The Health of the “Older Women” in Accra,Ghana: Results of the Women’s Health Study of Accra

The health of women residing in the developing countries is not limited to reproductive health conditions or infectious diseases. While these illnesses remain serious threats to a healthy life, as the population ages, the prevalence of illnesses considered to be of significance only in industrialized nations also increasingly afflicts the residents of the developing worlds. The health and well-being of the older women was evaluated in the 2003 Women’s Health Study of Accra. This community based survey and clinical and laboratory examination of 1,328 women identified a significantly high prevalence of malaria and chronic, non-communicable diseases in all age groups without regard to education level or income. Hypertension, diabetes and obesity are significantly prevalent in women age 50 years and older. The prevalence of conditions which adversely affect health and quality of life, including impaired visual acuity, poor dentition, pain and limitations with mobility is significant in the women age 50 years and older. While these data are specific to Ghana, they have the potential to be generalizable to women in other urban areas in transition. As the life expectancy is increasing in developing countries, an increased awareness and treatment of chronic health conditions in the older women is critical to ensure a healthy life as they enter their golden years.     

Diabetes multimorbidity combinations and disability in the Mexican Health and Aging Study, 2012–2015

PurposeThe aim of this study was to investigate the relationship between specific combinations of chronic conditions and disability in Mexican older adults with diabetes.MethodsThis was a prospective cohort study of Mexican adults (n = 2558) with diabetes and aged 51 or older that used data from the 2012 and 2015 waves of the Mexican Health and Aging Study. The main outcome was an index that measured ability to perform activities of daily living and instrumental activities of daily living. The main independent variables were diabetes multimorbidity combinations, defined as diabetes and at least one other chronic condition. The authors calculated the prevalence of each multimorbidity combination present in the sample in 2012 and used negative binomial regression models to estimate the association of the most prevalent of these combinations with disability incidence in 2015.ResultsThe three most prevalent combinations were: 1) diabetes-hypertension (n = 637, 31.9%) 2) diabetes-hypertension-depression (n = 388, 19.4%) and 3) diabetes-depression (n = 211, 10.6%). In fully adjusted models comparing participants with specific multimorbidity combinations to participants with diabetes alone, the combinations that had an increased association with disability were diabetes-hypertension-depression, diabetes-depression and diabetes-hypertension-arthritis-depression. In nested models, the addition of arthritis to combinations including depression increased this association.ConclusionsConsistent with prior studies, multimorbidity combinations including depression were associated with increased risk of disability. However, the effect size of this relationship was lower than what had been previously been reported internationally. This highlights the need for globally oriented multimorbidity research.     

Epidemiology of Left Ventricular Systolic Dysfunction and Heart Failure in the Framingham Study: An Echocardiographic Study Over 3 Decades

Objectives

The purpose of this study was to describe the temporal trends in prevalence of left ventricular systolic dysfunction (LVSD) in individuals without and with heart failure (HF) in the community over a 3-decade period of observation.

Duration of breast-feeding and the incidence of type 2 diabetes mellitus in the Shanghai Women’s Health Study

Aims/hypothesis The aim of this study was to examine the association between lifetime breast-feeding and the incidence of type 2 diabetes mellitus in a large population-based cohort study of middle-aged women. Methods This was a prospective study of 62,095 middle-aged parous women in Shanghai, China, who had no prior history of type 2 diabetes mellitus, cancer or cardiovascular disease at study recruitment. Breast-feeding history, dietary intake, physical activity and anthropometric measurements were assessed by in-person interviews. The Cox regression model was employed to evaluate the association between breast-feeding and the risk of type 2 diabetes mellitus. Results After 4.6 years of follow-up, 1,561 women were diagnosed with type 2 diabetes mellitus. Women who had breastfed their children tended to have a lower risk of diabetes mellitus than those who had never breastfed [relative risk (RR) = 0.88; 95% CI, 0.76–1.02; p = 0.08]. Increasing duration of breast-feeding was associated with a reduced risk of type 2 diabetes mellitus. The fully adjusted RRs for lifetime breast-feeding duration were 1.00, 0.88, 0.89, 0.88, 0.75 and 0.68 (p trend = 0.01) for 0, >0 to 0.99, >0.99 to 1.99, >1.99 to 2.99, >2.99 to 3.99 and ≥4 years in analyses adjusted for age, daily energy intake, BMI, WHR, smoking, alcohol intake, physical activity, occupation, income level, education level, number of live births and presence of hypertension at baseline. Conclusions/interpretation Breast-feeding may protect parous women from developing type 2 diabetes mellitus later in life.     

Alcohol Dependence,Other Psychiatric Disorders,and Health‐Related Quality of Life: A Replication Study in a Large Random Sample of Enrollees in the Veterans Health Administration

The purpose of this study was to investigate the relationship between alcohol dependence and health‐related quality of life (HRQoL) in people with and without other selected psychiatric disorders. A sample of 127,308 Veterans Health Administration enrollees completed a survey that included questions about alcohol use and the Veterans SF‐36, a well‐validated measure of HRQoL. In addition, a Veterans Administration database was used to obtain respondents' past‐year history of alcohol dependence and other psychiatric disorders. Comorbid psychiatric disorders significantly moderated or attenuated the relationship between alcohol dependence and HRQoL. Respondents with a history of alcohol dependence plus one or more other psychiatric disorders had significantly lower HRQoL in domains pertaining to psychological and social functioning than respondents with alcohol dependence only. Effect size differences (mean differences of clinical groups/pooled standard deviation) were large (greater than 0.80 of one standard deviation). Respondents with a history of alcohol dependence only vs. no history of alcohol dependence had poorer HRQoL. Effect size differences were small to moderate (between 0.20 and 0.50 of one standard deviation). Findings highlight the important moderating influence of comorbid psychiatric disorders in the relationship between alcohol dependence and HRQoL. As comorbid psychiatric disorders are often associated with poorer treatment outcome, findings also provide strong corroboration for the importance of treating other psychiatric disorders concurrently with alcohol dependence.     

Health effects of air pollution exposure on children and adolescents in São Paulo, Brazil

Children and adolescents have been considered more susceptible to the effects of air pollution than adults. In order to investigate the responses of children of different ages to air pollution exposure, daily records of hospital admissions for children in five age groups (equal or less than 2 years of age, 3-5, 6-13, 14-19, and all ages together, i.e., from 0-19 years of age) were obtained from January 1993 to November 1997 in S?o Paulo, Brazil, and were compared to daily records of PM10, O3, SO2, CO and NO2 concentrations in ambient air. For each age group a generalized additive Poisson regression was fitted controlling for smooth functions of time, temperature, humidity, and days of the week, with an additional indicator for holidays. Polynomial distributed lag models were used to estimate the 7-day cumulative effect of each pollutant. Children 2 years or less were the most susceptible to the effects of all five pollutants with an increase of 9.4% (95% CI: 7.9,10.9) in respiratory admissions associated with each interquartile range increase in PM10. The oldest group was the second most susceptible to air pollutants, with each interquartile range increase in PM10 associated with a 5.1% (95% CI: 0.3,9.8) increase in respiratory admissions. An interquartile range increase in CO was associated with an 11.3% (95% CI: 5.9,16.8) increase in respiratory hospitalizations. When a multipollutant model was used, the effect of PM10 on respiratory admissions for all ages together was unchanged, while the SO2 and the other pollutants effect was substantially reduced. This study showed that daily respiratory hospital admissions for children and adolescents in S?o Paulo increased with air pollution, and that the largest effects were found for the youngest (2 years or less) and oldest (14-19 years) age groups.     

Prevalence of vitamin D deficiency, insufficiency and secondary hyperparathyroidism in the elderly inpatients and living in the community of the city of São Paulo, Brazil

The occurrence of osteoporotic fractures in the elderly is associated with reduced levels of vitamin D and resulting secondary hyperparathyroidism, and inpatients are the ones at a higher risk. In Brazil, given its high level of insolation, the populations large amount of vitamin D is inferred to be adequate. In this study we aimed to assess the serum levels of 25-hydroxivitamin D (25OHD), parathormone (PTH) and ionized calcium (Cai), as well as to analyze the prevalence of both hypovitaminosis D and secondary hyperparathyroidism in the elderly living in the city of S?o Paulo. We studied 177 inpatients (125 women and 52 men) with mean age (SD) 76.6 (9.0) years, and 243 outpatients (168 women and 75 men) aged 79.1 (5.9) years. In this assessment 71.2% in the inpatients group and 43.8% in the outpatients group had 25OHD levels below the minimum recommended (50 nmol/l), with the women presenting with levels considerably lower than the men. Secondary hyperparathyroidism occurred in 61.7% of the inpatients and in 54% of the outpatients. Considering the results achieved, we recommend vitamin D supplementation in effective doses for the Brazilian elderly population, in addition to suggesting a discussion for the implementation of vitamin D-enhanced food policies, particularly oriented to the ones at a greater risk.     

Sleep duration,C-reactive protein and risk of incident coronary heart disease – results from the Framingham Offspring Study

BackgroundBoth sleep-duration and C-reactive protein (CRP) are useful predictors of coronary heart disease (CHD). The increased CRP level is associated with the unusual sleep-duration. However, it is unclear whether CRP impacts the CHD risk prediction of sleep-duration.Methods and resultsA total of 3381 individuals from the Framingham Offspring Study, aged 30+, CHD-free, and without missing measurement of CRP and sleep-duration and being followed to the end of 2007 were included in this analysis. Hazards ratio (HR) from the Cox regression models was used to evaluate the strength of association between the sleep-duration, CRP levels, and risk of incident CHD. Compared to sleep-duration 7–8 h (n = 2512) after adjusting for age and gender, the HR (95% CL) of incident CHD were 1.42 (1.15, 1.76, p < 0.005) for sleep-duration ≤6 h (n = 588) and 1.23 (0.90, 1.70, p < 0.2) for sleep-duration ≥9 h (n = 281), respectively. A further adjustment for other covariates including CRP did not change the CHD risk association. When subjects were categorized into 9 groups by sleep-duration (≤6, 7–8, and ≥9 h) and CRP levels (<1, 1–3, and ≥3 mg/L), and compared to those whose sleep-duration was 7–8 h and CRP levels were <1 mg/L, the HRs of CHD were similar for sleep-duration in ≤6 h or ≥9 h categories regardless of their CRP levels. The increased CRP levels, however, did show an increased risk for CHD when sleep-duration was 7–8 hConclusionThe levels of CRP do not significantly attenuate the association between sleep duration and incident CHD.     

How to assess frailty and the need for care? Report from the Study of Health and Drugs in the Elderly (SHADES) in community dwellings in Sweden

Knowledge about the need for care of elderly individuals in community dwellings and the factors affecting their needs and support is limited. The aim of this study was to characterize the frailty of a population of elderly individuals living in community dwellings in Sweden in relation to co-morbidity, use of drugs, and risk of severe conditions such as malnutrition, pressure ulcers, and falls. In 2008, 315 elderly individuals living in community dwellings were interviewed and examined as part of the SHADES-study. The elderly demonstrated co-morbidity (a mean of three diseases) and polypharmacy (an average of seven drugs). More than half the sample was at risk for malnutrition, one third was at risk for developing pressure ulcers, and nearly all (93%) had an increased risk of falling and a great majority had cognitive problems. Age, pulse pressure, body mass index, and specific items from the modified Norton scale (MNS), the Downton fall risk index (DFRI), and the mini nutritional assessment (MNA-SF) were related to different outcomes, defining the need for care and frailty. Based on the results of this study, we suggest a single set of items useful for understanding the need for care and to improve individual based care in community dwellings.     

Health‐Related Quality of Life in Children and Adolescents with Asthma: Results from the ESTAR Study

Our aim was to assess the psychosocial well‐being of asthmatic children and adolescents, the influencing factors, and to determine the effect of inpatient rehabilitation on their quality of life; 226 asthmatic children and adolescents participated in the inpatient rehabilitation (IG). The comparison group (CG) included 92 asthmatic children and adolescents receiving standard medical treatments. Patients were aged between 8 and 16 years and were predominantly male. The health‐related quality of life was measured with the German version of the “Paediatric Asthma Quality of Life Questionnaire.” Interviews were carried out for IG 2 weeks before the commencement of their inpatient stay and 1 year after their stay ended. The same time schedule was carried out for CG. All patients reported a mild to moderate impairment of their quality of life. Girls described a slightly lower quality of life than boys. With increasing asthma severity, quality of life decreased. Inpatients described a lower quality of life than CG at enrollment. Inpatient rehabilitation resulted in a greater improvement of quality of life over time for IG than for CG. Gender and severity status had no effect on this time course. The only modestly affected quality of life may reflect the good adaptation to the disease and medical treatment. Children and adolescents in the IG recorded improvements in their quality of life. Differences in quality of life based on gender and disease severity were not shown to influence the improvements. In summary, inpatient rehabilitation results in an improvement of health‐related quality of life. Further research concerning the psychosocial situation of children and adolescents in this setting is needed.     

El Niño and associated outbreaks of severe malaria in highland populations in Irian Jaya, Indonesia: a review and epidemiological perspective

Perennial malaria is a major public health problem for most coastal, lowland and foothill populations in Irian Jaya (western New Guinea), the largest and easternmost province of Indonesia. Malaria at higher elevations above 1,500 m is considered intermittent and highly unstable, providing a constant threat of epidemics. Beginning in late August 1997, a significant increase of unexplained deaths was reported from the central highland district of Jayawijaya. The alarming number of fatalities rapidly escalated into September, dropping off precipitously by late October. More than 550 deaths due to "drought-related" disease had been officially reported from the district during this 10-week period. The outbreaks occurred in extremely remote areas of steep mountainous terrain inhabited by primitive shifting agriculturist populations. Microscopical evidence and site survey data implicated malaria as the principal cause of the excess morbidity and mortality at elevations between approximately 1,000 and 2,200 m. The dramatic increase in malaria and associated deaths was indirectly related to the prolonged and severe drought created by the prevailing 1997-98 El Ni?o Southern Oscillation (ENSO) affecting the Australasian region. Clinical cases of malaria were described as severe, due, in large part to the low level of naturally acquired immunity (NAI) in these highland populations and the predominance of Plasmodium falciparum infection. Disease may have been further exacerbated by the population's compromised nutritional status because of severe shortages of staple foods affected by the drought. Based on a retrospective investigation, an 'a posteriori' epidemiological explanation of the probable, interrelated causes of the epidemic is presented. Beginning in late July 1997, drought conditions resulted in numerous, transient pools of standing water along zones of steep gradient streams normally associated with fast-flowing water. This permitted sufficient and rapid increases in vector populations (Anopheles punctulatus complex) that either could sustain recently introduced or intensified local low-level malaria transmission. Moreover, water and food shortages contributed to increased demographic movement and exposure to high risk malaria endemic lowlands, thus increasing the prevalence of human infections and infectious reservoirs in those populations returning to the highlands. The eventual rapid drying and elimination of the vector larval habitats along stream beds, combined with mass antimalarial drug distribution are believed, in part, to be responsible for the rapid decline of severe malaria and related deaths. Area delimited and isolated focal outbreaks of malaria are recognized as occasional, periodic events in these highlands. This epidemic produced great concern because of the broad regionalized extent of the problem, the culmination of many independent outbreaks occurring during the same period that overwhelmed the local health care and control capabilities. We predict communicable disease outbreaks, including malaria, may likely increase in periodicity in the Irian Jaya highlands as socioeconomic development and population movements increase. This investigation further underscores the importance of malaria and its impact on presumed NAI deficient highland populations. Furthermore, the association of ENSO-related climatic anomalies and heightened infectious disease transmission is illustrative of how rapidly changing local weather events can dramatically alter disease patterns. These circumstantial findings, albeit important, point to the urgent need for more definitive understanding of highland malaria dynamics, the development of a sustainable longitudinal surveillance system, and appropriate outbreak response capabilities for the highlands of Irian Jaya.     

Gender differences in the impact of adolescent smoking on lung function and respiratory symptoms. the Nord-Trøndelag Health Study,Norway, 1995-1997

Girls take up smoking at least as frequently as boys. Few studies have focused on gender differences in the impact of adolescent smoking. We evaluated the sex-specific effect of adolescent smoking on respiratory symptoms and lung function. All students in junior high and high schools in Nord-Tr?ndelag County Norway, 1995-97, were invited to participate in a cross-sectional study. Information on smoking habits and respiratory symptoms was obtained by self-administered questionnaires. Spirometry was performed in accordance with ATS standards. Eight-thousand-three-hundred and five students (83%) completed both questionnaire and spirometry. Among 6811 students aged 13-18 years (50.3% girls) with no history of asthma, 2993 (43.9%) reported never smoking, 665 (98%) reported occasional smoking, and 667 (9.9%) reported daily smoking (mean initiation age: 13.9 years). More boys than girls were heavy smokers. In all smoking categories, smokers reported a higher prevalence of respiratory symptoms than nonsmokers; symptoms increased with smoke burden. Girls reported more symptoms compared to boys with comparable smoke burden. A dose-response relation between smoking and reduced lung function was found only in girls. Girls were more vulnerable than boys to the impact of smoking on respiratory symptoms and lung function.     

Prevalence, incidence and types of mild anemia in the elderly: the ��Health and Anemia�� population-based study

Background

Hemoglobin concentrations slightly below the lower limit of normal are a common laboratory finding in the elderly, but scant evidence is available on the actual occurrence of mild anemia despite its potential effect on health. The objectives of this study were to estimate the prevalence and incidence of mild grade anemia and to assess the frequency of anemia types in the elderly.

Design and Methods

This was a prospective, population-based study in all residents 65 years or older in Biella, Italy.

Results

Blood test results were available for analysis from 8,744 elderly. Hemoglobin concentration decreased and mild anemia increased steadily with increasing age. Mild anemia (defined as a hemoglobin concentration of 10.0–11.9 g/dL in women and 10.0–12.9 g/dL in men) affected 11.8% of the elderly included in the analysis, while the estimated prevalence in the entire population was 11.1%. Before hemoglobin determination, most mildly anemic individuals perceived themselves as non-anemic. Chronic disease anemia, thalassemia trait, and renal insufficiency were the most frequent types of mild anemia. The underlying cause of mild anemia remained unexplained in 26.4% of the cases, almost one third of which might be accounted for by myelodysplastic syndromes. In a random sample of non-anemic elderly at baseline (n=529), after about 2 years, the annual incidence rate of mild anemia was 22.5 per 1000 person-years and increased with increasing age.

Conclusions

The prevalence and incidence of mild anemia increase with age and mild anemia affects more than one out of ten elderly individuals. Unexplained anemia is common and may be due to myelodysplastic syndromes in some cases.     

Effects of productivity, consumers, competitors, and El Niño events on food chain patterns in a rocky intertidal community

We experimentally manipulated nutrient input to a rocky intertidal community, using nutrient-diffusing flowerpots, to determine (i) whether nutrients limited intertidal productivity, (ii) how a large-scale oceanographic disturbance (an El Ni?o event) affected patterns of nutrient limitation, (iii) the relative impacts of molluscan grazers and nutrient limitation, and (iv) if responses to experimental nutrient addition among trophic levels were more consistent with prey-dependent or ratio-dependent food chain models. Nutrients measurably increased the abundance of micrograzers (amphipods and chironomid larvae), but not algal biomass, during the summer of an El Ni?o year. Nutrients had no effects in two non-El Ni?o years and during the autumn of an El Ni?o year. Adding nutrients did not affect food chain stability as assessed by temporal variation in algal biomass and micrograzer abundance. Large molluscan grazers caused large reductions in micrograzers and smaller reductions in algae, indicating consistent consumer effects. The results demonstrate that in this intertidal community, nutrient limitation can occur under conditions of nutrient stress, that top-down grazing effects are typically stronger than bottom-up nutrient effects, and that prey-dependent models are more appropriate than ratio-dependent models.