailty was a significant predictor of mortality for HD patients. Factors such as age, malnutrition and low blood pressure are the factors to be associated with frailty. Interdialytic weight gain inducing excessive ultrafiltration volume is an important risk factor.     

Bone density changes in pregnant women treated with heparin: a prospective, longitudinal study.

Heparin plus aspirin significantly improves the live birth rate of women with primary antiphospholipid syndrome. Osteopenia is a major concern of long-term heparin therapy. We studied prospectively the bone mineral density (BMD) changes during pregnancy and the puerperium in 123 women with primary antiphospholipid syndrome treated with low-dose aspirin and subcutaneous low-dose heparin (46 women took unfractionated heparin and 77 took low-molecular-weight heparin). Lumbar spine, neck of femur and forearm BMD were measured, using dual energy X-ray absorptiometry, at 12 weeks gestation, immediately postpartum and 12 weeks postpartum. The mean heparin duration was 27 weeks (range 22-29). During pregnancy, BMD decreased by 3.7% (P < 0.001) at the lumbar spine and by 0.9% (P < 0.05) at the neck of femur with no significant change at the forearm. Lactation was associated with a significant decrease in the lumbar spine and neck of femur BMD. There was no significant difference in BMD changes between the two heparin preparations. No woman suffered a symptomatic fracture. Long-term heparin treatment during pregnancy is associated with a small but significant decrease in BMD at the lumbar spine and neck of femur. This decrease is similar to that previously reported to occur in untreated pregnancies.     

Psychological factors in the aetiology of infertility: a prospective cohort study

The objectives were to identify and measure psychological factorscharacterizing the period following the cessation of contraceptionand to assess these psychological factors as predictors of thecouples' fertility. A cohort of 63 couples with initially undeterminedfertility status was prospectively studied, first shortly afterthe cessation of contraception, then 13 months later. The ChildProject Questionnaire was constructed to assess psychologicalvariations following the cessation of contraception. An InterspouseDifference Score was constructed to measure the difference betweenthe spouses' responses. Three male and three female factorswere derived from the questionnaire. The Interspouse DifferenceScore was significantly greater in infertile than in fertilecouples. Two psychological factor scores were significantlyhigher in fertile subjects: the wives' level of positive expectationsrelated to motherhood, and the husbands' quality of integrationbetween the wish for a child and sexual relationships. Withinthe group of fertile couples, time to pregnancy was predictedby the husbands' above-cited factor and by the wives' frequencyof thoughts and concerns related to the desired child. The resultssupport the conclusion that in both women and men, psychologicalfactors specifically related to the project of conceiving achild are significant predictors of the couple's fertility status.     

Self-reported early trauma as a predictor of adult personality: a study in a military sample

Exposure to early trauma has frequently been linked to adult psychopathology, including personality disorders. This cross-sectional study explored the relationship between personality and retrospectively rated levels of early trauma in 242 soldiers. Multiple regression analyses showed a significant relationship between early trauma and adult personality as exposure to emotional trauma predicted levels of self-directedness and cooperativeness on the Temperament and Character Inventory (TCI; C. R. Cloninger, T. R. Przybeck, D. M. Svrakic, & R. D. Wetzel, 1994). Overall, these results suggest that early emotional trauma may be related to personality dimensions associated with poor impulse control and interpersonal behavior. These results are noteworthy considering that they were obtained in a healthy sample. They show that early trauma may become ingrained in personality and hamper the potential to effectively engage in social interactions, increasing the risk of emotional and cognitive problems.     

Association between type of birth attendants and neonatal mortality: Evidence from a National survey

BackgroundAlthough Lesotho has one of the highest childhood mortality levels in Southern Africa, there has been limited research on the link between type of birth attendant and neonatal mortality in Lesotho. This study examined the relationship between type of birth attendant and neonatal mortality while controlling for socio-demographic characteristics of mothers in LesothoMethodsThe study used data from the children''s file of 2014 Lesotho Demographic and Health Survey data. Kaplan-Meier method was used to estimate neonatal mortality rate and Cox proportional hazard regression model was used to assess the association between type of birth attendant and neonatal mortality.ResultsResult shows that 5.3% of all births attended to by non-SBAs resulted into neonatal mortality compared to 2.8% of those attended to by SBA. Result further shows that regardless of socio-demographic characteristics, the risks of neonatal mortality were significantly higher with non-SBAs compared to SBA in Lesotho (HR: 2.00, CI: 1.31–3.06).ConclusionThe risk of neonatal mortality is two times higher among children delivered by Non-SBA. Scale-up in access and uptake of SBA is recommended in Lesotho. Thus, Policy on scale-up access to SBA at delivery at no costs need to be put in place.     

Temperament and character associated with depressive symptoms in women: analysis of two genetically informative samples

Although previous research has explored associations between personality and depressive symptoms, a limited number of studies have assessed the extent to which genetic and environmental influences explain the association. This study investigated how temperament and character were associated with depressive symptoms in 131 pairs of twin and sibling women in early adulthood, as well as 326 pairs of twin women in middle adulthood. Results indicated that genetic influences accounted for a moderate to substantial percentage of the association between these personality features and depressive symptoms, emphasizing the role of genetic influences. Nonshared environmental influences made important contributions to the association between character and depressive symptoms, particularly in the sample of middle‐aged twin women. These findings suggest that unique social experiences and relationships with a partner in adulthood may play an important role in these associations between character and depressive symptoms. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–19, 2009.     

Desmoplastic reaction in biopsy specimens of early colorectal cancer: a Japanese prospective multicenter study

We previously reported that detection of desmoplastic reaction (DR) in pretreatment biopsy specimens was useful for predicting the depth of submucosal invasion (SM depth) in nonpedunculated early colorectal cancers (ECRCs) in a retrospective study. Here, we performed a prospective multicenter study for verification of our previous findings. Subjects were diagnosed with ECRC by endoscopy, and with adenocarcinoma from the biopsy specimens. Eleven institutions affiliated with the Japanese Society for Cancer of the Colon and Rectum participated in this collaborative study. A total of 112 patients with ECRC were enrolled. For nonpedunculated ECRCs, presence of DR was significantly correlated with SM depth. The sensitivity and specificity of detection of DR for prediction of pSM2 (tumor invasion ≥1000 μm) in nonpedunculated ECRCs were 68.6% and 92.0%, respectively. Evaluation of DR in pretreatment biopsy specimens may be useful for the clinicopathological diagnosis of colorectal carcinoma with massive invasion into the submucosal layer.     

Skipping Breakfast and Risk of Mortality from Cancer,Circulatory Diseases and All Causes: Findings from the Japan Collaborative Cohort Study

Background

Breakfast eating habits are a dietary pattern marker and appear to be a useful predictor of a healthy lifestyle. Many studies have reported the unhealthy effects of skipping breakfast. However, there are few studies on the association between skipping breakfast and mortality. In the present study, we examined the association between skipping breakfast and mortality from cancer, circulatory diseases and all causes using data from a large-scale cohort study, the Japan Collaborative Cohort Study (JACC) Study.

Methods

A cohort study of 34,128 men and 49,282 women aged 40–79 years was conducted, to explore the association between lifestyle and cancer in Japan. Participants completed a baseline survey during 1988 to 1990 and were followed until the end of 2009. We classified participants into two groups according to dietary habits with respect to eating or skipping breakfast and carried out intergroup comparisons of lifestyle. Multivariate analysis was performed using the Cox proportional hazard regression model.

Results

There were 5,768 deaths from cancer and 5,133 cases of death owing to circulatory diseases and 17,112 cases for all causes of mortality during the median 19.4 years follow-up. Skipping breakfast was related to unhealthy lifestyle habits. After adjusting for confounding factors, skipping breakfast significantly increased the risk of mortality from circulatory diseases [hazard ratio (HR) = 1.42] and all causes (HR = 1.43) in men and all causes mortality (HR = 1.34) in women.

Conclusion

Our findings showed that skipping breakfast is associated with increasing risk of mortality from circulatory diseases and all causes among men and all causes mortality among women in Japan.     

A prospective study of change in sleep duration: associations with mortality in the Whitehall II cohort

STUDY OBJECTIVES: Although sleep curtailment has become widespread in industrialised societies, little work has examined the effects on mortality of change in sleep duration. We investigated associations of sleep duration and change in sleep duration with all-cause, cardiovascular, and non-cardiovascular mortality. DESIGN: Prospective cohort study. Data are from baseline (Phase 1, 1985-88) and Phase 3 (1991-93), with mortality follow-up of 17 and 12 years respectively. SETTING: The Whitehall II study of 10,308 white-collar British civil servants aged 35-55 at baseline. PARTICIPANTS: 9781 participants with complete data were included in the analyses at Phase 1, and 7729 of the same participants were included in the analyses at Phase 3 and the analyses of change in sleep duration. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: U-shaped associations were observed between sleep (< or =5, 6, 7, 8, > or =9 hours) at Phase 1 and Phase 3 and subsequent all-cause, cardiovascular, and non-cardiovascular mortality. A decrease in sleep duration among participants sleeping 6, 7, or 8 hours at baseline was associated with cardiovascular mortality, hazard ratio 2.4 (95% confidence intervals 1.4-4.1). However, an increase in sleep duration among those sleeping 7 or 8 hours at baseline was associated with non-cardiovascular mortality, hazard ratio 2.1 (1.4-3.1). Adjustment for the socio-demographic factors, existing morbidity, and health-related behaviours measured left these associations largely unchanged. CONCLUSIONS: This is the first study to show that both a decrease in sleep duration and an increase in sleep duration are associated with an increase in mortality via effects on cardiovascular death and non-cardiovascular death respectively.     

Immediate and long-term outcome of left-sided infective endocarditis. A 12-year prospective study from a contemporary cohort in a referral hospital

The aim of this study was to describe the immediate and long-term prognosis of a contemporary cohort of patients with left-sided infective endocarditis (LSIE). A prospective observational cohort study was conducted in a referral centre. Between January 2000 and December 2011, all consecutive adult patients with LSIE were followed-up until death, relapse, recurrence, need for late surgery, or last control. During the active phase of IE, 174 of 438 patients underwent surgery (40% overall; 43% native valve (NVIE), 30% prosthetic valve (PVIE)) and 125 died (29% overall; 26% NVIE, 39% PVIE). The median follow-up in survivors was 3.2 years (interquartile range (IQR) 1.0-6.0 years). Relapses occurred in seven patients (2.2%; 95% CI, 1.1–4.5) and recurrences in eight (2.6%; 95% CI, 1.3-5.0), with an incidence density of 0.0067 per patient-year (95% CI, 0.0029–0.0133) and high mortality (75% of recurrences). Only four of 130 survivors (3.1%; 95% CI, 1.2–7.6) who were treated surgically during the active phase of the disease, and 14/183 (7.7%; 95% CI, 4.6–12.4) of those not undergoing surgery needed operation during follow-up (p 0.09). In the 313 survivors, actuarial survival was 86% at 1 year (87% NVIE, 83% PVIE), 79% at 2 years (81% NVIE, 72% PVIE) and 68% at 5 years (71% NVIE, 57% PVIE). At 1 year, 115 of 397 patients (29.0%; 95% CI, 24.7–33.6) remained alive, with no surgery requirement, relapse or recurrence. LSIE is associated with considerable in-hospital and long-term mortality, especially PVIE. However, relapses, recurrences and the need for late surgery are uncommon.