Comparative impact of hearing and vision impairment on subsequent functioning.

OBJECTIVES: The purpose of this study was to compare independent impacts of two levels of self-reported hearing and vision impairment on subsequent disability, physical functioning, mental health, and social functioning. DESIGN: A 1-year prospective cohort study. SETTING: San Francisco Bay Area, California. PARTICIPANTS: Two thousand four hundred forty-two community-dwelling men and women age 50 to 102 from the Alameda County Study (California). MEASUREMENTS: Hearing and vision impairment were assessed in 1994. Outcomes, measured in 1995, included physical disability (activities of daily living, instrumental activities of daily living, physical performance, mobility, and lack of participation in activities), mental health (self-assessed, major depressive episode), and social functioning (feeling left out, feeling lonely, hard to feel close to others, inability to pay attention). All 1995 outcomes were adjusted for baseline 1994 values. RESULTS: Both impairments had strong independent impacts on subsequent functioning. Vision impairment exerted a more wide-ranging impact on functional status, ranging from physical disability to social functioning. However, the results also highlighted the importance of hearing impairment, even when mild. CONCLUSIONS: These impairments can be partially ameliorated through prevention, assessment, and treatment strategies. Greater attention to sensory impairments by clinicians, patients, public health advocates, and researchers is needed to enhance functioning in older adults.

Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships.

Several recent prospective analyses involving community-based populations have demonstrated a protective effect on survival for frequent attendance at religious services. How such involvement increases survival are unclear. To test the hypothesis that religious attendance might serve to improve and maintain good health behaviors, mental health, and social relationships, changes and consistencies in these variables were studied between 1965 and 1994 for 2,676 Alameda County Study participants, from 17 to 65 years of age in 1965, who survived to 1994. Measures included smoking, physical activity, alcohol consumption, medical checkups, depression, social interactions, and marital status. Those reporting weekly religious attendance in 1965 were more likely to both improve poor health behaviors and maintain good ones by 1994 than were those whose attendance was less or none. Weekly attendance was also associated with improving and maintaining good mental health, increased social relationships, and marital stability. Results were stronger for women in improving poor health behaviors and mental health, consistent with known gender differences in associations between religious attendance and survival. Further understanding the mechanisms involved could aid health promotion and intervention efforts.

Are the obese at greater risk for depression?

Two waves of data from a community-based study (Alameda County Study, 1994-1995) were used to investigate the association between obesity and depression. Depression was measured with 12 items covering Diagnostic and Statistical Manual of Mental Disorders: DSM-IV diagnostic criteria for major depressive episode. Following US Public Health Service criteria, obese subjects were defined as those with body mass index scores at the 85th percentile or higher. Covariates were age, sex, education, marital status, social isolation and social support, chronic medical conditions, functional impairment, life events, and financial strain. Results were mixed. In cross-sectional analyses, greater odds for depression in 1994 were observed for the obese, with and without adjustment for covariates. When obesity and depression were examined prospectively, controlling for other variables, obesity in 1994 predicted depression in 1995 (odds ratio (OR) = 1.73, 95% confidence interval (CI): 1.04, 2.87). When the data were analyzed with obesity defined as a body mass index of > or = 30, cross-sectional results were the same. However, the prospective multivariate analyses were not significant (OR = 1.43, 95% CI: 0.85, 2.43). Although these data do not resolve the role of obesity as a risk factor for depression, overall the results suggest an association between obesity and depression. The authors found no support for the "jolly fat" hypothesis (obesity reduces risk of depression). However, there has been sufficient disparity of results thus far to justify continued research.

Negative consequences of hearing impairment in old age: a longitudinal analysis.

To determine whether functional and psychosocial outcomes associated with hearing impairment are a direct result or stem from prevalent comorbidity, we analyzed the impact of two levels of reported hearing impairment on health and psychosocial functioning one year later with adjustments for baseline chronic conditions. Physical functioning, mental health, and social functioning decreased in a dose-response pattern for those with progressive levels of hearing impairment compared with those reporting no impairment. Our results demonstrate an independent impact of hearing impairment on functional outcomes, reveal increasing problems with higher levels of impairment, and support the importance of preventing and treating this highly prevalent condition.

New NHLBI clinical guidelines for obesity and overweight: will they promote health?

OBJECTIVES: The purpose of this study was to assess the justification, on the basis of mortality, of the new National Heart, Lung, and Blood Institute (NHLBI) guidelines on obesity and overweight and to discuss the health implications of declaring all adults with a body mass index of 25 through 29 "overweight." METHODS: The relationships between NHLBI body mass index categories and mortality for individuals older than 31 years were analyzed for 6253 Alameda County Study respondents aged 21 through 75 years. Time-dependent proportional hazards models were used to adjust for changes in risk factors and weight during follow-up. RESULTS: Adjusted relative risks of mortality for 4 NHLBI categories compared with the category "normal" indicated that only being underweight or moderately/extremely obese were associated with higher mortality. Specific risk varied significantly by sex. CONCLUSIONS: Our results are consistent with other studies and fail to justify lowering the overweight threshold on the basis of mortality. Current interpretations of the revised guidelines stigmatize too many people as overweight; fail to account for sex, race/ethnicity, age, and other differences; and ignore the serious health risks associated with low weight and efforts to maintain an unrealistically lean body mass.

Sleep complaints and depression in an aging cohort: A prospective perspective.

OBJECTIVE: Most research on the association between sleep disturbances and depression has looked at cross-sectional data. The authors used two waves of data from a panel study of community residents aged 50 years or more to investigate this issue prospectively. METHOD: Data on symptoms of major depressive episodes and sleep problems were examined for a subgroup of the 1994 and 1995 surveys of the Alameda County (California) Study (N=2,370). The authors examined the effects of age, gender, education, marital status, social isolation, functional impairment, financial strain, and alcohol use. Depression was measured with 12 items that covered the DSM-IV diagnostic criteria for major depressive episodes, including insomnia and hypersomnia. RESULTS: The prevalences were 23. 1% for insomnia and 6.7% for hypersomnia in 1994. Sleep was a significant correlate of depression, as were being female, older age, social isolation, low education, financial strain, and functional impairment. When sleep problems and depression were examined prospectively, with controls for the effects of the other variables, sleep problems in 1994 predicted depression in 1995. However, other symptoms of major depressive episodes-anhedonia, feelings of worthlessness, psychomotor agitation/retardation, mood disturbance, thoughts of death-were much stronger predictors of future major depression. CONCLUSIONS: Sleep disturbance and other symptoms that are diagnostic for major depression are strongly associated with the risk of future depression. Sleep disturbance appears to be a less important predictor of depression. More epidemiologic research is needed on the relative contributions of the range of depressive symptoms to the risk of clinical depression.

Comparative strength of association between religious attendance and survival.

OBJECTIVE: Analyze effects on long-term survival of frequent religious attendance compared with four widely-accepted beneficial health behaviors. METHOD: Calculate gender-specific associations with mortality over 29 years for religious attendance, cigarette smoking, physical activity, alcohol consumption, and non-religious social involvement. Subjects were 5,894 participants in the Alameda County Study age 21-75. Analyses use proportional hazards modeling with time-dependent measures to adjust for subsequent changes in attendance and each health behavior over the follow-up period. All statistical models adjust for the same variables. RESULTS: For women, the protective effect of weekly religious attendance was of the same order of magnitude as the four other health behaviors. For men, the protective effect of weekly religious attendance was less than for any of the other health behaviors. CONCLUSIONS: The protective effect of religious attendance for women is comparable to those observed for several commonly recommended health behaviors: for men the protective effect of religious attendance is more modest. This strong gender difference may be a key to understanding how religious attendance exerts its effects.

Response to health insurance by previously uninsured rural children.

OBJECTIVE: To examine the healthcare utilization and costs of previously uninsured rural children. DATA SOURCES/STUDY SETTING: Four years of claims data from a school-based health insurance program located in the Mississippi Delta. All children who were not Medicaid-eligible or were uninsured, were eligible for limited benefits under the program. The 1987 National Medical Expenditure Survey (NMES) was used to compare utilization of services. STUDY DESIGN: The study represents a natural experiment in the provision of insurance benefits to a previously uninsured population. Premiums for the claims cost were set with little or no information on expected use of services. Claims from the insurer were used to form a panel data set. Mixed model logistic and linear regressions were estimated to determine the response to insurance for several categories of health services. PRINCIPAL FINDINGS: The use of services increased over time and approached the level of utilization in the NMES. Conditional medical expenditures also increased over time. Actuarial estimates of claims cost greatly exceeded actual claims cost. The provision of a limited medical, dental, and optical benefit package cost approximately $20-$24 per member per month in claims paid. CONCLUSIONS: An important uncertainty in providing health insurance to previously uninsured populations is whether a pent-up demand exists for health services. Evidence of a pent-up demand for medical services was not supported in this study of rural school-age children. States considering partnerships with private insurers to implement the State Children's Health Insurance Program could lower premium costs by assembling basic data on previously uninsured children.

Prospective data on sleep complaints and associated risk factors in an older cohort.

OBJECTIVE: The purpose of this study is to provide data on the prevalence of insomnia and hypersomnia among older persons, the stability of these sleep complaints over time, and factors associated with disturbed sleep, in particular age. METHOD: Data on symptoms of insomnia and hypersomnia were examined for the 1994 to 1995 cohort of the Alameda County Study. In addition to age, the effects of gender, education, marital status, chronic medical conditions, functional impairment, life events, financial strain, and mood disturbance were examined using multiple logistic analyses. RESULTS: Prevalence in 1994 was 23.4% for insomnia and 6.8% for hypersomnia. There was moderate concordance between sleep complaints in 1994 and 1995 (kappa=.43). There was a tendency for insomnia and hypersomnia to increase with age in 1995, but not in 1994. Only gender, mood disturbance, and chronic health problems predicted insomnia. Life events, mood disturbance, and chronic conditions predicted hypersomnia. Age, net of the effects of other factors, was not associated with risk of either insomnia or hypersomnia. CONCLUSIONS: The results contribute to the expanding body of evidence concerning the important roles of psychological and somatic dysfunction in sleep disturbance. Age in and of itself is not a risk factor for insomnia or hypersomnia. That is, after adjustment for an array of putative risk factors for sleep problems, it seems the association between sleep difficulties and age is primarily due to depressed mood and physical health problems.

Endocrine mechanisms underlying the growth effects of developmental lead exposure in the rat.

A dose-response study was conducted to examine the growth suppression associated with developmental lead exposure in a rat model and to determine the endocrine mechanisms underlying these effects. Ad libitum intake of lead acetate (0.05% to 0.45% w/v) was initiated in time-impregnated female Sprague-Dawley rats (n = 10-15/group) at gestational day 5. At birth, pups were culled to four male and four females per litter. Lead exposure of dams continued until weaning, following which lead exposure of pups was continued until sacrifice at age 2 , 35, 55, and 85 days. Birth weight and prepubertal and pubertal growth rates were significantly suppressed. Growth rates were suppressed to a much greater degree in male as compared to female pups. Decreased growth rates were accompanied by a significant decrease in plasma insulin-like growth factor 1 (IGF1) concentrations and (1) a significant increase in pituitary growth hormone (GH) content during puberty in pups of both sexes, (2) a delay in the developmental profiles of the GH-dependent male-specific liver enzymes cytochrome P-450 CYP2C11 and N-hydroxy-2-acetylaminofluorene sulfotransferase, and (3) continued suppression of these enzymes in lead-exposed adult male pups. In addition, significant decreases in plasma sex steroids, testosterone (male) and 17beta-estradiol (female), were observed during puberty. Postpuberty, at age 85 d, both IGF1 and sex steroid levels were indistinguishable from control pups despite continued lead exposure. Growth rates were also similar in control and lead-exposed pups between age 57 and 85 d. Data suggest that the mechanism underlying lead-induced sex-independent suppression of growth observed in these studies involves disruption of GH secretion during puberty. It is possible that the mechanisms underlying the greater suppression of somatic growth observed at puberty in lead-exposed male offspring may be due to the additional hypoandrogenization produced by the action of lead on the hypothalamic-pituitary-testicular axis.

Religiosity buffers effects of some stressors on depression but exacerbates others.

Although religiosity is protective for mortality and morbidity, its relationship with depression is unclear. We used the 1994 Alameda County Study survey of 2,537 subjects aged 50-102 to analyze associations between two forms of religiosity and depression as well as the extent to which religiosity buffers relationships between stressors and depression. Non-organizational religiosity included prayer and importance of religious and spiritual beliefs; organizational religiosity included attendance at services and other activities. Non-organizational religiosity had no association with depression; organizational religiosity had a negative relationship that weakened slightly with the addition of health controls. Both forms of religiosity buffered associations with depression for non-family stressors, such as financial and health problems. However, non-organizational religiosity exacerbated associations with depression for child problems, and organizational religiosity exacerbated associations with depression for marital problems, abuse, and caregiving. Religiosity may help those experiencing non-family stressors, but may worsen matters for those facing family crises.

Adolescents' insight in heavy drinking.

PURPOSE: Because so few adolescents with alcohol problems seek treatment, this study examined the factors associated with adolescents' recognition or insight into having a substance use problem. METHOD: Data were extracted from a self-report questionnaire used in an epidemiological study of public middle school students on substance abuse in Arkansas. Those drinking heavily were divided into "admitters" and "deniers" based on their response to the question of having a substance use problem. Odds ratios were calculated to measure the association of several variables with admitting a problem. RESULTS: Of 3395 adolescents, 13.4% (455) met or exceeded our threshold for heavy drinking. Only 15.9% (65) of these heavy drinkers acknowledged having a substance use problem. Reporting more types of negative social events related to alcohol use and scoring higher on a measure of positive alcohol expectancies were significantly related to admitting to a substance use problem. Recent health care contact and perceived environmental factors did not independently contribute to insight. CONCLUSIONS: If these results are generalizable, treatment and educational interventions should emphasize linking alcohol use and negative social consequences.

Effects on pubertal growth and reproduction in rats exposed to lead perinatally or continuously throughout development.

The reproductive, endocrine, and growth effects of developmental lead exposure were assessed using a rat model in which 0.6% lead acetate (w/v) was administered in the drinking water ad libitum during different developmental periods to determine if lead actions were a result of direct effects of continuous exposure to the metal ion or secondary to disrupted neonatal "endocrine imprinting." Sprague Dawley rats were exposed to lead: (1) from gestational d 5 through birth; (2) during pregnancy and lactation; (3) during lactation only; (4) from birth through adulthood; or (5) from gestational d 5 through adulthood. Lead effects were measured on the development of aspects of the reproductive system, adult sex steroid levels, and growth rates in both male and female animals. The relative weights of male secondary sex organs in adult offspring were not significantly affected in any of the lead-treated groups. In contrast, female pups exposed to lead from birth through adulthood or from gestational day 5 through adulthood were observed to have significantly delayed vaginal opening and disrupted estrus cycling. These effects on female reproductive physiology were not observed in animals where lead exposure was confined only to pregnancy or lactation. Significant suppression of adult mean serum testosterone levels was only observed in male pups exposed to lead continuously from gestational age 5 d throughout life. Lead decreased birth weight in all animals exposed in utero and mean body weights were significantly decreased in all lead-treated groups up to weaning. Analysis of growth curves revealed that all lead-treated groups had significantly reduced growth rates during lactation. However, in addition, in male pups exposed to lead during pregnancy and lactation, from birth or from gestational age 5 d, growth rates were also significantly reduced during puberty. Postpubertal growth rates were unaffected in any lead-treated group. Thus, delayed female reproductive development and suppression of adult male serum testosterone concentration required continuous exposure to the heavy metal. Little evidence was observed for an alteration of "endocrine imprinting" by lead on either reproductive or growth parameters. Exposure during early development (pregnancy and lactation) resulted in no permanent effects in this model other than small (10%) decreases in the body weight of pups postpuberty.

Antecedents of frailty over three decades in an older cohort.

Studies of disability in old age have focused on gross measures of physical functioning. More useful results for prevention might be gleaned from examining risk factors associated with frailty, a concept implying a broader range of more subtle problems in multiple domains. This study conceptualized frailty as involving problems or difficulties in two or more functional domains (physical, nutritive, cognitive, and sensory) and analyzed prospective predictors. Subjects were 574 Alameda County Study respondents age 65-102. One-fourth scored as frail; there was no gender difference. Frail persons reported reduced activities, poorer mental health, and lower life satisfaction. Cumulative predictors over the previous three decades included heavy drinking, cigarette smoking, physical inactivity, depression, social isolation, fair or poor perceived health, prevalence of chronic symptoms, and prevalence of chronic conditions. By modifying these risk factors, it may be possible to postpone the onset of frailty or ameliorate its further development.

Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning.

BACKGROUND: Although the relation between low income and poor health is well established, most previous research has measured income at only one time. METHODS: We used income information collected in 1965, 1974, and 1983 from a representative sample of adults in Alameda County, California, to examine the cumulative effect of economic hardship (defined as a total household income of less than 200 percent of the federal poverty level) on participants who were alive in 1994. RESULTS: Because of missing information, analyses were based on between 1081 and 1124 participants (median age, 65 years in 1994). After adjustment for age and sex, there were significant graded associations between the number of times income was less than 200 percent of the poverty level (range, 0 to 3) and all measures of functioning examined except social isolation. As compared with subjects without economic hardship, those with economic hardship in 1965, 1974, and 1983 were much more likely to have difficulties with independent activities of daily living (such as cooking, shopping, and managing money) (odds ratio, 3.38; 95 percent confidence interval, 1.49 to 7.64), activities of daily living (such as walking, eating, dressing, and using the toilet) (odds ratio, 3.79; 95 percent confidence interval, 1.32 to 9.81), and clinical depression (odds ratio, 3.24; 95 percent confidence interval, 1.32 to 7.89) in 1994. We found little evidence of reverse causation -- that is, that episodes of illness might have caused subsequent economic hardship. CONCLUSIONS: Sustained economic hardship leads to poorer physical, psychological, and cognitive functioning.

Does growing old increase the risk for depression?

OBJECTIVE: Most research examining age as a risk factor for depression has been based on cross-sectional data. To investigate the effect of aging on rates of depression prospectively, the authors used two waves of data from a panel study of community residents 50 years old and older. METHOD: Data on symptoms of major depressive episodes were examined for the 1994 and 1995 cohorts of the Alameda County Study. The authors examined age, gender, marital status, education, financial strain, chronic medical conditions, functional impairment, cognitive problems, life events, neighborhood problems, social isolation, and social support. Depression was measured with 12 items covering DSM-IV diagnostic criteria for major depressive episodes. RESULTS: Point prevalence of major depressive episodes was 8.7% in 1994 and 9.0% in 1995. Among the subjects 60 years old and older, there was a tendency toward higher prevalence in 1995. The highest prevalence rates in 1994 and in 1995 were among those 80 years old and older. Subjects who were depressed in 1994 were at greater risk for depression in 1995. When the effects of age and other psychosocial risk factors in 1994 were controlled, there were no significant age effects on depression in 1995. Multivariate analyses demonstrated that the initial age effects were due mainly to chronic health problems and functional impairment. Gender, chronic health conditions, problems with activities of daily living, cognitive problems, neighborhood problems, and social isolation in 1994 all were significant predictors of depression in 1995. CONCLUSIONS: Healthy, normally functioning older adults are at no greater risk for depression than younger adults. What seem to be age-related effects on depression are attributable to physical health problems and related disability.

Prevalence and correlates of depression in an aging cohort: the Alameda County Study.

Data on symptoms of major depressive episodes were examined for the 1994 cohort (n = 2,417) of the Alameda County Study (mean age = 65). In addition to age, we examined gender, education, marital status, social isolation and social support, perceived physical and mental health, chronic medical conditions, functional impairment, life events, financial strain, and neighborhood quality. The point prevalence of symptoms of major depressive episodes was 6.6 percent for men and 10.1 percent for women, with a trend for prevalence to increase with age. When the effects of the other psychosocial risk factors were controlled, there were no significant age effects. Multivariate analyses demonstrated that apparent initial age effects were due almost entirely to chronic health problems and functional impairment. The implications are clear: Healthy, normal-functioning older adults are at no greater risk of depression than younger adults. Apparent age-related effects on depression are attributable to physical health problems and related disability.

Immune and clinical impact of Lactobacillus acidophilus on asthma.

BACKGROUND: Animal and human studies have suggested that yogurt containing live active bacteria leads to improved immune and clinical responses. Specific benefits of yogurt containing L. acidophilus on allergic asthma have been hypothesized but not studied. METHODS: In a crossover double-blinded design, the effect of live active yogurt (225 g twice daily) with or without L. acidophilus was studied in 15 adult patients with moderate asthma. Immune and clinical parameters were measured before and after the two 1-month crossover phases. RESULTS: No significant changes were noted in peripheral cell counts, IgE, IL-2, or IL-4 when comparing the two diets to each other. Concanvalin A-stimulated lymphocytes from patients who consumed yogurt containing L. acidophilus produced borderline elevated interferon gamma levels (P = .054). No differences were noted in mean daily peak flows or changes in spirometric values. Quality of life indices were unchanged when comparing the two groups. CONCLUSIONS: Yogurt containing L. acidophilus generated trends in the increase in interferon gamma and decreased eosinophilia; however, we were unable to detect changes in clinical parameters in asthma patients in association with these modest immune changes.

New burdens or more of the same? Comparing grandparent, spouse, and adult-child caregivers.

This study compares the health of 42 grandparent, 44 spouse, and 130 adult-child caregivers with 1,669 noncaregivers in 1994 and 1974. In 1994, all three caregiver groups had poorer mental health than the noncaregivers; grandparent caregivers also had poorer physical health and greater activity limitations. Spouse and adult-child caregivers had not differed from the noncaregivers 20 years prior, but grandparent caregivers had experienced poorer health than the noncaregivers and more stressful life events than the other caregivers. Caregiving appears to add new burdens to otherwise normal lives for spouse and adult-child caregivers, while being yet another aspect of a difficult life course for grandparent caregivers.

Frequent attendance at religious services and mortality over 28 years.

OBJECTIVES: This study analyzed the long-term association between religious attendance and mortality to determine whether the association is explained by improvements in health practices and social connections for frequent attenders. METHODS: The association between frequent attendance and mortality over 28 years for 5286 Alameda Country Study respondents was examined. Logistic regression models analyzed associations between attendance and subsequent improvements in health practices and social connections. RESULTS: Frequent attenders had lower mortality rates than infrequent attenders (relative hazard [RH] = 0.64;95% confidence interval [CI] = 0.53,0.77). Results were stronger for females. Health adjustments had little impact, but adjustments for social connections and health practices reduced the relationship (RH = 0.77; 95% CI = 0.64, 0.93). During follow-up, frequent attenders were more likely to stop smoking, increase exercising, increase social contacts, and stay married. CONCLUSIONS: Lower mortality rates for frequent religious attenders are partly explained by improved health practices, increased social contacts, and more stable marriages occurring in conjunction with attendance. The mechanisms by which these changes occur have broad intervention implications.