Decline in Instrumental Activities of Daily Living over 4-Year: The Association with Hearing, Visual and Dual Sensory Impairments among Non-Institutionalized Women.

OBJECTIVE: Most older adults express the wish to live at home as long as possible, thus autonomy promoting measures are essential. Hearing and visual impairments are common among older people, and they have been consistently associated with functional disability. However, longitudinal data are scarce, notably regarding dual sensory impairments (both in hearing and vision). We aimed at assessing the relationship between hearing, visual, and dual sensory impairments, and subsequent decline in instrumental activities of daily living (IADL). DESIGN: Longitudinal. SETTING: the French E3N-elderly sub-cohort. PARTICIPANTS: 4,010 community-dwelling older women born between 1925 and 1930, and free of IADL limitations in 2006. MEASUREMENTS: Hearing and visual impairments were self-reported in 2006. IADLs were evaluated in 2006 and 2010. RESULTS: After 4 years of follow-up, 588 women became limited in their IADLs. In logistic regression models adjusted for potential confounders, odds ratios [95% confidence interval] for developing IADL limitations were 1.18 [0.98; 1.41], 1.98 [1.26; 3.11], and 2.61 [1.50; 4.54] for hearing, visual, or both sensory impairments respectively, compared with no sensory impairment at baseline. CONCLUSION: Results suggest that among autonomous older women, visual, and to a lesser extent, hearing impairment, have a short-term negative impact on their ability to perform daily activities, with some evidence of a multiplicative effect between sensory impairments. Appropriate evaluation and management of sensory impaired elderly, and more particularly those with dual impairments, may contribute to prevent disability in aging.

[Appraisal of the optical diagnostic technique for cervical intra-epithelial neoplasia by polarimetric imaging "Polcolpo". Comparison with colposcopic and histological diagnoses by biopsy]. / Étude prospective comparant les performances de la colposcopie classique à la colposcopie guidée par polarimétrie sur la détection des néoplasies intra-épithéliales du col utérin.

OBJECTIVES: The main objective of this study was to compare the performances of polarimetric imaging and standard colposcopy for the detection of CIN. MATERIALS AND METHODS: We performed a monocentric prospective clinical study. The standard colposcopic diagnosis obtained during a first consultation was compared to the diagnosis provided by polarimetric imaging in a second consultation. In addition to the biopsies guided by classical or polarimetric colposcopy, a systematic biopsy taken at a predefined location allowed to calculate the specificities and sensitivities of both techniques. RESULTS: One hundred and forty-one patients were included, all of them with anomalous Pap smears. Sixty-seven cone biopsies were taken, 69 % of which were eventually diagnosed with CIN2+ lesions. The sensitivities and specificities were found to be equal for standard and polarimetric colposcopies. CONCLUSION: We could not demonstrate any improvement of the diagnostic performances with polarimetric colposcopy alone. However, for both healthy and pathological cervices, we observed interesting polarimetric responses involving other characteristics than those we initially assumed, and which will be taken into account in a future study.

Dietary fat intake in relation to cognitive change in high-risk women with cardiovascular disease or vascular factors.

BACKGROUND/OBJECTIVES: Dietary fat intake may influence the rate of cognitive change among those at high risk due to vascular disease or risk factors. SUBJECTS/METHODS: Women's Antioxidant Cardiovascular Study began in 1995-1996 as a randomized trial of antioxidants and B vitamin supplementation for secondary prevention in women with cardiovascular disease or ≥3 coronary risk factors. From 1998-1999, eligible participants aged ≥65 years were administered a telephone cognitive battery including five tests of general cognition, memory and category fluency (n=2551). Tests were administered four times over 5.4 years. The primary outcome was a global composite score averaging z-scores of all tests. Multivariable generalized linear models for repeated measures were used to evaluate the difference in cognitive decline rates across tertiles of total fat and various types of fat. RESULTS: Total fat intake or different types of fat were not related to cognitive decline. However, older age significantly modified the association: among the oldest participants, higher intakes of mono- and polyunsaturated fat were inversely related to cognitive decline (P-interaction: 0.06 and 0.04, respectively), and the rate differences between the highest and lowest tertiles were cognitively equivalent to the rate differences observed with being 4-6 years younger. CONCLUSIONS: In women at high risk of cognitive decline due to vascular disease or risk factors, dietary fat intake was not associated with 5-year cognitive change. However, a possible protective relation of unsaturated fats with cognitive decline in the oldest women warrants further study.

Occupational exposure to solvents and cognitive performance in the GAZEL cohort: preliminary results.

BACKGROUND: The impact of occupational exposure to solvents on cognitive ageing remains unclear. We examined whether long-term occupational exposure is associated with poor cognitive performance in late midlife. METHODS: Participants in the GAZEL cohort, set up in 1989, are employees of the French national electricity and gas company. Data on the working environment were used to create measures of cumulative exposures to solvents using a job-exposure matrix. In 2002-2004, cognitive performance was assessed using the Digit Symbol Substitution Test (DSST) and the Mini Mental State Examination in 5,242 participants (aged 55-65 years). RESULTS: In cross-sectional analysis using multiple logistic regression, there was a greater risk of poor cognitive performance (DSST score <25th percentile) among those with high exposure to benzene (OR = 1.58; 95% CI 1.31-1.90) and the grouped categories of chlorinated (OR = 1.39; 95% CI 1.3-2.3), aromatic (OR = 1.76; 95% CI 1.08-2.87), and petroleum solvents (OR = 1.50; 95% CI 1.23-1.81). CONCLUSIONS: These results suggest that occupational exposures to solvents may be associated later in life with cognitive impairment, even after taking into account the effects of education, employment grade, and numerous health factors.

[Risk of breast cancer related to pregnancy]. / Risque de cancer du sein lié à la grossesse.

After a pregnancy, there is a transitory increase in the risk of breast cancer. During the pregnancy, the number of mammary epithelial cells increases massively. This increase seems partly due to the expansion of stem cells and proliferating intermediate cells. This proliferation of epithelial cells is accompanied by angiogenesis and by recruitment of stromal cells, as well as changes of the extracellular matrix. During any pregnancy, there is cell trafficking between mother and foetus. Hematopoietic or mesenchymal foetal stem cells are transferred in maternal circulation and could be used by the tumor as support cells and take part in the tumoral development. The study of the mechanisms of this specific oncogenesis may help to develop chemoprevention strategies.

Modified Mediterranean diet and survival after myocardial infarction: the EPIC-Elderly study.

Mediterranean diet is associated with lower incidence of coronary heart disease, and two randomised trials indicated that it improves prognosis of coronary patients. These trials, however, relied on a total of 100 deaths and evaluated designer diets in the clinical context. We have evaluated the association of adherence to the modified Mediterranean diet, in which unsaturates were substituted for monounsaturates, with survival among elderly with previous myocardial infarction within the European Prospective Investigation into Cancer and nutrition (EPIC) study. As of December 2003, after a median follow-up of 6.7 years, 2671 EPIC participants from nine countries were 60 years or older and had prevalent myocardial infarction but no stroke or cancer at enrolment, complete information on dietary intakes and important covariates and known survival status. Adherence to the modified Mediterranean diet was assessed through a 10-unit-scale. Mortality ratio in relation to modified Mediterranean diet was estimated through Cox regression controlling for possible confounding. Increased adherence to modified Mediterranean diet by two units was associated with 18% lower overall mortality rate (95% confidence interval 7-27%, fixed effects model). There was no significant heterogeneity by sex, age at enrolment, or country, although the association tended to be less evident among northern Europeans. Associations between food groups contributing to the modified Mediterranean diet and mortality were generally weak. A diet inspired by the Mediterranean pattern that can be easily adopted by Western populations is associated with substantial reduction of total mortality of coronary patients in the community.