Is gout associated with reduced quality of life? A case-control study

Objectives. To compare quality of life (QOL) between gout casesand controls in a primary care population and to investigatewhether impaired QOL in gout is secondary to co-morbid factorsor to intrinsic factors related to gout itself. Methods. A postal questionnaire was sent to all adults agedover 30 yrs registered with two general practices. The questionnaireassessed a history of gout (doctor diagnosed, or episodes suggestiveof acute crystal synovitis) and medical and musculoskeletalco-morbidities. QOL was assessed using the WHOQoL-Bref instrument.Possible cases of gout attended for clinical assessment wherethe diagnosis was verified on clinical grounds. Overall QOL,satisfaction with health and QOL across four domains were comparedbetween gout cases and controls and then entered into a linearregression model adjusting for gout, age, gender, body massindex and medical and musculoskeletal co-morbidities. Results. Of 13 684 questionnaires mailed, 3082 completed questionnaireswere returned (23%). From 289 suggested cases of gout, 137 caseswere confirmed by clinical assessment. Compared with controls,cases had impaired overall QOL (15.67 vs 16.41, P = 0.003),satisfaction with health (13.16 vs 14.45, P < 0.001) andphysical health-related QOL (14.08 vs 15.95, P < 0.001).On multi-variate analysis, gout remained associated with impairedphysical health-related QOL (ß = –0.059, P =0.001) but not overall QOL (ß = –0.024, P =0.198) or satisfaction with health (ß = –0.028,P = 0.142). Conclusions. Gout associates with poor overall QOL mainly resultingfrom associated co-morbidity. Physical health-related QOL, however,remains impaired after adjustment for co-morbidities. KEY WORDS: Gout, Quality of life, General practice Submitted 11 January 2007; revised version accepted 2 May 2007.     

Is retinal vein occlusion associated with depression symptoms?: A nationwide cohort study

Retinal vessels share similar anatomical and physiological characteristics with the cerebral microvasculature, and abnormal cerebral blood flow is reportedly associated with depressive disorder. However, there is limited evidence regarding the relationship between depression and the risk of retinal vein occlusion (RVO). This study aimed to investigate the association between depression and the prospective risk of RVO using nationally representative longitudinal data. This retrospective, nationwide, population-based cohort study included 9,178,222 people aged 20 years or older who underwent the Korean National Health Screening Program examination in 2009. The depression group consisted of subjects whose initial diagnoses were made between 2009 and 2010 (n = 128,700). The predictive value for RVO was analyzed using multivariate Cox proportional hazard regression models.From the Kaplan–Meier curves, the depression group showed significantly higher RVO incidence probability, relative to the comparison group (P < .0001). After all confounding variables were adjusted, the hazard ratio of RVO in the depression group with or without recurrence was 1.2 (95% confidence interval [CI]: 1.076–1.338) and 1.087 (95% CI: 1.012–1.167), respectively, relative to the comparison group. This is the first nationwide, population-based, epidemiologic study that evaluated the association between depression and the risk of RVO development. The presence of depression was significantly associated with increased risks of RVO, and the recurrence of depression showed a higher RVO incidence probability.     

Does parental smoking cessation encourage their young adult children to quit smoking? A prospective study

AIMS: To investigate the extent to which parental early and late smoking cessation predicts their young adult children's smoking cessation. DESIGN: Parental early smoking cessation status was assessed when children were in 3rd grade, parental late smoking cessation was assessed when children were in 11th grade, and young adult children's smoking cessation was assessed 2 years after high school. SETTING: Forty Washington State school districts participated in the Hutchinson Smoking Prevention Project. PARTICIPANTS AND MEASUREMENTS: Participants were the 1553 families in which parents were ever regular smokers who had a young adult child smoking at least weekly at 12th grade who also reported their smoking status 2 years later. Questionnaire data were gathered on parents and their young adult children (49% female and 91% Caucasian) in a cohort with a 94% retention rate. FINDINGS: Parents who quit early had children with 1.8 (OR = 1.80; 95% CI = 1.22, 2.64) times higher odds of quitting smoking for at least 1 month in young adulthood compared to those whose parents did not quit early. In contrast, there was no association (OR = 0.84; 95% CI = 0.47, 1.51) between parents quitting late and their young adult children's smoking cessation. CONCLUSIONS: Parental early smoking cessation is associated with increased odds of their young adult children's smoking cessation. Parents who smoke should be encouraged to quit when their children are young.     

Are mitochondrial haplogroups associated with extreme longevity? A study on a Spanish cohort

Mitochondrial haplogroups could influence individual susceptibility to mitochondrial DNA (mtDNA) damage, and human longevity, as indicated by previous studies with Caucasian (European) or Asian cohorts. Here, we compared the frequency of mtDNA haplogroups in a group of Spanish (Caucasian) centenarians (n = 65, aged 100–108 years, 58 women, most from the central part of Spain) and a group of healthy young adults (n = 138, 62 women, aged 20–40 years) of the same ethnic origin. We did not find significant differences between centenarians and the control group (P > 0.2). Only two centenarians (both women) had the haplogroup J, which hampered comparison with the control group (n = 15, five women). Our data confirm that the potential effects of mitochondrial haplogroups on human longevity might be population/geographic specific, with important differences between studies (notably, with regard to the previously reported potential benefit brought about by the haplogroup J) arising from the different living environment and ethnic background of the study cohorts.     

Can reduced smoking be a way for smokers not interested in quitting to actually quit?

The predominating way to stop smoking is to do it abruptly. At every given time, the large majority of smokers are not motivated or willing to try and give up. Some smokers are entirely happy with their smoking, a larger group would like to smoke less and a third group wants to quit. With the abrupt quitting message we are only addressing those wanting to quit. Maybe not even all, since some of them may have tried many times already and learned that they cannot quit abruptly. They may have given up on giving up. Some interesting results are given in recent studies that have recruited smokers not motivated to quit but interested in reducing their smoking. From nine randomized placebo-controlled trials where smokers were given behavioural support and pharmacological assistance, motivation to quit seemed to have increased, and in each trial, a proportion of these unmotivated smokers gave up smoking. It is suggested that for smokers unable or not interested in giving up abruptly, a softer and more gradual approach should be considered. Such an approach may bring new smokers into treatment, produce more people wanting to quit and improve public health.     

Is central obesity associated with cirrhosis-related death or hospitalization? A population-based, cohort study.

BACKGROUND & AIMS: We aimed to determine the interaction between body fat distribution (central versus peripheral) and increased body mass index (BMI) with regards to the risk of cirrhosis-related death or hospitalization. METHODS: Participants included 11,434 persons aged 25-74 years without evidence of cirrhosis at entry into the study or during the first 5 years of follow-up who were subsequently followed for a mean of 12.9 years as part of the first National Health and Nutrition Examination Survey. Participants were categorized into "normal-weight" (BMI < 25 kg/m 2 , N = 5750), "overweight" (BMI 25 to < 30 kg/m 2 , N = 3770), and "obese" (BMI > or = 30 kg/m 2 , N = 1914). The subscapular to triceps skinfold thickness ratio (SFR) was used to categorize body fat distribution into central (SFR > 1, N = 5211) and peripheral (SFR < or = 1, N = 6223). RESULTS: Cirrhosis resulted in death or hospitalization of 88 participants during 149,888 person-years of follow-up (59/100,000 person-years). Among persons with a central body fat distribution, cirrhosis-related deaths or hospitalizations were more common in obese persons (115/100,000 person-years, adjusted hazard ratio 2.2, 95% confidence interval [CI] 1.1-4.6) and in overweight persons (94/100,000 person-years, adjusted hazard ratio 1.5, 95% CI 0.8-3.0) compared to normal-weight persons (59/100,000 person-years). However, among persons with a peripheral fat distribution, there was no association between obesity (adjusted hazard ratio 0.7, 95% CI 0.3-1.6) or overweight (adjusted hazard ratio 0.8, 95% CI 0.2-2.8) and cirrhosis-related death or hospitalization. CONCLUSIONS: The risk of cirrhosis-related death or hospitalization appears to be increased in the presence of cirrhosis, but only among persons with a central fat distribution. The excess risk associated with central obesity might be related to insulin resistance and hepatic steatosis.     

Too late to quit? Effect of smoking and smoking cessation on morbidity and mortality among the elderly in a longitudinal study

This prospective study of the elderly population estimated the risks of smoking for morbidity and mortality and identified whether cessation of smoking reduced the risk of disease. Data came from face-to-face interviews that used a population-based probability sample of those aged 60 years or over in Taiwan, provided by the Population and Health Research Center, Bureau of Health Promotion. In total, 4,049 subjects were included at the baseline year of 1989 and followed up in 1993 and 1996. Smoking-related variables included current smoking status, smoking history, daily consumption, and years since the cessation of smoking. Cox regression models were used to analyze the relative risks for morbidity and mortality, controlling for demographics, physical function, and comorbidities. The sample was made up of 50.2% nonsmokers, 15.2% ex-smokers, and 34.6% current smokers in the baseline year. Current smokers were more likely to have lower respiratory tract diseases throughout the study. Current smokers had a higher risk of stroke from 1989 to 1993. No dose-response relationship for smoking exposure or impact of years since smoking cessation was found. Whether cessation of smoking is protective should be investigated for middle-aged adults followed to old age. An effective strategy for smoking cessation in the elderly is suggested, and people should be encouraged to quit smoking at any time.     

Is diverticulosis associated with colorectal neoplasia? A cross-sectional colonoscopic study

OBJECTIVE: To determine the relationship between distal diverticulosis and risk for colorectal neoplasia. METHODS: Patients undergoing first-time colonoscopy for any indication were eligible if they had no prior polypectomy, colonic resection, or inflammatory bowel disease. Patients completed a survey about risk factors for colorectal cancer (CRC) prior to colonoscopy. Endoscopists, blinded to study objective and survey results, recorded the size, extent (none, few, or many), and location of diverticuli and polyps. RESULTS: The 502 participants were 67% male with a mean age of 58.6 yr. Twenty-three percent had extensive distal diverticulosis (EDD), 36% had > or =1 adenoma, and 14% had advanced neoplasia. Overall comparison of those with EDD versus few or no diverticuli revealed no differences in the risks of any neoplasia or advanced neoplasia, either distally (26.7%vs 25.4%; 12.9%vs 8.8%, respectively) or proximally (25%vs 18.4%; 6.0%vs 4.9%). Compared to women with few or no distal diverticuli, however, women with EDD were more likely to have any neoplasia and advanced neoplasia, both distally (34.6%vs 16.3%; p= 0.03, and 23.1%vs 5.7%; p= 0.003) and proximally (30.8%vs 14.9%; p= 0.049, and 11.5%vs 4.3%, p= 0.13). Adjustment for age did not affect results for advanced distal neoplasia (OR = 3.92; CI: 1.18-13); however, adjustment for the presence of a distal neoplasm eliminated the increased risk of proximal neoplasia associated with EDD (OR = 1.31; CI: 0.43-4.02). CONCLUSION: In this study, women with EDD were more likely to have advanced distal neoplasia. The presence of distal neoplasia in women with EDD accounted for their increased risk of proximal neoplasia. Distal diverticulosis was not independently associated with proximal neoplasia in men or women.     

Which components of the Mediterranean diet are associated with dementia? A UK Biobank cohort study

GeroScience - Cohort studies suggest that the Mediterranean diet is associated with better global cognition in older adults, slower cognitive decline and lower risk of dementia. However, little is...     

Crohn's disease and smoking: Is it ever too late to quit?

BackgroundSmoking increases CD risk. The aim was to determine if smoking cessation at, prior to, or following, CD diagnosis affects medication use, disease phenotypic progression and/or surgery.MethodsData on CD patients with disease for ≥ 5 yrs were collected retrospectively including the Montreal classification, smoking history, CD-related abdominal surgeries, family history, medication use and disease behaviour at diagnosis and the time when the disease behaviour changed.Results1115 patients were included across six sites (mean follow-up—16.6 yrs). More non-smokers were male (p = 0.047) with A1 (p < 0.0001), L4 (p = 0.028) and perianal (p = 0.03) disease. Non-smokers more frequently received anti-TNF agents (p = 0.049). (p = 0.017: OR 2.5 95%CI 1.18–5.16) and those who ceased smoking prior to diagnosis (p = 0.045: OR 2.3 95%CI 1.02–5.21) progressed to complicated (B2/B3) disease as compared to those quitting at diagnosis. Patients with uncomplicated terminal ileal disease at diagnosis more frequently developed B2/B3 disease than isolated colonic CD (p < 0.0001). B2/B3 disease was more frequent with perianal disease (p < 0.0001) and if i.v. steroids (p = 0.004) or immunosuppressants (p < 0.0001) were used. 49.3% (558/1115) of patients required at least one intestinal surgery. More smokers had a 2nd surgical resection than patients who quit at, or before, the 1st resection and non-smokers (p = 0.044: HR = 1.39 95%CI 1.01–1.91). Patients smoking > 3 cigarettes/day had an increased risk of developing B2/B3 disease (p = 0.012: OR 3.8 95%CI 1.27–11.17).ConclusionProgression to B2/B3 disease and surgery is reduced by smoking cessation. All CD patients regardless of when they were diagnosed, or how many surgeries, should be strongly encouraged to cease smoking.     

Is retinal vasculature change associated with risk of obesity? Longitudinal cohort study in Japanese adults: The Funagata study

Aims/Introduction: To examine the association between baseline retinal vessel caliber change and prevalence, and 5‐year incidence of obesity in the adult Japanese population of the Funagata study. Materials and Methods: Of 900 individuals (age ≥ 35 years) who underwent systemic and retinal examinations in the Funagata study during 2000–2002, 584 (64.8%) were not obese as defined by body mass index (BMI) ≥ 25 kg/m², and considered at risk of incident obesity. In 2005–2007, 454 patients returned for 5‐year follow‐up examination (52.9%). Incidence of overweight was defined as subjects who were not overweight at baseline examination (BMI < 23 kg/m²), but overweight (BMI ≥ 23 to <25 kg/m²) at follow up, and that of obesity as subjects who were not obese at baseline examination (BMI < 25 kg/m²), but obese (BMI ≥ 25 kg/m²) at follow up. Results: The prevalence of obesity at baseline was 35.1% (316/900); there was a cross‐sectional association between wider retinal venular diameters and obesity (adjusted odds ratio [OR] per +1 standard deviation (SD) change: 1.18; 95% confidence interval [CI]: 1.02–1.35) after adjusting for age and sex. Cumulative incidence of obesity between baseline and 5‐year follow up was 10.6% (32/303). Although the risk of incident overweight or obesity was higher in persons with wider retinal venular caliber, there were no statistically significant associations between baseline venular caliber and 5‐year incidence of obesity. Conclusions: Although we found significant cross‐sectional associations of retinal venodilation with the prevalence of overweight, we could not confirm that retinal venodilation preceded the development of obesity in this population. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00086.x , 2011)     

Is elective cesarean section associated with a higher risk of asthma? A meta-analysis

Abstract

Background: Recent meta-analyses indicate that children delivered by cesarean section have increased risk for asthma. However, the studies included in these previous meta-analyses showed significant heterogeneity. Furthermore, no previous meta-analysis has distinguished the association of elective and emergency CS, spontaneous and instrumental vaginal deliveries (VD) with the odds of asthma. Objective: To examine the association between specific mode of delivery and the prevalence of asthma. Methods: PUBMED, Google Scholar, EMBASE, and MEDLINE were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated from the prevalence of asthma in children born by elective CS, emergent CS, instrumental VD and spontaneous VD. Meta-analysis was then used to derive a combined OR. Heterogeneity between studies was also tested in the findings. Results: A total of 26 studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by CS (OR?=?1.16, 95% CI 1.14, 1.29), and no evidence of heterogeneity was found (I²?=?24.6%). Elective and emergency CS moderately increased the risk of asthma (OR?=?1.21, 95% CI 1.17, 1.25; I²?=?39.9%; OR?=?1.23, 95% CI 1.19–1.26). The risk of asthma was also higher in the children born by instrumental VD (OR?=?1.07, 95% CI, 1.04–1.11) but with evidence of heterogeneity (I²?=?54.9%). Conclusion: About 20% increase in the subsequent risk of asthma was both found in children delivered by elective and emergency CS. The increasing rates of CS worldwide might partly explain the concomitant rise in asthma during the same time period.     

Is left ventricular hypertrophy a low-level inflammatory state? A population-based cohort study

Background and AimsCross-sectional studies have shown that chronic sub-clinical inflammation is associated with left ventricular hypertrophy (LVH), but results are conflicting. We investigated the association between baseline LVH and high-sensitivity C-reactive protein (CRP) values, both cross-sectionally and after a six-year-follow-up, in a population-based cohort (n = 1564) and a subgroup from this cohort (n = 515), without obesity, diabetes, metabolic syndrome or any drugs.Methods and ResultsECG tracings at baseline were interpreted according to the Cornell voltage-duration product criteria: 166/1564 subjects (10.6%) showed LVH. Patients with baseline LVH showed increased BMI, waist circumference, blood pressure, and a worse metabolic pattern. Their CRP values both at baseline and at follow-up were almost two-fold higher than in patients without LVH. Similar results were found in the healthier sub-sample. In a multiple regression model, CRP at follow-up was directly associated with baseline LVH (expressed as Cornell voltage-duration product) in the whole cohort (β = 0.0003; 95%CI 0.0002–0.0006; p < 0.001) and in the sub-sample (β = 0.0003; 0.0002–0.0004; p < 0.001), after adjusting for age, sex, BMI, waist circumference, smoking, exercise levels, blood pressure and baseline CRP values.ConclusionBaseline LVH, which is associated with systemic inflammation, predicts increased CRP values at follow-up, independently of cardiovascular and metabolic risk factors, both in a population-based cohort and a healthier sub-sample. The inflammatory consequences of LVH might be an intriguing subject for further researches.     

Is Pica under-reported in children with sickle cell disease? A pilot study in a Belgian cohort

Abstract

Background

For centuries, writers have recorded their observations on pica. Nevertheless the association of pica with sickle cell disease (SCD) was poorly documented.

Methods

Cross-sectional evaluation performed on SCD children and caregivers attending the outpatient clinic who were invited to complete questionnaires assessing behavior of pica.

Results

Out of 55 sickle cell children, 31(56.4%) reported practicing pica regularly. Substances ingested by patients covered a broad spectrum. Compared with the non-pica group, subjects who reported pica were younger and had lower hemoglobin (8.3 g/dl (7.6–9.7) vs. 9.1 g/dl (7.9–10.5): P < 0.01). The level of ferritin, zinc, copper, and lead was similar between the pica and non-pica groups (P > 0.05).

Discussion

In this series, there are many substances consumed by SCD children and adolescents, and we did not find an occurrence of similar substances among this select group. Pica children were younger and more anemic than non-pica patients.

Conclusion

This study suggests that pica remains an unknown and under-reported clinical problem in children with SCD and seems to be related to the severity of anemia. The next step of this project aims to clarify causal mechanisms for pica and its association with SCD in a larger population.