Air pollution and humidity as triggering factors for stroke. Results of a 12-year analysis in the West Paris area.

BACKGROUND AND PURPOSE: Previous studies have suggested an association between stroke and meteorological factors, air pollution and acute respiratory infections as triggering factors. Often, these factors have been evaluated separately. We evaluated the association between all these environmental triggering factors and calls for suspected stroke in a suburb in west Paris from 2004 to 2015. METHODS: We used data from the emergency medical dispatching center of all calls for suspected stroke (SAMU 78), climatic parameters (MétéoFrance), pollution (AIRPARIF), and data from influenza epidemic surveillance networks (GROG and Sentinelles). The association between short-term exposure (1-day lag) to environmental triggering factors and stroke occurrence was analyzed using negative-binomial log linear regression model for counting time series. RESULTS: Between 2004 and 2015, a total of 11,037 calls for suspected stroke were recorded. In bivariate analysis, there were associations between calls for suspected stroke and temperature (mean, maximum and minimum), humidity and influenza epidemic. In multivariable analysis, only two variables were associated with calls for suspected stroke: humidity [3.93% excess relative risk (ERR) of stroke per 10% increase in humidity; 95% confidence interval (CI), 1.42 to 6.51; P<0.002] and pollution on the "Air Parif Atmo" scale (2.86% ERR of stroke per 1 unit increase; 95% CI, 1.01 to 4.75; P=0.002). CONCLUSIONS: This study suggests that short-term exposure to air pollution and a high level of humidity are associated with a significant excess relative risk of calls for suspected stroke.

Factors Influencing Serum-Hydroxivitamin D Levels and Other Bone Metabolism Parameters in Healthy Older Women.

OBJECTIVE: Older women have frequently low serum 25-hydroxivitamin D (25[OH]D) concentrations, high parathormone (PTH) levels and low bone mineral density (BMD) values. Endogenous synthesis, dietary habits, sunlight exposure and fat-mass-mediated storage may influence 25(OH)D levels and bone metabolism, but the relevance of these factors in the elderly has yet to be fully elucidated. We aimed to investigate the influence of dietary vitamin D intake and fat mass on serum 25(OH)D levels and bone metabolism in older women. DESIGN: Cross-sectional. SETTING: Community. PARTICIPANTS: 218 fit older women attending a biweekly mild fitness program. MEASUREMENTS: Dietary habits was investigated through a 3-day record questionnaire. Serum 25(OH)D and intact parathormone (PTH) concentrations were measured by radioimmunoassay and by a 2-step immunoradiometric assay, respectively. BMD and body composition were estimated using dual-energy X-ray absorptiometry with fan-beam technology. RESULTS: Only fat mass showed a significant negative association with 25(OH)D (ß=-3.76, p<0.001), and positive associations with whole body, lumbar, femoral neck and total hip BMD. Binary logistic analysis revealed a protective effect of adiposity on secondary hyperparathyroidism (OR=0.42, 95%CI:0.19-0.92, p=0.03). Dietary vitamin D intake was not associated to any of these outcomes. CONCLUSION: Fat mass has a greater influence on serum 25(OH)D than dietary vitamin D intake.

Effect of weight loss on mortality in overweight and obese nursing home residents during a 5-year follow-up.

BACKGROUND/OBJECTIVES: The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI). SUBJECTS/METHODS: A longitudinal study was conducted on 161 NH residents aged ⩾ 70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ⩾ 25 and weight stable/gain, BMI ⩾ 25 and weight loss, BMI<25 and weight stable/gain and BMI <25 and weight loss). RESULTS: People with a BMI ⩾ 25 and weight loss suffered the worst decline in activities of daily living, whereas those with a BMI <25 and weight loss had the most significant decline in nutritional status, which coincided with the worst decline in the Multidimensional Prognostic Index among the groups whose weight changed. Compared with those with a BMI ⩾ 25 and weight stable/gain (reference group), those with a BMI <25 were at the highest risk of dying (in association with weight loss: hazard ratio HR=3.60, P=0.005; in association with weight stable/gain: HR=2.45, P=0.01), and the mortality risk was also increased in people with a BMI ⩾ 25 and weight loss (HR=1.74, P=0.03). CONCLUSIONS: In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese.

Duration of breastfeeding as a risk factor for vertebral fractures.

PURPOSE: Among the risk factors for osteoporosis and fractures, gynecological history (fertile period, parity and breastfeeding) play an important part. Changes in calcium metabolism to enable an adequate mineral transfer to the milk have a prominent role in bone loss during breastfeeding. Data on the influence of breastfeeding in postmenopausal osteoporosis are inconsistent. The aim of the present study was to identify any association between duration of breastfeeding and vertebral fractures in postmenopausal women. METHODS: All patients underwent the following tests: bone mineral density measurements of the lumbar spine (L1-L4) and the total and femoral neck using dual-energy X-ray absorptiometry and antero-posterior and lateral radiography of the thoracic and lumbar spine to identify vertebral fractures. RESULTS: The study involved 752 women with a mean age of 64.5±9.3; 23% of them reported vertebral osteoporotic fractures. The women with vertebral fractures had breastfed for longer periods (11.8±12.9 vs. 9.3±11.2months, p=0.03) and had more pregnancies (2.6±2.2 vs. 2.2±1.3, p=0.002). Breastfeeding for more than 18months was associated with a two-fold risk of developing vertebral fractures (OR 2.12, 95% CI 1.14-5.38, p=0.04), particularly in those without current or past use of drugs positively affecting bone. CONCLUSIONS: Our study showed an association between long periods of breastfeeding and vertebral fractures, supporting a role for lengthy lactation as a risk factor for osteoporotic fractures after menopause. Bearing in mind all the benefits of breastfeeding, this finding suggests the importance of an adequate calcium and vitamin D intake during pregnancy and breastfeeding, with the aid of dietary supplements if necessary.

Association between dietary folate intake and serum insulin-like growth factor-1 levels in healthy old women.

OBJECTIVE: High serum levels of insulin-like growth factor-1 (IGF-1) seem to coincide with higher rates of some types of cancer and the risk of all-cause mortality in old people. Eating vegetables seems to reduce IGF-1 levels because they are rich in micronutrients such as vitamins. This study investigates the possible association between vitamin intake and IGF-1 levels in a representative group of healthy elderly women with Mediterranean dietary habits. DESIGN: This cross-sectional study included 124 healthy women with a mean age of 71.3 ± 4.2 years and a mean body mass index (BMI) of 27.37 ± 3.48 kg/m(2) attending a mild fitness program twice a week at public gyms in Padova. The main parameters considered were IGF-1 (measured by chemiluminescence) and diet, assessed on the basis of a 3-day record and a questionnaire on the frequency with which they usually ate certain foods. RESULTS: The mean IGF-1 level for the sample as a whole was 136.2 ± 38.9 µg/l, and was significantly lower in women with a higher folate intake (p = 0.04). On simple linear analysis, the vitamins found associated with serum IGF-1 levels were: folates (r: -0.25; p = 0.003); vitamin E (r: -0.21; p = 0.01); vitamin D (r: -0.17; p = 0.03); and riboflavin (r: -0.16; p=0.03). After removing the effect of calorie, protein, carbohydrate and fat intake, and other known potential confounders (age, BMI, alcohol intake), only folate intake correlated with IGF-1 levels (r = -0.17; p = 0.04). CONCLUSION: A folate-rich diet could have the effect of lowering circulating IGF-1 levels in elderly women.

[Links between stress factors, mental health and initial consumption of tobacco and alcohol during pre-adolescence]. / Liens entre stresseurs, santé psychique et premières consommations de tabac et d'alcool à la préadolescence.

BACKGROUND: We know the effects of stress hassles and life events on mental health at pre-adolescence and the impact of the first experiences with alcoholic beverages and tobacco, where the precocity of the initiation tends to encourage abuse and later dependence on these substances. The goal of this study was to look into the related effect of environmental factors (daily hassles, life events, and social support) on perceived mental health and on the initiation and consumption of tobacco and alcohol by preadolescents. POPULATION: The study was carried out in 12 institutions in a French department ("Indre-et-Loire") in the "Région Centre", including students from the last year of primary school (fifth grade) and the first two years of middle school (sixth and seventh grades): all nine elementary schools in Joué-lès-Tours, the second largest city of the department, and three middle schools in Tours and surrounding areas (urban, semi-rural and inner city). The sample was made up of 476 preadolescents attending school, 234 girls (49%) and 242 boys (51%), 267 primary school and 209 middle school students, with an average age of 11 years and 7 months. MATERIAL: Standardized questionnaires, specific to this population: with a scale of daily hassles, life events, mental health, and social support, were used. They proved to be adapted to each of them (Cronbach alpha coefficient>0.70) and the types of hassles and life events corresponded to the psycho developmental knowledge specific of this period. For the middle school students, dependence on tobacco was defined according to the "Hooked on nicotine checklist". PROCEDURE: In April 2004 in class (anonymity guaranteed). RESULTS: The results show that the hassles (considered in terms of occurrence or intensity, that is, the perceived stress) and life events (occurrence and negative perception) have a negative effect on mental health. In particular, pressure due to family problems has the greatest influence on mental health. For primary school students, this is followed by problems linked to self-perception; for middle school students, those linked to school. The consequences of hassles and life events on mental health allowed us to verify the solidity of the model used in previous studies [the Lausanne pediatric psychiatry team ], even with a younger preadolescent population. The effect of daily hassles is greater than that of life events, but they are not independent of one another (mediational model). Social support plays a modulating and protective role in mental health and the effects of daily hassles and life events. The prevalence of preadolescent smokers (simple experimentation or more or less regular use) is 5.7% (n=26). The prevalence of alcohol use is greater, encompassing more than one-third of subjects (33.4%; n=153). The influence of daily hassles can be seen both on the age of initiation to alcoholic beverages and to use of alcohol and intoxications. It is also observed on the age of initiation to tobacco and nicotine dependence (only taken into account for middle school students). That is to say that they promote precocity in the consumption of these products and increase their use. The absence of links with tobacco consumption may be due to the low number of preadolescent tobacco users. Life events also show an effect on tobacco and alcohol consumption, but it is lesser and should be moderated. Mental health is also correlated (but weakly) to the use of alcoholic beverages and intoxications. This applies more specifically to middle school students. Finally, the role of social support cannot be distinguished. CONCLUSIONS: This study shows the degree that daily hassles impact mental health and the recourse to psychoactive substances during preadolescence. Precocious use of tobacco and alcohol, the abuse of these substances and occasionally the beginning of dependence should be considered, at the very least, as warning signs for states of tension on individual, familial and environmental levels, or even as signs of established problems which could be revealed through a thorough clinical.