Relationship Between Sexual Orientation and Human Papillomavirus-Related Oral Cancer Knowledge and Awareness.

Purpose: Human papillomavirus (HPV)-related oral cancers are increasing, and lesbian, gay, bisexual, and other people with a minority sexual orientation may be disproportionately impacted. This study examined the relationship between sexual orientation and HPV-related oral cancer knowledge. Methods: Data from 10,859 adult participants in the 2017-2019 Health Information National Trends Survey 5, cycles 1-3, were obtained. The three data sets were merged, and weighted multiple imputation (n = 15) was applied to address missingness. Weighted logistic regression analyses examined differences in HPV-related oral cancer knowledge between sexual minority versus heterosexual participants by sex, after adjustment for race, ethnicity, age, education, income, insurance, regular medical provider, and smoking status. Results: In this weighted sample, age ranged from 18 to 101 years (mean = 56.3 years); 42% were males, 5.2% were sexual minority men/women, and 94.8% were heterosexual/straight. Overall, only 19% of respondents were aware that HPV can cause oral cancer. After controlling for sociodemographic factors, there were no significant differences in HPV-related oral cancer knowledge for sexual minority men (adjusted odds ratio [AOR]: 1.10; 95% confidence interval [95% CI]: 0.86-1.42) or women (AOR: 0.98; 95% CI: 0.76-1.26) compared with those who were heterosexual/straight. Conclusion: Overall, knowledge of HPV-related oral cancer was low, regardless of sexual orientation. There were no differences in HPV-related oral cancer knowledge between sexual minority men and women compared with their heterosexual counterparts. Educational programs are needed to increase awareness of the HPV/oral cancer link. Further research on differences in HPV-related oral cancer knowledge and attitudes by sexual orientation and the intersection of other demographic factors is warranted.

Human Papillomavirus Knowledge and Recommendation Practices Among Conference Attendees.

Purpose: The purpose of this cross-sectional study was to assess the American Academy of Pediatric Dentistry (AAPD) 2019 Annual Session attendees' knowledge, recommendation behaviors, and education regarding human papillomavirus (HPV) and HPV immunization. Methods: Conference attendees were recruited to complete a paper survey assessing demographic characteristics, education resources, HPV recommendation behaviors, and knowledge. Results: A total of 188 surveys were completed. The mean knowledge score was 7.7±1.6 (range equals zero to 10). Students/residents had the highest knowledge score (8.2±1.3; P=0.02). The statement, "Dentists should make HPV immunization recommendations," had strong agreement (3.8±0.9, range equals one to five) compared to discussing patient immunization status (2.2±1.2). The most utilized information source was personal knowledge (47.9 percent), and the least utilized were American Dental Association statements (8.5 percent). Conclusions: Participants agree dentists should make human papillomavirus immunization recommendations, but they prefer not to discuss patient immunization status. Interventions are needed to increase HPV knowledge by improving the uptake of formal organization statements.

Opportunities for Age-Specific Interprofessional Collaboration Between Physicians and Dentists in Pediatric Patients.

Purpose: The purpose of this study was to examine national data for trends in pediatric patient visits to dentists and physicians that may inform future interprofessional practice. Methods: Data for 95,677 children, aged zero to 17 years, captured between 2011 and 2012 from the National Survey of Children's Health were examined to compare the number of visits made to dentists and physicians at each year of age. Results: The average age was 8.9±5.2 (standard deviation) years; 28.6 percent were receiving Medicaid. Comparisons showed that, while physician visits were more common than dentist visits at younger ages, children aged nine years and older had more dentist visits than physician visits per year (P<0.001). Stratified analyses showed similar patterns in the frequency of physician and dentist visits within boys (P<0.001), girls (P<0.001), English speakers (P<0.001), and non-English speakers (P<0.001). Conclusions: Physicians have an opportunity to address oral health in younger children, and dentists have an opportunity to address systemic health for older children. For five-year-olds and younger, physicians should incorporate oral health evaluations and dentist-referrals. For nine-year-olds and older, dentists should provide counseling on healthy weight, nutrition, and human papillomavirus (HPV) vaccination; monitoring for diabetes and asthma; and screening for smoking, vaping, and sleep apnea.

Association of Race and Major Adverse Cardiac Events (MACE): The Atherosclerosis Risk in Communities (ARIC) Cohort.

BACKGROUND AND AIMS: To evaluate the association of self-reported race with major adverse cardiac events (MACE) and modification of this association by paraoxonase gene (PON1, PON2, and PON3) single nucleotide polymorphisms (SNPs). METHODS: Included in this longitudinal study were 12,770 black or white participants from the Atherosclerosis Risk in Communities (ARIC) cohort who completed a baseline visit (1987-1989) with PON genotyping. Demographic, behavioral, and health information was obtained at baseline. MACE was defined as first occurrence of myocardial infarction, stroke, or CHD-related death through 2004. Cox proportional hazards regression was used to evaluate the association between race and MACE after adjustment for age, gender, and other demographic and cardiovascular risk factors such as diabetes and hypertension. Modification of the association between PON SNPs and MACE was also assessed. RESULTS: Blacks comprised 24.6% of the ARIC cohort; overall, 14.0% of participants developed MACE. Compared with whites, blacks had 1.24 times greater hazard of MACE (OR = 1.24,95%CI = 1.10,1.39) than whites after adjusting for age, gender, BMI, cigarette and alcohol use, educational and marital status, and aspirin use. This association became nonsignificant after further adjustment for high cholesterol, diabetes, and hypertension. None of the evaluated SNPs met the significance level (p < 0.001) after Bonferroni correction for multiple comparisons. CONCLUSIONS: No association between race and MACE was identified after adjusting for high cholesterol, diabetes, and hypertension, suggesting that comorbidities are major determinants of MACE; medical intervention with focus on lifestyle and health management could ameliorate the development of MACE. Further studies are needed to confirm this observation.

Physical Activity and Trajectories of Cognitive Change in Community-Dwelling Older Adults: The Rancho Bernardo Study.

BACKGROUND: Although physical activity has been associated with better cognitive function and reduced dementia risk, its association with cognitive decline in normal aging remains uncertain. OBJECTIVE: To determine whether physical activity in youth and older age are associated with age-related cognitive change. METHODS: Over a period of 27 years, 2,027 community-dwelling adults (mean age 73.5; 60% women) of the Rancho Bernardo Study of Healthy Aging completed up to seven cognitive assessments, including tests of global cognitive function, executive function, verbal fluency, and episodic memory. At each visit, participants reported concurrent physical activity. At baseline (1988- 1992), participants additionally reported physical activity as a teenager and at age 30. For each age period, participants were classified as regularly active (3+ times/week) or inactive. RESULTS: Associations between concurrent physical activity and better cognitive function were stronger with advancing age on all tests, even after accounting for education, health, and lifestyle factors, as well as survival differences (ps < 0.05). Baseline physical activity did not predict rates of cognitive decline (ps > 0.40). Individuals who were physically active at age 30 and older age maintained the highest global cognitive function with advancing age (p = 0.002). CONCLUSION: Regular physical activity is associated with better cognitive function with advancing age. Physical activity in young adulthood may contribute to cognitive reserve, which together with physical activity in later years, may act to preserve cognitive function with age.

Effects of APOE on cognitive aging in community-dwelling older adults.

OBJECTIVE: The apolipoprotein E (APOE) gene is an established risk factor for sporadic Alzheimer's disease, with elevated risk for ε4-carriers and reduced risk for ε2-carriers. However, it is unclear whether APOE modifies risk for cognitive decline in normal aging. The objective of this study was to determine whether ε2 and ε4 are associated with rates of normal cognitive aging, and whether associations of ε4 with cognitive decline are modified by sex, education or health behaviors (exercise, alcohol consumption, smoking). METHOD: A community-based sample of 1,393 older adults were genotyped for APOE and underwent cognitive assessment up to seven times over a maximum of period of 27 years. RESULTS: ε2-carriers showed slower executive function decline with age relative to ε3 homozygotes or ε4-carriers, whereas ε4-carriers demonstrated more rapid executive function and verbal fluency decline. Accelerated executive function decline was particularly pronounced in ε4-carriers with lower education. After excluding individuals with cognitive impairment, faster executive function decline was still apparent in ε4-carriers, and the effect of ε4 on episodic memory interacted with alcohol consumption, such that only ε4-carriers who did not drink showed more rapid memory decline than ε4 noncarriers. The influence of ε4 on cognitive aging did not differ by sex, nor was it modified by smoking or exercise. CONCLUSIONS: These findings indicate that the ε2 and ε4 alleles have differential effects on cognitive aging, and that negative effects of ε4 may be partly mitigated by behavioral choices. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Association of the C-Reactive Protein Inflammatory Biomarker with Breast Cancer Incidence and Mortality in the Women's Health Initiative.

Purpose: To examine associations of prediagnosis high-sensitivity C-reactive protein (hsCRP) with breast cancer incidence and postdiagnosis survival and to assess whether associations are modified by body mass index (BMI).Methods: A prospective analysis of the Women's Health Initiative was conducted among 17,841 cancer-free postmenopausal women with baseline hsCRP measurements. Cox proportional hazards models were used to examine associations between hsCRP concentrations and (i) breast cancer risk (n cases = 1,114) and (ii) all-cause mortality after breast cancer diagnosis. HRs are per 1 SD in log hsCRP.Results: hsCRP was not associated with breast cancer risk overall [HR = 1.05; 95% confidence interval (CI), 0.98-1.12]; however, an interaction between BMI and hsCRP was observed (Pinteraction = 0.02). A 1 SD increase in log hsCRP was associated with 17% increased breast cancer risk (HR = 1.17; 95% CI, 1.03-1.33) among lean women (BMI < 25), whereas no association was observed among overweight/obese (BMI ≥ 25) women. Prediagnosis hsCRP was not associated with overall mortality (HR, 1.04; 95% CI, 0.88-1.21) after breast cancer diagnosis; however, an increased mortality risk was apparent among leaner women with higher hsCRP levels (HR, 1.39, 95% CI, 1.03-1.88).Conclusions: Prediagnosis hsCRP levels are not associated with postmenopausal breast cancer incidence or survival overall; however, increased risks are suggested among leaner women. The observed effect modification is in the opposite direction of a previous case-control study finding and warrants further investigation.Impact: Associations of higher CRP levels with incident breast cancer and survival after breast cancer may depend on BMI. Cancer Epidemiol Biomarkers Prev; 26(7); 1100-6. ©2017 AACR.

Dental vs. Medical Students' Comfort with Smoking Cessation Counseling: Implications for Dental Education.

The aim of this study was to determine if dental and medical students have similar feelings of professional responsibility, comfort, and confidence with counseling patients about smoking cessation during their clinical years. All third- and fourth-year osteopathic medical (N=580) and dental students (N=144) at Western University of Health Sciences were invited to participate in a survey in April-July 2014, either electronically or in person, regarding their perceived professional responsibility, comfort, and confidence in counseling smokers about quitting and major constraints against counseling smokers about quitting. Respondents' demographic characteristics, smoking history, and history of living with a smoker were also assessed. Response rates were 21% (124/580) for medical and 82% (118/144) for dental students. Most of the responding medical (99.2%) and dental (94.9%) students reported feeling it was their professional responsibility to counsel patients about smoking cessation. Medical student respondents were significantly more comfortable and confident counseling patients about smoking cessation than dental student respondents (p<0.001). Students in the third year were just as comfortable and confident counseling patients about smoking cessation as students in the fourth year (p>0.10). There were no differences by age, but students who were former smokers were significantly more comfortable and confident counseling about smoking cessation than were nonsmokers (p=0.001). While almost all of the responding students reported feeling responsible for counseling patients about smoking cessation, the medical students and former smokers were more comfortable and confident performing this counseling. These results suggest the need for additional training in counseling techniques for dental students and nonsmokers. Future studies should assess the impact of medical and dental students' smoking cessation counseling.

Optimism and Mortality in Older Men and Women: The Rancho Bernardo Study.

Purpose. To examine the associations of optimism and pessimism with all-cause, cardiovascular disease (CVD), coronary heart disease (CHD), and cancer mortality in a population-based sample of older men and women followed ≤12 years. Methods. 367 men and 509 women aged ≥50 from the Rancho Bernardo Study attended a 1999-2002 research clinic visit when demographic, behavioral, and medical history were obtained and completed a 1999 mailed survey including the Life Orientation Test-Revised (LOT-R). Mortality outcomes were followed through 2012. Results. Average age at baseline was 74.1 years; during follow-up (mean = 8.1 years), 198 participants died, 62 from CVD, 22 from CHD, and 49 from cancer. Total LOT-R, optimism and pessimism scores were calculated. Participants with the highest optimism were younger and reported less alcohol use and smoking and more exercise. Cox proportional hazard models showed that higher total LOT-R and optimism, but not pessimism scores, were associated with reduced odds of CHD mortality after adjusting for age, sex, alcohol, smoking, obesity, physical exercise, and medication (HR = 0.86, 95% CI = 0.75, 0.99; HR = 0.77, 95% CI = 0.61, 0.99, resp.). No associations were found for all-cause, CVD, or cancer mortality. Conclusions. Optimism was associated with reduced CHD mortality in older men and women. The association of positive attitudes with mortality merits further study.

Relation of Depressive Symptoms With Coronary Artery Calcium Determined by Electron-Beam Computed Tomography (from the Rancho Bernardo Study).

Studies linking depressive symptoms and coronary artery calcium (CAC), a measure of subclinical atherosclerosis, have yielded mixed results. No longitudinal studies of depressive symptoms and CAC have included older adults of both genders. This study examined the association of depressive symptoms with CAC and CAC progression in older men and women. Participants were 417 community-dwelling older adults (mean age = 67 ± 7) with no history of heart disease who attended a 1997 to 1999 research clinic visit when depressive symptoms were assessed using the Beck Depression Inventory (BDI). CAC was measured using electron-beam computed tomography in 2000 to 2002 and again in 2005 to 2007. Median BDI was 3, range = 0 to 37; 39% of men and 10% of women had severe CAC (Agatston score ≥ 400) in 2000 to 2002. Ordinal logistic regression analyses examining the odds of greater compared with lesser CAC severity by BDI quartiles showed an unexpected negative association whereby women with the lowest depressive symptoms had 2.4 times the odds of increasing CAC severity compared with women in the second BDI quartile (95% CI 1.1 to 5.4). A nonlinear, U-shaped association was observed in men with those in the first and fourth BDI quartiles having 2.6 and 3.0 times higher odds of increasing CAC severity than subjects in the second quartile (95% CI 1.2 to 5.6 and 1.3 to 6.9, respectively) after adjustment for coronary heart disease risk factors. No significant associations were observed for CAC progression although similar nonlinear patterns were observed in men. In conclusion, our results suggest that depressive symptoms have a gender-specific, cross-sectional association with CAC but no statistically significant associations with CAC progression.

The association of periodontal disease with kidney function decline: a longitudinal retrospective analysis of the MrOS dental study.

BACKGROUND: Identifying modifiable risk factors for chronic kidney disease (CKD) is essential for reducing its burden. Periodontal disease is common, modifiable and has been implicated as a novel potential CKD risk factor, but evidence of its association with kidney function decline over time is limited. METHODS: In a longitudinal retrospective cohort of 761 elderly men with preserved kidney function [estimated glomerular filtration rate > 60 mL/min/1.73 m(2) using a calibrated creatinine and cystatin C (eGFRcr-cys) equation] at baseline, we performed multivariable Poisson's regression to examine the association of severe periodontal disease with incident CKD, defined as incident eGFRcr-cys <60 mL/min/1.73 m(2) and rapid (>5% annualized) eGFRcr-cys decline. Severe periodontal disease was defined in two ways: (i) ≥5 mm proximal attachment loss in 30% of teeth examined (European Workshop in Periodontology Group C, European Workshop); and (ii) 2+ interproximal sites with attachment loss ≥6 mm and 1+ interproximal sites with probing depth ≥5 mm (Centers for Disease Control/American Academy of Periodontology, CDC/AAP). RESULTS: At baseline, the mean age was 73.4 (SD 4.8) years, the median eGFRcr-cys was 82.4 mL/min/1.73 m(2), and 35.5 and 25.4% of participants had severe periodontal disease by European Workshop and CDC/AAP criteria, respectively. After a mean follow-up of 4.9 years (SD 0.3), 56 (7.4%) participants had incident CKD. Severe periodontal disease was associated with a 2-fold greater rate of incident CKD [incidence rate ratio (IRR) 2.01 (1.21-3.44), P = 0.007] after adjusting for confounders compared with not severe periodontal disease by European Workshop criteria but did not reach statistical significance by CDC/AAP criteria [IRR 1.10 (0.63-1.91), P = 0.9]. CONCLUSIONS: Severe periodontal disease may be associated with incident clinically significant kidney function decline among a cohort of elderly men.

Body adiposity index as a risk factor for the metabolic syndrome in postmenopausal Caucasian, African American, and Filipina women.

AIMS: To investigate the utility of the body adiposity index (BAI) and its association with the metabolic syndrome (MetS) in older Caucasian (n=369), African American (n=336) and Filipina (n=275) women. METHODS: Dual energy X-ray absorptiometry, anthropometric measures, plasma glucose and medical history were assessed in 1993-1999. RESULTS: Despite smaller body size, 32.7% of Filipina women had higher MetS compared to African American and Caucasian women based on the National Cholesterol Education Program (NCEP) (32.7% vs 19.6% and 13.3%, respectively) or the International Diabetes Federation (IDF) (42.6% vs 33.0% and 18.7%, respectively ps<0.05). BAI had higher positive correlations with BMI, %body fat (%BF), and %truncal fat in Caucasian than African American and Filipina women. Adjusted for age, smoking, estrogen use, exercise, and alcohol intake, odds of the MetS (NCEP) were 2.08 (95%CI: 1.52-2.85) by BAI, 3.04 (95%CI: 2.11-4.38) by BMI, and 2.13 (95%CI: 1.52-3.00) by %BF for Caucasian women; 0.92 (95%CI: 0.69-1.23) by BAI, 1.44 (95%CI: 1.09-1.90) by BMI, and 1.12 (95%CI: 0.84-1.50) by %BF for African American women; and 1.14 (95%CI: 0.88-1.47) by BAI, 1.51 (95%CI: 1.15-1.97) by BMI, and 0.96 (95%CI: 0.74-1.25) by %BF for Filipinas. CONCLUSION: BAI was better able to assess adiposity in postmenopausal Caucasian women compared to African American and Filipina women. This index can distinguish ethnic differences in MetS confirmed by %BF.

Relation of serum uric acid to severity and progression of coronary artery calcium in postmenopausal White and Filipino women (from the Rancho Bernardo study).

Elevated serum uric acid (UA) is associated with cardiovascular disease (CVD) but its association with coronary artery calcium (CAC) is inconsistent. This study examined ethnic differences in the association of UA levels with CAC severity and progression. Participants included 202 white and 166 Filipino postmenopausal women without known CVD. White women originated from the Rancho Bernardo cohort study, whereas Filipino women were convenience sampled from comparable localities. Baseline UA levels and CVD risk factors were measured in 1995 to 1999. CAC was assessed by electron beam computed tomography (EBCT) in 2000 to 2002 (EBCT1) and repeated in 2005 to 2007 (EBCT2). EBCT1 CAC density scores were categorized by severity: minimal 0 to 10, mild 11 to 100, moderate 101 to 399, and severe ≥400. Progression was defined as CAC volume score increases of ≥2.5 mm3 between scans. White women were older at baseline than Filipinas (64.6 vs 59.3 years, p<0.001). Filipinas had increased UA levels (235.8 vs 294.2 µmol/L, p<0.001), diabetes (35.5% vs 5.2%, p<0.001), hypertension (69.6% vs 45.2%, p<0.001), and statin use (32.8% vs 18.7%, p=0.002). CAC severity did not vary by ethnicity (p=0.502), but Filipinas experienced more CAC progression than whites (53.0% vs 39.1%, p=0.016). Adjustment for CVD risk factors identified a positive association between UA levels and increasing CAC severity at EBCT1 in Filipinas (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.05 to 1.71) but not whites (OR 0.94, 95% CI 0.71 to 1.25). Higher UA levels predicted CAC progression in both cohorts (OR 1.26, 95% CI 1.02 to 1.56). In conclusion, these results support use of UA as an ethnicity-specific marker of CAC severity and as a marker of CAC progression among postmenopausal women.

The impact of pre-operative weight loss on incidence of surgical site infection and readmission rates after total joint arthroplasty.

This study characterized a cohort of obese total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients (1/1/2008-12/31/2010) and evaluated whether a clinically significant amount of pre-operative weight loss (5% decrease in body weight) is associated with a decreased risk of surgical site infections (SSI) and readmissions post-surgery. 10,718 TKAs and 4066 THAs were identified. During the one year pre-TKA 7.6% of patients gained weight, 12.4% lost weight, and 79.9% remained the same. In the one year pre-THA, 6.3% of patients gained weight, 18.0% lost weight, and 75.7% remained the same. In TKAs and THAs, after adjusting for covariates, the risk of SSI and readmission was not significantly different in the patients who gained or lost weight pre-operatively compared to those who remained the same.

Do patients lose weight after joint arthroplasty surgery? A systematic review.

BACKGROUND: The ability of patients with a total joint arthroplasty (TJA) to lose weight after surgery has been investigated in a few studies with inconsistent results. QUESTIONS/PURPOSES: We asked: (1) What is the quality of evidence of current published literature on postoperative weight trends for patients who have had a TJA? (2) Do patients lose any weight after TJA? (3) Do patients lose a clinically meaningful amount of weight after TJA? METHODS: We conducted a systematic review of PubMed and the Cochrane Library. Studies were summarized according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Studies were reviewed for quality of evidence and limitations according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Twelve studies were identified, one case-cohort study and 11 case series. Most studies were from single-surgeon or single-hospital series. Five studies included THAs and TKAs, four only THAs, and three only TKAs. We determined study type, level of evidence, inclusion criteria, procedures, proportion of patients who changed weight, body composition assessment, time of composition assessment, statistical analysis performed, and subgroup analysis conducted. RESULTS: Owing to the observational nature of the studies and the serious limitations identified, all were considered very low quality according to GRADE criteria. Studies reported 14% to 49% of patients had some weight loss at least 1 year postoperatively. CONCLUSIONS: We found no conclusive evidence that weight or body composition increases, decreases, or remains the same after TJA.

Elevated natriuretic peptide levels and cognitive function in community-dwelling older adults.

BACKGROUND: Natriuretic peptides have prognostic value across a wide spectrum of cardiovascular diseases and may predict cognitive dysfunction in patients with cardiovascular disease, even in the absence of previous stroke. Little is known about the association of natriuretic peptides with cognitive function in community-dwelling adults. We assessed the association between N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cognitive function in community-dwelling ambulatory older adults in the Rancho Bernardo Study. METHODS: We studied 950 men and women, aged 60 years and older, who attended a research clinic visit where a medical history and examination were performed, and blood for cardiovascular disease risk factors and NT-proBNP levels were obtained. Three cognitive function tests were administered: the Mini Mental State Examination (MMSE), Trail-Making Test B (Trails B), and Category Fluency. RESULTS: Participants with high NT-proBNP levels (≥450 pg/mL; n=198) were older and had a higher prevalence of coronary heart disease (12% vs 30%), and stroke (5% vs 11%; P≤.001 for both). In unadjusted analyses, all 3 cognitive function test scores were significantly associated with NT-proBNP levels (P<.001). After adjusting for age, sex, education, hypertension, body mass index, exercise, alcohol use, smoking, low density lipoprotein cholesterol, creatinine clearance, and previous cardiovascular disease, elevated NT-proBNP levels remained independently associated with poor cognitive performance on MMSE (odds ratio [OR] 2.0; 95% confidence interval [CI], 1.1-3.6; P=.02) and Trails B (OR 1.7; 95% CI, 1.2-2.7; P=.01), but not Category Fluency (OR 1.4; 95% CI, 0.9-2.2; P=.19). Results were unchanged after excluding the 6% of participants with a history of stroke. CONCLUSIONS: NT-proBNP levels were strongly and independently associated with poor cognitive function in community-dwelling older adults.

Insulin-like growth factor-I and cancer mortality in older men.

CONTEXT: Although numerous studies have explored the relation of IGF-I with cancer incidence, few have investigated the association between IGF-I and cancer mortality. OBJECTIVE: This study examined the association of serum IGF-I levels with cancer mortality in older community-dwelling men. DESIGN, SETTING, AND PARTICIPANTS: We conducted a prospective, population-based study of 633 men aged 50 yr and older (mean = 73) who attended a 1988-1991 research clinic visit when blood was obtained for measurement of IGF-I. Participants were followed for vital status through July 2006. MAIN OUTCOME MEASURE: All-cancer mortality was assessed. RESULTS: Median IGF-I was 96 ng/ml. During the 18-yr follow-up, 368 deaths occurred; 74 (20%) were due to cancer. Cox regression analyses showed a significant quadratic association between IGF-I and all-cancer mortality (P = 0.039). Higher levels of IGF-I were associated with progressively higher risk of cancer death after adjusting for age, IGF-binding protein-1, adiposity, exercise, current smoking, and previous cancer. The adjusted risk of cancer death was statistically significant for IGF-I levels above 120 ng/ml, with magnitudes of effect ranging from 1.61 [95% confidence interval (CI) = 1.28-2.02] to 2.61 (95% CI = 1.46-4.64). For the 46% of men with IGF-I above 100 ng/ml, the risk of fatal cancer was 1.82 (95% CI = 1.11-2.96) compared to the risk with lower levels. CONCLUSIONS: Higher serum IGF-I in older men is associated with increased risk of cancer death, independent of age, adiposity, lifestyle, and cancer history. These results suggest caution in the use of IGF-I-enhancing therapies to slow the adverse effects of aging.

Endogenous oestrogens predict 4-year decline in verbal fluency in postmenopausal women: the Rancho Bernardo Study.

OBJECTIVE: Despite overwhelming biological plausibility, evidence for a protective effect of oestrogen on cognitive function in postmenopausal women is inconsistent. This study examines the association between endogenous oestrogen levels and subsequent 4-year decline in cognitive function test performance in community-dwelling older women. DESIGN: Longitudinal cohort study. PARTICIPANTS: Three hundred and forty-three postmenopausal women (median age 70 years). MEASUREMENTS: Between 1984 and 1987, serum for measurement of sex hormones was obtained along with relevant covariates. Cognitive function was assessed in 1988-1991 and again in 1992-1996 using the Category Fluency test, the Mini-Mental Status Exam (MMSE) and Trail Making Test B (Trails B). RESULTS: Women in the highest tertile of oestrone and bioavailable oestradiol had respectively 1.75 (95% CI 1.02, 3.07) and 1.79 (95% CI 1.04, 3.10) higher odds of 4 year decline in Category Fluency, a test of frontal lobe function, compared to those in the lowest tertile, independent of age and education. The 20% of women with highest tertile levels of both oestrone and bioavailable oestradiol had a twofold higher odds of verbal fluency loss (OR = 2.17; 95% CI 1.21, 3.89). Adjustment for testosterone levels or for obesity-related factors associated with high endogenous oestrogens (higher body mass index, waist girth, and triglycerides and lower high-density lipoprotein cholesterol) did not alter results. Neither oestrogen was associated with change in MMSE or Trails B scores. CONCLUSIONS: Higher endogenous oestrogen levels were associated with a greater decline in verbal fluency in postmenopausal women. This association was not explained by elevated androgens or by obesity or obesity-related factors.

Treated hypothyroidism, cognitive function, and depressed mood in old age: the Rancho Bernardo Study.

OBJECTIVE: Overt hypothyroidism is associated with cognitive impairment, which can be reversed if treated early and appropriately. We compared cognitive function (CF) of euthyroid older adults with those who had long-term treated hypothyroidism. METHODS: Between 1999 and 2003, the CF of 885 euthyroid and 149 hypothyroid-treated older adults (primary hypothyroidism after surgery or autoimmune thyroid disease) was assessed using three standardized CF tests: the modified mini-mental state examination, Trails B, and verbal fluency. Depressed mood was assessed using the Beck Depression Inventory (BDI). Only participants with thyroid stimulating hormone (TSH) in the normal range were included. RESULTS: The treated hypothyroid group had been treated with l-thyroxine for an average of 20 years. Those with treated hypothyroidism were older than the euthyroid group (76.1+/-9.6 vs 73.6+/-10.2 years, P=0.005) and were much more often women (81.6 vs 54.8%, P<0.001). TSH levels were similar between groups (median interquartile range=1.57 (1.19) vs 1.54 (1.59) mIU/l, P=0.81). Compared to euthyroid, the treated hypothyroidism group had more frequent antidepressant medication use (19.5 vs 8.5%, P<0.001) but similar BDI scores. Performance on the three CF tests did not differ by thyroid hormone treatment. Results were not changed after adjustment for age, sex, antidepressant medication use, exercise, and total cholesterol. CONCLUSION: Long-term treated hypothyroidism is not associated with impaired CF or depressed mood in old age. The lack of association with CF is reassuring with regard to long-term use of thyroid hormone therapy.

Vasomotor symptoms and mortality: the Rancho Bernardo Study.

OBJECTIVE: The purpose of this study was to examine the associations of vasomotor symptoms with risk of all-cause, cardiovascular disease (CVD), and coronary heart disease (CHD) mortality in community-dwelling older women, with a mean age of 69 years. METHODS: This prospective population-based study included 867 postmenopausal women who provided lifestyle and menopause-related history at the 1984 to 1987 visit of the Rancho Bernardo Study and answered a 1989 mailed questionnaire on menopause and vasomotor symptoms. Ninety-eight percent were followed for vital status through July 2004. RESULTS: Overall, 73% reported hot flashes, of whom 39% also reported night sweats. During the 11.5-year average follow-up, there were 405 deaths, of which 194 were attributed to CVD and 71 to CHD. Hot flashes alone were not associated with all-cause mortality, but women who, in addition to hot flashes, also had night sweats had an almost 30% (hazard ratio [HR], 0.72; 95% CI, 0.55-0.94) lower all-cause mortality risk compared with women without this symptom, independent of body mass index, past or current use of estrogen or progestin, physical exercise, and smoking habit. There was a similar lower risk of CVD and CHD mortality in women with night sweats when adjusted for past or current use of estrogen or progestin (HR, 0.62; 95% CI, 0.42-0.92 and HR, 0.51; 95% CI, 0.26-0.99, respectively). These associations were independent of hormone use but were no longer significant after adjusting for body mass index, physical exercise, and smoking. CONCLUSIONS: Reported night sweats at menopause are associated with reduced risk of death over the following 20 years, independent of multiple risk factors including past or current use of postmenopausal estrogen therapy.