Health behaviours of teachers and other education professionals in France: can we do better?

Education professionals play a critical role in health education, both as knowledge providers and as role-models. Drawing on the CONSTANCES French cohort (baseline 2012-19) and adjusting for important confounders, we compared education professionals (n = 14 730) with a random sample of non-education sector employees (n = 34 244) on three indicators of high-risk behaviour (at-risk drinking, current smoking, past-year cannabis use) and three indicators of unhealthy lifestyle (low physical activity, poor adherence to nutritional guidelines, overweight/obesity). Among education professionals, we distinguished between teachers (n = 12 820), school principals (n = 372), senior education advisers (n = 189), school health professionals (n = 128) and school service staff (n = 1221). Compared with non-education sector employees with similar demographic and socioeconomic profiles, teachers were less likely to be at-risk drinkers, to smoke, to have used cannabis in the past year and to be overweight/obese. Other non-teaching education professionals were also less involved in high-risk behaviours than non-education employees, but results were more mixed concerning some lifestyle indicators, with certain non-teaching education professional groups showing a higher likelihood of being physically inactive or overweight/obese. In this nationwide French study, our results suggest a window of opportunity to promote school staff health but also indirectly, that of the youth with whom they interact daily. We suggest that school staff should be supported in health matters not only through the provision of health information but also most importantly, through the development of a favourable and supportive environment enabling them to put health knowledge into practice.

Education professionals play a crucial role in health education, notably as role-models, since they come into contact with students on a daily basis. Therefore, examining their health behaviours may be instructive. In this nationwide French study, teachers appeared to behave more healthily compared with non-education sector employees in important domains such as alcohol consumption or tobacco use. However, certain non-teaching education professional groups were more likely to be physically inactive or overweight/obese. Our results highlight opportunities for interventions aimed at raising health awareness and empowerment among school staff. A comprehensive health promotion approach integrating our findings would draw less on a vertical or top-down transfer of knowledge and depend more on participation and exchange among school staff, on teachers leading by example, as well as on the development of a supportive school environment.

Burnout symptomatology and social support at work independent of the private sphere: a population-based study of French teachers.

PURPOSE: To investigate the relationship between social support at work and burnout among teachers, independent of the teachers' private social and environmental context. METHODS: In the 2013 "Teachers' Quality of Life" population-based study (France, n = 2653), burnout symptomatology was assessed using the Maslach Burnout Inventory. The score for each dimension (emotional exhaustion, depersonalization and personal accomplishment) was dichotomized using extreme tertiles. Global score for social support at work, and subscores by source and type were derived from the Karasek Job Content Questionnaire and were categorized into tertiles (low, medium, and high). The private context was appraised through the "social relationships" and "environment" subscales of the short version of the World Health Organization Quality of Life Questionnaire. Associations between social support at work and burnout indicators were evaluated among 2473 teachers with complete data, using logistic regression models adjusted for the private context plus sociodemographic and work-related characteristics. RESULTS: Eight percent of the teachers showed simultaneously high emotional exhaustion, high depersonalization and low personal accomplishment symptoms and were considered as burnout cases. After controlling for the private context, teachers who reported high social support at work were significantly less likely to report burnout [odds ratio (95% confidence interval) high vs. low = 0.62 (0.40, 0.98)]. When distinguishing the source of social support at work, only high social support from supervisors remained significantly associated with a lower risk of burnout [0.43 (0.27, 0.71)]. CONCLUSIONS: Improving social support at work, especially from a hierarchical point of view, may be an effective target to promote teacher's well-being.

How do self and proxy dependency evaluations agree? Results from a large cohort of older women.

BACKGROUND: epidemiological studies based on questionnaires can face difficulties when collecting data on functional ability of older people, and may thus use a proxy to obtain or confirm data. It is therefore of importance to compare data from older people and from their proxies, to establish to what extent proxies' answers can be used as a substitute or a complement in epidemiological studies on dependency. OBJECTIVE: we evaluated agreement in dependency assessment, and identified factors associated with discrepancy between older people and proxy reports, in a large postal epidemiological survey. METHODOLOGY: autonomy of 5,164 community-dwelling women from the French E3N cohort study aged 75-83 was self- and proxy-evaluated with the instrumental activities of daily living (IADL) scales. Agreement was assessed using Cohen's Kappa coefficients, and factors associated with discrepancy were determined using logistic regression models. RESULTS: there was agreement between self and proxy dependency assessment in 90.8% of the women, with satisfactory Cohen's kappa. Discrepancy was associated with older age, poor self-reported health, prior low level of physical activity and the proxy being the partner. DISCUSSION: we found that a proxy could be a reliable source of dependency assessment in large epidemiological surveys, and that some characteristics of the older person and of the proxy could modulate the agreement between proxy- and self-dependency assessments.

What Levers to Promote Teachers' Wellbeing during the COVID-19 Pandemic and Beyond: Lessons Learned from a 2021 Online Study in Six Countries.

To highlight effective levers to promote teachers' wellbeing worldwide, particularly during difficult times such as the COVID-19 pandemic, we investigated work-related factors associated with teacher wellbeing, across borders and cultures. In six countries/territories, we examined the factors that were most consistently and strongly associated with two indicators of wellbeing at work: (i) job satisfaction; and (ii) work/life balance, and three indicators of general wellbeing: (i) subjective health; (ii) mental health; and (iii) life satisfaction. Between May and July 2021, after 18 months of the pandemic, 8000 teachers answered the first edition of the International Barometer of Education Personnel's Health and Wellbeing (I-BEST): 3646 teachers from France, 2349 from Québec, 1268 from Belgium, 302 from Morocco, 222 from The Gambia, and 215 from Mexico. For each country/territory and each wellbeing indicator, we used a forward stepwise regression procedure to identify important determinants among a carefully selected set of 31 sociodemographic, private, and professional life factors. Aside from healthcare access, the factors most consistently and strongly associated with teacher wellbeing in France, Québec and Belgium (samples whose size were ≥1000) were related to the psychosocial and the organizational dimensions of work, namely: feeling of safety at school, autonomy at work, and the quality of relationships with superiors and quality of relationships with students. In the smaller samples of teachers from the three remaining countries (Morocco, The Gambia and Mexico), exploratory analyses showed that the feeling of safety and autonomy at work were, there too, consistently associated with wellbeing indicators. During the COVID-19 pandemic, the factors most consistently associated with teachers' wellbeing across countries were related to security and autonomy at work, supporting the importance to consider these aspects in a continuous, structural way at school. Factors associated with teachers' wellbeing in very different contexts require further cross-cultural study.

Vigorous Physical Activity and Cognitive Trajectory Later in Life: Prospective Association and Interaction by Apolipoprotein E e4 in the Nurses' Health Study.

BACKGROUND: The apolipoprotein E (APOE) e4 allele is a well-established genetic risk factor of brain aging. Vigorous physical activity may be particularly important in APOE-e4 carriers, but data have been inconsistent, likely due to differences in the timing of the physical activity assessment, definition of cognitive decline, and/or sample size. METHODS: We prospectively evaluated the association between vigorous physical activity and cognition assessed at least 9 years later, according to APOE-e4 carrier status. Biennially from 1986, Nurses' Health Study participants reported their leisure-time physical activities. Starting in 1995-2001 and through 2008, participants (aged 70+ years) underwent up to 4 repeated cognitive telephone assessments (6 tasks averaged together using z-scores). RESULTS: Among 7252 women, latent process mixed models identified 3 major patterns of cognitive change over 6 years: high-stable, medium-stable, and decline. Taking the high-stable cognitive trajectory as the outcome reference in multinomial logistic regressions, highest tertile of vigorous physical activity (≥5.9 metabolic-equivalent [MET]-hours/wk) compared to lowest tertile (≤0.9 MET-hours/wk) was significantly associated with subsequent lower likelihood of the medium-stable trajectory in the global score (odds ratio [OR] [95% CI] = 0.72 [0.63, 0.82]), verbal memory (OR [95% CI] = 0.78 [0.68-0.89]), and telephone interview of cognitive status score (OR [95% CI] = 0.81 [0.70-0.94]). Vigorous physical activity was also associated with lower likelihood of decline in category fluency (OR [95% CI] = 0.72 [0.56, 0.92]). We observed some evidence (p-interaction = .07 for the global score) that the association was stronger among APOE-e4 carriers than noncarriers (OR [95% CI] = 0.60 [0.39, 0.92] vs 0.82 [0.59, 1.16]). CONCLUSION: Midlife vigorous physical activity was associated with better cognitive trajectories in women in their seventies, with suggestions of stronger associations among APOE-e4 carriers.

Teachers' Health: How General, Mental and Functional Health Indicators Compare to Other Employees? A Large French Population-Based Study.

Teachers' health is a key factor of any successful education system, but available data are conflicting. To evaluate to what extent teachers' health could be at risk, we used pre-pandemic data from the CONSTANCES population-based French cohort (inclusion phase: 2012-2019) and compared teachers (n = 12,839) included in the cohort with a random subsample selected among all other employees (n = 32,837) on four self-reported health indicators: perceived general health, depressive symptoms (CES-D scale), functional limitations in the last six months, and persistent neck/back troubles (Nordic questionnaire). We further restricted our comparison group to the State employees (n = 3583), who share more occupational similarities with teachers. Lastly, we focused on teachers and evaluated how their health status might differ across teaching levels (primary, secondary, and higher education). As compared to non-teacher employees, and even after adjusting for important demographic, socioeconomic, lifestyle, and occupational confounders, teachers were less likely to report bad perceived health and depressive symptoms but were more likely to present functional limitations. Trends were similar in the analyses restricted to State employees. Within the teaching population, secondary school teachers were more likely to report depressive symptoms but less frequently declared persistent neck/back troubles than primary school teachers. Our descriptive cross-sectional study based on a probability sampling procedure (secondary use of CONSTANCES inclusion data) did not support the idea that teachers' health in France was particularly at risk in the pre-pandemic period. Both cross-cultural and longitudinal studies are needed to further gain information on the topic of teachers' health around the world and to monitor its evolution over time, particularly during crises impacting the education system such as the COVID-19 pandemic.

Validation study of a French version of the modified telephone interview for cognitive status (F-TICS-m) in elderly women.

OBJECTIVE: To evaluate the performance of a French version of the modified Telephone Interview for Cognitive Status (F-TICS-m) in identifying cognitive decline among elderly women. METHODS: All women aged 72-86 participating in the 'Etude Epidémiologique auprès de Femmes de l'Education Nationale' (E3N) cohort and living in or near Paris constituted the target population of the validation study. Volunteer women (n = 120) underwent both a 20-min telephone interview and a face-to-face neuropsychological examination at an interval of few days (median interval: 10 days). The telephone interview included F-TICS-m, as well as a recall of key elements of a short story, arithmetic/verbal problems and two verbal fluency tests. Neuropsychological examination consisted of a standardized battery of cognitive tests (including the Mini-Mental State Examination (MMSE), the Free and Cued Selective Reminding Test-FCSRT, Trailmaking tests A and B, the similarities subtest of the Wechsler Adult Intelligence Scale-III, etc.) the Instrumental Activities of Daily Living questionnaire, and the Geriatric Depression Scale. Neuropsychological examination led to classification of each subject as cognitively normal (n = 92) or impaired/demented (n = 28). RESULTS: F-TICS-m showed satisfactory internal consistency (Cronbach's alpha = 0.69). It correlated linearly with MMSE (Pearson's r = 0.72). Concurrent validity against the gold-standard classification was satisfactory, with an area under the ROC curve (AUC) of 0.83. The combination of F-TICS-m and the other telephone tests had no additional effect on discrimination power in our sample (AUC = 0.81). CONCLUSION: F-TICS-m is a valid instrument for assessing the overall cognitive status of French elderly women. Its validity in men and its reproducibility warrant further studies.

Long-term association of food and nutrient intakes with cognitive and functional decline: a 13-year follow-up study of elderly French women.

The objective of the present study was to determine the potential long-term impact of dietary habits on age-related decline among 4809 elderly women (born between 1925 and 1930) in the 'Etude Epidémiologique de Femmes de la Mutuelle Générale de l'Education Nationale' (E3N) study, a French epidemiological cohort. In 1993, an extensive diet history self-administered questionnaire was sent to all participants, and in 2006 another questionnaire on instrumental activities of daily living (IADL) and recent cognitive change was sent to a close relative or friend of each woman. Logistic models adjusted for socio-demographic, lifestyle and health factors were performed to evaluate associations between habitual dietary intakes and two outcomes of interest based on the informant response: recent cognitive decline and IADL impairment. Recent cognitive decline was associated with lower intakes of poultry, fish, and animal fats, as well as higher intakes of dairy desserts and ice-cream. IADL impairment was associated with a lower intake of vegetables. The odds of recent cognitive decline increased significantly with decreasing intake of soluble dietary fibre and n-3 fatty acids but with increasing intake of retinol. The odds of IADL impairment increased significantly with decreasing intakes of vitamins B2, B6 and B12. These results are consistent with a possible long-term neuroprotective effect of dietary fibre, n-3 polyunsaturated fats and B-group vitamins, and support dietary intervention to prevent cognitive decline.

Voice disorders and mental health in teachers: a cross-sectional nationwide study.

BACKGROUND: Teachers, as professional voice users, are at particular risk of voice disorders. Among contributing factors, stress and psychological tension could play a role but epidemiological data on this problem are scarce. The aim of this study was to evaluate prevalence and cofactors of voice disorders among teachers in the French National Education system, with particular attention paid to the association between voice complaint and psychological status. METHODS: The source data come from an epidemiological postal survey on physical and mental health conducted in a sample of 20,099 adults (in activity or retired) selected at random from the health plan records of the national education system. Overall response rate was 53%. Of the 10,288 respondents, 3,940 were teachers in activity currently giving classes to students. In the sample of those with complete data (n = 3,646), variables associated with voice disorders were investigated using logistic regression models. Studied variables referred to demographic characteristics, socio-professional environment, psychological distress, mental health disorders (DSM-IV), and sick leave. RESULTS: One in two female teachers reported voice disorders (50.0%) compared to one in four males (26.0%). Those who reported voice disorders presented higher level of psychological distress. Sex- and age-adjusted odds ratios [95% confidence interval] were respectively 1.8 [1.5-2.2] for major depressive episode, 1.7 [1.3-2.2] for general anxiety disorder, and 1.6 [1.2-2.2] for phobia. A significant association between voice disorders and sick leave was also demonstrated (1.5 [1.3-1.7]). CONCLUSION: Voice disorders were frequent among French teachers. Associations with psychiatric disorders suggest that a situation may exist which is more complex than simple mechanical failure. Further longitudinal research is needed to clarify the comorbidity between voice and psychological disorders.

Individual and contextual covariates of burnout: a cross-sectional nationwide study of French teachers.

BACKGROUND: Limited information on the covariates of burnout syndrome in French teachers is available. The aim of this study was to evaluate the relative contributions of individual and contextual factors on the three burnout dimensions: emotional exhaustion, depersonalization, and reduced personal accomplishment. METHODS: The source data come from an epidemiological postal survey on physical and mental health conducted in 2005 among 20,099 education workers (in activity or retired) selected at random from the health plan records of the national education system. The response rate was 52.4%. Teachers in activity currently giving classes to students who participated in the survey (n = 3,940) were invited to complete a self-administered questionnaire including the Maslach Burnout Inventory. 2,558 teachers provided complete data (64.9%). Variables associated with high emotional exhaustion (highest quartile of score), high depersonalization (highest quartile), and reduced personal accomplishment (lowest quartile) were evaluated using multivariate logistic regression. Studied variables referred to demographic characteristics, socio-professional environment, job dissatisfaction, experienced difficulties at work, and teaching motivations. RESULTS: Different variables were associated with each burnout dimension. Female teachers were more susceptible to high emotional exhaustion and reduced personal accomplishment, whereas male teachers were more susceptible to high depersonalization. Elementary school teachers were more susceptible to high emotional exhaustion, but less susceptible to high depersonalization and reduced personal accomplishment than their higher school level counterparts. Experienced difficulties with pupils were associated with all three dimensions. A socio-economically underprivileged school neighbourhood was also related to high emotional exhaustion and high depersonalization. CONCLUSION: Programs to enhance teaching environment might be an interesting approach to try to prevent burnout. It would be useful to take the different dimensions into account in planning the intervention.

[Epidemiology of Alzheimer's disease: methodological approaches and new perspectives]. / Epidémiologie de la maladie d'Alzheimer : aspects méthodologiques et nouvelles perspectives.

Over the last 20 years, a number of epidemiological studies on Alzheimer's disease (AD) have been conducted on large cohorts providing databases for studying the disease frequency, and leading to a more global overview of AD risk factors. However, precise identification of factors which potentiate or delay the pathological process of the disease is still incomplete. One of the major problems comes from difficulties for defining the cases and obtaining good clinical diagnoses in population-based studies. Moreover, it is difficult to determine the chronology of exposure-disease relationships whatever the factors studied: vascular factors, life habits (dietary habits, physical, social or intellectual activities...). Which life-course period is important for proposing interventions to modify these factors remains a central question. The longer follow-up of large cohorts and a better knowledge of potential risk factors constitute a research priority if we want to prevent efficiently AD in the near future.

Overall and work-related well-being of teachers in socially disadvantaged schools: a population-based study of French teachers.

OBJECTIVES: As a human service profession, teaching presents specific risk factors that could be intensified in socially disadvantaged schools and, ultimately, impact the service quality. The aim of the present study was to evaluate the association between school socioeconomic status and teachers' well-being. DESIGN: Population-based postal survey 'Teachers' Quality of Life' (MGEN Foundation for Public Health/French Ministry of Education; 2013). To categorise the school socioeconomic status, we used the 'Education Priority Area (EPA)' administrative classification, which is chiefly based on the proportion of underprivileged students and is available for primary and lower secondary state schools. PARTICIPANTS: In-service French teachers randomly selected from among the teaching staff administrative list of the French Ministry of Education after stratification by sex, age and type of school. OUTCOME MEASURES: Indicators of well-being at work included a question on job satisfaction, job difficulty evolution and the Maslach Burnout Inventory. The short version of the WHO Quality of Life questionnaire was used to evaluate overall well-being. Among primary and lower secondary school teachers, we evaluated cross-sectional associations between school EPA status and indicators of well-being, using logistic or linear regressions stratified by school level and adjusted for sociodemographic and work-related characteristics. RESULTS: In the adjusted models, there was no significant difference in work-related well-being between teachers in EPA and non-EPA schools, both in primary school (n=154 vs n=788) and in lower secondary school (n=113 vs n=452). Regarding overall well-being, the only significant differences were seen among primary school teachers, with teachers in EPA schools reporting a worse perception of physical health and living environment than teachers in non-EPA schools. CONCLUSION: Using a representative sample of French teachers, we did not observe substantial differences in work-related well-being between teachers in EPA and non-EPA schools.

Intake of vegetables, legumes, and fruit, and risk for all-cause, cardiovascular, and cancer mortality in a European diabetic population.

We examined the associations of intake of vegetables, legumes and fruit with all-cause and cause-specific mortality in a population with prevalent diabetes in Europe. A cohort of 10,449 participants with self-reported diabetes within the European Prospective Investigation into Cancer and Nutrition study was followed for a mean of 9 y. Intakes of vegetables, legumes, and fruit were assessed at baseline between 1992 and 2000 using validated country-specific questionnaires. A total of 1346 deaths occurred. Multivariate relative risks (RR) for all-cause mortality were estimated in Cox regression models and RR for cause-specific mortality were derived in a competing risk model. An increment in intake of total vegetables, legumes, and fruit of 80 g/d was associated with a RR of death from all causes of 0.94 [95% CI 0.90-0.98]. Analyzed separately, vegetables and legumes were associated with a significantly reduced risk, whereas nonsignificant inverse associations for fruit intake were observed. Cardiovascular disease (CVD) mortality and mortality due to non-CVD/non-cancer causes were significantly inversely associated with intake of total vegetables, legumes, and fruit (RR 0.88 [95% CI 0.81-0.95] and 0.90 [0.82-0.99], respectively) but not cancer mortality (1.08 [0.99-1.17]). Intake of vegetables, legumes, and fruit was associated with reduced risks of all-cause and CVD mortality in a diabetic population. The findings support the current state of evidence from general population studies that the protective potential of vegetable and fruit intake is larger for CVD than for cancer and suggest that diabetes patients may benefit from a diet high in vegetables and fruits.

Differential dietary nutrient intake according to hormone replacement therapy use: an underestimated confounding factor in epidemiologic studies?

Observational studies and randomized controlled trials have produced divergent results concerning the effect of hormone replacement therapy (HRT) on cardiovascular disease and, to a lesser extent, dementia. Residual confounding (confounding that remains even after adjustment for various socioeconomic and lifestyle factors) is one explanation that has been offered for these divergent results. The authors used data collected between 1990 and 1995 from 6,697 French women aged 61-72 years participating in a prospective cohort study to explore the hypothesis that nutritional intake varies according to HRT use and thus may be a source of residual confounding. After the authors adjusted for health and lifestyle factors, HRT users, compared with never users, had significantly higher intakes of alcohol; omega3 fatty acids; vitamins B6, B12, and D; and phosphorus and a lower intake of starch. These differential nutrient intakes were related to differences in eating habits. In particular, HRT users in the studied sample, compared with nonusers, ate significantly more fish. Most of the dietary differences were seen in both early users and delayers of HRT. To limit residual confounding in observational studies, dietary factors may be important parameters to be taken into account in analyses of HRT use and health outcomes.

Self-Reported Change in Quality of Life with Retirement and Later Cognitive Decline: Prospective Data from the Nurses' Health Study.

To investigate whether a positive transition into retirement may be associated with later cognitive aging, we included a subset of 4,926 Nurses' Health Study participants who retired from work at ages 60-69, then provided a subjective assessment of the change in overall quality of life (QOL) with retirement. Subsequently (range: 1 month to 4.7 years later), when all were aged 70+ years, they completed a baseline telephone cognitive battery evaluating global cognition, episodic memory, and executive function. They had up to three follow-up cognitive assessments. Controlling for various occupational factors before retirement and socioeconomic, lifestyle, and health-related factors as of the baseline cognitive assessment, we used generalized linear models for repeated measures to estimate mean differences in rates of cognitive decline across categories of QOL transition at retirement: "worse", "same", or "better". Over a median 6 years of follow-up, the global cognitive score change was -0.123 on average. Compared with women who reported no change in QOL at retirement (31%), women who reported improvement (61%) showed a significantly slower rate of cognitive decline (difference = +0.011 95% CI = 0.004, 0.019). This mean difference was equivalent to that observed between women who were 2 years apart in age. No significant differences in cognitive decline rates were observed for the women who reported worsened QOL (8%). Secondary analyses to address possible reverse causation showed robust associations. A positive transition into retirement was associated with better maintenance of cognitive function over time in aging women. These findings need to be replicated in other populations.

Health behaviors: is there any distinction for teachers? A cross-sectional nationwide study.

BACKGROUND: Health behaviors, as important modifiable determinants of health, are consistently targeted by prevention messages. Teachers, as educators and role models, may play a key-role in bringing such messages to children and adolescents. It is not clear which areas of prevention could be improved in collaboration with teachers to promote healthy behaviors at the population level through health education in schools. METHODS: to evaluate teacher's health awareness, we compared their health/risk behaviors to those of non-teachers, taking into account demographic and socioeconomic factors that could confound crude differences. We used data from the 2010 Health Barometer, a cross-sectional nationally-representative French survey conducted by telephone among 27,653 persons aged 15-85. Adjusting sequentially for potential confounders, we compared six indicators of lifestyle and risky conducts (at-risk drinking, current smoking, cannabis use, gambling, corpulence, sleep duration) between teachers (n = 725) and two comparison groups: other occupations (n = 12,483) on the one hand, and other intermediate and managerial/professional occupations (n = 6,026) on the other. RESULTS: In the fully-adjusted models, teachers were less likely than other occupations to smoke, to have used cannabis in the last 12 months, to gamble regularly and to be overweight or obese. When restricting the comparison group to other occupations belonging to the same socio-professional category, differences were attenuated, but remain highly significant for tobacco, cannabis and gambling. No significant differences were observed between teachers and non-teachers regarding alcohol use and sleep duration, once important confounders had been adjusted for. CONCLUSIONS: Our results suggest that teachers behave on the whole more healthily than other adults with a similar demographic and socioeconomic profile. The absence of a teacher distinction toward at-risk drinking needs to be examined in more detail.

Caffeine and cognitive decline in elderly women at high vascular risk.

BACKGROUND: Persons with vascular disorders are at higher risk of cognitive decline. OBJECTIVE: To determine whether caffeine may be associated with cognitive decline reduction in elderly at high vascular risk. METHODS: We included 2,475 women aged 65+ years in the Women's Antioxidant Cardiovascular Study, a randomized trial of antioxidants and B vitamins for cardiovascular disease secondary prevention. We ascertained regular caffeine intake at baseline (1995-1996) using a validated 116 item-food frequency questionnaire. From 1998-2000 to 2005-2006, we administered four telephone cognitive assessments at two-year intervals evaluating global cognition, verbal memory, and category fluency. The primary outcome was the change in global cognitive score, which was the average of the z-scores of all tests. We used generalized linear models for repeated measures that were adjusted for various sociodemographic, health, and lifestyle factors to evaluate the difference in cognitive decline rates across quintiles of caffeine intake. RESULTS: We observed significantly slower rates of cognitive decline with increasing caffeine intake (p-trend = 0.02). The rate difference between the highest and lowest quintiles of usual caffeine intake (>371 versus <30 mg/day) was equivalent to that observed between those who were 7 years apart in age (p = 0.006). Consumption of caffeinated coffee was significantly related to slower cognitive decline (p-trend = 0.05), but not other caffeinated products (e.g., decaf, tea, cola, chocolate). We conducted interaction analyses and observed stronger associations in women assigned to vitamin B supplementation (p-interaction = 0.02). CONCLUSIONS: Caffeine intake was related to moderately better cognitive maintenance over 5 years in older women with vascular disorders.

Respondents in an epidemiologic survey had fewer psychotropic prescriptions than nonrespondents: an insight into health-related selection bias using routine health insurance data.

OBJECTIVES: Using register-based insurance data, we aimed to evaluate health-related differences between respondents and nonrespondents in a mailed epidemiologic survey, with a particular focus on mental health. STUDY DESIGN AND SETTING: In 2005, 19,406 adults covered by the national education system health insurance plan were sent a general health questionnaire including a significant part devoted to mental health. Of them, 52% responded. Using multivariable logistic regression models, we compared participants and nonparticipants on various sociodemographic characteristics, morbidity variables, and health care utilization indicators derived from the routine health insurance databases, regardless of response status. Mental health was appraised through the reimbursement of psychiatric services and the volume of psychotropic prescriptions received in 2004-05. RESULTS: In addition to traditional sociodemographic covariates of participation, we observed that respondents used more medical services than nonrespondents (visits to general practitioners, dentists, and specialists other than psychiatrists) but essentially for somatic disorders, as they also were prescribed significantly fewer psychotropic drugs. CONCLUSION: Response bias may impact estimation quality even in apparently sociodemographically homogeneous populations. Our results confirmed that persons with mental complaints are less likely to respond to a survey focused on their troubles and illustrate the risk of underestimation of psychiatric disease in population-based surveys.

Mediterranean diet and cognitive decline in women with cardiovascular disease or risk factors.

BACKGROUND: Cardiovascular disease and vascular risk factors increase rates of cognitive impairment, but very little is known regarding prevention in this high-risk group. The heart-healthy Mediterranean-type dietary pattern may beneficially influence both vascular and cognitive outcomes. OBJECTIVES: We examined the association between Mediterranean-style diet and cognitive decline in women with prevalent vascular disease or ≥3 coronary risk factors. DESIGN/PARTICIPANTS/SETTING: Prospective cohort study among 2,504 women participants in the Women's Antioxidant Cardiovascular Study (WACS), a cohort of female health professionals. Adherence to a Mediterranean-style diet was determined at WACS baseline (1995-1996) using a 0- to 9-point scale with higher scores indicating higher adherence. In 1998-2000, participants aged ≥65 years underwent a telephone cognitive battery including five tests of global cognition, verbal memory, and category fluency. Tests were administered three additional times across 5.4 years. STATISTICAL ANALYSES PERFORMED: We used multivariable-adjusted generalized linear models for repeated measures to compare the annual rates of cognitive score changes across tertiles of Mediterranean diet score, as assessed at WACS baseline. RESULTS: In both basic- and multivariable-adjusted models, consuming a Mediterranean-style diet was not related to cognitive decline. No effect modification was detected by age, education, depression, cardiovascular disease severity at WACS baseline, or level of cognition at initial assessment. CONCLUSIONS: In women at higher risk of cognitive decline due to vascular disease or risk factors, adherence to a Mediterranean-style diet was not associated with subsequent 5-year cognitive change.

Physical activity and cognition in women with vascular conditions.

BACKGROUND: Individuals with vascular disease or risk factors have substantially higher rates of cognitive decline, yet little is known about means of maintaining cognition in this group. METHODS: We examined the relation between physical activity and cognitive decline in participants of the Women's Antioxidant Cardiovascular Study, a cohort of women with prevalent vascular disease or at least 3 coronary risk factors. Recreational physical activity was assessed at baseline (October 1995 through June 1996) and every 2 years thereafter. Between December 1998 and July 2000, a total of 2809 women 65 years or older underwent a cognitive battery by telephone interview, including 5 tests of global cognition, verbal memory, and category fluency. Tests were administered 3 additional times over 5.4 years. We used multivariable-adjusted general linear models for repeated measures to compare the annual rates of cognitive score changes across levels of total physical activity and energy expended in walking, as assessed at Women's Antioxidant Cardiovascular Study baseline. RESULTS: We found a significant trend (P < .001 for trend) toward decreasing rates of cognitive decline with increasing energy expenditure. Compared with the bottom quintile of total physical activity, significant differences in rates of cognitive decline were observed from the fourth quintile (P = .04 for the fourth quintile and P < .001 for the fifth quintile), or the equivalent of daily 30-minute walks at a brisk pace. This was equivalent to the difference in cognitive decline observed for women who were 5 to 7 years younger. Regularly walking for exercise was strongly related to slower rates of cognitive decline (P = .003 for trend). CONCLUSION: Regular physical activity, including walking, was associated with better preservation of cognitive function in older women with vascular disease or risk factors.