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Biomedical subjects

A Hofman

Publications and source records attributed to A Hofman.

At least 271 records · Page 15Linked to original sources
PubMed1997

Differences in health status of older adults with pain in the hip or knee only and with additional mobility restricting conditions.

OBJECTIVE: To determine differences in health status of people aged 55 to 74 years with pain in the hip or knee only and with additional mobility restricting conditions. METHODS: A subsample from a community based study on pain, disability, comorbidity, and radiological osteoarthritis (OA) was used to identify a group with current pain in the hip or knee only (n = 62), a group with additional mobility restricting conditions (n = 124), and a reference group without pain and radiological OA (n = 72). Health status was measured with the IRGL instrument (Impact of Rheumatic diseases on General health and Lifestyle). Additional mobility restricting conditions were self-reported. RESULTS: The most reported additional conditions were more widespread joint pain and stiffness, and cardiovascular and respiratory problems. The group with pain in the hip or knee only had less mobility than the reference group (p < 0.05), but had higher mobility (p < 0.05), less pain (p < 0.001), less psychological distress (p < 0.01), and less effect of symptoms on daily life (p < 0.001) than the group with additional conditions. No differences were found in background variables or comorbidity. Multivariate logistic regression analysis showed that the group with additional conditions differed from the group with knee or hip pain only with respect to joint pain (OR 1.18), cheerfulness (OR 0.9), and effect on daily life (OR 1.1). CONCLUSION: The health status of people with pain in the hip or knee only is comparable to that of a reference group without pain. Health status is lower when pain in the hip or knee is present in combination with additional mobility restricting conditions. This last group is at greater risk of psychological distress and physical dysfunctioning.

Activities of Daily Living↗
PubMed1996

[Costs due to osteoporosis-induced fractures in The Netherlands; possibilities for cost control].

OBJECTIVE: Evaluation of the medical costs of osteoporotic fractures in the Netherlands and a discussion of the possibilities of cost control. DESIGN: Cost calculation using published data combined with data from routine hospital and nursing home registration. SETTING: The Netherlands. METHODS: We estimated the total cost of osteoporosis related to fractures of the hip, forearm and vertebrae. Incidence data and data from hospital and nursing home stays were related to information about costs. The analysis was performed for men and women aged 50 and older based on data from 1993. The validity of the assumptions was tested in a sensitivity analysis. RESULTS: The direct medical cost of osteoporosis-related fractures was estimated to be over 400 million builders each year. More than one-third of this cost originated in the group aged 85 and over, while this group only represented 1.3% of the population. About 85% of the costs were caused by hip fractures. Of those costs of hip fractures 80% was due to the hospital admissions. The length of stay in the hospital was associated with discharge status (the length of stay for patients going to a nursing home was almost 8 days longer than for patients leaving for their own homes) and age (the length of stay increased by 0.3 days/year of age). The cost of the stay in a nursing home and of ambulatory care were 20% and 10%, respectively, of the total costs. CONCLUSION: In the short term, cost control is mainly possible by reducing the length of stay in the hospital. This can be done by providing better methods of discharge to suitable care facilities. The cost-effectiveness of prevention of fractures is at present unclear. Due to the duration of the treatment and the frequency of fractures at high ages, the timing of the intervention is of great importance.

Aged↗
PubMed1996

Reduced response to activated protein C is associated with increased risk for cerebrovascular disease.

BACKGROUND: Resistance to activated protein C (APC), which results from various factors, including a mutation in the gene for coagulant factor V, has been associated with increased risk for venous thrombosis. However, its relation to arterial disease is still not well defined. OBJECTIVE: To investigate the association of both response to APC and the factor V Leiden mutation with arterial disease. DESIGN: Population-based case-control study. SETTING: A district of Rotterdam, the Netherlands. PARTICIPANTS: 115 patients with a history of myocardial infarction; 112 patients with a history of stroke, transient ischemic attack, or both; and 222 age-matched controls without arterial disease chosen from among 7983 persons in the Rotterdam Study cohort. Patients using anticoagulant drugs were excluded. MEASUREMENTS: Response to APC was determined in double-centrifuged platelet-poor plasma. Patients were genotyped for the Arg 506 to Gln mutation in the gene for coagulant factor V. RESULTS: The prevalence of cerebrovascular disease increased gradually and corresponded to a decreasing response to APC (odds ratio per 1-unit decrease of response to APC, 1.43 [95% CI, 1.12 to 1.81], adjusted for age and sex). Adjustment for the factor V mutation did not change the findings. We found no association between response to APC and myocardial infarction or between factor V mutation and cerebrovascular disease or myocardial infarction. CONCLUSIONS: Low response to APC is associated with an increased risk for cerebrovascular disease but not with an increased risk for myocardial infarction, independent of the factor V Leiden mutation. The association between the factor V Leiden mutation and cerebrovascular disease or myocardial infarction remains to be determined.

Aged↗
PubMed1996

Dietary antioxidants and cognitive function in a population-based sample of older persons. The Rotterdam Study.

Antioxidants have been implicated in processes related to atherosclerosis, aging, and selective neuronal damage, all of which may ultimately affect cognitive function. In a sample of older persons, the authors examined the cross-sectional relation between cognitive function and dietary intake of beta-carotene and vitamins C and E. The data were derived from 5,182 community participants aged 55-95 years in the population-based Rotterdam Study in the period 1990 to 1993. Dietary intake was estimated from a semi-quantitative food frequency questionnaire and categorized into five levels of intake. Cognitive function was measured with the 30-point Mini-Mental State Examination (MMSE) and characterized as unimpaired (> 25 points) or impaired (< or = 25 points). Logistic regression analysis was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for cognitive impairment. After adjustment for age, education, sex, smoking, total caloric intake, and intake of other antioxidants, a lower intake of beta-carotene was associated with impaired cognitive function (< 0.9 mg vs. > or = 2.1 mg intake, OR = 1.9, 95% CI 1.2-3.1; p for trend < 0.04). There was no association between cognitive function and intake of vitamins C and E. These cross-sectional observations are compatible with the view that beta-carotene-rich foods may protect against cognitive impairment in older people. The finding could also reflect unmeasured confounding, measurement error, or a change in food habits that resulted from rather than preceded the onset of cognitive impairment.

Aged↗
PubMed1996

[Ultrasound assessment of the calcaneus: for the time being a conservative approach in clinical use; the ERGO study (Erasmus Rotterdam Health and the Elderly)].

OBJECTIVE: To examine whether ultrasound measurements of the calcaneus can help to identify subjects with a risk for non-vertebral fractures. DESIGN: Cross-sectional survey. SETTING: The suburb of Ommoord in Rotterdam, the Netherlands. METHODS: 1421 subjects (631 men, 790 women) underwent both ultrasound measurements of the calcaneus and bone mineral density measurement of the femoral neck by dual energy X-ray absorptiometry (DXA). At the calcaneus speed of sound (SOS in m/s) and broadband ultrasound attenuation (BUA in dB/MHz) were measured. In addition, all subjects were asked about fractures in the preceding 5 years. The frequency of non-vertebral fractures was examined per tertile of SOS and BUA. In addition, we examined whether there was a trend in the number of fractures per tertile of SOS or BUA, within tertiles of femoral neck bone mineral density. RESULTS: The measures of SOS, BUA and bone mineral density (DXA-measured) are comparable as predictors of fractures. Subjects with values of SOS, BUA or bone mineral density in the lowest tertiles were all found to report two to three times as many fractures as subjects with values for these variables in the highest tertiles. Within tertiles of bone mineral density, subjects with a low SOS reported more fractures than subjects with a high SOS. For BUA a similar but less pronounced pattern was visible. Nevertheless, the area under the receiver operating characteristic (ROC) curve was 0.63 for SOS and 0.64 for BUA, comparable to 0.62 for bone mineral density of the proximal femur. Combining ultrasound and bone mineral density measurements had limited effect on the area under the ROC curve (0.65). CONCLUSIONS: Subjects with lower values of ultrasound parameters are at increasing risk of fracture, especially if low ultrasound values are accompanied by a lower bone mineral density. It remains to be seen whether ultrasound parameters are useful for screening.

Absorptiometry, Photon↗
PubMed1996

Low diastolic blood pressure and atherosclerosis in elderly subjects. The Rotterdam study.

BACKGROUND: A low diastolic blood pressure has been associated with increased cardiovascular risk. The following proposed mechanisms underlie this phenomenon: a low diastolic pressure that compromises coronary blood flow, a low diastolic pressure that is due to deteriorating health, and a low diastolic pressure that is a consequence of stiffening of the large arteries. Atherosclerosis may be the link between stiffening of the arteries, a low diastolic pressure, and an increased cardiovascular risk. OBJECTIVE: To study whether a low diastolic blood pressure in older subjects is a reflection of atherosclerosis. METHODS: The Rotterdam (the Netherlands) Study is a population-based follow-up study of 7983 subjects (age, > or = 55 years) who are living in the suburb of Ommoord of Rotterdam. Baseline measurements included ultrasonographic evaluation of the carotid arteries, measurement of blood pressure, and determination of other cardiovascular risk factors. The main cross-sectional analyses were performed among 930 subjects who currently were not using blood pressure-lowering drugs. RESULTS: A J-shaped association of the intima-media thickness of the common carotid artery with diastolic blood pressure was found with a nadir from 60 to 69 mm Hg. The intima-media thickness was increased in subjects with a diastolic pressure that was less than 60 mm Hg compared with that in subjects with a diastolic pressure that was between 60 and 69 mm Hg (a difference of 0.033 mm [95% confidence limits; 0.001, 0.065]). Beyond a diastolic pressure of 70 mm Hg, a gradual increase in the intima-media thickness was observed. The association was most pronounced among subjects with relatively high pulse pressures. CONCLUSIONS: Results of the present study indicate the existence of a J-shaped association between carotid atherosclerosis and diastolic pressure. These findings support the hypothesis that in elderly subjects, a low diastolic pressure may be a reflection of widespread atherosclerosis.

Age Distribution↗
PubMed1996

A new variant of Creutzfeldt-Jakob disease in the UK.

BACKGROUND: Epidemiological surveillance of Creutzfeldt-Jakob disease (CJD) was reinstituted in the UK in 1990 to identify any changes in the occurrence of this disease after the epidemic of bovine spongiform encephalopathy (BSE) in cattle. METHODS: Case ascertainment of CJD was mostly by direct referral from neurologists and neuropathologists. Death certificates on which CJD was mentioned were also obtained. Clinical details were obtained for all referred cases, and information on potential risk factors for CJD was obtained by a standard questionnaire administered to patients' relatives. Neuropathological examination was carried out on approximately 70% of suspect cases. Epidemiological studies of CJD using similar methodology to the UK study have been carried out in France, Germany, Italy, and the Netherlands between 1993 and 1995. FINDINGS: Ten cases of CJD have been identified in the UK in recent months with a new neuropathological profile. Other consistent features that are unusual include the young age of the cases, clinical findings, and the absence of the electroencephalogram features typical for CJD. Similar cases have not been identified in other countries in the European surveillance system. INTERPRETATION: These cases appear to represent a new variant of CJD, which may be unique to the UK. This raises the possibility that they are causally linked to BSE. Although this may be the most plausible explanation for this cluster of cases, a link with BSE cannot be confirmed on the basis of this evidence alone. It is essential to obtain further information on the current and past clinical and neuropathological profiles of CJD in the UK and elsewhere.

Adolescent↗
PubMed1996

[Stroke in the elderly: prevalence and frequency of hospitalization; the ERGO study (Erasmus Rotterdam Health and the Elderly). The ERGO research group].

OBJECTIVE: To evaluate the prevalence of self-reported and medically confirmed stroke, and the degree to which the event leads to hospitalization. DESIGN: Cross-sectional study. SETTING: The suburb of Ommoord in Rotterdam. METHODS: The Rotterdam Study is a single centre population-based prospective follow-up study of 7983 subjects, aged 55 years and over, living in the suburb of Ommoord of Rotterdam. Information of stroke was based on the question 'Did you ever suffer from a stroke, diagnosed by a physician'? If yes, additional medical information was obtained from the general practitioner. The present analysis is based on the first 4982 participants of the Rotterdam Study (1878 men and 3104 women) of whom data on both self-reported and medically confirmed stroke were available. RESULTS: Prevalence of self-reported stroke was 5.8% for men and 4.0% for women. Of self-reported strokes 55% could medically be confirmed, yielding a prevalence of 3.5% for men and 1.9% for women. The prevalence of first and only stroke was 4.5% and 3.0% for men and 3.3% and 1.7% for women, respectively and increased with age. The percentage of hospitalization was 55% for self-reported first and only stroke and 61% for medically confirmed first and only stroke. CONCLUSION: Among elderly subjects, self-reported stroke was relatively common and in 55% the stroke was confirmed by medical records. About 55% of the patients with a first stroke were hospitalized.

Aged↗
PubMed1996

Age-related macular degeneration and smoking. The Rotterdam Study.

OBJECTIVE: To assess the relation between cigarette smoking and age-related macular degeneration (AMD) in a population of elderly persons. DESIGN: A cross-sectional, community-based study. SETTING: City district of Rotterdam, the Netherlands. PARTICIPANTS: A total of 6174 persons 55 years and older who participated in the Rotterdam Study. In 36 persons atrophic AMD and in 65 persons neovascular AMD were diagnosed. MAIN OUTCOME MEASURES: Age-related macular degeneration was diagnosed by evaluating fundus transparencies, smoking behavior was identified by interviewing subjects, and the presence of atherosclerosis was assessed by the ankle-arm systolic blood pressure index. Relative risks and 95% confidence intervals (CIs) were calculated using multivariate logistic regression analysis. RESULTS: In subjects younger than 85 years, current smokers had a 6.6-fold increased risk of neovascular AMD vs those who had never smoked (95% CI, 2.8-15.9). Former smokers had a 3.2-fold increased risk of neovascular AMD vs nonsmokers in this age group (95% CI, 1.4-7.4). These associations were not observed in subjects 85 years or older. Smoking was not associated with atrophic AMD. A strong increased risk of neovascular AMD was present in those who had smoked more than 10 pack-years (relative risk, 6.5; 95% CI, 2.9-14.8). Adjusting the results for atherosclerosis did not change the association. Persons who had quit smoking 20 or more years before the eye examination had no increased risk. CONCLUSIONS: The results provide evidence for a dose-response relationship between smoking and AMD, particularly in persons with the neovascular form of the disease.

Aged↗
PubMed1996

Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age. The Rotterdam Study.

OBJECTIVE: To investigate the relationship of osteoarthritis (OA) to bone mineral density (BMD) and rate of bone loss. METHODS: The study group consisted of 2,745 persons (1,624 women) from the general elderly population. Disability was assessed by the Health Assessment Questionnaire. Femoral neck BMD was measured at baseline and, in 1,723 subjects, after 2 years of followup. Knee and hip radiographic OA was assessed on anteroposterior radiographs. RESULTS: With the exception of knee radiographic OA in men, radiographic OA was associated with significantly increased BMD (3-8%). BMD increased significantly according to the number of affected sites and the Kellgren score. Radiographic OA was also associated with significantly elevated bone loss with age (in men, only for radiographic OA of the hip). A significant increase in relation to the number of affected sites and the Kellgren score (except with regard to knee OA in men) was found, independent of disability. CONCLUSION: Radiographic OA is associated with high BMD and increased rate of bone loss. This suggests a more pronounced difference in BMD earlier in life.

Age Factors↗
PubMed1996

A large-scale population-based study of the association of vitamin D receptor gene polymorphisms with bone mineral density.

Conflicting results have been reported on the association between restriction fragment length polymorphisms (RFLPs) at the vitamin D receptor (VDR) gene locus (i.e., for BsmI, ApaI, and TaqI) and bone mineral density (BMD). We analyzed this association in a large population-based sample (n = 1782) of men and women aged 55-80 years using a novel direct haplotyping polymerase chain reaction (PCR) test to monitor the three polymorphic sites simultaneously. The direct haplotyping test we developed demonstrated a larger degree of genetic polymorphism at the VDR gene locus than described until now. None of the individual RFLPs were associated with BMD at the proximal femur. By analyzing allele dose effects, we identified a VDR haplotype allele weakly associated with low BMD. This allele, as one representative of the group of b alleles, is different from the BsmI allele previously reported by other groups to be associated with low BMD. This suggests allelic heterogeneity at the VDR locus in relation to BMD. Our results indicate at most a small effect of the VDR genotype on BMD in this elderly population. Since anonymous polymorphisms were analyzed, alternative explanations for our results include linkage to another nearby bone-metabolism related gene.

Absorptiometry, Photon↗
PubMed1996

Vascular risk factors, atherosclerosis, cerebral white matter lesions and cerebral perfusion in a population-based study.

We studied risk factors for cerebral vascular disease (blood pressure and hypertension, factor VIIc, factor VIIIc, fibrinogen), indicators of atherosclerosis (intima-media thickness and plaques in the carotid artery) and cerebral white matter lesions in relation to regional cerebral blood flow (rCBF) in 60 persons (aged 65-85 years) recruited from a population-based study. rCBF was assessed with single-photon emission tomography using technetium-99m d, l-hexamethylpropylene amine oxime (99mTc-HMPAO). Statistical analysis was performed with multiple linear regression with adjustment for age, sex and ventricle-to-brain ratio. A significant positive association was found between systolic and diastolic blood pressure and temporo-parietal rCBF. In analysis with quartiles of the distribution, we found a threshold effect for the relation of low diastolic blood pressure (</=60 mmHg) and low temporo-parietal rCBF. Levels of plasma fibrinogen were inversely related to parietal rCBF, with a threshold effect of high fibrinogen levels (>3.2 g/l) and low rCBF. Increased atherosclerosis was related to low rCBF in all cortical regions, but these associations were not significant. No consistent relation was observed between severity of cerebral white matter lesions and rCBF. Our results may have implications for blood pressure control in the elderly population.

Aged↗
PubMed1996

Apolipoprotein E genotype and concomitant clinical features in early-onset Alzheimer's disease.

We have studied the relationship between the apolipoprotein E gene (APOE) and the development of myoclonus, tremors, rigidity and seizures in 168 patients with probable early-onset Alzheimer's disease (AD). There was a statistically significantly lower risk of tremor for carriers of the epsilon 4 allele of APOE. This allele was also associated with an increased risk of myoclonus. Our findings suggest that there may be differences in progression and clinical appearance in early-onset AD related to the APOE genotype.

Alleles↗
PubMed1996

Association of diabetes mellitus and dementia: the Rotterdam Study.

Dementia and non-insulin-dependent diabetes mellitus (NIDDM) are highly prevalent disorders in the elderly. Diabetes has repeatedly been reported to affect cognition, but its relation with dementia is uncertain. We therefore studied the association between diabetes and dementia in the Rotterdam Study, a large population-based study in the elderly. Of 6330 participants, aged 55 to 99 years old, complete information on diabetes and presence of dementia was available. Diabetes was diagnosed as use of anti-diabetes medication or random or post-load serum glucose over 11 mmol/1. Dementia was diagnosed through a stepped approach, including a sensitive screening of all participants and a comprehensive diagnostic work-up. Diabetes was present in 724 (11.4%) subjects. Of the 265 dementia patients 59 (22.3%) had diabetes. Multiple logistic regression analyses, adjusting for age and sex differences, revealed a positive association between diabetes and dementia (odds ratio: 1.3, 95% confidence interval 1.0-1.9). In particular, strong associations were found between dementia and diabetes treated with insulin (odds ratio: 3.2, 95% confidence interval: 1.4-7.5) The relation was strongest with vascular dementia but was also observed with Alzheimer's disease. These associations were independent of educational attainment, smoking, body mass index, atherosclerosis, blood pressure and antihypertensive drug treatment, and could not be explained by clinical cerebra infarctions. The results suggest that NIDDM is associated with dementia. Alzheimer's disease may be more frequent in elderly diabetic patients treated with insulin.

Age Factors↗
PubMed1996

Lipoproteins and apolipoproteins in the young and familial risk of coronary atherosclerosis.

The aim of this study was to assess the predictive value of lipoproteins and apolipoproteins at a young age for the development of coronary artery disease at middle and older ages. Because children of coronary artery disease patients are at high risk themselves we compared lipoprotein and apolipoprotein levels between the offspring of parents with and without coronary artery disease. We selected a group of male patients (n = 90), who had severe coronary atherosclerosis at angiography, and a reference group of male controls (n = 62), who had no coronary atherosclerosis at angiography. Lipoprotein and apolipoprotein levels were determined in 115 sons and 73 daughters of the patients with severe coronary atherosclerosis. These were compared to levels in 68 sons and 47 daughters of controls. Additionally, lipoprotein and apolipoprotein levels were compared between patients and controls as well as between their spouses. In sons of patients, lower levels of HDL3 cholesterol (-0.07 mmol/1, standard error of the mean (SEM) 0.03, P < 0.05) and apolipoprotein A2 (-5.1 mg/dl (SEM, 1.4), P < 0.0001) were found compared to sons of controls. Similar differences were observed in daughters of such patients without, however, achieving statistical significance. No significant differences between the groups of offspring were found for total cholesterol, LDL cholesterol, HDL and HDL2 cholesterol, triglycerides and apolipoproteins A-I and B. Patients had higher levels of total (group difference 0.6 mmol/1 (SEM, 0.18), P < 0.001) and LDL cholesterol (0.6 mmol/1 (SEM, 0.17), P < 0.001), triglycerides (0.6 mmol/1 (SEM, 0.16), P < 0.001) and apolipoprotein B (21.2 mg/dl (SEM, 5.1), P < 0.001), and lower HDL cholesterol (0.1 mmol/1 (SEM, 0.04), P < 0.05) than controls. Spouses of patients had higher levels of triglycerides (0.23 mmol/1 (SEM, 0.11), P < 0.05). Our findings add to the growing evidence that predictors for atherosclerotic disease can be detected relatively early in life. It is concluded that reduced levels of HDL3 cholesterol and apolipoprotein A2 may be early risk indicators for coronary atherosclerosis later in life.

Adult↗
PubMed1996

Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid artery. The Rotterdam Study.

To evaluate the association between common carotid intima-media thickness and noninvasively assessed atherosclerosis elsewhere in the carotid artery, we used data from the Rotterdam Study, a single-center population-based, prospective follow-up study among 7983 subjects aged 55 years or older. Baseline measurements included ultrasonographic evaluation of the vessel wall characteristics of the carotid arteries, that is, assessment of the presence of atherosclerotic lesions, measurement of common carotid intima-media thickness, and determination of the presence of hemodynamically significant stenosis. The present analysis is based on data obtained from the first 1000 participants. The results were adjusted for age and gender. An increase of 1 standard deviation in common carotid intima-media thickness (0.19 mm) doubled the risk of plaques in the carotid bifurcation: odds ratio 2.0 (95% confidence interval (CI): 1.6, 2.4). For hemodynamically significant stenosis of the right internal carotid artery (> or = 50%), a 1.4 (95% CI: 1.0, 2.0) increased risk was found. The risk of atherosclerotic plaques in the bifurcation in subjects with an intima-media thickness above 0.89 mm (upper quintile) relative to those with an intima-media thickness below 0.63 mm (lowest quintile) was 6.0 (95% CI: 3.5, 10.2). For internal carotid artery stenosis, a relative risk of 2.8 (95% CI 0.5, 15.7) was found. The findings of the present study provide evidence that increased common carotid intima-media thickness indicates atherosclerosis at other sites of the carotid artery. This study lends support to the view that noninvasively assessed increased intima-media thickness of the distal common carotid artery is an indicator of generalized atherosclerosis.

Aged↗