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Biomedical subjects

A Spiro

Publications and source records attributed to A Spiro.

At least 19 recordsLinked to original sources
PubMed2006

Delta-aminolevulinic acid dehydratase polymorphism and the relation between low level lead exposure and the Mini-Mental Status Examination in older men: the Normative Aging Study.

OBJECTIVE: To determine whether a polymorphism the in delta-aminolevulinic acid dehydratase (ALAD) gene modifies the neurotoxicity of lead in older adults. METHODS: The authors studied men participating in the Department of Veterans Affairs' Normative Aging Study, assessing their recent exposure to lead by measuring blood lead (n = 915) at each triennial clinic visit, and, beginning in 1991, assessing their cumulative exposure by measuring lead levels in tibia (n = 722) and patella (n = 720), using K-shell x ray fluorescence. Starting in 1993 and again at each triennial visit, the authors administered the Mini-Mental State Examination (MMSE) to assess their cognitive functioning. The relation of the lead biomarkers to MMSE score was evaluated and this association was compared among men who carried the variant allele, ALAD-2, versus men without the allele. RESULTS: Sixteen per cent of men carried the ALAD-2 allele. Median tibia and patella lead levels (first-third quartile) were 19 (13-28) and 27 (18-39) microg/g. Blood lead levels were consistent with non-occupational exposure: only 6% of men had levels > or =10 microg/dl. In multivariable adjusted analyses, higher levels of blood lead were associated with poorer performance on the MMSE. This association was most pronounced among ALAD-2 carriers, among whom a 3 microg/dl increment in blood lead (the interquartile range) was associated with a 0.26 point lower mean MMSE score (95% CI -0.54 to 0.01), compared with a 0.04 point lower score (95% CI -0.16 to 0.07) among non-carriers. The modest 0.22 point difference in these associations did not attain statistical significance, however (p(interaction) = 0.13). The associations between bone lead levels and MMSE score did not vary by ALAD-2 status. CONCLUSIONS: Although not statistically significant, these findings suggest that ALAD genotype may modify blood lead's adverse association with cognition among older men who had community exposures to lead. However, despite a relatively large sample size and the use of sensitive methods for measuring lead burden, the evidence overall was fairly weak.

Adult↗
PubMed2003

Increased preventive practices lead to greater tooth retention.

Prior research has rarely examined the impact of ADA-recommended preventive practices on tooth retention. We hypothesized that better oral hygiene leads to increased tooth retention. We examined the association of cross-sectional and long-term assessments of preventive practices, as well as various combinations of hygiene practices, with tooth retention. Among 736 male participants in the VA Dental Longitudinal Study, we utilized cross-sectional and longitudinal self-reports of toothbrushing, dental floss use, annual prophylaxis, and combinations of such behaviors, and examined their association with clinically assessed numbers of teeth. Baseline and long-term hygiene behaviors (except brushing) were associated with an increased baseline number of teeth and decreased subsequent tooth loss. Use of multiple hygiene behaviors was associated with greater tooth retention, cross-sectionally and longitudinally. Adherence to ADA recommendations for preventive care leads to better oral health, and consistently practicing preventive behaviors over the long term confers greater benefits than doing so over the short term.

Adult↗
PubMed2001

Is negative affectivity associated with oral quality of life?

OBJECTIVES: The personality trait of negative affectivity (NA) is associated with reports of worse physical health, more symptoms and worse health-related quality of life but its associations with oral quality of life (OQOL) are unexplored. In this study we examined the association of NA with OQOL. METHODS: We drew on data from two samples of older men: The VA Dental Longitudinal Study (DLS; n=177) and the Veterans Health Study (VHS; n=514), which included three measures of oral quality of life: the Oral Health-Related Quality of Life Measure (OHQOL), the Oral Health Impact Profile (OHIP), and the Geriatric Oral Health Assessment Instrument (GOHAI). For each OQOL measure, and the GOHAI and OHIP subscales, two regression models were estimated to examine the marginal change in variance due to NA: the first model included age, number of teeth, and self-rated oral health, and the second added NA. RESULTS: In both bivariate and multivariate analyses, higher NA was consistently associated with worse scores on the OQOL measures. In the regression analyses, NA explained an additional.01 to 18% of the variance in OQOL, explaining the most variance in the OHIP and the least in the OHQOL. The addition of NA explained more variance in the more subjective, psychologically oriented GOHAI and OHIP subscales than it did in the more objective, physical function oriented subscales. CONCLUSIONS: Psychosocial factors such as personality are significantly associated with quality of life ratings. Such associations should be taken into account when OQOL measurements are used and interpreted.

Activities of Daily Living↗
PubMed2001

Self-reported and clinical oral health in users of VA health care.

BACKGROUND: This article describes the oral health of users of Veterans Administration (VA) health care using both clinical and self-report measures, and models relationships between these measures and self-perceived oral health. METHODS: We conducted a cross-sectional study of 538 male users of VA outpatient care in the Boston area. Questionnaires assessed self-reported oral health, oral-specific health-related quality of life, health behaviors, and sociodemographic information. Clinical data were collected on oral mucosa status, number of teeth and root tips, dental caries, and periodontal treatment need. We report clinical and self-reported oral health status by age group (era of military service). We regressed models of self-perceived oral health on clinical indices and self-reported measures of the impact of oral health on daily life, adjusting for sociodemographic characteristics and health behavior. RESULTS: Among those participants aged 65 to 91 years old, 2.8%, 18.7%, and 41.5% rated their oral health as excellent, very good, or good, respectively. Among 50- to 64-year-old men, the corresponding values were 1.4%, 18.5%, and 40.4%, while among those aged 22 to 49 years old, the values were 2.3%, 17%, and 34.1%. Tooth loss was common among users of VA care; 34% of those aged 65-90 years, 28% of those aged 50-64 years, and 8% of those aged 25-49 years had no teeth. Periodontal treatment needs were uniformly high among persons with teeth; mild mucosal change was common, and 10% had root tips. Regression models showed self-perceived oral health was better in persons with more teeth and recent dental treatment, and worse with tooth mobility, coronal decay, and more medical problems. Measures of the impact of oral conditions on daily life added significantly to the amount of explained variance in self-perceived oral health. CONCLUSIONS: Clinical conditions and the impact of oral health on daily life are important determinants of self-perceived oral health.

Adult↗
PubMed2001

Stroke risk predicts verbal fluency decline in healthy older men: evidence from the normative aging study.

Risk factors for stroke cause ischemic changes in the cerebral white matter that may affect frontal lobe functions more than other brain functions. Therefore, stroke risk could specifically affect performance on behavioral indexes traditionally associated with frontal lobe function such as verbal fluency. The authors examined this hypothesis in 235 healthy older men (mean age = 66.41 years) who received concurrent medical and neuropsychological examinations twice at a 3-year interval. Relations between stroke risk and decline in verbal fluency, memory, and visuospatial performance were analyzed through regression, controlling for age and education. Age was associated with decline in all cognitive functions; stroke risk was associated with decline only on verbal fluency. The relation between stroke risk and fluency decline was 80% as large as that between age and fluency decline. These results suggest that stroke risk rivals the effects of aging on verbal fluency performance.

Aged↗
PubMed2001

Oral health of ambulatory care patients.

OBJECTIVES: This project assessed the clinical oral health status of Veterans Administration (VA) patients and examined the relationship between oral health and both sociodemographic factors and dental care utilization. METHODS: Data were collected on 538 users of VA ambulatory medical care. Oral health was assessed by clinical examinations, and dental use and sociodemographic information are based on self-report. RESULTS: Younger, more educated VA patients with higher incomes had more teeth, fewer untreated and treated root caries, and were less likely to be edentulous or to have dentures. Dental utilization emerged as the most important aspect of veterans' oral health status, even after sociodemographic factors were controlled. Compared with the general population, veterans have poorer oral health with the exception of coronal caries. CONCLUSION: Compared with national studies, VA patients appear to have worse oral health. The importance of sociodemographic factors and dental utilization that has been found in other studies applies to veterans' oral health as well.

Adult↗
PubMed2001

Longitudinal findings from the Normative Aging Study: III. Personality, individual health trajectories, and mortality.

Individual differences in physical and psychological health trajectories were examined in 1,515 Normative Aging Study men. Mean age at baseline was 47.15 years (range = 28-80), and average follow up was 18.55 years (range = 8-25). Both linear and nonlinear growth curves were estimated with random-effects models and then clustered to identify patterns of change. Men whose physical health trajectories were characterized by high, increasing symptoms were higher in hostility and anxiety, were overweight, and smoked. Those whose trajectories were characterized by low symptoms were emotionally stable, educated, nonsmokers, and thin. Men with high, stable psychological trajectories had high hostility; those with low, stable trajectories had high emotional stability; those with moderate anxiety levels had nonlinear trajectories with peaks in psychological symptoms at different life stages. Personality had life-long effects on health trajectories, but these effects varied across traits and health outcomes.

Adult↗
PubMed2000

Optimism and depression as predictors of physical and mental health functioning: the Normative Aging Study.

Dispositional optimism has been linked in previous studies to better health outcomes. We sought to examine the independent associations of dispositional optimism and depressive symptoms with physical and mental functioning in a cohort of healthy middle-aged and older men. The study was conducted among 659 subjects in the Veterans Administration (VA) Normative Aging Study. Dispositional optimism and depressive symptomatology were measured in 1991 and 1990, respectively, by the Life Orientation Test and the Center for Epidemiologic Studies--Depression Scale (CES-D). The dependent variables, functioning and well-being, were measured in 1992 by the Medical Outcomes Study Short-Form Health Survey (SF-36). In multivariate regression models, optimism was associated with higher levels of general health perceptions, vitality, and mental health, and lower levels of bodily pain, but not to physical functioning, social functioning, or role limitations due to physical or emotional problems. Depressive symptomatology was associated with reduced levels of functioning across all SF-36 domains. The findings for optimism and depression were statistically significant after mutual adjustment in multivariate regression models. Optimism and depression are independent predictors of functional status among aging men.

Aged↗
PubMed2000

Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans.

The association between physician-diagnosed medical disorders and combat-related posttraumatic stress disorder (PTSD) symptoms was examined in 605 male combat veterans of World War II and the Korean conflict. Physician exams were performed at periodic intervals beginning in the 1960s. PTSD symptoms were assessed in 1990. Cox regression was used to examine the onset of each of 12 disorder categories as a function of PTSD symptoms, controlling for age, smoking, alcohol use, and body weight at study entry. Even with control for these factors, PTSD symptoms were associated with increased onset of arterial, lower gastrointestinal, dermatologic, and musculoskeletal disorders. There was only weak evidence that PTSD mediated the effects of combat exposure on morbidity. Possible mediators of the relationship between combat exposure, PTSD, and physical morbidity are discussed.

Adult↗
PubMed2000

Negative affectivity and health-related quality of life.

OBJECTIVES: Although personality is known to influence patients' self-ratings of health, its effects on reports of health-related quality of life (HRQOL) have not been fully described. We examined the relationship between a dimension of personality called negative affectivity (NA; a general disposition to experience negative mood states) and HRQOL, controlling for age and common chronic physical and mental diseases. METHODS: We used data from 3 samples of veterans: the Department of Veterans Affairs (VA) Normative Aging Study (NAS), the Veterans Health Study (VHS), and the VA Women's Health Project (VA WHP). For each of the 8 SF-36 scales and the physical and mental component summary scales, 2 regression models were estimated, the first of which included only chronic diseases and age and the second of which added NA. RESULTS: NA was consistently negatively associated with SF-36 scale scores in bivariate analyses. The regression models indicated that across the 3 samples, NA explained between 0% and 13.9% additional variance in the scales, with the least additional variance in the physical function domains (range 0-2.6%) and the most in the mental function domains (range 0-13.9%). Results from the summary scales were similar: NA explained none of the variance in the physical component summary and 3.5% to 10.4% in the mental component summary. These results were largely consistent across the 3 samples. CONCLUSIONS: These results suggest the importance of NA in patients' ratings of HRQOL beyond that of age and chronic conditions. Thus, clinicians and researchers who rely on measures such as the SF-36 to assess health status should consider that personality, as well as underlying health, can affect self-ratings of HRQOL.

Aged↗
PubMed2000

A bead-based method for multiplexed identification and quantitation of DNA sequences using flow cytometry.

A new multiplexed, bead-based method which utilizes nucleic acid hybridizations on the surface of microscopic polystyrene spheres to identify specific sequences in heterogeneous mixtures of DNA sequences is described. The method consists of three elements: beads (5.6-microm diameter) with oligomer capture probes attached to the surface, three fluorophores for multiplexed detection, and flow cytometry instrumentation. Two fluorophores are impregnated within each bead in varying amounts to create different bead types, each associated with a unique probe. The third fluorophore is a reporter. Following capture of fluorescent cDNA sequences from environmental samples, the beads are analyzed by flow cytometric techniques which yield a signal intensity for each capture probe proportional to the amount of target sequences in the analyte. In this study, a direct hybrid capture assay was developed and evaluated with regard to sequence discrimination and quantitation of abundances. The target sequences (628 to 728 bp in length) were obtained from the 16S/23S intergenic spacer region of microorganisms collected from polluted groundwater at the nuclear waste site in Hanford, Wash. A fluorescence standard consisting of beads with a known number of fluorescent DNA molecules on the surface was developed, and the resolution, sensitivity, and lower detection limit for measuring abundances were determined. The results were compared with those of a DNA microarray using the same sequences. The bead method exhibited far superior sequence discrimination and possesses features which facilitate accurate quantitation.

Base Sequence↗
PubMed2000

Relations between health-related quality of life and well-being: the gerontologist's new clothes?

Is the recent construct of health-related quality of life (HQL) distinct from what gerontologists have long referred to as "well-being" or "life satisfaction?" We addressed this question using data from men in the VA Normative Aging Study to examine relations among twelve scales assessing HQL and seven scales of well-being (WB). We hypothesized that these two constructs would be distinct factorially, and that the derived factors would have different correlates. Correlations between scales of HQL and WB were moderate. When the nineteen scales were factored, four factors were extracted with HQL and WB scales generally loading on separate factors. The factors had distinct patterns of relations with general quality of life, personality, and the presence of a health problem, controlling for sociodemographics. These results suggest that HQL is distinct from the older construct of well-being. Although the two constructs are conceptually related, there is only a moderate amount of statistical overlap between them. Gerontologists should readily adopt health-related quality of life, which maintains continuity with such classics as well-being. This new construct, although needing slight alterations to broaden its assessment of well-being and life satisfaction, holds promise as more than an accessory in the study of health and well-being among older persons.

Activities of Daily Living↗
PubMed2000

Personality, family history, and alcohol use among older men: the VA Normative Aging Study.

BACKGROUND: We examined personality traits (Sociability, Impulsivity, Neuroticism) as mediators of the effects of family history on alcohol outcomes. METHODS: A sample of 485 men reported on family history of alcohol problems in 1973, completed the Eysenck Personality Inventory in 1976, and responded to a survey on alcohol use in 1982. RESULTS: Using structural equation modeling, family history was found to have direct effects on number of drinks per day and on the number of alcohol problems, as well as indirect effects mediated through Neuroticism. There were no effects of Sociability or Impulsivity on either alcohol outcome. CONCLUSIONS: In this sample of older men, family history had both direct and indirect effects, and personality traits found to affect alcohol outcomes were different from those that have been found in younger men.

Adult↗
PubMed1999

Combat exposure, posttraumatic stress disorder symptoms, and health behaviors as predictors of self-reported physical health in older veterans.

We used path analysis to model the effects of combat exposure, posttraumatic stress disorder (PTSD) symptoms, and health behaviors on physical health. Participants were 921 male military veterans from the Normative Aging Study. Their mean age at time of study was 65. Measures of combat exposure, PTSD symptoms, smoking, and alcohol problems were used to predict subsequent self-reported physical health status. Both combat exposure and PTSD were correlated with poorer health. In path analysis, combat exposure had only an indirect effect on health status, through PTSD, whereas PTSD had a direct effect. Smoking had a small effect on health status but did not mediate the effects of PTSD, and alcohol was unrelated to health status. We conclude that PTSD is an important predictor of physical health and encourage further investigation of health behaviors and other possible mediators of this relationship.

Age Factors↗
PubMed1999

Mental disorders and mental health treatment among U.S. Department of Veterans Affairs outpatients: the Veterans Health Study.

OBJECTIVE: The authors examined the self-reported presence and treatment of current depressive disorder, posttraumatic stress disorder (PTSD), and alcohol-related disorder in a group of outpatient veterans. METHOD: Data were obtained from the Veterans Health Study, a longitudinal investigation of male veterans' health. A representative sample of 2,160 outpatients (mean age = 62 years) was drawn from Boston-area U.S. Department of Veterans Affairs (VA) outpatient facilities. The participants completed screening measures for depression, PTSD, and alcohol-related disorder. Mental health treatment was assessed by interviews. RESULTS: The screening criteria for at least one current mental disorder were satisfied by 40% (N = 856) of the patients. Screening rates were 31% (N = 676) for depression, 20% (N = 426) for PTSD, and 12% (N = 264) for alcohol-related disorder. Patients who screened positively for current mental disorders were younger, less likely to be married or employed, and more likely to report traumatic exposure than were those without mental disorders. Of those who met the screening criteria for any of the targeted mental disorders, 68% (N = 579) reported receiving mental health treatment. Younger, Caucasian men and those who reported more traumatic exposure were more likely to report receiving mental health treatment than were others who screened positively for mental disorders. CONCLUSIONS: Screening rates of depression and PTSD and rates of mental health treatment were considerably higher among these VA outpatients than among similar patients in primary care in the private sector. Although the VA is currently meeting the mental health care needs of its patients, future fiscal constraints could affect most adversely the treatment of non-Caucasian and older patients and those with a history of traumatic exposure.

Alcoholism↗
PubMed1999

Preventive dental behaviors and their association with oral health status in older white men.

While prevention practices are widely encouraged, the link between the performance of preventive behaviors and oral health status has rarely been examined. This study investigates the association between preventive dental behaviors (recent and long-term) and oral health status and compares the strength of such associations. Longitudinal data over six time points on 649 dentate white men were obtained from the VA Dental Longitudinal Study (DLS). Participants' oral health was measured through dental examinations, and preventive dental behaviors--i.e., toothbrushing, flossing, using interdental devices, seeking dental prophylaxis, and undergoing dental treatment-were assessed by self-report. Oral health status was measured in terms of (1) functioning teeth, (2) sound-equivalent teeth, (3) decayed, missing, and filled teeth, and (4) decayed and filled root surfaces. Pearson correlation and linear regression analysis revealed significant positive associations between most preventive behaviors and measures of oral health status. Dental prophylaxis emerged as the strongest predictor of oral health status. Long-term preventive dental behavior measures explained more variance in oral health status than short-term preventive behaviors measured cross-sectionally.

Aged↗
PubMed1998

Prospective study of a self-report type A scale and risk of coronary heart disease: test of the MMPI-2 type A scale.

BACKGROUND: Several methods exist by which to assess type A behavior (TAB). Although the videotaped clinical interview is regarded as the "gold standard," self-report measures have also proved useful in assessing TAB in large population studies. The purpose of this study was to examine prospectively the relationship of TAB to risk of coronary heart disease (CHD) incidence with the use of the revised Minnesota Multiphasic Personality Inventory (MMPI-2) Type A Scale. To the best of our knowledge, this is the first test of this scale in the context of predicting CHD incidence. METHODS AND RESULTS: The study was performed in the VA Normative Aging Study, an ongoing cohort of older (mean age, 61 years) community-dwelling men. A total of 1305 men who were free of diagnosed CHD in 1986 completed the MMPI-2 Type A Scale. During an average 7.0 years of follow-up, 110 cases of incident CHD occurred. Compared with men in the lowest quartile of type A scores, men in the highest quartile had multivariate adjusted relative risks of 2.86 (95% CI, 1.19 to 6.89; P for trend=0.016) for combined CHD death and nonfatal myocardial infarction (MI) and 2.30 (95% CI, 1.32 to 4.01; P for trend=0.001) for combined CHD death/nonfatal MI plus angina pectoris. The relationship of TAB to CHD was independent of measures of anger and cynicism. CONCLUSIONS: The MMPI-2 Type A Scale predicts CHD incidence. Further research is warranted to examine the correlation, if any, between this scale and the videotaped clinical interview.

Adult↗