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H J Cohen

Publications and source records attributed to H J Cohen.

At least 37 records · Page 2Linked to original sources
PubMed1999

Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly.

PURPOSE: To investigate whether interleukin-6 and C-reactive protein levels predict all-cause and cause-specific mortality in a population-based sample of nondisabled older people. SUBJECTS AND METHODS: A sample of 1,293 healthy, nondisabled participants in the Iowa 65+ Rural Health Study was followed prospectively for a mean of 4.6 years. Plasma interleukin-6 and C-reactive protein levels were measured in specimens obtained from 1987 to 1989. RESULTS: Higher interleukin-6 levels were associated with a twofold greater risk of death [relative risk (RR) for the highest quartile (> or = 3.19 pg/mL) compared with the lowest quartile of 1.9 [95% confidence interval, CI, 1.2 to 3.1]). Higher C-reactive protein levels (> or = 2.78 mg/L) were also associated with increased risk (RR = 1.6; CI, 1.0 to 2.6). Subjects with elevation of both interleukin-6 and C-reactive protein levels were 2.6 times more likely (CI, 1.6 to 4.3) to die during follow-up than those with low levels of both measurements. Similar results were found for cardiovascular and noncardiovascular causes of death, as well as when subjects were stratified by sex, smoking status, and prior cardiovascular disease, and for both early (<2.3 years) and later follow-up. Results were independent of age, sex, body mass index, and history of smoking, diabetes, and cardiovascular disease, as well as known indicators of inflammation including fibrinogen and albumin levels and white blood cell count. CONCLUSIONS: Higher circulating levels of interleukin-6 and C-reactive protein were associated with mortality in this population-based sample of healthy older persons. These measures may be useful for identification of high-risk subgroups for anti-inflammatory interventions.

Aged↗
PubMed1999

Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults.

METHODS: A probability sample of 3,968 community-dwelling adults aged 64-101 years residing in the Piedmont of North Carolina was surveyed in 1986 as part of the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) program of the National Institutes of Health. Attendance at religious services and a wide variety of sociodemographic and health variables were assessed at baseline. Vital status of members was then determined prospectively over the next 6 years (1986 1992). Time (days) to death or censoring in days was analyzed using a Cox proportional hazards regression model. RESULTS: During a median 6.3-year follow-up period, 1,777 subjects (29.7%) died. Of the subjects who attended religious services once a week or more in 1986 (frequent attenders), 22.9% died compared to 37.4% of those attending services less than once a week (infrequent attenders). The relative hazard (RH) of dying for frequent attenders was 46% less than for infrequent attenders (RH: 0.54, 95% CI 0.48-.0.61), an effect that was strongest in women (RH 0.51, CI 0.434).59) but also present in men (RH 0.63, 95% CI 0.52-0.75). When demographics, health conditions, social connections, and health practices were controlled, this effect remained significant for the entire sample (RH 0.72, 95% CI 0.64-.81), and for both women (RH 0.65, 95% CI 0.554-.76, p<.0001) and men (RH 0.83, 95% CI 0.69-1.00, p=.05). CONCLUSIONS: Older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently.

Aged↗
PubMed1999

Serum IL-6 level and the development of disability in older persons.

BACKGROUND: The serum concentration of interleukin 6 (IL-6), a cytokine that plays a central role in inflammation, increases with age. Because inflammation is a component of many age-associated chronic diseases, which often cause disability, high circulating levels of IL-6 may contribute to functional decline in old age. We tested the hypothesis that high levels of IL-6 predict future disability in older persons who are not disabled. METHODS: Participants at the sixth annual follow-up of the Iowa site of the Established Populations for Epidemiologic Studies of the Elderly aged 71 years or older were considered eligible for this study if they had no disability in regard to mobility or in selected activities of daily living (ADL), and they were re-interviewed 4 years later. Incident cases of mobility-disability and of ADL-disability were identified based on responses at the follow-up interview. Measures of IL-6 were obtained from specimens collected at baseline from the 283 participants who developed any disability and from 350 participants selected randomly (46.9%) from those who continued to be non-disabled. FINDINGS: Participants in the highest IL-6 tertile were 1.76 (95% CI, 1.17-2.64) times more likely to develop at least mobility-disability and 1.62 (95% CI, 1.02-2.60) times more likely to develop mobility plus ADL-disability compared with to the lowest IL-6 tertile. The strength of this association was almost unchanged after adjusting for multiple confounders. The increased risk of mobility-disability over the full spectrum of IL-6 concentration was nonlinear, with the risk rising rapidly beyond plasma levels of 2.5 pg/mL. INTERPRETATION: Higher circulating levels of IL-6 predict disability onset in older persons. This may be attributable to a direct effect of IL-6 on muscle atrophy and/or to the pathophysiologic role played by IL-6 in specific diseases.

Activities of Daily Living↗
PubMed1999

Association of interleukin-6 and other biologic variables with depression in older people living in the community.

OBJECTIVES: The prevalence of depression increases with age, as does the prevalence of higher levels of the cytokine interleukin-6 (IL-6). This analysis was performed to determine the association between increased levels of this cytokine and depression in a population-based sample. DESIGN: Cross-sectional cohort study. SETTING: Rural and urban counties in North Carolina. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: The association between IL-6 and other biologic variables with self-report depression was examined in 1686 persons aged 70 years and older in the third in-person survey wave (1991) of the Duke Established Population for Epidemiologic Studies of the Elderly (EPESE). Bivariate associations were established by the Spearman correlation, adjusted for age. A stepwise linear logistic regression model was used to derive a final model to assess multivariable effects on CES-D scores. RESULTS: Depression was correlated with IL-6 (P = .011), D-Dimer (P = .017), alpha-1-globulin (P = .023), alpha-2-globulin (P = .002), and beta globulin (P = .012). After controlling for age, race, and gender, IL-6 levels remained the only biologic variable significantly associated with depression (P = .035). CONCLUSION: These data suggest that the inflammatory marker, IL-6, is associated with depression in older people in this cross-sectional study. These results are compatible with the hypothesis of cytokine (IL-6) stimulation in geriatric depression as part of an overall immunoendocrine dysregulation.

Age Distribution↗
PubMed1999

Increase in extracellular glutatione peroxidase in plasma and lungs of mice exposed to hyperoxia.

Extracellular glutathione peroxidase (E-GPx) is a selenium-dependent enzyme that can reduce hydrogen peroxide and phospholipid hydroperoxides. E-GPx is found in plasma and extracellular fluids such as bronchoalveolar lavage fluid. Because lung is one of the tissues that is capable of synthesizing and secreting E-GPx, the effect of exposure to hyperoxia on E-GPx in plasma and lung were studied in an injury model of hyperoxia exposure in adult mice. Exposure to 100% oxygen for 72 h resulted in an increase of 55% in plasma GPx activity and an increase of 50% in the amount of E-GPx protein in the plasma. Exposure to hyperoxia was also associated with an increase in the amount of E-GPx protein in lungs. The 7-fold increase in the amount of E-GPx protein in lungs was not due to plasma contamination of lungs from mice exposed to hyperoxia. E-GPx in the lung is calculated to account for 10% of lung GPx activity in control mice. However, E-GPx is calculated to account for 45% of lung GPx activity in the lungs of mice exposed to hyperoxia for 72 h. Further studies are needed to determine whether the increase in lung E-GPx is due to changes in translation or stability of E-GPx. The role of E-GPx in protecting the lung from oxidative damage warrants further study.

Animals↗
PubMed1999

Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: the North Carolina EPESE.

OBJECTIVES: This cohort study evaluated racial differences in mortality among Blacks and Whites 65 years and older. METHODS: A total of 4136 men and women (1875 Whites and 2261 Blacks) living in North Carolina were interviewed in 1986 and followed up for mortality until 1994. Hazard ratios (HRs) for all-cause and cause-specific mortality were calculated, with adjustment for sociodemographic and coronary heart disease (CHD) risk factors. RESULTS: Black persons had higher mortality rates than Whites at young-old age (65-80 years) but had significantly lower mortality rates after age 80. Black persons age 80 or older had a significantly lower risk of all-cause mortality (HR of Blacks vs Whites, 0.75; 95% confidence interval [CI] = 0.62, 0.90) and of CHD mortality (HR 0.44: 95% CI = 0.30, 0.66). These differences were not observed for other causes of death. CONCLUSIONS: Racial differences in mortality are modified by age. This mortality crossover could be attributed to selective survival of the healthiest oldest Blacks or to other biomedical factors affecting longevity after age 80. Because the crossover was observed for CHD deaths only, age overreporting by Black older persons seems an unlikely explanation of the mortality differences.

Black or African American↗
PubMed1999

Intrauterine fetal diagnosis for hematologic and other congenital disorders.

Advances in prenatal diagnostic techniques allow for earlier, more rapid, and more effective detection of congenital disorders. The indications, diagnostic accuracy, and risks for invasive diagnostic techniques including amniocentesis, chorionic villus sampling, and fetal blood sampling are reviewed. Recent advances in non-invasive detection methods, such as fetal ultrasound and the isolation of fetal cells in the maternal circulation are discussed. Additionally, the intrauterine diagnosis of congenital infections and chromosomal and Mendelian disorders, as well as hematologic disorders are summarized.

Adult↗
PubMed1998

Developmental expression of extracellular glutathione peroxidase suggests antioxidant roles in deciduum, visceral yolk sac, and skin.

Extracellular glutathione peroxidase (EGPx) is a secreted selenium-dependent enzyme that reduces hydroperoxides and organic hydroperoxides. Selenium deficiency in females is associated with infertility and spontaneous abortion, suggesting a role for selenium-requiring proteins during embryonic development. To gain insight into functions of EGPx in vivo, we determined sites of murine EGPx synthesis by in situ hybridization during embryogenesis and in adult tissues. At E7.5 of development, high EGPx expression was found in the maternally derived deciduum, with lower levels of accumulation in the embryonic visceral endoderm. At E9.5, the major sites of expression were the yolk sac endoderm and heart musculature. By E16.5, EGPx mRNA expression persisted in yolk sac endoderm but also accumulated significantly in atrially derived myocytes, ossification centers, adipose tissue, intestinal epithelium, and in a ventral-to-dorsal gradient in developing skin. Glutathione peroxidase activity due to EGPx protein was identified in the fluids surrounding the developing mouse embryo at midgestation. The expression of EGPx in tissues at the maternal-fetal interface--deciduum, visceral yolk sac, and skin--suggests that EGPx may serve to protect the embryo from oxidant damage. In adult mice, we identified the S1 segment of the kidney proximal tubules as the primary site of EGPx mRNA accumulation, with lower EGPx levels in atrial cardiac muscle, intestine, skin, and adipose tissue. These findings suggest that EGPx may serve a wider antioxidant role than previously recognized in the interstitium of multiple localized tissues, particularly those associated with the active transport of lipids.

Amniotic Fluid↗
PubMed1998

Plasma glutathione peroxidase and its relationship to renal proximal tubule function.

Selenium-dependent extracellular glutathione peroxidase (E-GPx) is found in plasma and other extracellular fluids. Previous studies have indicated that patients with chronic renal failure on dialysis have low plasma GPx activity. In this study, dialysis patients had approximately 40% of control plasma GPx activity, while anephric individuals had lowest plasma GPx activities ranging from 2 to 22% of control. The residual plasma GPx activity in anephric individuals could be completely precipitated by anti-E-GPx antibodies, indicating that all plasma GPx activity can be attributed to E-GPx in both normal and anephric individuals. Plasma GPx activity rises rapidly following kidney transplantation, often reaching normal values within 10 days. The plasma GPx activity in some transplanted patients rises to levels higher than the normal range, followed by a return to the normal range. Since E-GPx in the kidney is primarily synthesized in the proximal tubules, we investigated whether nephrotoxic agents known to disrupt proximal tubule function also affected plasma GPx activity. The beta-lactam antibiotic cephaloglycin rapidly caused a decrease in plasma GPx activity in rabbits. In addition, the chemotherapeutic agent ifosfamide caused a decrease in plasma GPx activity in pediatric osteosarcoma patients. Fanconi syndrome associated with either ifosfamide therapy or valproic acid therapy also caused a decrease in plasma GPx activity. Thus plasma GPx activity is related to kidney function and is decreased in certain situations where nephrotoxic drugs are administered. Monitoring plasma GPx activity may have predictive value in evaluating the function of transplanted kidneys or in predicting those patients particularly at risk of nephrotoxic injury associated with certain medications.

Adult↗
PubMed1998

Developing a summary measure of medical status.

Health status surveys and assessments typically obtain detailed information on specific physical health conditions. While such specific details are important, it is frequently also valuable to have a summarized evaluation of medical conditions which can be used to compare subjects, or for statistical analyses. Using data from the Duke Established Populations for Epidemiologic Studies of the Elderly survey, we indicate how to obtain a weighted sum of chronic medical conditions. Like the sum of the same conditions, it explains variance in selected measures of health service use and health status, in some instances making a contribution beyond that of the summed measure. It is a significantly better predictor of mortality within six years.

Evaluation Studies as Topic↗
PubMed1998

Racial differences in the prevalence of monoclonal gammopathy in a community-based sample of the elderly.

PURPOSE: To determine if there is an increased prevalence of monoclonal gammopathy in elderly blacks compared with whites, analogous to the difference in incidence of multiple myeloma reported for the two racial groups and to confirm age and gender relationships. PATIENTS AND METHODS: Subjects were from the Duke Established Populations for the Epidemiologic Study of the Elderly, selected on the basis of stratified random household sampling. Blacks were oversampled to allow for increased statistical precision in racial comparisons. In all, 1,732 subjects (aged > 70 years) consented to blood drawing and constitute the sample for this study. Monoclonal immunoglobulins were determined by agarose gel electrophoresis and immunofixation. RESULTS: One hundred six subjects (6.1%) had a monoclonal gammopathy. There was a greater than twofold difference in prevalence between blacks (8.4%) and whites (3.8%) (P < 0.001); monoclonal gammopathy prevalence increased with age, and was greater in men than women. Those with monoclonal gammopathy did not differ from those without in socioeconomic status, urban/rural residence, or education. The presence of monoclonal gammopathy was not associated with any specific diseases nor with impaired functional status. There was a slight increase in serum creatinine levels and decrease in hemoglobin and albumin levels in patients with monoclonal gammopathy, but no difference in interleukin-6 (IL-6) levels. Moreover, IL-6 levels were not correlated significantly with the level of monoclonal protein. CONCLUSION: Prevalence of monoclonal gammopathy is significantly greater among blacks than whites in a community-based sample, in approximately the same ratio that multiple myeloma has been reported in the two groups. Given the absence of correlation with environmental factors, there may be a biological racial difference in susceptibility to an early event in the carcinogenic process leading to multiple myeloma.

Age Distribution↗
PubMed1998

Benzodiazepine use and cognitive function among community-dwelling elderly.

OBJECTIVE: To evaluate the relation between benzodiazepine use and cognitive function among community-dwelling elderly. METHODS: This prospective cohort study included 2765 self-reporting subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly. The subjects were cognitively intact at baseline (1986-1987) and alive at follow-up data collection 3 years later. Cognitive function was assessed with the Short Portable Mental Status Questionnaire (unimpaired versus impaired and change in score) and on the basis of the number of errors on the individual domains of the Orientation-Memory-Concentration Test. Benzodiazepine use was determined during in-home interviews and classified by dose, half-life, and duration. Covariates included demographic characteristics, health status, and health behaviors. RESULTS: After control for covariates, current users of benzodiazepine made more errors on the memory test (beta coefficient, 0.35; 95% confidence interval [CI], 0.10 to 0.61) than nonusers. Further assessment of the negative effects on memory among current users suggested a dose response in which users taking the recommended or higher dose made more errors (beta coefficient, 0.57; 95% CI, 0.26 to 0.88) and a duration response in which long-term users made more errors (beta coefficient, 0.39; 95% CI, 0.05 to 0.73) than nonusers. Users of agents with long half-lives and users of agents with short half-lives both had increased memory impairment (beta coefficient, 0.32; 95% CI, 0.01 to 0.64 and beta coefficient, 0.38; 95% CI, 0.02 to 0.75, respectively) relative to nonusers. Previous benzodiazepine use was unrelated to memory problems, and current and previous benzodiazepine use was unrelated to level of cognitive functioning as measured with the other 4 tests. CONCLUSIONS: The results suggested that current benzodiazepine use, especially in recommended or higher doses, is associated with worse memory among community-dwelling elderly.

Aged↗
PubMed1998

The relationship between religious activities and cigarette smoking in older adults.

BACKGROUND: The objective of this study was to examine the relationship between religious activities and cigarette smoking in community-dwelling older adults. METHODS: Cigarette smoking and religious activities were assessed in a probability sample of 3968 persons age 65 years or older participating in the Duke Populations for Epidemiologic Studies of the Elderly (EPESE) survey. Participants were asked if they currently smoked, if they ever smoked, and how many cigarettes per day they smoked. Attendance at religious services, participation in private religious activities (prayer or Bible study), and use of religious media (religious TV or radio) were also assessed. Data were available for Waves I-III of the survey (1986, 1989, and 1992). Analyses were controlled for age, race, sex, education, alcohol use, physical health, and in the longitudinal analyses, smoking status at prior waves. RESULTS: Cross-sectional analyses revealed that participants who frequently attended religious services were significantly less likely to smoke cigarettes at all three waves. Likewise, elders frequently involved in private religious activity were less likely to smoke (Waves II and III). Total number of pack-years smoked was also inversely related to both attendance at religious services and private religious activities. Watching religious TV or listening to religious radio, on the other hand, was not related to smoking at Waves I and II nor to total pack-years smoked, but was positively related to current smoking at Wave III. Among those who smoked, number of cigarettes smoked was inversely related to frequency of attendance at religious services (Wave I), private religious activities (Wave III), and religious TV/radio (Waves II and III). Retrospective and prospective analyses revealed that religiously active persons were less likely to ever start smoking, not more likely to quit smoking. CONCLUSIONS: Religiously active persons are less likely to smoke cigarettes, and if they do smoke, smoke fewer cigarettes. Given the association between smoking and disease, and the widespread prevalence of both smoking and religious activity, this finding has implications for public health.

Aged↗
PubMed1998

Religious activity and depression among community-dwelling elderly persons with cancer: the moderating effect of race.

OBJECTIVES: Research has been oriented toward elucidating the links between religion and mental health. The purpose of this article is to further our knowledge in this area by examining the effect of religious activity on depressive symptomatology among community-dwelling elderly persons with cancer. We also test whether these effects differ between Blacks and Whites. METHODS: We use two waves of data collected from a community-dwelling sample of elderly persons living in North Carolina. Depressive symptomatology is measured using four subscales from the CES-D 20 scale: somatic-retarded activity, depressed affect, positive affect, and interpersonal relations. Measures of religious activity include service attendance, religious devotion, and watching or listening to religious programs. RESULTS: The findings indicate that among Blacks with cancer, religious activity is related to lower levels of depressive symptomatology; no such relationship is found for respondent with other illnesses or no illness. Further, the effects of religious activity are stronger among Blacks than Whites. DISCUSSION: The analyses lend support to the hypothesis that religious activity is a strong predictor of depression in elderly adults with cancer. This finding, however, is not as strong as we had anticipated.

Adaptation, Psychological↗
PubMed1998

Expression of extracellular glutathione peroxidase in human and mouse gastrointestinal tract.

Extracellular glutathione peroxidase (EGPx) is a glycosylated selenoprotein capable of reducing hydrogen peroxide, organic hydroperoxides, free fatty acid hydroperoxides, and phosphatidylcholine hydroperoxides. We found that human large intestinal explant cultures synthesize EGPx and cellular glutathione peroxidase (CGPx) and secrete EGPx. The level of EGPx mRNA expression relative to alpha-tubulin was similar throughout the mouse gastrointestinal tract. EGPx mRNA transcripts have been localized to mature absorptive epithelial cells in human and mouse large intestine. Western blot analysis of mouse intestinal protein has demonstrated the presence of EGPx protein in the small intestine, cecum, and large intestine, with the highest protein levels found in the cecum. Immunohistochemistry studies of human large intestine and mouse small and large intestine sections demonstrated the presence of EGPx protein within mature absorptive epithelial cells. In human large intestine and mouse small intestine, EGPx protein is also present in the extracellular milieu. These results suggest a role for EGPx in protection of the intestinal tract from peroxidative damage and/or in intercellular metabolism of peroxides.

Animals↗
PubMed1998

The relationship between religious activities and blood pressure in older adults.

OBJECTIVE: To examine the relationship between religious activities and blood pressure in community-dwelling older adults. METHOD: Blood pressure and religious activities were assessed in a probability sample of 3,963 persons age sixty-five years or older participating in the Duke EPESE survey. Participants were asked if their doctor had ever informed them that they had high blood pressure and if they were currently taking medication for high blood pressure. After the interview, systolic and diastolic blood pressure were measured following a standardized protocol. Data were available for three waves of the survey (1986, 1989-90, and 1993-94). Analyses were stratified by age (65-74 vs. over 75) and by race (Whites vs. Blacks) and were controlled for age, race, gender, education, physical functioning, body mass index, and, in longitudinal analyses, blood pressure from the previous wave. RESULTS: Cross-sectional analyses revealed small (1-4 mm Hg) but consistent differences in measured systolic and diastolic blood pressures between frequent (once/wk) and infrequent (< once/wk) religious service attenders. Lower blood pressures were also observed among those who frequently prayed or studied the Bible (daily or more often). Blood pressure differences were particularly notable in Black and younger elderly, in whom religious activity at one wave predicted blood pressures three years later. Among participants who both attended religious services and prayed or studied the Bible frequently, the likelihood of having a diastolic blood pressure of 90 mm Hg or higher was 40 percent lower than found in participants who attended religious services infrequently and prayed or studied the Bible infrequently (OR 0.60, 95% CI, 0.48-0.75, p < .0001). Among participants told they had high blood pressure, religiously active persons were more likely to be taking their blood pressure medication; this could not, however, explain the differences in blood pressure observed. While most religious activity was associated with lower blood pressure, those who frequently watched religious TV or listened to religious radio actually had higher blood pressures. CONCLUSIONS: Religiously active older adults tend to have lower blood pressures than those who are less active. This applies to attendance at religious services and private religious activities, but not to religious media. Physiological mechanisms are discussed.

Black or African American↗