Education, income, occupation, and the 34-year incidence (1965-99) of Type 2 diabetes in the Alameda County Study

BACKGROUND: Lower socioeconomic position (SEP) is related to higher prevalence of Type 2 diabetes, yet little is known about the relationship of SEP with incident diabetes. METHODS: The association between SEP, measured by self-reported education, income, and occupation, and Type 2 diabetes incidence was examined in a community sample of 6147 diabetes-free adults from Alameda County, CA. Cox proportional hazards models estimated the effect of baseline (1965) and time-dependent (value changes over time) measures of SEP on incident diabetes over a 34-year study period (1965-99). Demographic confounders (age, gender, race, and marital status) and potential components of the causal pathway (physical inactivity, smoking, alcohol consumption, body composition, hypertension, depression, and health care access) were included as fixed or time-dependent covariates. RESULTS: Education, income, and occupation were associated with increased diabetes risk in unadjusted models. In baseline models adjusted for demographics, respondents with <12 years of education had 50% excess risk compared with those with more education [hazard ratio (HR) = 1.5, 95% confidence interval (95% CI) 1.11-2.04], but income and occupation were no longer significantly associated with increased risk. Further adjustment minimized the significance of all associations. Time-dependent effects were consistently elevated for low education and male blue-collar occupation, but non-significant after full adjustment (HR = 1.1, 95% CI 0.79-1.47 and HR = 1.3, 95% CI 0.91-1.89, respectively). CONCLUSIONS: Socioeconomic disadvantage, especially with low educational attainment, is a significant predictor of incident Type 2 diabetes, although associations were largely eliminated after covariate adjustment. Obesity and overweight appear to mediate these associations.     

A rapid dietary assessment tool to determine intake of folate was developed and validated

BACKGROUND AND OBJECTIVE: Estimates of dietary folate intake are currently of considerable interest, but no rapid tools are available to assess dietary intake of folate that are well suited to everyday health promotion activities. We developed and tested the reliability and validity of two prototypes of a rapid dietary assessment tool (a folate intake tool, FIT) to determine dietary intake of folate. STUDY DESIGN AND SETTING: Five hundred and sixty eight men and women aged 33-83 years from Perth, Western Australia, completed one of the two prototypes of the tool and gave a fasting blood sample for measurement of serum folate. A subset (n=277) of participants completed the same tool on a second occasion 3-6 weeks later. RESULTS: The Pearson correlations (r) between folate score from the tool and serum folate were moderately high for both prototypes (FIT-A r=0.54; FIT-B r=0.49). The folate scores for the two prototypes were similar on repeat testing and correlated strongly (FIT-A r=0.75; FIT-B r=0.68). CONCLUSIONS: The rapid dietary assessment tool described here, FIT, provides a valid and reliable measurement of dietary intake of folate for both men and women.     

A network of investigator networks in human genome epidemiology

The task of identifying genetic determinants for complex, multigenetic diseases is hampered by small studies, publication and reporting biases, and lack of common standards worldwide. The authors propose the creation of a network of networks that include groups of investigators collecting data for human genome epidemiology research. Twenty-three networks of investigators addressing specific diseases or research topics and representing several hundreds of teams have already joined this initiative. For each field, the authors are currently creating a core registry of teams already participating in the respective network. A wider international registry will include all other teams also working in the same field. Independent investigators are invited to join the registries and existing networks and to join forces in creating additional ones as needed. The network of networks aims to register these networks, teams, and investigators; be a resource for information about or connections to the many networks; offer methodological support; promote sound design and standardization of analytical practices; generate inclusive overviews of fields at large; facilitate rapid confirmation of findings; and avoid duplication of effort.     

Sexually transmitted infections, prostatitis, ejaculation frequency, and the odds of lower urinary tract symptoms

Early life sexual factors, including histories of sexually transmitted infections, young-onset prostatitis, and frequency of ejaculation, were investigated in relation to lower urinary tract symptoms (LUTS) in a large case-control study nested within the Health Professionals Follow-up Study. In 1992, study participants were asked to provide information on their histories of sexually transmitted infections, prostatitis, ejaculation frequency, surgery for an enlarged prostate, and LUTS. Information on prostate surgery and LUTS was updated every 2 years. LUTS cases were defined as men who reported surgery for an enlarged prostate or high-moderate to severe LUTS (> or = 15 points on the American Urological Association symptom index) on any study questionnaires (n = 4,608). Controls were men who did not report surgery for an enlarged prostate and who scored 0-7 points on the American Urological Association symptom index on all questionnaires (n = 17,967). History of gonorrhea (adjusted odds ratio = 1.76, 95% confidence interval: 1.43, 2.15) or young-onset prostatitis (adjusted OR = 1.55, 95% confidence interval: 1.22, 1.96) was positively associated with LUTS. No association was observed between ejaculation frequency in early adulthood and LUTS. These results suggest that early genitourinary infections may contribute to later development of LUTS, although confirmation in additional population settings is warranted.     

Progression of Parkinson's disease following thalamic deep brain stimulation for tremor

We assessed the long-term effect of thalamic deep brain stimulation (DBS) on motor symptoms and progression of Parkinson's disease (PD) in PD patients treated for resting and postural/action tremor. Thalamic DBS was performed in 17 patients with treatment-resistant resting and postural/action tremor. Nine patients were available for follow-up examination a mean of 5.5 years after surgery. Three had tremor-dominant PD. DBS produced marked improvement in resting and postural/action tremor in target upper extremity in all 9 patients, which persisted unchanged at the time of the last follow-up visit 5.5 years after surgery. PD severity with DBS 'on' and 'off' 1 year after surgery was compared to PD severity at the last follow-up visit using UPDRS (Unified Parkinson's Disease Rating Scale) III motor scores and individual motor item subscores. Patients were tested while on medication. There was no significant worsening of tremor, rigidity, speech, postural stability, gait, or axial bradykinesia with DBS either on or off at the last follow-up visit compared to the 12-month visit. UPDRS III motor scores were unchanged. However, global assessment of PD progression and increased mean L-dopa dose and L-dopa equivalent daily dose at the time of last follow-up visit indicated that a progression of PD had occurred.     

Dysregulation of dopamine signaling in the dorsal striatum inhibits feeding

Dopamine signaling is an important component of many goal-directed behaviors, such as feeding. Acute disruption of dopamine signaling using pharmacological agents tends to inhibit normal feeding behaviors in rodents. Likewise, genetically engineered dopamine-deficient (DD) mice are unable to initiate sufficient feeding and will starve by approximately 3 weeks of age if untreated. Adequate feeding by DD mice can be achieved by daily administration of L-3,4-dihydroxyphenylalanine (L-dopa), a precursor of dopamine, which can be taken up by dopaminergic neurons, converted to dopamine, and released in a regulated manner. In contrast, adequate feeding cannot be restored with apomorphine (APO), a mixed agonist that activates D1 and D2 receptors. Viral restoration of dopamine production in neurons that project to the dorsal striatum also restores feeding in DD mice. Administration of amphetamine (AMPH) or nomifensine (NOM), drugs which increase synaptic dopamine concentration, inhibits food intake in virally rescued DD mice (vrDD) as in control animals. These results indicate that the dysregulation of dopamine signaling in the dorsal striatum is sufficient to induce hypophagia and suggest that regulated release of dopamine in that brain region is essential for normal feeding and, probably, many other goal-directed behaviors.     

Providing a numerical measure of oral health--can it be done and how accurate is it?

An Index of Oral Health (OHX) was developed by Burke and Wilson in the mid 90s. Use of the index involves assessing patient comfort and satisfaction in addition to the assessment of caries, periodontal disease, toothwear, mucosa, occlusion and dentures, where appropriate. On completion of this structured examination, the clinician arrives at an overall oral health index (OHX) for the patient, which is expressed as a fraction of the maximum achievable score. The index was modified by Denplan UK by amending the calculations to produce the Oral Health Score (OHS). The Reproducibility of the OHX and OHS was tested at Birmingham Dental Hospital and School during 2001 and 2002 and was found to be satisfactory. The dentists' opinions on the OHX and OHS were assessed by means of questionnaires. Most of the dentists felt that both were easy to use.     

Simvastatin suppresses LPS-induced Akt phosphorylation in the human monocyte cell line THP-1

BACKGROUND: Activation of the small GTPase, Rac, requires post-translational modification by isoprenylation. Statins interfere with this process by blocking the synthesis of isoprenoid intermediates. The protein kinase Akt is a multifunctional regulator of cell behavior that has been linked to Rac activation. We have shown that lipopolysaccharide (LPS) stimulation leads to Rac activation in THP-1 cells. Therefore, we hypothesized that LPS stimulation would also activate Akt, a downstream effector of Rac, and that this may be blocked by statin pretreatment. MATERIALS AND METHODS: THP-1 cells were maintained in 1% fetal calf serum with or without 20 microM simvastatin for 24 h, followed by LPS stimulation for increasing time. Cytoskeletal changes were observed using Alexa-Phalloidin. Akt was immunoprecipitated from total cell lysate. Activated Akt was detected by immunoblotting with a phospho-Akt antibody and was quantified by image densitometry. RESULTS: LPS stimulation of THP-1 cells results in membrane ruffling and cell polarization. Furthermore, LPS increased Akt activation in THP-1 cells when compared with the nonstimulated controls. Akt phosphorylation peaked after 15 min of LPS stimulation and was suppressed by pretreatment with simvastatin. CONCLUSIONS: These data demonstrate that LPS stimulation leads to increased Akt phosphorylation, which can be suppressed with simvastatin pretreatment. This suggests one possible mechanism through which simvastatin could modulate LPS-induced signaling events in monocytes to improve the host response to Gram-negative infections.     

A community survey of loneliness

BACKGROUND: Loneliness is associated with an increased incidence of a wide range of physical and mental health problems. The detection, prevention and amelioration of loneliness is an important public health issue for nurses. METHODS: This study reports findings from the 2002 Central Queensland Social Survey. The aims of the study were to (i). establish the extent of loneliness in a community sample; and (ii). to identify the factors that are predictors of loneliness. A random sample of 1241 subjects were interviewed by Computer-Assisted Telephone Interviewing. This interview included the Loneliness Scale formulated by De Jong Gierveld and Kamphuis. FINDINGS: Loneliness is a common phenomenon and risk factors include experience of domestic violence in current relationship, not having recent paid employment, not being married/partnered, and the number of children under 18 years in a household. Loneliness is not associated with higher rates of health care professional consultations. CONCLUSION: Loneliness is a very common problem and should be seen as a major public health issue. Nurses, through a community capacity building framework, have a major role to play in the prevention of loneliness.