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Biomedical subjects

I Kawachi

Publications and source records attributed to I Kawachi.

At least 73 records · Page 4Linked to original sources
PubMed1999

A prospective study of weight change and health-related quality of life in women.

CONTEXT: The mean body weight of US adults increased by 3.6 kg (7.6 lb) during the past 15 years, but few studies exist that examine the impact of such weight change on functional health status. OBJECTIVE: To investigate, prospectively, the association between weight change and health-related quality of life in women. DESIGN AND SETTING: Nurses' Health Study, a 4-year prospective observational study from 1992 to 1996, using the Medical Outcomes Study Short-Form 36 Health Status Survey (a self-administered 36-item questionnaire) to measure quality of life. PARTICIPANTS: A cohort of 40098 women (from 46-71 years old in 1992) grouped according to 3 patterns of weight change over the 4-year period: women whose weight remained within 2.25 kg (5 lb) of their baseline weight, women who lost 2.25 kg (5 lb) or more, and women who gained 2.25 kg (5 lb) or more. MAIN OUTCOME MEASURES: Change in scores on 7 health-related quality-of-life dimensions: physical functioning, vitality, bodily pain, limitations in role functioning due to emotional or physical problems, social functioning, and mental health, measured by the Short-Form 36 Health Status Survey. RESULTS: A total of 15602 women (39%) maintained their weight, 15160 (38%) gained between 2.25 and 9.0 kg (5-20 lb), and 6667 (17%) lost between 2.25 and 9.0 kg (5-20 lb). Weight gain was associated with decreased physical function and vitality, and increased bodily pain regardless of baseline weight. For example, the odds ratio for developing role limitations due to physical problems was 2.05 (95% confidence interval, 1.69-2.49) for the leanest women who gained 9.0 kg (20 lb) or more. Weight loss in overweight women was associated with improved physical function and vitality as well as decreased bodily pain. Weight change was more strongly associated with physical rather than mental health. The impact of weight change, especially weight gain, was just as strong in women 65 years and older as in women younger than 65 years. CONCLUSIONS: These longitudinal data support current US guidelines for women of all body mass index levels to avoid weight gain. Weight maintenance and, in cases of overweight, weight loss are desirable and likely to be beneficial for physical function, vitality, and bodily pain.

Aged↗
PubMed1999

Relation of consumption of vitamin E, vitamin C, and carotenoids to risk for stroke among men in the United States.

BACKGROUND: Antioxidants increase the resistance of low-density lipoprotein to oxidation and may thereby reduce risk for atherosclerosis. OBJECTIVE: To determine whether intake of vitamin E, vitamin C, or carotenoids predict risk for total or ischemic stroke. DESIGN: Prospective observational study. SETTING: The Health Professionals Follow-up Study. PARTICIPANTS: 43,738 men 40 to 75 years of age who did not have cardiovascular disease or diabetes. MEASUREMENTS: Repeated and validated dietary assessments were done by using a self-administered 131-item food-frequency questionnaire, which included questions on dose and duration of vitamin supplement use. The follow-up period was 8 years. RESULTS: A total of 328 strokes occurred: 210 ischemic, 70 hemorrhagic, and 48 unclassified. After adjustment for age, smoking, hypertension, hypercholesterolemia, body mass index, physical activity, parental history of myocardial infarction, alcohol consumption, and total energy intake, the relative risk for ischemic stroke in the top quintile of vitamin E intake (median, 411 IU/d) compared with the bottom quintile (5.4 IU/d) was 1.18 (95% CI, 0.77 to 1.82). The relative risk for ischemic stroke in the top quintile of vitamin C intake (1167 mg/d) compared with the bottom quintile (95 mg/d) was 1.03 (CI, 0.66 to 1.59). Results for total stroke were similar. Associations of vitamin intake with hemorrhagic stroke were also nonsignificant, but the CIs were wide. Neither dose nor duration of vitamin E or vitamin C supplement use was related to risk for total or ischemic stroke. The relative risk for ischemic stroke was 1.16 (CI, 0.81 to 1.67) in men using 250 IU or more of vitamin E supplementation per day compared with men who used no vitamin E supplements and was 0.93 (CI, 0.60 to 1.45) in men using 700 mg or more of vitamin C supplementation per day compared with men who used no vitamin C supplements. A significant inverse relation between lutein intake and risk for ischemic stroke was seen but was not independent of other dietary factors. CONCLUSIONS: Vitamin E and vitamin C supplements and specific carotenoids did not seem to substantially reduce risk for stroke in this cohort. Modest effects, however, cannot be excluded.

Adult↗
PubMed1999

Alcohol consumption, cigarette smoking, and risk of benign prostatic hyperplasia.

Alcohol consumption and cigarette smoking were evaluated in relation to development of benign prostatic hyperplasia (BPH) among 29,386 members of the Health Professionals Follow-up Study. Men who were 40-75 years old in 1986 and free of prior BPH surgery, diagnosed cancer at baseline, and prostate cancer at baseline and during follow-up were followed for incidence of BPH surgery from 1986 to 1994. Cases were men who reported BPH surgery between 1986 and 1994 (n = 1,813) or who scored > or = 15 points of 35 on seven lower urinary tract symptom questions modified from the American Urological Association symptom index in 1992 and 1994 (n = 1,786); noncases were men who scored < or = 7 points (n = 20,840). After controlling for age, race/ethnicity, body mass index, physical activity, and mutually for alcohol intake and smoking, moderate alcohol consumption was inversely related with total BPH (30.1-50 g/day vs. 0: odds ratio (OR) = 0.59, 95% confidence interval (CI) 0.51-0.70; p trend < 0.0001), although the relation was attenuated at high intake (> or = 50.1 g/day vs. 0: OR = 0.72, 95% CI 0.57-0.90). Current cigarette smoking was positively related to total BPH only among those who smoked 35 or more cigarettes/day (compared with never smokers: OR = 1.45, 95% CI 1.07-1.97). These findings suggest that moderate alcohol consumption and avoidance of smoking may benefit BPH.

Adult↗
PubMed1999

Socioeconomic status, hostility, and risk factor clustering in the Normative Aging Study: any help from the concept of allostatic load?

OBJECTIVE: To examine the relationships between socioeconomic status (SES), psychosocial vulnerability (hostility), and allostatic load. Allostatic load refers to the cumulative physiological cost of adaptation to stress. METHOD: We examined the relationships between SES (as measured by educational attainment), hostility, and allostatic load in the Normative Aging Study, a longitudinal study of community-dwelling men aged 21 to 80 years and free of known chronic medical conditions at entry in the 1960s. In 1986, the revised Minnesota Multiphasic Personality Inventory was administered by mail, from which a hostility measure was derived by summing the scores from three Cook-Medley subscales: Hostile Affect, Hostile Attribution, Aggressive Responding. An index of allostatic load was constructed from data collected during physical exams conducted between 1987 and 1990 (i.e. measures reflecting "wear and tear" on the cardiovascular, endocrine, and metabolic systems). Cross-sectional relationships between education, hostility, and allostatic load were examined in 818 men. RESULTS: Separate linear regression analyses indicated that lower levels of educational attainment and greater hostility were both associated with higher allostatic load scores (p < .05 and p < .01, respectively). Less education was also associated with higher hostility (p < .001). When allostatic load was regressed simultaneously on education and hostility, the effect of education was attenuated, while hostility (p < .05) maintained an independent effect. CONCLUSIONS: Our findings suggest that lower levels of education and greater hostility are associated with greater "wear and tear" on the body. The effects of education on allostatic load may be mediated by hostility.

Adaptation, Physiological↗
PubMed1999

The CAG repeat within the androgen receptor gene and benign prostatic hyperplasia.

OBJECTIVES: Shorter CAG repeat lengths in exon 1 of the androgen receptor (AR) gene are associated with a stronger transcriptional activity of the AR and with a higher risk of prostate cancer. Because benign prostatic hyperplasia (BPH) is an androgen-dependent condition, we examined the hypothesis that men with shorter AR gene CAG repeat lengths have an increased risk of developing BPH. METHODS: Using data from the Health Professionals Follow-up Study (HPFS), we evaluated the relationship between AR gene CAG repeat length and prevalent BPH, as defined by BPH surgery, by enlarged prostate gland detected by digital rectal examination, and by urinary symptoms as determined by the American Urological Association Symptom Index. RESULTS: The odds ratio for BPH surgery or enlarged prostate gland was 1.92 (95% confidence interval [CI] 1.22 to 3.03; P [trend] = 0.0002), comparing AR gene CAG repeat length of 1 9 or less to 25 or more. Results were similar for the end points of BPH surgery (P [trend] = 0.002) and for enlarged prostate gland (P [trend] = 0.001). For a six-repeat decrease in CAG repeat length, the odds ratio for having moderate or severe urinary obstructive symptoms from an enlarged prostate gland was 3.62 (95% CI 1.51 to 8.67; P = 0.004). CONCLUSIONS: Variability in the AR gene CAG repeat influences the development of symptomatic BPH, particularly in predicting obstructive urinary symptoms. Our findings support further study to establish the appropriate clinical relevance.

Adult↗
PubMed1999

Women's status and the health of women and men: a view from the States.

We examined the status of women in the 50 American states in relation to women's and men's levels of health. The status of women in each state was assessed by four composite indices measuring women's political participation, economic autonomy, employment and earnings, and reproductive rights. The study design was cross-sectional and ecologic. Our main outcome measures were total female and male mortality rates, female cause-specific death rates and mean days of activity limitations reported by women during the previous month. Measures of women's status were strikingly correlated with each of these health outcomes at the state level. Higher political participation by women was correlated with lower female mortality rates (r = -0.51), as well as lower activity limitations (-0.47). A smaller wage gap between women and men was associated with lower female mortality rates (-0.30) and lower activity limitations (-0.31) (all correlations, P < 0.05). Indices of women's status were also strongly correlated with male mortality rates, suggesting that women's status may reflect more general underlying structural processes associated with material deprivation and income inequality. However, the indices of women's status persisted in predicting female mortality and morbidity rates after adjusting for income inequality, poverty rates and median household income. Associations were observed for specific causes of death, including stroke, cervical cancer and homicide. We conclude that women experience higher mortality and morbidity in states where they have lower levels of political participation and economic autonomy. Living in such states has detrimental consequences for the health of men as well. Gender inequality and truncated opportunities for women may be one of the pathways by which the maldistribution of income adversely affects the health of women.

Cause of Death↗
PubMed1999

Crime: social disorganization and relative deprivation.

Crime is seldom considered as an outcome in public health research. Yet major theoretical and empirical developments in the field of criminology during the past 50 years suggest that the same social environmental factors which predict geographic variation in crime rates may also be relevant for explaining community variations in health and wellbeing. Understanding the causes of variability in crime across countries and across regions within a country will help us to solve one of the enduring puzzles in public health, viz. why some communities are healthier than others. The purpose of this paper is to present a conceptual framework for investigating the influence of the social context on community health, using crime as the indicator of collective wellbeing. We argue that two sets of societal characteristics influence the level of crime: the degree of relative deprivation in society (for instance, measured by the extent of income inequality), and the degree of cohesiveness in social relations among citizens (measured, for instance, by indicators of 'social capital' and 'collective efficacy'). We provided a test of our conceptual framework using state-level ecologic data on violent crimes and property crimes within the USA. Violent crimes (homicide, assault, robbery) were consistently associated with relative deprivation (income inequality) and indicators of low social capital. Among property crimes, burglary was also associated with deprivation and low social capital. Areas with high crime rates tend also to exhibit higher mortality rates from all causes, suggesting that crime and population health share the same social origins. Crime is thus a mirror of the quality of the social environment.

Adolescent↗
PubMed1999

Social capital: a guide to its measurement.

The primary aims of this paper are to review the concept of social capital and related constructs and to provide a brief guide to their operationalization and measurement. We focus on four existing constructs: collective efficacy, psychological sense of community, neighborhood cohesion and community competence. Each of these constructs taps into slightly different, yet overlapping, aspects of social capital. The existence of several instruments to measure each of these constructs calls for further study into their use as measures of social capital. Despite differences in the approach to measurement, there is general agreement that community characteristics, such as social capital, should be distinguished from individual characteristics and measured at the community level.

Humans↗
PubMed1999

Health behaviors, social networks, and healthy aging: cross-sectional evidence from the Nurses' Health Study.

Physical function is a significant component of health-related quality of life among older adults. Potential correlates of healthy aging, including health behaviors and social network characteristics, were examined among 56,436 US women aged 55-72 in 1992. Healthy aging was assessed by maintenance of physical function measured by four subscales of the Medical Outcomes Study Short Form (SF)-36 Health Survey: physical functioning; role limitations; freedom from bodily pain; and vitality. Individual health behaviors, defined as current smoking, alcohol consumption, sedentary behavior, and being overweight each contributed to significant decrements in functioning across all age-groups. After controlling for these health behaviors and other confounders (age, race, education, and co-morbid conditions), elements of a woman's social network were significantly correlated with functional status. Strong predictors of high functioning among older women were having close friends and relatives and presence of a confidant. For example, the absence of a confidant was associated with a 4.44 point reduction in physical functioning (95% CI: -7.0, -1.9), and a 5.68 point reduction in vitality (95% CI: -7.9, -3.4). These effects were comparable in magnitude to those observed among heavy smokers, or women in the highest category of body mass index.

Aged↗
PubMed1999

Plasma steroid hormones, surgery for benign prostatic hyperplasia, and severe lower urinary tract symptoms.

Because benign prostatic hyperplasia (BPH) may be influenced by plasma steroid hormones, we examined their relation in the Health Professionals Follow-up Study. In 1993-1995, 18,000 cohort members provided blood. We selected as cases men who had had surgery for BPH (n=174) or who scored 20-35 points (n=126) on the American Urological Association index of severity of lower urinary tract symptoms. Cases were matched by age to men who scored</=3 points and without an enlarged prostate or elevated prostate-specific antigen. We estimated the odds ratio (OR) of BPH surgery and severe lower urinary tract symptoms for plasma testosterone (T), dihydrotestosterone (DHT), androstanediol glucuronide (AAG), estradiol (E2), and sex hormone binding globulin (SHBG) in multivariable conditional logistic regression models. Compared to the lowest tertiles, men in the middle (OR=1.42) and top (OR=1.78) tertiles of AAG were at increased risk for having either BPH surgery or severe lower urinary tract symptoms (P-trend=0.02). Men in the middle (OR=0.58) and top (OR=0.60) tertiles of E2 were at lower risk. T level was unrelated to surgery and symptoms. Our findings support opposing roles for DHT, reflected by its metabolite AAG, and E2 in the etiology of BPH.

Journal Article↗
PubMed1999

Social capital and community effects on population and individual health.

Social capital refers to those features of social relationships--such as levels of interpersonal trust and norms of reciprocity and mutual aid--that facilitate collective action for mutual benefit. Social capital is believed to play an important role in the functioning of community life across a variety of domains, ranging from the prevention of juvenile delinquency and crime, the promotion of successful youth development, and the enhancement of schooling and education to the encouragement of political participation. More recently, researchers have begun to apply the concept to explain variations in health status across geographic localities. In preliminary analyses, the higher the stocks of social capital (as indicated by measures of trust and reciprocity in social surveys), the higher appear to be the health achievement of a given area. Strengthening the social capital within communities may provide an important avenue for reducing socioeconomic disparities in health.

Adult↗
PubMed1999

Workplace exposure to passive smoking and risk of cardiovascular disease: summary of epidemiologic studies.

We reviewed the published epidemiologic studies addressing the relationship between workplace exposure to environmental tobacco smoke (ETS) and cardiovascular disease risk in three case-control studies and three cohort studies. Although the point estimates of risk for cardiovascular disease exceeded 1.0 in five of six studies, none of the relative risks was statistically significant because of the small number of cardiovascular end points occurring in individual studies. In common with most epidemiologic investigations of the health risks of ETS, none of the workplace studies included independent biochemical validation of ETS exposure. In contrast to the evidence on increased cardiovascular disease risk from exposure to spousal ETS, studies of ETS exposure in the workplace are still sparse and inconclusive. Conversely, there is no biologically plausible reason to believe that the hazards of ETS exposure that have been demonstrated in the home should not also apply to the workplace.

Epidemiologic Studies↗
PubMed1999

Social capital and self-rated health: a contextual analysis.

OBJECTIVES: Social capital consists of features of social organization--such as trust between citizens, norms of reciprocity, and group membership--that facilitate collective action. This article reports a contextual analysis of social capital and individual self-rated health, with adjustment for individual household income, health behaviors, and other covariates. METHODS: Self-rated health ("Is your overall health excellent, very good, good, fair, or poor?") was assessed among 167,259 individuals residing in 39 US states, sampled by the Behavioral Risk Factor Surveillance System. Social capital indicators, aggregated to the state level, were obtained from the General Social Surveys. RESULTS: Individual-level factors (e.g., low income, low education, smoking) were strongly associated with self-rated poor health. However, even after adjustment for these proximal variables, a contextual effect of low social capital on risk of self-rated poor health was found. For example, the odds ratio for fair or poor health associated with living in areas with the lowest levels of social trust was 1.41 (95% confidence interval = 1.33, 1.50) compared with living in high-trust states. CONCLUSIONS: These results extend previous findings on the health advantages stemming from social capital.

Adult↗
PubMed1999

Income inequality and health: pathways and mechanisms.

The relationship between income and health is well established: the higher an individual's income, the better his or her health. However, recent research suggests that health may also be affected by the distribution of income within society. We outline the potential mechanisms underlying the so-called relative income hypothesis, which predicts that an individual's health status is better in societies with a more equal distribution of incomes. The effects of income inequality on health may be mediated by underinvestment in social goods, such as public education and health care; disruption of social cohesion and the erosion of social capital; and the harmful psychosocial effects of invidious social comparisons.

Health Status↗
PubMed1999

Income inequality, primary care, and health indicators.

BACKGROUND: The significant association of income inequality with a variety of health indicators is receiving increasing attention. There has also been increasing evidence of a link between primary care and improved health status. We examined the joint relationship between income inequality, availability of primary care, and various health indicators to determine whether primary care has an impact on health indicators by modifying the adverse effect of income inequality. METHODS: Our ecologic study used the US states as the units of analysis. In analyzing the data, we looked at the associations among income inequality, primary care, specialty care, smoking, and health indicators, using Pearson's correlation coefficients for intercorrelations and the adjusted multiple regression procedure. To examine the effect of inequality and primary care on health outcome indicators, we conducted path analyses according to a causal model in which inequality affects health both directly and indirectly through its impact on primary care. RESULTS: Our study indicates that both primary care and income inequality exerted a strong and significant direct influence on life expectancy and total mortality (P <.01). Primary care also exerted a significant direct influence on stroke and postneonatal mortality (P <.01). Although levels of smoking are also influential, the effect of income inequality and primary care persists after controlling for smoking. Primary care serves as one pathway through which income inequality influences population-level mortality and at least some other health outcome indicators. CONCLUSIONS: It appears possible that a primary care orientation may, in part, overcome the severe adverse effects on health of income inequalities.

Cerebrovascular Disorders↗
PubMed1999

[Occurrence of argyrophilic grains in multiple system atrophy: histopathological examination of 26 autopsy cases].

Argyrophilic grain disease (AGD) is a progressive disorder producing dementia in elderly individuals characterized by the presence of numerous AGs in the limbic system. However, the occurrence of AGs has been reported in other neurodegenerative conditions including Alzheimer's disease, Pick's disease, progressive supranuclear palsy and corticobasal degeneration, all of which show tau-positive cytoskeletal abnormalities. We examined the brains of 26 patients with multiple system atrophy (MSA), a neurodegenerative disorder fundamentally lacking tau pathology, histologically and immunocytochemically. Numerous AGs were found in the limbic system in 5 patients, of whom two had shown mild dementia. Immunocytochemically, these AGs were labeled with antibodies against phosphorylation-dependent and -independent tau protein, but not alpha-synuclein, whereas oligodendroglial cytoplasmic inclusions found exclusively in MSA were immunoreactive for alpha-synuclein and, less consistently, for phosphorylation-independent tau but not for phosphorylation-dependent tau protein. Furthermore, many phosphorylation-dependent tau-positive neurons and significant numbers of ballooned neurons (BNs) were found in the limbic system in all of the 5 patients with AGs. These findings suggest that AGs can occur with relatively high frequency in the limbic system of MSA patients, and that as in AGD, they may be accompanied by tau-positive neurons and BNs.

Aged↗
PubMed1999

Incidence rates and risk factors for acute urinary retention: the health professionals followup study.

PURPOSE: We define incidence rates and risk factors for acute urinary retention. MATERIALS AND METHODS: In 1992, 41,276 United States male health professionals 45 to 83 years old self-reported baseline health data and American Urological Association symptom index scores. In 1995 a subset reported the year of any episode of acute urinary retention requiring catheterization. Of 8,418 respondents 6,100 without a history of prostate cancer, prostatectomy or acute urinary retention before 1992 provided data. Incidence rates from 1992 to 1995 were calculated and risk factors were assessed using logistic regression. RESULTS: During 15,851 person-years of followup 82 men reported an episode of acute urinary retention (sampling weighted incidence 4.5/1,000 person-years, 95% confidence intervals 3.1 to 6.2). Rates increased with age and baseline symptom severity. In men with symptom score 0 to 7 (none or mild lower urinary tract symptoms) the incidence of acute urinary retention increased from 0.4/1,000 person-years for those 45 to 49 years old to 7.9/1,000 person-years for those 70 to 83 years old. In men with symptom score 8 to 35 (moderate or severe lower urinary tract symptoms) rates increased from 3.3/1,000 person-years for those 45 to 49 years old to 11.3/1,000 person-years for those 70 to 83 years old. Men with a clinical diagnosis of benign prostatic hyperplasia and a symptom score 8 or greater had the highest rates (age adjusted incidence 13.7/1,000 person-years). All 7 lower urinary tract symptoms comprising the American Urological Association symptom index individually predicted acute urinary retention (age adjusted odds ratio 1.8 to 2.9 for symptoms occurring more than 25% of the time during the last month). The sensation of incomplete bladder emptying, having to void again after less than 2 hours and a weak urinary stream were the best independent symptom predictors. Use of medications with adrenergic or anticholinergic side effects also predicted acute urinary retention. CONCLUSIONS: Acute urinary retention occurred relatively infrequently but older age, moderate or severe lower urinary tract symptoms, a diagnosis of benign prostatic hyperplasia and specific drug therapies significantly increased the risk of occurrence.

Acute Disease↗