The association of thyroid stimulating hormone levels with cognitive function and depressed mood: the Rancho Bernardo study.

OBJECTIVE: To evaluate the association of thyroid stimulating hormone levels with cognitive function and depressed mood in a community-based sample. DESIGN: Cross-sectional study. SETTING: Clinic visit in 1999- 2003. PARTICIPANTS: Community-dwelling men (N=447) and women (N=663) aged 42-99 years. MEASUREMENT: Cognitive function was assessed with the Buschke-Fuld Selective Reminding Test, the Modified Mini-Mental State Examination, Trails B, and category fluency. Depressed mood was assessed with the Beck Depression Inventory (BDI). A fasting blood sample was obtained for thyroid stimulating hormone (TSH) measurement. RESULTS: Mean age was 73.6 +/- 10.0 in men and 74.3 +/- 10.4 in women. Mean TSH was 1.9 mu IU/ml in both sexes; 9.0% of men and 24% of women reported thyroid medication use. Mean BDI scores were 4.6 +/- 4.1 in men and 5.2 +/- 4.3 in women; 9% of men and 11% of women used antidepressants. Before and after adjustment for covariates or exclusion of participants taking thyroid hormones, no associations were observed between TSH and cognitive function (ps > 0.10). TSH was inversely associated with BDI (p=0.03) in men, but not women. CONCLUSIONS: Thyroid stimulating hormone level was unrelated to cognitive function in men and women, and was inversely associated with depressed mood in men only, possibly reflecting the greater use of both thyroid medications and antidepressants by women.

Plasma trace elements and cognitive function in older men and women: the Rancho Bernardo study.

OBJECTIVE: This study examines the sex-specific associations of plasma concentrations of iron, copper, and zinc with cognitive function in older community-dwelling adults. DESIGN: Cross-sectional study. SETTING: 1988-92 follow-up clinic visit. PARTICIPANTS: 602 men and 849 women (average age=75 +/- 8 years) who were community-dwelling and not clinically demented. MEASUREMENTS: Blood samples were assayed for trace elements and 12 cognitive function tests were administered. Sex-specific analyses were adjusted for age, education, alcohol consumption, smoking, exercise, and estrogen use in women. RESULTS: Men and women differed significantly in education and alcohol intake (p's < 0.001), concentrations of plasma iron, copper and zinc (p's < 0.001) and scores on 11 of 12 cognitive function tests (p=0.04 to < 0.001). Regression analyses showed significant inverted U-shaped associations in men; both low and high iron levels were associated with poor performance on total and long-term recall and Serial 7's (p's=0.018, 0.042 and 0.004, respectively) compared to intermediate concentrations. In women, iron and copper concentrations had inverse linear associations with Buschke total, long and short-term recall and Blessed scores (p's < 0.05). Zinc was positively associated with performance on Blessed Items (p=0.008). Analyses comparing cognitive function using categorically defined mineral concentrations yielded similar sex specific results. CONCLUSION: Optimal trace element concentrations may exist for optimal cognitive function in older adults, and these levels may differ by sex and cognitive function domain.

Insulin resistance precedes weight loss in adults without diabetes : the Rancho Bernardo Study.

Insulin resistance is closely associated with both aging and overweight; yet in old age, weight loss is common, although insulin resistance increases. To study this paradox, the authors evaluated the role of insulin resistance in weight change among older adults from the Rancho Bernardo Study cohort. Participants were 725 nondiabetic men and women who were aged 50-89 years when weight and insulin were measured at baseline (1984-1987). The participants were evaluated again in 1992-1996, at which time weight was remeasured. Fasting insulin and homeostasis model assessment (HOMA) measurements were evaluated in separate but parallel statistical models as surrogates for insulin resistance. Insulin resistance, when defined as the top quartile of fasting insulin level or HOMA value, was significantly associated with weight loss before and after adjustment for baseline weight and age (fasting insulin: beta = -1.30 kg, p = 0.01; HOMA: beta = -1.18 kg, p = 0.01). Results were the same for men versus women, for the overweight (body mass index (weight (kg)/height (m)(2)) > 26.6) [corrected] versus the normal weight (body mass index < or = 26.6) [corrected], and for younger persons (age <70 years) versus older persons (age > or = 70 years). Insulin-resistant individuals had a threefold increased likelihood of losing 10 or more kg compared with those without insulin resistance. The authors conclude that hyperinsulinemia, independently of age and baseline weight, may have a catabolic effect in the elderly.

Metabolic syndrome and ischemic heart disease in elderly men and women.

Associations between metabolic syndrome components and prevalent ischemic heart disease (IHD) were investigated in a cross-sectional, community-based study of elderly men (n = 1,015) and women (n = 1,259) in Rancho Bernardo, California, in 1984-1987. In both sexes, there were significant positive associations between IHD defined by resting electrocardiogram criteria and age, systolic blood pressure, fasting and postchallenge hyperglycemia, total cholesterol/high density lipoprotein cholesterol (HDL cholesterol) ratio, and triglycerides and an inverse significant association with HDL cholesterol. High collinearity and interactions between serum insulin and metabolic syndrome variables were accounted for by uncorrelated principal components identified by factor analysis. In both men and women, three uncorrelated principal components were identified, representing a central metabolic factor (body mass index, fasting and 2-hour serum insulin, high serum triglycerides, and low HDL cholesterol), a glucose factor, and a blood pressure factor. In a multivariate model with age and sex, all three factors were significantly associated with IHD by electrocardiogram criteria; central metabolic factor (odds ratio (OR) = 1.6, p = 0.001), glucose factor (OR = 1.4, p < 0.001), blood pressure factor (OR = 1.2, p = 0.005), age (10 years) (OR = 1.8, p < 0.001), and female sex (OR = 0.5, p < 0.02). Similar results were obtained in analyses using clinically manifest IHD as the outcome. These results support the thesis that the metabolic syndrome exerts effects through different risk factors by different mechanisms.

The association of behavior and lifestyle factors with menstrual symptoms.

The present study examines the association of obesity, cigarette smoking, alcohol consumption, and exercise with the prevalence of menstrual cycle disorders among 2912 women aboard U.S. Navy ships. Self-administered surveys obtained information on weight, height, cigarette smoking, alcohol consumption, and exercise. Participants also indicated whether they experienced cramps or pain during their period requiring medication or time off work, bleeding between periods, excessive frequency of periods, heavy periods, periods lasting for longer than a week, scanty menstrual flow, and irregular periods during the past 90 days. Women ranged in age from 18 to 49 years, with an average of 26 years. After adjustment for age, race, and pay grade, current cigarette smoking was associated with increased risk of all menstrual symptoms and cycle disorders. As compared with nonsmokers, current smokers were at increased risk of cramps or pain requiring medication or time off work (odds ratio [OR] = 1.13, 95% confidence interval [CI] = 1.03, 1.25), bleeding between periods (OR = 1.22, CI = 1.09, 1.38), excessive frequency of periods (OR = 1.33, CI = 1.17, 1.51), heavy periods (OR = 1.17, CI = 1.06, 1.29), periods lasting longer than a week (OR = 1.31, CI = 1.16, 1.48), scanty flow (OR = 1.13, CI = 1.01, 1.29), and irregular periods (OR = 1.14, CI = 1.05, 1.24). Obesity, exercise, and alcohol consumption did not show consistent associations with menstrual symptoms or cycle disorders. Logistic regression models that included age, race, pay grade, and all behavioral and lifestyle variables indicated only cigarette smoking was associated with an increased risk of bleeding between periods (OR = 1.33, CI = 1.05, 1.68), excessive frequency of periods (OR = 1.38, CI = 1.21, 1.58), periods lasting longer than a week (OR = 1.45, CI = 1.13, 1.84), and irregular periods (OR = 1.25, CI = 1.05, 1.47). Although the lifestyle factors are all potentially modifiable, results suggest that only interventions targeted at smoking cessation might be useful in reducing the prevalence of menstrual symptoms, cycle disorders, and time lost from work.

Birth weight, adult weight, and girth as predictors of the metabolic syndrome in postmenopausal women: the Rancho Bernardo Study.

OBJECTIVE: Recent studies have demonstrated an association between low birth weight and chronic and metabolic disorders in adulthood such as type 2 diabetes, hypertension, and dyslipidemia. These disorders tend to cluster in a condition known as the metabolic syndrome (syndrome X). Only two studies have reported an association of birth weight to the metabolic syndrome. The present study is distinguished as the only study to focus on postmenopausal women. RESEARCH DESIGN AND METHODS: Subjects were 303 community-dwelling, postmenopausal Caucasian women aged 50-84 years. Metabolic and anthropometric variables were measured at a clinic visit; birth weight was assessed by self-report on a mailed questionnaire. RESULTS: The metabolic syndrome, defined as the simultaneous presence of hypertension, dyslipidemia, and abnormal glucose tolerance, was present in 7.9% of these women. Compared with women in the highest birth weight tertile (8.1-13.0 lb, mean 9.4 lb), those in the lowest birth weight tertile (2.5-6.8 lb, mean 5.5 lb) exhibited an increased prevalence (12.0 vs. 4.3%, P < 0.05) and 2.41 times the risk (95% CI 1.06-5.51) of developing the metabolic syndrome. Women with a heavy birth weight had an increased risk of adult obesity. Nevertheless, women in the lowest birth weight tertile who became adults in the highest tertile of BMI (>25.2 kg/m2) or waist circumference (>80.7 cm) had the highest prevalence of the metabolic syndrome (approximately 30%). CONCLUSIONS: Low birth weight coupled with adult obesity is a strong determinant of the metabolic syndrome in postmenopausal women.

Morbidity and mortality in the wilderness.

The medical literature is limited regarding current wilderness morbidity and mortality statistics. Available studies concentrate on selected wilderness activities. This study retrospectively examines wilderness injuries, illnesses, and mortality based on case incident report files from eight National Park Service parks within California over a three-year period. Data were extracted regarding type of illness or injury, body area affected, age, gender, month in which the event occurred, and activity in which the victim was involved at the time of the event. The overall occurrence of nonfatal events was 9.2 people per 100,000 visits. More than 70% of all nonfatal events were related to musculoskeletal or soft-tissue injury. The most frequently involved body area was the lower limbs (38%). Seventy-eight mortalities occurred during the three years studied, resulting in an overall mortality rate of 0.26 deaths per 100,000 visits. Men accounted for 78% of the deaths. Heart disease, drowning and falls were the most common causes of death. The information and statistics on morbidity and mortality in California wilderness areas that this study provides may be used to guide future wilderness use, education, and management. A standardized, computerized database would greatly facilitate future evaluations, decisions, and policies.

Mortality hazard associated with prescription hypnotics.

BACKGROUND: The American Cancer Society's Cancer Prevention Study II was a large survey designed primarily to examine cancer risks such as cigarette smoking. From the same survey and methods, data on usage of "prescription sleeping pills" in 1982 were examined. METHODS: Standardized mortality ratios were computed. Because sleeping pill use could be a proxy for other risk factors, cox proportional hazards models were computed to control for possible confounding factors as extensively as the data permitted. RESULTS: Men and women who reported taking prescription sleeping pills 30+ times in the past month had standardized mortality ratios of 3.18 and 2.82, respectively; controlling for 10-year age groups (p < 0.001). The standardized mortality ratios for usage 1-29 times/month were 1.8 and 1.48, respectively (p < 0.001). In proportional hazards models that controlled for 30 other risk factors and comorbidities simultaneously, the excess mortality risk associated with usage 30+ times per month remained significant, but hazard ratios were reduced to 1.35 for men and 1.22 for women. CONCLUSIONS: Use of hypnotics was associated with excess mortality. This methodology could not determine if hypnotic compounds caused the risks associated with their use, nor could the risks of individual compounds be determined. Since millions of Americans are currently taking hypnotics, long-term controlled trials are urgently needed to further guide both patients and physicians.

Type A behavior pattern, heart disease risk factors, and estrogen replacement therapy in postmenopausal women: the Rancho Bernardo Study.

Cardiovascular disease is the leading cause of death among older American women. Estrogen replacement therapy (ERT) appears to reduce the risk of heart disease. For nearly five decades, the Type A behavior pattern (TABP) has been implicated in the cardiac morbidity and mortality of both men and women, but no studies have examined the use of replacement estrogen or whether its association with heart disease risk factors is different in Type A versus Type B women. We examined the effects of ERT and TABP on heart disease risk factors in a large population-based sample. Subjects were 1070 postmenopausal women, aged 50-89 years, who had been participants in the Rancho Bernardo Study. At a clinic visit made during 1984-1987, TABP was assessed with the Bortner Rating Scale, and heart disease risk factors (total cholesterol, high-density and low-density lipoprotein (HDL and LDL), triglycerides, fasting and postchallenge insulin and glucose, and blood pressure) were measured. Based on a median split (median = 154.0) of scores on the Bortner Rating Scale, 52% of these women were classified as Type A. Type A women were significantly younger than Rating women (mean = 68.4 versus 71.0 years, respectively). After adjustment for age, significantly more Type A than Type B women were on ERT (35% versus 24.7%, p = 0.001). Analyses stratified by TABP indicated that within the Type A group, current users of ERT had higher levels of HDL cholesterol (p) = 0.001) and lower levels of LDL cholesterol (p < 0.01), fasting plasma glucose (p < 0.001), and fasting insulin (p < 0.01). Among Type B women, current users of ERT had higher levels of HDL cholesterol (p = 0.07) and triglycerides (p < 0.01), lower levels of LDL cholesterol (p < 0.01), and lower systolic blood pressure (p < 0.05) but no significant differences in either fasting or postchallenge levels of either plasma glucose or serum insulin (each p < 0.01). Results of this study suggest that ERT may be associated with significant differences in the heart disease risk factor profile in Type A versus Type B women, and these differences may favor Type A women.

Gender differences in hospitalizations for IDDM among adolescents in California, 1991. Implications for prevention.

OBJECTIVE: Describe gender differences in hospitalizations for IDDM to investigate the need for gender-specific interventions to reduce diabetes-related morbidity. RESEARCH DESIGN AND METHODS: Analyses were based on hospital discharges with any mention of IDDM (n = 2,889) and the subset of these for IDDM as a principal diagnosis (n = 2,270) in California children, ages 0-18 years during 1991. Pregnancy-related hospitalizations were excluded. RESULTS: Females had more diabetes hospitalizations among discharges with any mention of diabetes, among discharges with diabetes as a principal diagnosis, and among discharges with diabetic ketoacidosis as a principal diagnosis. For diabetes as a principal diagnosis, females had 40% more hospitalizations, 44% more repeated hospitalizations, 23% more individuals hospitalized, and significantly higher rates of hospitalizations for ages 10-14 years (50 vs. 38 per 100,000) and for ages 15-18 years (68 vs. 29 per 100,000). Gender differences occurred primarily in adolescents, were independent of complicating conditions at the time of hospitalization, and were observed for diabetic ketoacidosis alone. CONCLUSIONS: Adolescent females had more diabetes hospitalizations than did males. The underlying cause may be biological or behavioral. Management protocols tailored for young women may be required to reduce hospitalizations for IDDM among females.

Parental divorce: effects on individual behavior and longevity.

Using an archival prospective design, the authors studied associations among parental divorce occurring during participants' childhood, adult psychosocial mediators, and mortality over the life span of a subgroup of participants (N = 1,261) in the Terman Life Cycle Study (1921-1991). Children from divorced families grew up to show a higher risk of premature mortality across the life span. The higher mortality risk for men was explained, in part, when 3 mediating factors were controlled: Men who had experienced parental divorce were more likely to have their own marriages end in divorce, obtained less education, and engaged in fewer service activities. Women who had experienced parental divorce smoked more and were more likely themselves to divorce, both of which predicted higher mortality risk. The findings extend previous work on the negative sequelae of parental divorce to long-term effects on personality and longevity.

Hysterectomy, oophorectomy, and heart disease risk factors in older women.

OBJECTIVES: This study examined the relation of hysterectomy and oophorectomy to heart disease risk factors. METHODS: Data were collected and analyzed for 1150 women aged 50 through 89. RESULTS: Of these women, 21.8% reported hysterectomy with bilateral oophorectomy; 22.1%, hysterectomy with ovarian conservation. Compared with women without hysterectomy, oophorectomized women, especially those 20 or more years postmenopause, had increased lipids, lipoproteins, glucose, and insulin; blood pressures were increased among current estrogen users. Women with hysterectomies with ovarian conservation had similar or more favorable risk factors than nonhysterectomized women. CONCLUSIONS: Bilateral oophorectomy, but not hysterectomy, may have long-term negative consequences for heart disease risk factors not totally ameliorated by estrogen use.

Prevalence of sleep-disordered breathing in ages 40-64 years: a population-based survey.

Previous research has offered widely varying prevalence estimates for sleep apnea in the population, leaving uncertain which breathing patterns are abnormal. To explore the distribution of sleep apnea in the population and its co-morbidities, random telephone dialing was used between 1990 and 1994 to recruit subjects for a prevalence survey of sleep-disordered breathing in San Diego adults. Events from which blood oxygen desaturations > or = 4% resulted were monitored with home recording instruments, usually for three consecutive nights. Among 190 women ages 40-64 years, a median of 4.3 desaturation events per hour of sleep were observed. A higher median of 6.7 events per hour was observed among 165 men. Frequencies were much higher among members of minority groups, leading to a standard estimate that 16.3% of U.S. Hispanics and racial minorities have > or = 20 events/hour as compared to 4.9% of non-Hispanic Whites ages 40-64. Obesity indicated by body-mass index was the most important demographic predictor of sleep-disordered breathing, followed by age, male gender, and ethnicity. Quality of well-being was not significantly impaired in subjects with more respiratory events; however, there was some increase in blood pressure and wake-within-sleep associated with sleep-disordered breathing. This survey indicates that sleep-disordered breathing is more common, especially among minorities, than had been previously believed, but less co-morbidity may be associated.

DES awareness and exposure: the 1994 California Behavioral Risk Factor Survey.

INTRODUCTION: Diethylstilbestrol (DES), a drug used in millions of pregnancies between 1938 and 1971, is the first known human transplacental carcinogen. DES is also associated with other serious health problems for those exposed to it either in utero or while pregnant; however, many men and women are unaware of their exposure or how to protect their health. This first population-based study of DES awareness is part of the National Cancer Instututes's National DES Education Program. METHODS: In 1994, 2,077 women and 1,625 men 23 years of age and over responded to the California Behavioral Risk Factor Survey (BRFS). These subjects were either born during the years DES was in use (men and women 23-53 years old in 1994) or could have been pregnant during those years (women 39 years or older). RESULTS: Analyses weighted to the 1994 California age and ethnicity distribution indicate that only 43% of women and 22% of men had over heard of DES (P < .001). Although 44% of Caucasians had heard of DES, only 10% of Hispanics, 27% of African Americans, and 24% of other races had heard of DES. Within each group, women had heard of DES significantly more often than men. Only 17% of women and 5% of men had ever tried to confirm whether they were exposed to DES in utero, and 8% of women whether they were exposed while pregnant. CONCLUSIONS: Given the serious health consequences of DES exposure and available prevention strategies, this lack of awareness warrants an immediate educational effort.

GHb is a better predictor of cardiovascular disease than fasting or postchallenge plasma glucose in women without diabetes. The Rancho Bernardo Study.

OBJECTIVE: To examine the relation between GHb, fasting plasma glucose (FPG), postchallenge plasma glucose (PCPG), and mortality from cardiovascular disease (CVD) and ischemic heart disease (IHD) in older adults. RESEARCH DESIGN AND METHODS: A community-based study of 1,239 nondiabetic older adults followed for an average of 8 years, from baseline (1984-1987) to 1993. RESULTS: GHb, but not FPG or PCPG, was significantly related to CVD and IHD mortality in women but not men. The age-adjusted relative hazard for those in the highest quintile of GHb (> or = 6.7%) compared with women with lower levels was 2.37 for fatal CVD (95% CI = 1.30-4.31, P = 0.005) and 2.43 for IHD (95% CI = 1.12-5.25, P = 0.024). This association persisted after adjustment for all covariates (age, systolic blood pressure, BMI, LDL, HDL, triglycerides, cigarette smoking, antihypertensive medication use, and estrogen use). GHb was significantly associated with LDL and HDL levels in women, but the association between GHb and CVD or IHD persisted after adjustment for these lipoproteins. CONCLUSIONS: We concluded that GHb is a better predictor of CVD and IHD mortality than FPG or PCPG in women without diabetes; no single measure of glycemia was predictive in men. The reason for the sex difference is unexplained.

Practice styles. A comparison of obstetricians and nurse-midwives.

Iain Chalmers and the National Perinatal Epidemiology Unit, Oxford, England, developed a comprehensive listing of perinatal care procedures shown to reduce the frequency of adverse outcomes during pregnancy and childbirth. This list was used as a framework for a pilot study conducted in 1992 that reviewed similarities and differences in opinion and practice style between certified nurse-midwives (CNMs) and obstetrician/gynecologists. Twenty CNMs and 57 obstetrician/gynecologists who were active clinical practitioners in San Diego commented on 24 items drawn from Chalmers' work. The CNMs were more likely to favor the availability of social and psychological support variables and to use them in their practice. The groups were more alike than different in their views concerning preventive interventions during the prenatal period. CNMs were more likely to support the availability of alternatives to maternal positions for labor and birth, exhalatory breathing, and delayed pushing and less likely to support the availability of electronic fetal monitoring, epidural anesthesia, episiotomy, and active management of the third stage. A small sample size and limited response rate restricted interpretation and generalizability of these data. Nevertheless the data offer support for other studies with similar findings. They also suggest that health system administrators should inform women and families about differences in practice styles before families select from among the various insurance options that may, in the end, restrict the choice of provider or birth setting.