Disabling effects of chronic disease and impairment.
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PURPOSE: To explore the relationship between self-reported physical functional health and mortality. METHODS: A cohort of 17,777 men and women aged 41-80 years who completed the anglicised 36-item short-form questionnaire (UK SF-36) in 1996-2000 were followed prospectively until 2004, average 6.5 years, for mortality from all causes, from cardiovascular disease, from cancer, and from all other causes. RESULTS: During 115,527 person-years of follow-up, 1065 deaths occurred. After adjusting for age, body mass index, systolic blood pressure, cholesterol, smoking, diabetes, and social class, the relative risks (RR) for all cause mortality were 2.15 (95% CI: 1.54, 2.99) and 2.42 (1.57, 3.74), cardiovascular mortality were RR = 2.71 (1.47, 4.98) and 3.09 (1.30, 7.33), and death from other causes excluding cancer RR = 2.88 (1.43, 5.79) and 5.22 (1.21, 22.53) in men and women respectively for those who were in the lowest compared to top quintile of SF-36 scores. These associations remained unchanged after exclusion of deaths during the first two years of follow-up and were also consistent in different age groups. CONCLUSIONS: Poor self-reported physical functional health in men and women without known instances of prevalent cardiovascular disease or cancer predicts total and cardiovascular disease mortality in the general population independently of known risk factors.
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Relying on data derived from medical records of past visits to a physician, patients' charts were examined to evaluate the effectiveness of a single nutrition counseling session provided by the same registered dietitian in improving outcome measures for patients with type 2 diabetes mellitus or cardiovascular disease. This was a retrospective study of 175 patients' charts from which laboratory data were extracted before and at 3 months after seeing the dietitian. Records were categorized into two groups based on whether the patient had attended or not attended a single nutrition counseling session. At 3 months, the group that received the nutrition counseling had statistically significant improvements in blood values and body mass index compared with the group that did not receive nutrition counseling. This study further confirms the value of a single nutrition counseling session as an effective approach to treating type 2 diabetes and cardiovascular disease.
OBJECTIVES: To estimate the incidence of erectile dysfunction (ED) in a population-based sample during 5 years' follow-up and determine how the rate was affected by age and medical conditions. METHODS: The target population comprised all men aged 50, 60, or 70 years residing in the study area at the time the study began. Questionnaires were mailed to 3143 men in 1994 and to 2864 men in 1999. The follow-up sample consisted of the 1442 men who responded to both the baseline and the follow-up questionnaires. ED was assessed by two questions concerning the subject's ability to achieve and maintain an erection sufficient for intercourse. We estimated the incidence of minimal ED among the 391 men free of ED, of moderate ED in the 1130 with no or minimal ED, and of complete ED among the 1323 men free of complete ED at baseline. RESULTS: The incidence of minimal ED was 127 cases per 1000 person-years (95% confidence interval 110 to 148). For moderate ED, it was 41 (95% confidence interval 36 to 47) and for complete ED, it was 18 (95% confidence interval 15 to 22). The incidence of minimal ED increased 40% and moderate ED 80% with each decade increment in age; the incidence of complete ED increased 190%. The incidence of ED was increased in men with diabetes (rate ratio 2.4 for minimal, 2.6 for moderate, and 3.4 for complete ED). Hypertension, heart disease, arthritis, pulmonary disease, and cerebrovascular disease had little or no effect on the incidence of ED. CONCLUSIONS: ED is a commonly occurring disorder that increases in incidence strongly between 50 and 75 years of age. Diabetes is a major determinant of ED, but hypertension, heart disease, arthritis, and cerebrovascular disease increase the incidence of ED only marginally.
The association between dietary fat consumption and risk of cancer, especially colon, breast, prostate, and ovary cancer, has been debated for many years. Ecologic studies over the past 30 years have demonstrated the correlation of greater dietary fat intake with higher mortality due to various cancers. Migrant studies also have shown that increased fat consumption may be associated with increased risk of cancer. Specific saturated fatty acids raise blood cholesterol levels and, thereby, increase the risk of atherosclerosis. Greater fat, intake is a major cause of obesity and hypertension, diabetes, and gallbladder disease. Higher fat intake may heighten the risk of breast cancer directly through increased blood estrogen levels and/or secondarily through increased obesity. The critical experimental studies to determine the effects of a low-fat diet on disease risk have not been completed, but reducing fat in the US diet has the potential to decrease morbidity and mortality substantially.
The primary nutritionally linked diseases are coronary heart disease, stroke and cancers of the stomach, colon, pancreas, prostate, breast, ovary, and endometrium. Dietary fats operate through a promoting mechanism. An S-shaped dose-response curve with a threshold has been demonstrated in models of breast and colon cancer in which the standard Western fat intake of 40% of energy yields a high level of promotion, and reduction of fat to 10% to 20% of energy (the traditional Japanese fat intake) has a low promoting action. In models of breast and colon cancer, saturated fats such as beef fat or lard, and monounsaturated oils, such as olive oil, display only a weak promoting effect, with the incidence of induced tumors being similar at intake levels of 40% and 10% of energy. On the other hand, the n-6-polyunsaturated oils display a strong promoting effect. Such findings may have a parallel in the low but definitely increasing slope of postmenopausal breast cancer incidence in the past 30 years as the American public decreased saturated fat intake to avoid heart disease and increased use of the n-6-polyunsaturated oils. Mechanisms underlying the cancer-promoting effect in the colon stem from increased hepatic production of bile acids, which are transferred to the intestinal tract via the bile. Ingestion of 40% fat calories yields higher concentrations of bile acids in the colon than lower levels of dietary fat ingestion. Cancer in the mammary gland is promoted through higher concentrations of fats and phospholipids in the gland as well as increased levels of estrogen secondary to production by the ovary and other endocrine tissues that, in turn, affect the generation of pituitary hormones such as prolactin and growth hormone. The n-3-fats, as found in fish and fish oils, have a pronounced inhibitory effect in models of colon and breast cancer, presumably through their shifting of prostaglandin metabolism to the generation of prostaglandins, which lower cell proliferation potential and, thus, decrease promotional effects. The role of dietary fat as a promoter can be modified by other nutritional components. Finally, one of the best pieces of evidence for an enhancing effect of many dietary fats in the nutritionally linked cancers is the current increase in the incidence of these diseases in Japan as the nutritional habits of people in that country become more Westernized.
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In this 12-month trial standard exercise training was compared with a group-mediated cognitive-behavioral (GMCB) intervention with respect to effects on long-term adherence and change in physical function of older adults who were either at risk for or had cardiovascular disease. Participants (147 older men and women) were randomized to the 2 treatments. Outcomes included self-reportedphysical activity, fitness, and self-efficacy. The GMCB treatment produced greater improvements on all outcomes than did standard exercise therapy. Regardless of treatment assignment, men had more favorable change on the study outcomes than did women. Analysis of a self-regulatory process measure in the GMCB group revealed that change in barriers efficacy was related to change in physical activity and fitness. Results suggest that teaching older adults to integrate physical activity into their lives via GMCB leads to better long-term outcomes than standardized exercise therapy.
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This paper summarizes Dutch epidemiological findings on the impact of a low selenium (Se) status on mortality from cardiovascular disease (CVD) and cancer. Se status parameters of Dutch subjects are compared to those from Finland and the USA, and the concept of a threshold effect for Se on disease risk is discussed. Case-control analyses of prospective data suggest that low serum Se (below 105 micrograms/l) is not clearly associated with an excess risk of CVD death (relative risk RR = 1.6, 90% confidence interval Cl = 0.9-2.9). Se cancer findings indicate a possible gender difference in risk (in males RR = 2.7, 90% Cl = 1.2-6.2; in females RR = 1.5, 90% Cl = 0.5-4.5). Larger studies, monitoring a combination of Se status parameters are recommended.
BACKGROUND: The Italian Longitudinal Study on Aging (ILSA) evaluates the rates of diabetes, cardiovascular and neurological disorders in a random sample of 5632 Italians aged 65-84 years. METHODS: The ILSA has two components: a first screening phase administered to all participants, that includes a personal interview, physician examination, laboratory and diagnostic tests, and a second phase, consisting of the clinical confirmation of suspected cases by a specialist. RESULTS: Prevalence rates were significantly higher among men for myocardial infarction (10.7% versus 4.8%), cardiac arrhythmia (25.1% versus 20.3%) and peripheral artery disease (8.1% versus 5.2%), and among women for hypertension (67.3% versus 59.4%), heart failure (7.3% versus 5.4%) and dementia (7.2% versus 5.3%). No gender difference was found for stroke, angina, diabetes, Parkinsonism and distal symmetric neuropathy. Unreported diagnoses accounted for 85% of cases of distal symmetric neuropathy, for more than half the cases of cardiac failure, for 40% of cases of angina, and for more than one-third of cases arrhythmia, myocardial infarction, peripheral artery disease, hypertension, Parkinsonism. Data from the phase 1 interview showed substantial overreporting for myocardial infarction, peripheral artery disease, diabetes, and stroke. CONCLUSIONS: The authors conclude that self-reported information would lead to inaccurate estimates of prevalence rates suggesting the need for including the clinical ascertainment in any population-based epidemiological study.
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Blood donors have made important contributions to research, most notably in cross-sectional seroprevalence studies. The proposed New Zealand Blood Donors Health Study is a prospective cohort study of 30,000 New Zealand donors designed to investigate the determinants of common injuries, cardiovascular disease and cancer. While robust from an analytic perspective, the execution of prospective cohort studies in many settings is impeded by methodological, economic and organisational barriers. We examined the operational considerations of implementing a large-scale cohort study at a transfusion centre and evaluated measures taken to optimise data collection procedures. A pilot study of 1,000 participants revealed donor motivation to participate in this research was high (91% response rate). Comprehensive exposure data on lifestyle, behavioural and psychosocial factors were obtained from 95% of participants. Substantial heterogeneity in levels of potential risk factors was noted among respondents. Detailed dietary habit information and a study blood sample were obtained from 67% and 100% of participants, respectively. Study recruitment and baseline data collection was feasible during routine donor visits with minimal interruption to donor centre staff and procedures. We conclude the study design and characteristics of the regional donor program enhance the efficiency and significance of the proposed research.