Effects of gender, indigenous status and remoteness to health services on the occurrence of assault-related injuries in children and adolescents.

BACKGROUND: Assault-related injury is a devastating consequence of violence and is a prominent cause of morbidity and mortality in young age. However, reliable data sources are scarce and there has been a paucity of studies examining possible predisposing factors on the incidence of assault-related injury. METHOD: Logistic regression analyses were conducted to examine the effect of gender, indigenous status and remoteness to health services on sustaining assault-related injuries in patients aged 17 years and under by using data from the state-wide trauma registry in Queensland, Australia from 2005 to 2008. RESULTS: A total of 282 assault-related injury cases were identified. Indigenous females were at the highest risk of sustaining assault-related injuries (odds ratio (OR): 15.3, 95% confidence interval (CI): 8.17-28.6), followed by indigenous males (OR: 6.55, 95% CI: 3.60-11.9) and non-indigenous males (OR: 2.82, 95% CI: 1.78-4.47). Males were at a significantly higher risk than females in the group aged 13-17 years (OR: 2.11, 95% CI: 1.34-3.31). Living in a regional area was associated with a lower risk compared to major cities for non-indigenous people (OR: 0.59, 95% CI: 0.44-0.78). Indigenous people were at higher risk of sustaining an assault-related injury than non-indigenous people in regional areas (OR: 4.8, 95% CI: 3.14-7.42) and in remote areas (OR: 10.1, 95% CI: 2.64-38.69). CONCLUSIONS: The current study provides evidence of interaction effects among the predisposing factors. Identifying these factors is important to conduct effective preventive measures and trauma management plans focussing on high-risk groups of assault-related injuries in young age.

Epidemiology of traumatic epidural hematoma in young age.

BACKGROUND: Epidural hematoma (EDH) is a major traumatic brain injury and a potentially life-threatening condition, with the mortality rate in the young age group varying across studies. The aim of this analysis was to investigate the magnitude of traumatic EDH in young patients aged 0 year to 24 years in Queensland, Australia. METHODS: Study patients presented to the emergency department of 14 public hospitals participating in the Queensland Trauma Registry during 2005 to 2007 and were diagnosed and admitted for treatment of EDH. Age group comparisons were performed for demographic, injury, treatment, operation details, and outcome-related variables. RESULTS: We identified 224 young patients with traumatic EDH. The most frequent cause of injury was a fall in the 0 year to 9 years age groups and road traffic crash in those aged 10 years to 24 years. Almost 81% of the EDH cases were due to accidental injury, 17% due to assault, with the remainder due to self-harm and undetermined intent. Skull fracture was present in 75% of the study patients. Neurosurgical operations were performed on 40%. The overall Injury Severity Score adjusted in-hospital mortality rate was 4.8%. The odds of in-hospital mortality was 2.5 (95% confidence interval, 0.8-8.2) compared with older patients (25-64 years). CONCLUSIONS: The results indicate that the Injury Severity Score adjusted in-hospital mortality rates for young patients with EDH were 4.8%. Given the limited information on morbidity resulting from EDH, further analysis to examine modifiable factors for better management and to evaluate survivor's long-term health outcomes via a longitudinal follow-up study is warranted.

Characteristics and outcomes of injury patients in an Aboriginal and Torres Strait Islander population--Queensland Trauma Registry, Australia.

INTRODUCTION: There are few published data for the magnitude of injury-related health problems in indigenous people such as Aboriginal and Torres Strait Islanders. The objective of our study was to compare the characteristics and outcomes of injury in the indigenous population to the non-indigenous population, who are living in Queensland, Australia. METHODS: Participants were injured patients who presented to the emergency department for treatment and admitted to 15 public hospitals participating in the Queensland Trauma Registry (QTR) during 2003-2005. RESULTS: Amongst 38,036 injured patients, 1847 patients were identified as indigenous and 35,530 as non-indigenous. Compared to the non-indigenous group, the indigenous group was significantly younger with no difference by gender. The injury severity score (ISS) and percentage of major injury (ISS > or = 16) were lower in the indigenous group. Indigenous patients had a significantly higher percentage of penetrating type injuries compared to non-indigenous (19.5% vs. 12.5%). The age- and injury severity-adjusted mortality rate was also significantly higher in indigenous. In age-stratified logistic regression analysis, the injury severity-adjusted odds for mortality was 3.0 times higher [95% confidence interval (95% CI): 1.6-5.5] in the indigenous, compared to the non-indigenous group, in 40-64-year olds, whilst increased odds in other age groups were not statistically significant. CONCLUSION: Our results indicate that middle-aged indigenous patients are more likely to die due to injury compared to non-indigenous patients. This suggests that strategies are required to improve outcomes particularly in the most affected injury patient group.

Apolipoprotein E epsilon4 allele genotype and the effect of depressive symptoms on the risk of dementia in men: the Honolulu-Asia Aging Study.

CONTEXT: The apolipoprotein E epsilon4 (APOE epsilon4) allele is a genetic risk factor for Alzheimer disease. Recently, depression has also become recognized as a risk factor for dementia. However, the possible effect of the APOE genotype on the association between depression and dementia is unexamined. OBJECTIVE: To examine the independent and combined effects of depression and APOE epsilon4 on the risk of dementia and its subtypes. DESIGN: The Honolulu-Asia Aging Study, a population-based prospective cohort study of Japanese American men. SETTINGS AND PARTICIPANTS: Depressive symptoms and presence of the APOE epsilon4 allele were assessed between March 1991 and October 1993 in 1932 cognitively healthy men aged 71 to 90 years. Incident cases of dementia were diagnosed during approximately 6 years of follow-up based on neurologic assessment at 2 repeated examinations (April 1994-April 1996 and October 1997-February 1999). MAIN OUTCOME MEASURES: Overall dementia, Alzheimer disease, and vascular dementia. RESULTS: The interaction of depression and APOE epsilon4 was statistically significant in the analytical models. Compared with men with neither APOE epsilon4 nor depression, the risk of dementia in nondepressed men with APOE epsilon4 was not significant (hazard ratio, 1.1; 95% confidence interval [CI], 0.6-1.8); however, depressed men without APOE epsilon4 had a 1.6-fold greater risk (95% CI, 0.8-3.0), whereas depressed men with APOE epsilon4 had a 7.1-fold greater risk (95% CI, 3.0-16.7) of dementia. For subtypes, we found similar increased risks of Alzheimer disease. CONCLUSIONS: The APOE epsilon4 status modifies the association between depressive symptoms and dementia in elderly men. Because individuals with depressive symptoms and the APOE epsilon4 allele had a markedly increased risk of dementia, one might be especially watchful for early signs of dementia in the older person with depression who is also positive for the APOE epsilon4 allele. Because this cohort includes only men, further investigation in women is required.

Physical activity, physical function, and incident dementia in elderly men: the Honolulu-Asia Aging Study.

BACKGROUND: Although evidence is accumulating for a protective effect of late life physical activity on the risk of dementia, the findings are inconsistent, especially in men. We examined the association of late life physical activity and the modifying effect of physical function with future risk of dementia in a well-characterized cohort of elderly men participating in the Honolulu-Asia Aging Study (HAAS). METHODS: Physical activity by self-report and performance-based physical function was assessed in 2263 men aged 71-92 years without dementia at the baseline examination of the HAAS in 1991-1993. Follow-up for incident dementia occurred at repeat examinations conducted in 1994-1996 and 1997-1999. Analyses were based on Cox proportional hazards models with adjustment for potential confounders, including age, baseline cognitive function, education, and apolipoprotein E genotype. RESULTS: There were 173 incident cases of dementia with a mean follow-up of 6.1 years. Although the incidence of dementia tended to decline with increasing physical activity and function, there was a significant interaction between the latter two factors on dementia risk (p =.022). For men with low physical function, high levels of physical activity were associated with half the risk of dementia versus men who were the least active (hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.28-0.89), with a moderate level of physical activity also providing a protective effect (HR, 0.57; 95% CI, 0.32-0.99). Risk of dementia and Alzheimer's disease declined significantly with increasing physical activity. Findings persisted after age and risk factor adjustment. Similar associations were absent in men with moderate and high physical function. CONCLUSIONS: In elderly men with poor physical function, increasing general physical activity may potentially confer a protective effect or delay the onset for dementia.

Enhanced risk for Alzheimer disease in persons with type 2 diabetes and APOE epsilon4: the Cardiovascular Health Study Cognition Study.

BACKGROUND: Diabetes and the apolipoprotein E epsilon4 allele (APOE epsilon4) increase the risk for Alzheimer disease (AD). We hypothesize that APOE epsilon4 may modify the risk for AD in individuals with diabetes. OBJECTIVE: To examine the joint effect of type 2 diabetes and APOE epsilon4 on the risk of AD, AD with vascular dementia (mixed AD), and vascular dementia without AD. DESIGN: The Cardiovascular Health Study (CHS) Cognition Study (1992-2000) is a prospective study designed to identify all existing and new cases of dementia among study participants. Diagnoses were made according to international criteria for dementia and subtypes. There were 2547 dementia-free participants in the CHS Cognition Study cohort with complete information on APOE epsilon4 and type 2 diabetes status; among these, 411 new cases of dementia developed. Risk of dementia was estimated with a Cox proportional hazard model adjusted for age and other demographic and cardiovascular risk factors. RESULTS: Compared with those who had neither type 2 diabetes nor APOE epsilon4, those with both factors had a significantly higher risk of AD (hazard ratio, 4.58; 95% confidence interval, 2.18-9.65) and mixed AD (hazard ratio, 3.89; 95% confidence interval, 1.46-10.40). CONCLUSION: These data suggest that having both diabetes and APOE epsilon4 increases the risk of dementia, especially for AD and mixed AD.

Brain lesions on MRI and endogenous sex hormones in elderly men.

We investigated the association between MRI detected brain lesions and levels of endogenous sex hormones in Japanese-American men aged 74-95 years. Logistic regression was used to estimate the association (OR (95% CI)) of MRI outcome with tertiles of bioavailable testosterone, 17beta estradiol and sex hormone binding globulin (SHBG). There was a significantly increased risk for cerebral atrophy in the highest tertile of testosterone (3.1 (1.2-7.8)) compared to the lowest. We also found that men with the highest estradiol had a higher risk of lacunes (1.92 (1.1-3.2)). These relationships did not change with adjustment for the other sex hormones, cardiovascular risk factors, or other brain lesions. In contrast, men with the highest SHBG had a lower risk both of cerebral atrophy and lacunes, after adjusting for sex hormones and cardiovascular risk factors. There were no associations between sex hormones and hippocampal atrophy, white matter lesions, and large infarcts. Because the levels of hormone were measured close in time to the acquisition of the MRI, these associations may reflect neurodegeneration in brain regions regulating hormone levels.

Calcitonin gene-related peptide (CGRP)-containing nerve fibers in bone tissue and their involvement in bone remodeling.

Bone remodeling is a process of bone renewal accomplished by osteoclastic bone resorption and osteoblastic bone formation. These two activities are regulated by systemic hormones and by local cytokines and growth factors. Moreover, the nervous system and certain neuropeptides seem to be involved in regulation of bone remodeling. In this paper, we focus on the distribution of CGRP-containing nerve fibers and their dynamics, and discuss the role of these fibers as a possible mechanism for nervous system involvement in regulation of bone remodeling. CGRP-immunoreactive nerve fibers are widely distributed in bone tissue, such as periosteum and bone marrow, and show apparent regional distribution with different densities. They are often associated with blood vessels and show a beaded appearance. The wide distribution of CGRP-immunoreactive nerve fibers in bone tissue and the changes in distribution during bone development and regeneration suggest the involvement of these fibers in bone remodeling. The effect of CGRP on bone remodeling could partly be through its action on blood vessels, thereby regulating local blood flow. Moreover, in vitro biochemical data and the localization of CGRP-immunoreactive nerve fibers in the vicinity of bone cells suggest that they are directly involved in local regulation of bone remodeling by elevating the concentration of CGRP in the microenvironment around bone cells, especially during bone growth or repair.