Faculty Equity, Diversity, Culture and Climate Change in Academic Medicine: A Longitudinal Study.

There is a national call for academic medicine to use evidence-based initiatives to improve its culture and climate. The authors report data-driven policy and programmatic interventions that were associated with increased faculty diversity, equity, respectful behavior and improved faculty climate, at UC San Diego Health Sciences. METHODS: Based on demographic and survey data, interventions were designed to improve the climate between 2005 and 2015. Interventions included routine measuring and dissemination of demographic data, changes and dissemination of policy and procedures, and new and improved faculty development programming. Impact was measured using demographic data over time, salary equity studies, and school-wide climate surveys in 2005, 2011, and 2015. Specific outcomes included measures of diversity, salary equity, behavior, and climate. RESULTS: Over the ten-year period, the proportion of women increased from 16% to 23% of tenure/tenure-track faculty and 31%-40% of all faculty. Underrepresented minority faculty increased from less than 1%-7% of tenure/tenure-track faculty and from 5% to 8% of all faculty. While women continued to be paid less than men, the adjusted difference dropped from 23% to 12%. Reports of inappropriate behavior by faculty decreased significantly, while satisfaction and knowledge about institutional mentoring and resources improved. CONCLUSION: Multiple interventions including new faculty development programs, changes in policy, and measuring demographics/climate supported diverse faculty recruitment, enhanced a culture of respect and improved faculty morale. Cultural changes in policy, periodic faculty data collection with dissemination, and increased faculty development, improve the climate in academic medicine.

The Culture of Academic Medicine: Faculty Behaviors Impacting the Learning Environment.

OBJECTIVE: The culture of academic medical institutions impacts trainee education, among many other faculty and patient outcomes. Disrespectful behavior by faculty is one of the most challenging and common problems that, left unattended, disrupts healthy work and learning environments. Conversely, a respectful environment facilitates learning, creates a sense of safety, and rewards professionalism. The authors developed surveys and an intervention in an effort to better understand and improve climate concerns among health sciences faculty at the University of California, San Diego (UCSD), a research-intense, public, academic medical center. METHODS: An online "climate survey" of all UC San Diego health sciences faculty was conducted in 2011-2012. A strategic campaign to address the behavioral issues identified in the initial survey was subsequently launched. In 2015, the climate was re-evaluated in order to assess the effectiveness of the intervention. RESULTS: A total of 478 faculty members (223 women, 235 men, 35 % of faculty) completed the baseline survey, reporting relatively low levels of observed sexual harassment (7 %). However, faculty reported concerning rates of other disruptive behaviors: derogatory comments (29 %), anger outbursts (25 %), and hostile communication (25 %). Women and mid-level faculty were more likely to report these behavioral concerns than men and junior or senior colleagues. Three years after an institutional strategy was initiated, 729 faculty members (50 % of the faculty) completed a follow-up survey. The 2015 survey results indicate significant improvement in numerous climate factors, including overall respectful behaviors, as well as behaviors related to gender. CONCLUSIONS: In order to enhance a culture of respect in the learning environment, institutions can effectively engage academic leaders and faculty at all levels to address disruptive behavior and enhance positive climate factors.

Serum 25-hydroxyvitamin D and breast cancer in the military: a case-control study utilizing pre-diagnostic serum.

PURPOSE: The objective of this study was to ascertain whether a relationship exists between pre-diagnostic serum levels of 25-hydroxyvitamin D (25(OH)D) and risk of breast cancer in young women. METHODS: About 600 incident cases of breast cancer were matched to 600 controls as part of a nested case-control study that utilized pre-diagnostic sera. Logistic regression was used to assess the relationship between serum 25(OH)D concentration and breast cancer risk, controlling for race and age. RESULTS: According to the conditional logistic regression for all subjects, odds ratios for breast cancer by quintile of serum 25(OH)D from lowest to highest were 1.2, 1.0, 0.9, 1.1, and 1.0 (reference) (p trend = 0.72). After multivariate regression for subjects whose blood had been collected within 90 days preceding diagnosis, odds ratios for breast cancer by quintile of serum 25(OH)D from lowest to highest were 3.3, 1.9, 1.7, 2.6, and 1.0 (reference) (p trend = 0.09). CONCLUSIONS: An inverse association between serum 25(OH)D concentration and risk of breast cancer was not present in the principal analysis, although an inverse association was present in a small subgroup analysis of subjects whose blood had been collected within 90 days preceding diagnosis. Further prospective studies of 25(OH)D and breast cancer risk are needed.

Is dairy product consumption associated with the incidence of CHD?

OBJECTIVE: Studies examining the association of dairy consumption with incident CHD have yielded inconsistent results. The current prospective study examined the association between dairy consumption and CHD in a population-based sample of older community-dwelling adults. DESIGN: Baseline CHD risk factors were assessed and an FFQ was self-administered. Participants were followed for morbidity and mortality with periodic clinic visits and annual mailed questionnaires for an average of 16?2 years, with a 96% follow-up rate for fatal and non-fatal CHD. SETTING: Community. SUBJECTS: Participants were 751 men and 1008 women aged 50­93 years who attended a clinic visit in 1984­1987. RESULTS: At baseline the mean age was 70.6 (SD 9.8) years for men and 70.1 (SD 9.3) years for women. Participants who developed CHD during follow-up were significantly older (P < 0.001), had higher BMI (P = 0.035) and higher total cholesterol (P = 0.050), and were more likely to be male (P < 0.001), diabetic (P = 0.011) and hypertensive (P < 0.001), than those who did not develop CHD. Multivariate regression analyses adjusting for age, BMI, diabetes, hypertension, LDL-cholesterol and oestrogen use (in women) indicated that women who consumed low-fat cheese 'sometimes/often' and women who consumed non-fat milk 'sometimes/often' had an increased risk of incident CHD (hazard ratio 52.32; 95% CI 1.57, 3.41) and CHD (hazard ratio 51.48; 95% CI 1.02, 2.16) compared with women who 'never/rarely' ate these dairy products. CONCLUSIONS: Woman with higher intake of low-fat cheese and non-fat milk seem to have a higher risk of incident CHD. This needs further investigation considering recent evidence of cardiovascular benefits from certain dairy fat.

The association of self-reported measures with poor training outcomes among male and female U.S. Navy recruits.

This prospective study evaluated the association of self-reported health habits and behaviors in 2,930 Navy recruits with poor training outcomes, defined as graduating late or separating from training. Although 17% of the men and 21% of the women had a poor training outcome, results suggest that some self-reported measures were associated with poor training outcomes. Men who did not run or jog at least 1 month before basic training or had a previous lower limb injury without complete recovery and women reporting the same or less physical activity compared with their same-age counterparts were more likely to have a poor training outcome. An important first step in decreasing poor training outcomes is encouraging incoming recruits to participate in physical activity and taking steps to identify and rehabilitate recruits who are not completely healed from a lower limb musculoskeletal injury before reporting to basic training.

A system-wide health sciences faculty mentor training program is associated with improved effective mentoring and institutional climate.

Introduction: Mentorship is critical for faculty success, satisfaction, and engagement. However, many faculty, particularly underrepresented racial/ethnic (UR) faculty, lack access to high-quality mentoring. In an effort to improve mentoring for all faculty, we developed and implemented a formally structured faculty mentor training program (FMTP) across UC San Diego Health Sciences, which included institutional support, mentorship training, and department/division mentorship programs. Methods: FMTP impact was evaluated using three primary outcome variables: mentoring quality, mentoring behaviors, and institutional climate. Participants' self-assessed mentoring competencies were measured using validated instruments. Results: A total of 391 (23%) of Health Sciences faculty participated in FMTP. Participation rate was higher for women than men (30% versus 17%) and highest for UR faculty (39%). FMTP was implemented in 16 of 19 departments. Self-reported mentoring improved for FMTP participants with mentoring quality (p = 0.009) and meeting mentees' expectations (p = 0.01) continuing to improve for up to 2 years after training. However, participants were unsure if they were meeting UR mentees' expectations. FMTP participants were significantly more satisfied with mentoring quality (p < 0.001) compared to non-participants, with the greatest increase in satisfaction reported by UR faculty (38-61%). UR faculty reported improved overall morale (51-61%) and a perception that the environment was supportive for UR faculty (48-70%). Conclusion: The implementation of a system-wide formal structured FMTP was associated with improved faculty satisfaction, quality of mentoring, and institutional climate, especially for UR faculty.

Estrogen therapy and bone mineral density in African-American and Caucasian women.

Controlling for body size and composition, the authors examined the association between estrogen therapy and bone mineral density in older African-American and Caucasian women. In 1992-1998, 443 African-American and 989 Caucasian women aged 45-87 years were assessed for medication use, laboratory variables, behavioral characteristics, and bone mineral density. The mean age was 61.3 (95% confidence interval: 60.3, 62.3) years in African Americans and 71.0 (95% confidence interval: 70.4, 71.7) years in Caucasians (P < 0.001). All measures of body size and composition were significantly greater in the African-American women compared with Caucasian women (P < 0.001). As expected, African Americans had significantly higher bone mineral density at all 4 sites independent of age, weight, body composition, estrogen use, and lifestyle factors. Although Caucasians were significantly more likely to currently use estrogen (48.9% vs. 33.9%; P < 0.001), African Americans not using estrogen had significantly higher bone mineral density at all sites except the spine than Caucasians who were using estrogen. Regression models including age and lean mass explained the most variation in bone mineral density (R(2) range = 0.13-0.37). Results suggest that higher levels of bone mineral density in African-American women were not due to estrogen use.

Birth weight and cognitive performance in older women: the Rancho Bernardo study.

Low birth weight is associated with poorer cognitive function from infancy through early adulthood, but little is known about low birth weight and cognitive performance in the elderly. This study examines the association of birth weight with cognitive function in community-dwelling older women. Participants were 292 community-dwelling women aged 55-89 (median = 71 years) who attended a 1988-91 clinic visit when cognitive function was assessed, and responded to a 1991 mailed questionnaire assessing birth weight. All analyses were adjusted for age and education. Birth weight ranged from 2 to 12 pounds (lbs; mean = 7.4 +/- 1.9). When birth weight was categorized into tertiles (2-6.9 lbs, 7-8 lbs, and 8.1-12.4 lbs), women in the lowest tertile had significantly lower ("poorer") scores on Serial 7's, a test of concentration and calculation (p < 0.05). Other birth weight categorizations (lowest quartile or quintile, or birth weight <5.5 lbs vs. 5.6-8.9 lbs and >or=9 lbs) did not improve the prediction of poor performance on Serial 7's. Birth weight as a continuous variable was significantly and positively associated with Serial 7's test scores (p = 0.04). Results suggest that small decrements in cognitive function tasks involving calculation may persist throughout life in women who were of relatively low birth weight. Although this association could be spurious, it deserves further evaluation.

Obesity and other cardiovascular disease risk factors and their association with osteoarthritis in Southern California American Indians, 2002-2006.

OBJECTIVE: Assess age and sex differences in the association of obesity and other CVD risk factors with osteoarthritis (OA) in Southern California American Indian/Alaska Native (AIAN) adults. DESIGN: Cross-sectional study. SETTING: Southern California. PARTICIPANTS: 6,299 AIAN adults aged 35+ years from health clinic system. MAIN OUTCOME MEASURES: Osteoarthritis prevalence. RESULTS: Age-adjusted OA prevalence was 16.5% in women and 11.5% in men. OA prevalence increased with age and was higher in women. Very and morbid levels of obesity were associated with higher OA prevalence in some age groups. Hypertension was strongly associated with increased OA and current smoking tended to be associated with increased OA. For men, we found no association between diabetes and OA; however, diabetes was associated with more OA for women aged 35-54 years. CONCLUSIONS: Southern California AIANs may have lower OA prevalence than the US population as a whole. Comparisons of OA prevalence with other AIAN communities were not possible due to lack of other similar published results. Further studies are needed to determine the impact of OA within this understudied minority population.

Sex and age differences in the association of obesity and smoking with hypertension and type 2 diabetes in Southern California American Indians, 2002-2006.

OBJECTIVE: Assess age and sex differences in the association of obesity and smoking with diabetes and hypertension and report the prevalence of these cardiovascular disease (CVD) risk factors in Southern California American Indian/Alaska Native (AlAN) adults. DESIGN: Cross-sectional study. SETTING: Visit data from 2002-2006 were extracted from one Southern California AlAN health clinic system. PARTICIPANTS: 10,351 AIAN adults visiting the health clinic system. MAIN OUTCOME MEASURES: Odds ratios were examined to assess the association of obesity and smoking with diabetes and hypertension and prevalence rates for obesity, smoking, diabetes, and hypertension were reported. RESULTS: Obesity (women: 53%, men: 55%), smoking (women: 16%, men: 18%), diabetes (women: 14%, men: 16%), and hypertension (women: 32%, men: 37%) were very prevalent. For women aged -35 years, increasing obesity was significantly associated with diabetes. For men aged -25 years, morbid obesity and smoking were significantly associated with diabetes for many age groups. Increasing overweight/obesity and smoking were associated with hypertension among adults aged 18-65 years. CONCLUSIONS: Southern California AIANs had higher obesity, diabetes, and hypertension prevalence than the general Southern California population, and higher obesity prevalence compared to other AIANs. Highly prevalent risk factors create a great burden, as CVD is the leading cause of death among AIAN adults. AIANs are diverse and need interventions tailored to cultural customs and health problems most prevalent in each tribal community.

PTSD prevalence, associated exposures, and functional health outcomes in a large, population-based military cohort.

OBJECTIVES: Posttraumatic stress disorder (PTSD) results from experiencing or witnessing traumatic, life-threatening events including combat-related experiences. The purpose of this study was to investigate the prevalence of PTSD symptoms and diagnosis, self-reported exposures, and functional health in a large cross-section of the U.S. military. METHODS: This study used baseline Millennium Cohort data (July 2001 to June 2003) of 75,156 U.S. military members to assess the population-based prevalence of PTSD symptoms, self-reported exposures, and functional health as measured by the Medical Outcomes Study Short Form 36-Item Health Survey for Veterans (SF-36V). RESULTS: PTSD diagnosis without current symptoms was reported by 953 respondents (1.2%, weighted), 1,490 respondents (2.1%, weighted) reported no diagnosis but reported PTSD symptoms, and 287 respondents (0.4%, weighted) reported diagnosis and current symptoms. Self-reported exposure to chemical or biological warfare agents, protective countermeasures, or hearing alarms were associated with PTSD symptoms independent of other combat-like exposures. Physical health was similar among those with PTSD diagnosis and current PTSD symptoms. However, compared with the overall cohort, lower mental health summary means for those reporting current PTSD symptoms (mean = 27.8), current symptoms and diagnosis (mean = 24.6), and diagnosis without current symptoms (mean = 47.5) were found. CONCLUSIONS: Results suggest a 2.0% prevalence of PTSD symptoms without diagnosis and that self-reported threatening exposures were significantly associated with PTSD symptoms. Mental and physical health scores of those with current PTSD symptoms appear diminished, but suggest a return to cohort levels with resolution of PTSD symptoms.

Suspected nonalcoholic fatty liver disease and mortality risk in a population-based cohort study.

OBJECTIVE: Case series suggest that nonalcoholic fatty liver disease (NAFLD) is associated with increased all-cause and cardiovascular mortality. The current study compared the survival of subjects with and without suspected NAFLD in a population-based cohort, and placed the finding in the context of previously published case series. METHODS: Primary analysis assessed mortality for NHANES-III participants with and without suspected NAFLD using the National Death Index. Suspected NAFLD was based upon unexplained ALT elevation. The Olmsted County and Cleveland Clinic case series were also used for comparison. Survivals were compared using Proportional Hazards Model and direct age standardization. RESULTS: The NHANES cohort included 980 with and 6,594 subjects without suspected NAFLD. Over a mean of 8.7 yr, suspected NAFLD had a hazards ratio of 1.37 (95% CI 0.98-1.91) for all-cause mortality. In the 45-54 age group, suspected NAFLD had significantly higher all-cause (4.40 95% CI 1.27-13.23) and cardiovascular mortality (8.15, 95% CI 2.00-33.20) after adjusting for conventional cardiovascular risk factors. The age-standardized rate per 10,000 per year was 129 (95% CI 118-140) for the NHANES non-NAFLD cohort, 154 (95% CI 116-198) for the NHANES suspected NAFLD cohort, 214 (95% CI 157-279) for the Olmsted County series, and 426 (95% CI 298-573) for the Cleveland Clinic series. CONCLUSION: The magnitude of mortality risk in NAFLD depends on the setting and method of ascertainment. Suspected NAFLD in the 45-54 age group is a strong independent risk factor for cardiovascular death and warrants further cardiovascular risk management guidelines.

Current smoking and type 2 diabetes among patients in selected Indian Health Service clinics, 1998-2003.

OBJECTIVES: In non-American Indian/Alaska Native groups, current smoking prevalence is similar for those with or without diabetes (26%) We analyzed current smoking prevalence in American Indian/Alaska Natives by diabetes status. METHODS: Data were extracted from Indian Health Service clinic visit information from 1998 to 2003. After consolidation into unique patient records, the sample comprised 71221 patients aged 14 years or older with both diabetes and current smoking information. RESULTS: Cross-sectional results indicated that diabetic American Indian/Alaska Natives were significantly more likely than those without diabetes to be current smokers (29.8% vs 18.8%; P<.01). Smoking rates were 2 to 3 times higher among diabetic American Indians and Alaska Natives for each age category (P<.001), and current smokers with diabetes were more likely than nonsmokers to have glycosylated hemoglobin A1c levels at 8.0% or higher (P <.05). CONCLUSIONS: American Indian/Alaska Natives with diabetes at all sites and age categories were found to smoke at significantly higher rates than those without diabetes. Smoking cessation programs should target diabetic patients to more effectively prevent complications and promote successful management of diabetes in American Indians/Alaska Natives.

Parental beliefs and children's receipt of preventive care: another piece of the puzzle?

OBJECTIVE: To examine whether parental beliefs about routine checkups are associated with children's receipt of timely preventive care. DATA SOURCES: The 2001 United Way Outcomes and Community Impact Program telephone survey of San Diego County, including 918 households with children between 3 and 19 years of age, where the respondent was the parent. STUDY DESIGN: Cross-sectional analyses examined the relationship between parental beliefs and children's receipt of routine checkups in the past year, using the expanded behavioral model of health services utilization. RESULTS: Approximately 81 percent of children received routine visits as recommended during the prior year. Parents' beliefs about the timing of routine checkups were strongly associated with their children's receipt of recommended routine care, after controlling for important covariates (odds ratio=2.85, 95 percent confidence interval=1.7-4.8). Other significant factors included the parent's educational level, whether the child had a regular source of care, and whether the child was sick in the past year. CONCLUSIONS: Multiple factors, including parental beliefs, influence whether children receive recommended routine care. Understanding the role of these factors may help explain why even insured children do not receive preventive health care as recommended, and can be used to target children most likely to lack regular preventive care.

Acetaminophen (paracetamol) use, measles-mumps-rubella vaccination, and autistic disorder: the results of a parent survey.

The present study was performed to determine whether acetaminophen (paracetamol) use after the measles-mumps-rubella vaccination could be associated with autistic disorder. This case-control study used the results of an online parental survey conducted from 16 July 2005 to 30 January 2006, consisting of 83 children with autistic disorder and 80 control children. Acetaminophen use after measles-mumps-rubella vaccination was significantly associated with autistic disorder when considering children 5 years of age or less (OR 6.11, 95% CI 1.42-26.3), after limiting cases to children with regression in development (OR 3.97, 95% CI 1.11-14.3), and when considering only children who had post-vaccination sequelae (OR 8.23, 95% CI 1.56-43.3), adjusting for age, gender, mother's ethnicity, and the presence of illness concurrent with measles-mumps-rubella vaccination. Ibuprofen use after measles-mumps-rubella vaccination was not associated with autistic disorder. This preliminary study found that acetaminophen use after measles-mumps-rubella vaccination was associated with autistic disorder.

Career experiences and perceptions of underrepresented minority medical school faculty.

BACKGROUND: Although studies have outlined the benefit of diversity in academic medicine, the number of underrepresented minority (URM) faculty remains low. In 1998, University of California, San Diego (UCSD) School of Medicine with the Hispanic Center of Excellence began a formalized proactive faculty development program. Over the past 10 years, recruitment and retention of URM junior faculty have increased. We undertook a study to explore factors associated with this improvement. METHODS: Semistructured interviews were conducted with 18 out of 26 URM and 12 out of 26 randomly chosen non-URM assistant and associate faculty members throughout 2005. Interview content, based on a conceptual framework from Joanne Moody, included career path, knowledge and experience with faculty development programs and perceived faculty standing. RESULTS: URM faculty were more likely than majority faculty (44% vs. 8%, p = 0.04) to mention the importance of a role model in choosing their career path. URM faculty participated in faculty development programs at a higher rate than majority faculty (78% vs. 17%, p < 0.001), were more likely to find out about programs through personal contact (94% vs. 42%, p = 0.001) and reported more personal contacts prior to participation (78% vs. 33%, p = 0.02). URM faculty were older, graduated earlier and were more likely hired into a staff position prior to faculty appointment (61% vs. 17%, p = 0.02). CONCLUSIONS: Academic medical centers may find competitive URM candidates in staff positions and alternative faculty tracks within their institution. Informing URM faculty often and personally about opportunities for faculty development may increase their participation in career development programs and improve retention.

Is radiographic vertebral fracture a risk factor for mortality?

Clinical fractures predict increased mortality risk, but few studies report mortality based on prevalent radiographically defined vertebral fracture. This study examined whether radiographically defined vertebral fracture is a risk factor for mortality in older adults. The 1,580 participants in California (631 men, 949 women) were aged > or =50 years in 1992-1996. Lateral spine radiographs, and information about medical history and behaviors, were obtained. Overall, 55 (8.7%) men and 123 (13%) women had at least one prevalent fracture at baseline; of these, 48 women and 14 men had two or more. Over 7.6 years, 460 participants died, 27.6% without and 41.0% with prevalent fractures (p < 0.001). Prevalent vertebral fracture was not associated with all-cause mortality in both sexes combined (adjusted hazard ratio = 1.09, 95% confidence interval: 0.84, 1.42) or sex-specific analyses (women: adjusted hazard ratio = 1.15, 95% confidence interval: 0.83, 1.59; men: adjusted hazard ratio = 0.89, 95% confidence interval: 0.55, 1.46). However, women with two or more prevalent fractures had increased risk of all-cause mortality (adjusted hazard ratio = 1.56, 95% confidence interval: 1.01, 2.40; p = 0.04). Women with any prevalent vertebral fractures also had increased mortality risk from "other" causes (adjusted hazard ratio = 1.59, 95% confidence interval: 1.03, 2.45; p = 0.04) but not cardiovascular disease or cancer. A single radiographic vertebral fracture is not a risk for mortality in older women; larger, longer studies of men and those with two or more radiographic vertebral fractures are needed.

U.S. military deployment during 2001-2006: comparison of subjective and objective data sources in a large prospective health study.

PURPOSE: Studies researching service members' health after deployment have relied on self-reported deployment history, although validity of these data remains unknown. This study compared self-reported and electronic deployment data and explored differences in functional health. METHODS: Self-reported and military deployment data were compared for more than 51,000 participants enrolled in the Millennium Cohort Study (2004-2006). Kappa statistics were used to measure agreement. Analysis of variance was used to assess functional health, as measured by the Medical Outcomes Study Short Form 36-Item Health Survey for Veterans (SF-36V). RESULTS: Of 51,741 participants who completed the initial deployment question, objective records and self-report agreed in 47,355 (92%). Agreement was substantial for deployment status, frequency, and number of deployments (kappa = 0.81, 0.71, and 0.61, respectively). Deployment start dates agreed within 1 month for 82% of participants confirmed as deployed once. Participants' Mental and Physical Component Summary scores from the SF-36V did not differ by agreement level. CONCLUSIONS: These findings indicate substantial agreement between self-reported and objective deployment information and no clinically meaningful differences in functional health for the small proportion with inconsistent deployment information. These findings should be reassuring to investigators who examine military deployment as a determinant of future health.

Walking decreased risk of cardiovascular disease mortality in older adults with diabetes.

OBJECTIVE: This study examines the association of walking with mortality in persons with type 2 diabetes compared to those with normal glucose tolerance. STUDY DESIGN AND SETTING: This prospective study included community-dwelling adults from the Rancho Bernardo Study aged 50-90 years in 1984-86 who had type 2 diabetes (n=347) or normal glucose tolerance (n=1,317). During the 10-year follow up, Cox proportional hazards modeling was used to model time until death from all causes (n=538), coronary heart disease (CHD, n=143), other cardiovascular disease (non-CHD CVD, n=138), and other causes (n=257) while adjusting for multiple potential confounders. RESULTS: After adjusting for sex, age, smoking, body mass index, alcohol, exercise, history of CHD, and other covariates, adults with diabetes who walked > or =1 mile per day were half as likely to die from all causes combined (hazard ratio [HR]=0.54; 95% confidence interval [CI]: 0.33, 0.88), and less than one-fifth as likely to die from non-CHD CVD (HR=0.19; 95% CI: 0.04, 0.86) compared to adults with diabetes who did not walk. Walking was also protective among adults with normal glucose tolerance (HR=0.55; 95% CI: 0.32, 0.96). CONCLUSION: Results suggest walking > or =1 mile per day may provide strong protection from all-cause and non-CHD CVD mortality in older adults with diabetes.

Premature graying, balding, and low bone mineral density in older women and men: the Rancho Bernardo study.

OBJECTIVE: The authors report the association of balding or graying with BMD in older adults. METHOD: BMD was measured at the spine, hip, and total body in 1,207 participants. Of these, 508 women and 380 men responded to a 1986 survey about balding patterns; in 1994, all participants answered questions about graying. RESULTS: Among men, 10.7% reported graying, and 51.1%, balding; 9.9% of women reported graying, and 9.5%, balding. Models were adjusted for age, body mass index, alcohol consumption, smoking, exercise, calcium supplements, diuretics, glucocorticoids, thyroid hormone, and estrogen. CONCLUSION: Graying was not significantly associated with BMD in either group. Balding men averaged 5% lower total body BMD (p