Daily stair climbing is associated with decreased risk for the metabolic syndrome.

BACKGROUND: Stair climbing can be a vigorous lifestyle physical activity, and is associated with healthier lipoprotein profiles, lower body weight and blood pressure, as well as higher aerobic fitness. The present analysis of data from a cohort of late middle-aged men and women examined the association between daily stair climbing and the metabolic syndrome. METHODS: Data from 782 (423 women) participants (mean (SD) age 58.3 (0.95) years in the Dutch Famine Birth Cohort Study (2002-2004) were used to examine the cross-sectional association between self-reported daily stair climbing and the metabolic syndrome. Stair climbing was assessed by the question 'Do you climb stairs daily?' and the metabolic syndrome was defined using the established five components relating to lipid fractions, blood glucose levels, blood pressure and abdominal obesity. RESULTS: Not climbing stairs daily was associated with an increased incidence of the metabolic syndrome (OR = 1.90, 95% CI = 1.23, 2.92, p = 0.004) and a greater number of its components (F1,780 = 8.48, p = 0.004): these associations were still evident after adjusting for a variety of potential confounders. CONCLUSIONS: The most likely explanation for the current findings is that daily stair climbing may be protective against the metabolic syndrome. This result reinforces public health recommendations for increased stair climbing with evidence from physiological outcomes.

The utility of saliva for the assessment of anti-pneumococcal antibodies: investigation of saliva as a marker of antibody status in serum.

CONTEXT: Salivary antibodies may act as non-invasive marker of systemic immunity enabling assessment of vaccination and protection against bacterial infections. OBJECTIVE: To assess if levels of anti-pneumococcal (Pn) antibodies in saliva reflect concentrations in serum and determine whether saliva can accurately identify protective concentrations in serum. METHODS: IgG, IgA and IgM antibody levels in paired saliva and serum samples were measured against 12 Pn polysaccharide antigens in 72 healthy adults. RESULTS: Antibody levels in saliva correlated positively with serum across immunoglobulin classes, most strongly for IgA. Individuals who had protective antibody levels in serum demonstrated significantly higher IgG and IgA salivary antibody concentrations/secretion rates. Salivary IgG and IgA Pn antibodies were able to distinguish between those with/without protective levels in serum for the majority of serotypes. Salivary IgM antibodies were not able to differentiate protective status. Median IgG and IgA Pn salivary parameters were able to identify individuals who had protective levels in serum on ≥8/12 serotypes with moderate accuracy: median IgA secretion rates provided the best sensitivity (73%) and specificity (71%). CONCLUSIONS: These findings suggest that IgG and IgA Pn specific antibodies in saliva may be useful surrogate markers of antibody status in serum.

Cardiovascular and cortisol reactions to acute psychological stress under conditions of high versus low social evaluative threat: associations with the type D personality construct.

OBJECTIVES: Social evaluative threat is an important factor in the cardiovascular response to mental stress. This study examined whether Type D personality, characterized by social inhibition and negative affectivity, is associated with an adverse cardiovascular response to a non-social and social evaluative threat. METHODS: A total of 2300 students were screened for Type D personality, and 130 were selected for a nonsocial stress exposure condition (31 Type D, 30 non-Type D: 52% female) or a condition high in social evaluative threat (35 Type D, 34 non-Type D: 55% female). Systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), and salivary cortisol were measured. RESULTS: Social evaluative threat resulted in higher cardiovascular responses than the nonsocial challenge (SBP, p = .001, η = 0.092;DBP, p = .006, η = 0.058;HR, p = .006, η = 0.059). The greatest cardiovascular stress reactions were exhibited by Type D participants in the high social evaluation condition; reflected in significant group by condition interactions for SBP (F(1,126) = 7.29, p = .008, η = 0.055), DBP (F(1,126) = 5.23, p = .024, η = 0.040), and HR (F(1,126) = 5.04, p = .027, η = 0.038) reactivity. Only Type Ds in the social condition mounted a positive cortisol response (F(1,33) = 5.07, p = .031, η = 0.133). CONCLUSIONS: Type D individuals show different stress reactions depending on the social evaluative nature of the stress exposure. These findings suggest that dysregulation of the stress response in social situations potentially increases cardiovascular disease risk.

Evaluation of a Pharmacist-Specific Intervention on 30-Day Readmission Rates for High-Risk Patients with Pneumonia.

BACKGROUND: Pharmacist interventions have been shown to have an impact on reducing readmission rates, however further research is necessary to target resources to high-risk populations and determine the most effective bundle of interventions. OBJECTIVE: To evaluate the effect of a pharmacist-bundled intervention on 30-day readmission rates for high-risk patients with pneumonia. METHODS: A pilot study with a historical control conducted at a community, teaching-affiliated medical center. Up to 65 selected subjects were included if they had pneumonia and any of the following high-risk criteria: admission within 6 months, at least 5 scheduled home medications, chronic obstructive pulmonary disease (COPD), or heart failure. A retrospective chart review was conducted to compile the historical control group that received usual care between June and November 2013. Patients admitted from December 2013 through March 2014 were reviewed to receive a bundled intervention. The primary outcome was 30-day readmission rates. Risk factors and reasons for readmission, pharmacist clinical interventions, and the time interval between discharge and readmission were also evaluated. RESULTS: A trend toward a reduced 30-day readmission rate was observed in the intervention group (n = 43) compared to those who received usual care (n = 65) (27.9% vs 40.0%; relative risk [RR], 0.6977; 95% CI, 0.3965-1.2278; P = .2119). The most commonly identified high-risk inclusion criteria were having at least 5 scheduled home medications and COPD. The time interval between discharge and readmission did not considerably differ between groups (10.8 vs 10.6 days). CONCLUSIONS: The pharmacist-bundled intervention was associated with a reduced 30-day readmission rate for high-risk patients with pneumonia.

The association between spirituality and depression in parents caring for children with developmental disabilities: social support and/or last resort.

Associations between spirituality and depression were examined in parents of children with developmental disabilities using both quantitative and qualitative methodology. Spirituality was positively associated with depression, whereas social support was negatively related; parents with higher spiritual beliefs and lower levels of support had higher depression scores. Themes emerging from interviews were spiritual/religious coping as a way of dealing with difficulty, as a last resort, and as a form of release from their situation. Associations between spirituality and depression in these parents are more complex than previously thought.

Bereavement reduces neutrophil oxidative burst only in older adults: role of the HPA axis and immunesenescence.

BACKGROUND: The effect of the chronic stress of bereavement on immunity is poorly understood. Previous studies have demonstrated negative effects on immunity in older adults, and those who report higher depressive symptoms. The aim of the present study was to compare the effect of bereavement on neutrophil function in healthy young and old adults, also assessing serum levels of the stress hormones, cortisol and dehydroepiandrosterone sulphate (DHEAS). 41 young (mean age 32 years) and 52 older adults (mean age 72 years), bereaved and non-bereaved, took part in the study. They completed questionnaires on socio-demographic and health behaviour characteristics, as well as psychosocial variables, and provided a blood sample for analysis of neutrophil function (phagocytosis and reactive oxygen species (ROS) production) and stress hormone analysis. RESULTS: Bereaved participants in both age groups reported more symptoms of depression and anxiety than controls and scored moderately highly on bereavement-specific questionnaires for these symptoms. Despite this, young bereaved participants showed robust neutrophil function when compared to age-matched non-bereaved controls, and comparable stress hormone levels, while reduced neutrophil ROS production and raised stress hormone levels (cortisol:DHEAS ratio) were seen in the older bereaved group compared to their age-matched controls. CONCLUSIONS: Reduced neutrophil function among older bereaved participants may be the result of the inability to maintain stress hormone balance, specifically the cortisol:DHEAS ratio.

Evidence of a synergistic association between heart rate, inflammation, and cardiovascular mortality in patients undergoing coronary angiography.

AIMS: Both elevated inflammatory activity and sustained tachycardia reflect unfavourable cardiovascular risk profiles, and there is evidence to suggest the deleterious effects of inflammation are amplified by increased heart rate. The purpose of this study was to assess the interaction between resting heart rate and inflammation in cardiovascular mortality. METHODS AND RESULTS: A total of 3267 patients (2283 men), aged 18-95 years, scheduled for coronary angiography, were followed prospectively. By principle component analysis, we developed an overall multi-marker index of inflammation weighting the respective coefficients of five inflammatory markers including: interleukin-6, C-reactive protein, serum amyloid A, neutrophils, and fibrinogen. Cox proportional hazard regression models were employed to evaluate the relationship between inflammation and heart rate with cardiovascular mortality. Across 29,940 person years of follow-up, there were 546 (17%) deaths due to cardiovascular disease (CVD). Significantly, we observed a strong synergistic effect of inflammatory activity and concurrent elevated heart rate. For CVD mortality, patients in the highest quartile of inflammation had an adjusted hazard ratio (95% confidence interval) of 1.84 (1.31-2.57), P < 0.0001 if their resting heart rate was <75 b.p.m. Substantially, patients had a greater adjusted HR of 7.50 (3.21-17.50), P < 0.0001 if their resting heart rate was ≥75 b.p.m. CONCLUSION: The present analyses underline elevated inflammation as a risk factor for cardiovascular mortality. The effects of inflammation appeared to be strongly amplified by a faster resting heart rate. If confirmed by additional studies, this association may prove a useful adjunct for therapeutic approaches to alleviate symptoms and prolong survival.

Physical activity, life events stress, cortisol, and DHEA: preliminary findings that physical activity may buffer against the negative effects of stress.

The present study examined the relationship between habitual physical activity, life events stress, the diurnal rhythms of cortisol and DHEA, and the cortisol:dehydroepiandrosterone (DHEA) ratio in older adults. Thirty-six participants aged ≥ 65 reported their habitual physical activity, and indicated if a particular event happened to them in the past year (stress incidence) and how stressful they perceived the event to be (stress severity). Older adults with higher stress severity demonstrated a significantly higher cortisol:DHEA ratio. Individuals with higher stress incidence scores and who did not participate in aerobic exercise had a significantly higher cortisol:DHEA ratio and flatter DHEA diurnal rhythm compared with those who regularly participated in aerobic exercise. In conclusion, life events stress may have a negative impact on the cortisol:DHEA ratio in older adults. Under conditions of high stress exposure, exercise may protect older adults from an increased cortisol:DHEA ratio and flatter DHEA diurnal rhythm.

A randomized controlled trial of a cognitive behavioural patient education intervention vs a traditional information leaflet to address the cardiovascular aspects of rheumatoid disease.

OBJECTIVES: Cardiovascular disease (CVD) is responsible for 50% of the excess mortality for patients with RA. This study aimed to evaluate a novel 8-week cognitive behavioural patient education intervention designed to effect behavioural change with regard to modifiable CVD risk factors in people with RA. METHODS: This was a non-blinded randomized controlled trial with a delayed intervention arm. Participants were randomly assigned to receive the cognitive behavioural education intervention or a control information leaflet at a ratio of 1:1. The primary outcome measure was patient's knowledge of CVD in RA; secondary measures were psychological measures relating to effecting behaviour change, actual behaviour changes and clinical risk factors. Data were collected at baseline, 2 and 6 months. RESULTS: A total of 110 participants consented (52 in the intervention group and 58 in the control group) to participate in the study. At 6 months, those in the intervention group had significantly higher knowledge scores (P < 0.001); improved behavioural intentions to increase exercise (P < 0.001), eat a low-fat diet (P = 0.01) and lose weight (P = 0.06); and lower mean diastolic blood pressure by 3.7 mmHg, whereas the control group's mean diastolic blood pressure increased by 0.8 mmHg. There was no difference between the groups on actual behaviours. CONCLUSIONS: Patient education has a significant role to play in CVD risk factor modification for patients with RA, and the detailed development of this programme probably contributed to its successful results. It is disappointing that behaviours, as we measured them, did not change. The challenge, as always, is how to translate behavioural intentions into action. Larger studies, powered specifically to look at behavioural changes, are required. Trial registration. National Institute for Health Research, UKCRN 4566.

Do symptoms of depression predict telomere length? Evidence from the west of Scotland twenty-07 study.

OBJECTIVE: Psychological factors such as the stress of caregiving are emerging as predictors of telomere length, an index of biological aging. However, although lifetime major depressive disorder is associated with shorter telomeres, less is known about depressive symptoms. Depression and depressive symptoms are associated with a range of morbidities and mortality, but the extent to which they predict biological aging is unclear. The present study examined participants in the West of Scotland Twenty-07 Study across three age cohorts and four waves of data collection from 1992/1993 to 2007/2008. METHODS: Participants were 37, 57, and 76 years old at final data collection. Depressive symptoms were measured using the Hospital Anxiety and Depression Scale at each time point. Telomere length was assessed from 1063 blood samples collected at the final wave in 2007/2008 for respondents who also had depression data. RESULTS: Average depression symptoms (ß= -.12, p = .047) and their change over time (ß = -.12, p = .031) were negatively associated with telomere length, but only in the youngest cohort. Depressive symptoms were not cross sectionally associated with telomere length in 2007 to 2008 (ß= -.03, p = .45). In the youngest cohort only, depressive symptoms assessed in 1995 to 1997 and 2000 to 2004 were associated with shorter telomere length (ß = .14 [p = .046] and ß = .18 [p = .012], respectively), but not 1992 to 1993 or 2007 to 2008; associations in the middle- and older-aged cohorts were nonsignificant. CONCLUSIONS: Depressive symptoms are longitudinally associated with shorter telomere length, but only in younger adults.

Depression following hip fracture is associated with increased physical frailty in older adults: the role of the cortisol: dehydroepiandrosterone sulphate ratio.

BACKGROUND: Hip fracture in older adults is associated with depression and frailty. This study examined the synergistic effects of depression and hip fracture on physical frailty, and the mediating role of the cortisol:dehydroepiandrosterone sulphate (DHEAS) ratio. METHODS: This was an observational longitudinal study of patients with a hip fracture carried out in a hospital setting and with follow up in the community. Participants were 101 patients aged 60+ years (81 female) with a fractured neck of femur. Measurements of the ability to carry out activities of daily living (ADL), cognitive function, physical frailty and assays for serum cortisol and DHEAS were performed six weeks and six months post-hip fracture. Depressed and non-depressed groups were compared by ANOVA at each time point. RESULTS: Hip fracture patients who developed depression by week six (n = 38) had significantly poorer scores on ADL and walking indices of frailty at both week six and month six, and poorer balance at week six. The association with slower walking speed was mediated by a higher cortisol:DHEAS ratio in the depressed group. CONCLUSION: Depression following hip fracture is associated with greater physical frailty and poorer long term recovery post-injury. Our data indicate that the underlying mechanisms may include an increased cortisol:DHEAS ratio and suggest that correcting this ratio for example with DHEA supplementation could benefit this patient population.

Cardiovascular and cortisol reactions to acute psychological stress and adiposity: cross-sectional and prospective associations in the Dutch Famine Birth Cohort Study.

OBJECTIVE: In recent analyses of data from a large community sample, negative cross-sectional and prospective associations between cardiac stress reactivity and obesity were observed. The present study reexamined the association between cardiovascular reactivity and adiposity in the Dutch Famine Birth Cohort, with the additional aim of examining the association between cortisol reactivity and adiposity. METHODS: Blood pressure, heart rate, and salivary cortisol were measured at rest and in response to standard laboratory stress tasks in 725 adults. Height, weight, waist-and-hip circumference, and skinfold thickness were measured. Between 4 to 7 years later, 460 participants reported current height and weight. Obesity was defined as a body mass index of 30 kg/m(2) or higher. RESULTS: Those with a greater body mass index (ß = -0.39 beats per minute (bpm)), waist-to-hip ratio (ß = -0.15 bpm), and triceps and subscapular skinfold thicknesses (ß = -1.0 and -1.8 bpm) or who were categorized as obese (-3.9 bpm) displayed smaller cardiac reactions to acute stress (all p < .001). With the exception of waist-to-hip ratio, the same negative associations emerged for cortisol reactivity (all p ≤ .01). In prospective analyses, low cardiac reactivity was associated with an increased likelihood of becoming or remaining obese in the subsequent 4 to 7 years (odds ratio = 1.03, p = .01). All associations withstood adjustment for a range of possible confounders. CONCLUSIONS: The present analyses provide additional support for the hypothesis that it is low not high cardiac and cortisol stress reactivity that is related to adiposity.

Anti-TNFα therapy transiently improves high density lipoprotein cholesterol levels and microvascular endothelial function in patients with rheumatoid arthritis: a pilot study.

BACKGROUND: Rheumatoid arthritis (RA) is associated with increased morbidity and mortality from cardiovascular disease (CVD). This can be only partially attributed to traditional CVD risk factors such as dyslipidaemia and their downstream effects on endothelial function. The most common lipid abnormality in RA is reduced levels of high-density lipoprotein (HDL) cholesterol, probably due to active inflammation. In this longitudinal study we hypothesised that anti-tumor necrosis factor-α (anti-TNFα) therapy in patients with active RA improves HDL cholesterol, microvascular and macrovascular endothelial function. METHODS: Twenty-three RA patients starting on anti-TNFα treatment were assessed for HDL cholesterol level, and endothelial-dependent and -independent function of microvessels and macrovessels at baseline, 2-weeks and 3 months of treatment. RESULTS: Disease activity (CRP, fibrinogen, DAS28) significantly decreased during the follow-up period. There was an increase in HDL cholesterol levels at 2 weeks (p < 0.05) which was paralleled by a significant increase in microvascular endothelial-dependent function (p < 0.05). However, both parameters returned towards baseline at 12 weeks. CONCLUSION: Anti-TNFα therapy in RA patients appears to be accompanied by transient but significant improvements in HDL cholesterol levels, which coexists with an improvement in microvascular endothelial-dependent function.

Aging, health behaviors, and the diurnal rhythm and awakening response of salivary cortisol.

UNLABELLED: BACKGROUND/STUDY CONTEXT: The cortisol diurnal rhythm has previously been examined in relation to age and health behaviors. However, less is known about the relationship between multiple health behaviors and diurnal cortisol in the context of aging, where it is possible that the impact of health behaviors on cortisol varies as a function of age. This study compared the awakening response and diurnal rhythm of cortisol in young versus older adults in relation to health behaviors. METHODS: Twenty-four young students (aged 18-22) and 48 community-dwelling older adults (aged 65-88) completed an assessment of health behaviors (exercise, smoking, sleep, diet, alcohol) over the past year. Salivary cortisol was measured over the course of 1 day: immediately upon awakening, 30 min later, and then 3, 6, 9, and 12 h post awakening. Repeated measures/univariate analysis of variance (ANOVA) was used to test main effects of age and health behaviors, and any interaction effects in relation to diurnal cortisol. RESULTS: Older adults displayed significantly reduced cortisol upon awakening, a lower cortisol awakening response, and a flatter diurnal profile represented by a reduced area under the curve and cortisol slope. There was also a significant interaction of age, cortisol, and diet; younger adults with a higher fat and lower fruit and vegetable intake exhibited the flattened diurnal cortisol phenotype of the older adults. CONCLUSION: These findings suggest that the diurnal rhythm and awakening response of salivary cortisol is significantly reduced in older adults and that variations in the cortisol diurnal rhythm of younger adults are associated with dietary factors. Younger adults with a poor quality of food intake may be vulnerable to a reduction in the amplitude of the cortisol diurnal profile and this may have implications for other aspects of health.

Low cognitive ability in early adulthood is associated with reduced lung function in middle age: the Vietnam experience study.

OBJECTIVE: Reduced lung function has been linked to poorer cognitive ability later in life. In the present study, the authors examined the converse: whether there was a prospective association between cognitive ability in early adulthood and lung function in middle age. METHODS: Participants were 4256 male Vietnam-era US veterans. Cognitive ability was assessed by the Army General Technical Test on enlistment when participants were, on average, 20 years old (range: 17-34). Data on ethnicity and place of service were extracted from army files. Smoking behaviour, alcohol consumption, basic socio-demographics and whether participants had a physician-diagnosed chronic disease were determined by telephonic interview in middle age in 1985. Forced expiratory volume in one second (FEV(1)) was measured by spirometry at a 3-day medical examination in 1986. Height and weight were also measured. RESULTS: In linear regression models, poor cognitive ability in early adulthood was associated with reduced lung function in middle age, first adjusting for age and height, ß=0.17, p<0.001, then additionally adjusting for circumstantial, socio-demographic, lifestyle and health factors, ß=0.12, p=0.001. The same results were obtained when the analysis was confined to non-smokers. CONCLUSION: Not only is lung function related to subsequent cognitive ability, but poor cognitive ability earlier in life is also associated with reduced lung function in middle age.

Cardiovascular education for people with rheumatoid arthritis: what can existing patient education programmes teach us?

Patient education is an integral component of the management of chronic diseases. Education programmes designed for people with RA have historically aimed to improve their arthritis symptoms and outcomes. Novel educational material is required to address significant comorbidities, particularly cardiovascular disease (CVD) associated with RA. We appraise the components of education programmes incorporated in disease management in people with RA and programmes used for CVD prevention in the general population, including their design and delivery, use of behaviour theory, evaluation and long-term efficacy. We then integrate the findings in order to inform the development of educational material specifically addressing CVD in RA. This approach may be useful for other major comorbidities of RA as well as other musculoskeletal conditions.

Vascular function and morphology in rheumatoid arthritis: a systematic review.

OBJECTIVES: RA associates with significantly increased morbidity and mortality from cardiovascular disease (CVD). This may be due to complex interactions between traditional CVD risk factors, systemic rheumatoid inflammation and the vasculature. We reviewed the current literature to answer: (i) whether there is sufficient evidence that patients with RA have altered vascular function and morphology compared with normal controls; (ii) whether there is sufficient evidence to determine if such changes relate predominantly to systemic inflammation; and (iii) whether any changes of vascular function and morphology in RA can be modified with therapy. METHODS: The MEDLINE database was searched to identify publications from 1974 to 1 November 2010 pertaining to vascular function and morphology in RA. The total number of articles included in the present review was 93. This included 57 cross-sectional studies, 27 longitudinal studies without randomization and 9 longitudinal studies with randomization. RESULTS: Vascular function and morphology was impaired in RA relative to healthy controls. The majority of studies reported no associations between systemic inflammation and vascular function. Treatment with anti-inflammatory medication resulted in both transient and long-term improvements in the vasculature, but only a few studies reported associations between change in inflammation and change in vascular function and morphology. CONCLUSION: The link between systemic inflammation and vascular function and morphology is not wholly supported by the available literature. Long-term studies examining specific predictors (including CVD risk factors) on the vasculature in RA are needed.

Blood pressure reactions to acute mental stress and future blood pressure status: data from the 12-year follow-up of the West of Scotland Study.

OBJECTIVE: To test the reactivity hypothesis using blood pressure data collected 12 years after baseline. This study examined whether blood pressure reactions to acute mental stress predicted future blood pressure resting levels, as well as the temporal drift in resting blood pressure, and whether the prediction was affected by sex, age, and socioeconomic status. METHODS: Resting blood pressure was recorded at an initial baseline and in response to a mental stress task. Twelve years later, resting blood pressure was again assessed. Data were available for 1196 participants (645 women, 551 men), comprising, at the time of stress testing, 439 who were aged 24 years; 503, aged 44; and 254, aged 63. The participants included 531 who were from manual occupational households and 661 from nonmanual occupational households. RESULTS: In multivariate linear regression models, adjusting for a number of potential confounders, systolic blood pressure (SBP) reactivity positively predicted future resting SBP, as well as the upward drift in SBP over the 12 years (ß = 0.10, p < .001 in both cases). The effect sizes were smaller than those reported from an earlier 5-year follow-up. The analogous associations for diastolic blood pressure reactivity were not statistically significant. In multivariate logistic regression, high SBP reactivity was associated with an increased risk of being hypertensive 12 years later (odds ratio = 1.03, 95% confidence interval = 1.01-1.04, p < .001). CONCLUSIONS: The present findings that greater reactivity is associated with higher future resting blood pressure, more upward drift in resting blood pressure, and future hypertension provide support for the reactivity hypothesis.

Generalized anxiety disorder is associated with reduced lung function in the Vietnam Experience Study.

BACKGROUND: There is no clear consensus in the few studies to have explored the relationship between major mental health disorders and lung function. The present study examined the cross-sectional associations of generalized anxiety disorder (GAD) and major depressive disorder (MDD) with lung function in a large study of male US veterans. METHODS: Participants (N = 4256) were drawn from the Vietnam Experience Study. From military files, telephone interviews, and a medical examination, anthropometric, sociodemographic, and health data were collected. One-year prevalence of GAD and MDD was determined using DSM-III criteria. Forced expiratory volume in 1 second was measured by spirometry. RESULTS: In models that adjusted for age and height, both GAD (p < .001) and MDD (p = .004) were associated with lower forced expiratory volume in 1 second. In models additionally adjusting for weight, place of service, ethnicity, marriage, smoking, alcohol consumption, income, education, and major illness, GAD was still associated with poorer lung function (p = .01), whereas MDD was not (p = .18). CONCLUSIONS: Depression has very much been the focus of studies on mental health and physical health status. The current findings suggest that future research should perhaps pay equal attention to GAD.

Cognitive ability in early adulthood is associated with systemic inflammation in middle age: the Vietnam experience study.

We examined the prospective association between cognitive ability in early adulthood and erythrocyte sedimentation rate, a marker of inflammation, in middle age. Participants were 4256 male Vietnam era US veterans. Data on cognitive ability, assessed by the Army General Technical Test, ethnicity, and place of service were extracted from enlistment files. Smoking behaviour, alcohol consumption, basic socio-demographics, and whether participants suffered from a physician diagnosed chronic disease were determined by telephone interview in middle-age in 1985. Erythrocyte sedimentation rate, cholesterol, blood pressure, height, and weight were measured at a 3-day medical examination in 1986. In linear regression models that adjusted for age and then additionally for circumstantial, socio-demographic, lifestyle, and health factors, poor cognitive ability in early adulthood was associated with greater erythrocyte sedimentation rate in middle age, ß=-.09. Thus, it would appear that not only does systemic inflammation influence cognition, but also that poor cognitive ability earlier in life is associated with inflammation in middle-age.