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1.
PLoS Med ; 16(9): e1002890, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31479454

RESUMO

BACKGROUND: There has been a growing interest in understanding the effects of social networks on health-related behaviour, with a particular backdrop being the emerging prominence of complexity or systems science in public health. Social network interventions specifically use or alter the characteristics of social networks to generate, accelerate, or maintain health behaviours. We conducted a systematic review and meta-analysis to investigate health behaviour outcomes of social network interventions. METHODS AND FINDINGS: We searched eight databases and two trial registries from 1990 to May 28, 2019, for English-language reports of randomised controlled trials (RCTs) and before-and-after studies investigating social network interventions for health behaviours and outcomes. Trials that did not specifically use social networks or that did not include a comparator group were excluded. We screened studies and extracted data from published reports independently. The primary outcome of health behaviours or outcomes at ≤6 months was assessed by random-effects meta-analysis. Secondary outcomes included those measures at >6-12 months and >12 months. This study is registered with the International Prospective Register of Systematic Reviews, PROSPERO: CRD42015023541. We identified 26,503 reports; after exclusion, 37 studies, conducted between 1996 and 2018 from 11 countries, were eligible for analysis, with a total of 53,891 participants (mean age 32.4 years [SD 12.7]; 45.5% females). A range of study designs were included: 27 used RCT/cluster RCT designs, and 10 used other study designs. Eligible studies addressed a variety of health outcomes, in particular sexual health and substance use. Social network interventions showed a significant intervention effect compared with comparator groups for sexual health outcomes. The pooled odds ratio (OR) was 1.46 (95% confidence interval [CI] 1.01-2.11; I2 = 76%) for sexual health outcomes at ≤6 months and OR 1.51 (95% CI 1.27-1.81; I2 = 40%) for sexual health outcomes at >6-12 months. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in haemoglobin A1c (HbA1c), and smoking cessation. Because of clinical and measurement heterogeneity, it was not appropriate to pool data on these other behaviours in a meta-analysis. For sexual health outcomes, prespecified subgroup analyses were significant for intervention approach (p < 0.001), mean age of participants (p = 0.002), and intervention length (p = 0.05). Overall, 22 of the 37 studies demonstrated a high risk of bias, as measured by the Cochrane Risk of Bias tool. The main study limitations identified were the inclusion of studies of variable quality; difficulty in isolating the effects of specific social network intervention components on health outcomes, as interventions included other active components; and reliance on self-reported outcomes, which have inherent recall and desirability biases. CONCLUSIONS: Our findings suggest that social network interventions can be effective in the short term (<6 months) and longer term (>6 months) for sexual health outcomes. Intervention effects for drug risk outcomes at each time point were not significant. There were also significant intervention effects for some other health outcomes including alcohol misuse, well-being, change in HbA1c, and smoking cessation.

2.
Br J Gen Pract ; 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31501165

RESUMO

BACKGROUND: Although the importance of secondary prevention after transient ischaemic attack (TIA) or minor stroke is recognised, research is sparse regarding novel, effective ways in which to intervene in a primary care context. AIM: To pilot a randomised controlled trial (RCT) of a novel home-based prevention programme (The Healthy Brain Rehabilitation Manual) for patients with TIA or 'minor' stroke. DESIGN AND SETTING: Pilot RCT, home-based, undertaken in Northern Ireland between May 2017 and March 2018. METHOD: Patients within 4 weeks of a first TIA or 'minor' stroke received study information from clinicians in four hospitals. Participants were randomly allocated to one of three groups: standard care (control group) (n = 12); standard care with manual and GP follow-up (n = 14); or standard care with manual and stroke nurse follow-up (n = 14). Patients in all groups received telephone follow-up at 1, 4, and 9 weeks. Eligibility, recruitment, and retention were assessed; stroke/cardiovascular risk factors measured at baseline and 12 weeks; and participants' views were elicited about the study via focus groups. RESULTS: Over a 32-week period, 28.2% of clinic attendees (125/443) were eligible; 35.2% of whom (44/125) consented to research contact; 90.9% of these patients (40/44) participated, of whom 97.5% (39/40) completed the study. After 12 weeks, stroke risk factors [cardiovascular risk factors, including blood pressure and measures of physical activity] improved in both intervention groups. The research methods and the programme were acceptable to patients and health professionals, who commented that the programme 'filled a gap' in current post-TIA management. CONCLUSION: Findings indicate that implementation of this novel cardiac rehabilitation programme, and of a trial to evaluate its effectiveness, is feasible, with potential for clinically important benefits and improved secondary prevention after TIA or 'minor' stroke.

3.
BMC Public Health ; 19(1): 1182, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462249

RESUMO

BACKGROUND: An adolescent's perceptions of their family's and friends' smoking attitudes and behaviour can influence their own uptake of smoking. There are two broad sources of such social influence: observing the behaviour directly, and assimilating attitudes. METHODS: We analysed data collected for the evaluation of Dead Cool, a school based smoking prevention intervention in Northern Ireland (n=480 in 20 clusters). The main analysis fits three nested logistic regression models predicting pre-intervention susceptibility to taking up smoking, as reflected in responses to three attitudinal questions. Model 1 includes only personal characteristics as explanatory factors. Model 2 adds the behaviour of friends and family that would provide an opportunity for social influence through observational learning. Model 3 adds the susceptibility of friends. RESULTS: Each additional group of variables improved the model fit (with reduced AIC and BIC). However, in the final model, only three variables were found to be statistically significant (p<0.05) in predicting susceptibility to smoking initiation: rebelliousness (OR [1.1,1.3]) from the personal characteristics group; and, in the observational learning group, being friends with a smoker (OR [1.0,2.9]) and frequency of being in the same room or car with someone smoking (OR [2.0,9.0] for most frequent). Adding the two measures of diffusion of susceptibility through the friendship network improved the model fit, but neither was found to be statistically significant. CONCLUSIONS: The analysis provides additional evidence to support policies that could reduce children's exposure to smoking behaviour, and potential subsequent smoking initiation. No conclusions could be drawn about the diffusion of smoking attitudes through the school friendship networks of children.

4.
Eye (Lond) ; 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455900

RESUMO

OBJECTIVES: To evaluate the agreement between Goldmann applanation tonometry (GAT) and Ocular Response Analyser (ORA) intraocular pressure (IOP) measurements, and patients' preferences. METHODS: Both eyes of participants in the 'Glaucoma within the Northern Ireland Cohort for the Longitudinal Study of Ageing' (GwNICOLA) were included. Participants underwent GAT by a glaucoma expert and ORA tonometry in a random order. Investigators were masked to measurements between devices. Participants were asked which tonometer, if any, they would prefer. We estimated the 95% limits of agreement (95% LoA) and the variables that influence agreement between tonometers. RESULTS: There were 228 eyes of 120 participants included in this study. Mean age of participants was 68.0 years (SD 8.79) and 52.5% were female. For GAT-ORA IOPcc the mean difference with GAT (95% CI) was -0.23 mmHg (-0.57 mmHg, 0.11 mmHg) and the 95% LoA (95% CIs) were from 4.82 mmHg (5.15 mmHg, 4.48 mmHg) to -5.28 mmHg (-5.61 mmHg, -4.94 mmHg). 40.8% of eyes had an IOP difference of 2 mmHg or more between GAT and ORA IOPcc. Corneal resistance factor (CRF) as estimated by ORA influenced the agreement between GAT and ORA IOPcc. There were no differences in preference for method of tonometry. CONCLUSIONS: Although ORA IOPcc measurements with ORA did not show significant bias compared with GAT, the relatively large proportion of measurement differences between ORA IOPcc and GAT that were >2 mmHg indicates that GAT and ORA IOP measurements may not be interchangeable. There were no differences in preference for method of tonometry.

5.
BMJ Open ; 9(6): e027073, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31203243

RESUMO

INTRODUCTION: SITLESS is a randomised controlled trial determining whether exercise referral schemes can be enhanced by self-management strategies to reduce sedentary behaviour and increase physical activity in the long term, in community-dwelling older citizens. The intervention is complex and requires a process evaluation to understand how implementation, causal mechanisms and context shape outcomes. The specific aims are to assess fidelity and reach of the implementation, understand the contextual aspects of each intervention site, evaluate the mechanisms of impact, and explore perceived effects. METHODS AND ANALYSIS: Following the Medical Research Council guidance on complex interventions, a combination of qualitative and quantitative procedures is applied, including observational checklists and attendance registries, standardised scales (ie, Marcus's Self-Efficacy Questionnaire, Physical Activity Self-Regulation Scale and the Lubben Social Network Scale) at baseline, postintervention and follow-up assessments, semistructured questionnaires gathering contextual characteristics, and participant observations of the sessions. Semistructured interviews and focus groups with the participants and trainers are conducted at postintervention and during the follow-up to explore their experiences. Outcomes from the standardised scales are analysed as moderators within the impact evaluation. Descriptive results on context and perceived effects complement results on impact. The qualitative and quantitative findings will help to refine the logic model to finally support the interpretation of the results on the effectiveness of the intervention. ETHICS AND DISSEMINATION: The study design was approved by the respective Ethical Committee of Ramon Llull University, Southern Denmark, Northern Ireland and Ulm University. Participation is voluntary, and all participants are asked to sign informed consent before starting the study. A dissemination plan operationalises how to achieve a social impact by reaching academic and non-academic stakeholders. A data management plan describes the specific data sets and regulates its deposition and curation. All publications will be open access. TRIAL REGISTRATION NUMBER: NCT02629666; Pre-results.

6.
N Engl J Med ; 380(26): 2529-2540, 2019 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-31242362

RESUMO

BACKGROUND: Data regarding high-sensitivity troponin concentrations in patients presenting to the emergency department with symptoms suggestive of myocardial infarction may be useful in determining the probability of myocardial infarction and subsequent 30-day outcomes. METHODS: In 15 international cohorts of patients presenting to the emergency department with symptoms suggestive of myocardial infarction, we determined the concentrations of high-sensitivity troponin I or high-sensitivity troponin T at presentation and after early or late serial sampling. The diagnostic and prognostic performance of multiple high-sensitivity troponin cutoff combinations was assessed with the use of a derivation-validation design. A risk-assessment tool that was based on these data was developed to estimate the risk of index myocardial infarction and of subsequent myocardial infarction or death at 30 days. RESULTS: Among 22,651 patients (9604 in the derivation data set and 13,047 in the validation data set), the prevalence of myocardial infarction was 15.3%. Lower high-sensitivity troponin concentrations at presentation and smaller absolute changes during serial sampling were associated with a lower likelihood of myocardial infarction and a lower short-term risk of cardiovascular events. For example, high-sensitivity troponin I concentrations of less than 6 ng per liter and an absolute change of less than 4 ng per liter after 45 to 120 minutes (early serial sampling) resulted in a negative predictive value of 99.5% for myocardial infarction, with an associated 30-day risk of subsequent myocardial infarction or death of 0.2%; a total of 56.5% of the patients would be classified as being at low risk. These findings were confirmed in an external validation data set. CONCLUSIONS: A risk-assessment tool, which we developed to integrate the high-sensitivity troponin I or troponin T concentration at emergency department presentation, its dynamic change during serial sampling, and the time between the obtaining of samples, was used to estimate the probability of myocardial infarction on emergency department presentation and 30-day outcomes. (Funded by the German Center for Cardiovascular Research [DZHK]; ClinicalTrials.gov numbers, NCT00470587, NCT02355457, NCT01852123, NCT01994577, and NCT03227159; and Australian New Zealand Clinical Trials Registry numbers, ACTRN12611001069943, ACTRN12610000766011, ACTRN12613000745741, and ACTRN12611000206921.).


Assuntos
Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Medição de Risco/métodos , Troponina/sangue , Adulto , Idoso , Biomarcadores/sangue , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sensibilidade e Especificidade , Troponina I/sangue
7.
Lancet Glob Health ; 7(7): e968-e978, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31122906

RESUMO

BACKGROUND: Glaucoma, particularly primary angle closure glaucoma (PACG), is a leading cause of global blindness. Nearly half of all people with PACG are of Chinese descent. Population-level glaucoma screening has generally not been found to be cost-effective in high-income countries; however, this assessment has rarely been done in low-income or middle-income countries. We aimed to assess the cost-effectiveness and cost-utility of population-level glaucoma screening in China. METHODS: We developed decision-analytic Markov models for separate and combined screening for PACG and primary open angle glaucoma (POAG) to evaluate costs and benefits of community-level screening versus opportunistic case finding from a societal perspective. A cohort of individuals was followed in the model from age 50 years through a total of 30 1-year Markov cycles. Analyses were done separately for rural and urban settings. We did a meta-analysis of glaucoma prevalence studies in China to obtain prevalence estimates for PACG and POAG. Screening costs were taken from a Chinese screening programme and treatment costs from a tertiary Chinese eye hospital. Main outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years and incremental cost-effectiveness ratios (ICERs) using years of blindness avoided. We did one-way deterministic and simulated probabilistic sensitivity analyses to reflect uncertainty around ICURs and ICERs. FINDINGS: Compared with no screening, combined screening of POAG and PACG in rural China is predicted to result in an ICUR of US$569 (95% CI 17 to 4180) and an ICER of $1280 (-58 to 7940), both of which are below the WHO cost-effectiveness threshold of one to three times rural gross domestic product. For the urban China setting, combined screening is predicted to result in fewer net costs and greater gain in health benefits than no screening. Findings were robust in all sensitivity analyses. Over 30 years, a total of 246 (95% CI 63 to 628) and 1325 (510 to 2828) years of blindness are predicted to be avoided for every 100 000 rural and urban residents screened, respectively. INTERPRETATION: Population screening for glaucoma (POAG and PACG combined) is likely to be cost-effective in both urban and rural China. Future studies should investigate the effectiveness of interventions to improve acceptance of definitive care among people screened. FUNDING: Ulverscroft Foundation, Wenzhou Medical University Research Fund, Zhejiang Province Health Innovation Talents Project, and Wenzhou's Ten Major Livelihood Issues 2015.

9.
Aging Ment Health ; : 1-8, 2019 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-30955348

RESUMO

OBJECTIVE: To evaluate the relationship between loneliness and cognitive functioning, and whether depressive and anxiety symptoms have intermediate roles therein. METHODS: Information about 7,433 participants of the Irish Longitudinal Study on Ageing (a prospective, representative cohort study), aged over 50, was collected at three time-points two years apart, and analysed using Structural Equation Modelling to assess whether depressive and anxiety symptoms mediate the relationship between loneliness and cognitive functioning. Cognitive functioning was measured as a latent factor, with four indicators: measures of immediate and delayed word recall, verbal fluency, and a global measure (the MMSE). Loneliness was measured using the UCLA Loneliness scale, depressive symptoms using the CES-D-ML scale, and anxiety symptoms using the HADS-A scale. RESULTS: Loneliness at time-point 1 predicted cognitive functioning at time-point 3, ß = -0.103, p < 0.001, and depressive (ß = 0.426, p < 0.001) and anxiety (ß = 0.410, p < 0.001) symptoms at time-point 2. Depressive (ß = -0.020, p = 0.001) but not anxiety (ß = -0.000, p = 0.658) symptoms mediated the relationship between loneliness and cognitive functioning, total effect: ß = -0.123, p < 0.001. CONCLUSION: The relationship between loneliness and cognitive functioning is in part explained by its relationship with depressive symptoms. Statistically, the mediation model helps us understand possible mechanisms through which loneliness impacts cognitive functioning. Results have implications for cognitive functioning interventions for older adults, and imply that loneliness is also a worthwhile target for intervention.

10.
J Med Internet Res ; 21(4): e11394, 2019 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-31002304

RESUMO

BACKGROUND: Investigating participant engagement and nonusage attrition can help identify the likely active ingredients of electronic health interventions. Research on engagement can identify which intervention components predict health outcomes. Research on nonusage attrition is important to make recommendations for retaining participants in future studies. OBJECTIVE: This study aimed to investigate engagement and nonusage attrition in the Physical Activity Loyalty (PAL) scheme, a 6-month complex physical activity intervention in workplaces in Northern Ireland. The intervention included financial incentives with reward redemption and self-regulation techniques. Specific objectives were (1) to determine whether engagement in specific intervention components predicted physical activity at 6 months, (2) to determine whether engagement in specific intervention components predicted targeted mediators at 6 months, and (3) to investigate predictors of nonusage attrition for participants recording daily activity via the PAL scheme physical activity monitoring system and logging onto the website. METHODS: Physical activity was assessed at baseline and 6 months using pedometers (Yamax Digiwalker CW-701, Japan). Markers of engagement and website use, monitoring system use, and reward redemption were collected throughout the scheme. Random-effects generalized least-squares regressions determined whether engagement with specific intervention components predicted 6-month physical activity and mediators. Cox proportional hazards regressions were used to investigate predictors of nonusage attrition (days until first 2-week lapse). RESULTS: A multivariable generalized least-squares regression model (n=230) showed that the frequency of hits on the website's monitoring and feedback component (regression coefficient [b]=50.2; SE=24.5; P=.04) and the percentage of earned points redeemed for financial incentives (b=9.1; SE=3.3; P=.005) were positively related to 6-month pedometer steps per day. The frequency of hits on the discussion forum (b=-69.3; SE=26.6; P=.009) was negatively related to 6-month pedometer steps per day. Reward redemption was not related to levels of more internal forms of motivation. Multivariable Cox proportional hazards regression models identified several baseline predictors associated with nonusage attrition. These included identified regulation (hazard ratio [HR] 0.88, 95% CI 0.81-0.97), recovery self-efficacy (HR 0.88, 95% CI 0.80-0.98), and perceived workplace environment safety (HR 1.07, 95% CI 1.02-1.11) for using the physical activity monitoring system. The EuroQoL health index (HR 0.33, 95% CI 0.12-0.91), financial motivation (HR 0.93, 95% CI 0.87-0.99), and perceived availability of physical activity opportunities in the workplace environment (HR 0.96, 95% CI 0.93-0.99) were associated with website nonusage attrition. CONCLUSIONS: Our results provide evidence opposing one of the main hypotheses of self-determination theory by showing that financial rewards are not necessarily associated with decreases in more internal forms of motivation when offered as part of a complex multicomponent intervention. Identifying baseline predictors of nonusage attrition can help researchers to develop strategies to ensure maximum intervention adherence. TRIAL REGISTRATION: ISRCTN Registry ISRCTN17975376; http://www.isrctn.com/ISRCTN17975376 (Archived by WebCite at http://www.webcitation.org/76VGZsZug).

11.
Aging (Albany NY) ; 11(7): 2045-2070, 2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-31009935

RESUMO

Differences in health status by socioeconomic position (SEP) tend to be more evident at older ages, suggesting the involvement of a biological mechanism responsive to the accumulation of deleterious exposures across the lifespan. DNA methylation (DNAm) has been proposed as a biomarker of biological aging that conserves memory of endogenous and exogenous stress during life.We examined the association of education level, as an indicator of SEP, and lifestyle-related variables with four biomarkers of age-dependent DNAm dysregulation: the total number of stochastic epigenetic mutations (SEMs) and three epigenetic clocks (Horvath, Hannum and Levine), in 18 cohorts spanning 12 countries.The four biological aging biomarkers were associated with education and different sets of risk factors independently, and the magnitude of the effects differed depending on the biomarker and the predictor. On average, the effect of low education on epigenetic aging was comparable with those of other lifestyle-related risk factors (obesity, alcohol intake), with the exception of smoking, which had a significantly stronger effect.Our study shows that low education is an independent predictor of accelerated biological (epigenetic) aging and that epigenetic clocks appear to be good candidates for disentangling the biological pathways underlying social inequalities in healthy aging and longevity.

12.
Curr Nutr Rep ; 8(2): 53-65, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30949921

RESUMO

PURPOSE OF REVIEW: Nutrition is known to modulate the immune system and may alter neuroinflammatory processes implicated in the pathogenesis of Alzheimer's disease (AD) and progression of neurodegeneration. Here, we review the evidence for healthy dietary patterns and age-related cognition and discuss potential neuroinflammatory actions of diet on cognitive function. RECENT FINDINGS: Anti-inflammatory dietary patterns such as the Mediterranean diet (MD) and dietary approaches to stop hypertension (DASH) may be neuroprotective. Several dietary components consumed in the MD and DASH (omega-3 fatty acids, antioxidants and polyphenols) can inhibit neuroinflammation associated with AD. Anti-inflammatory diets may also attenuate neuroinflammation via indirect immune pathways from the gut microbiome and systemic circulation. Diet may influence cognitive ageing via several inflammatory pathways. However, data from human studies are lacking and the exact mechanisms linking diet to cognitive function remain elusive. Further dietary intervention studies are required to investigate diet-associated neurological change from the earliest through to latest stages of cognitive decline. Furthermore, incorporation of neuroimaging measures in intervention studies would advance current understanding of the mechanistic effects of dietary modification on neuroinflammation in the ageing brain.

13.
Artigo em Inglês | MEDLINE | ID: mdl-30999806

RESUMO

Based on biologically plausible mechanisms and previous research, it is possible to hypothesize a reciprocal association between sustained attention and loneliness. We investigated this association using a cross-lagged modeling approach. Using data from 6,239 participants aged over 50 in TILDA, a nationally representative study of aging, we used structural equation models to investigate potential cross-lagged associations between sustained attention and loneliness, measured at baseline and again after four years. Sustained attention at baseline had a small association with loneliness four years later, but loneliness at baseline was not associated with sustained attention at follow-up. Auto-regressive associations were strong for both loneliness over time and sustained attention over time. Sustained attention may account for a small proportion of the variance in loneliness over time among older adults, and may constitute a risk factor in the development of loneliness. Implications for the identification of at-risk individuals and the prevention of loneliness are discussed.

14.
J Epidemiol Community Health ; 73(7): 625-629, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30910857

RESUMO

BACKGROUND: Growing evidence indicates that prolonged sedentary behaviour increases the risk of several chronic health conditions and all-cause mortality. Sedentary behaviour is prevalent among adults in the UK. Quantifying the costs associated with sedentary behaviour is an important step in the development of public health policy. METHODS: National Health Service (NHS) costs associated with prolonged sedentary behaviour (≥6 hours/day) were estimated over a 1-year period in 2016-2017 costs. We calculated a population attributable fraction (PAF) for five health outcomes (type 2 diabetes, cardiovascular disease [CVD], colon cancer, endometrial cancer and lung cancer). Adjustments were made for potential double-counting due to comorbidities. We also calculated the avoidable deaths due to prolonged sedentary behaviour using the PAF for all-cause mortality. RESULTS: The total NHS costs attributable to prolonged sedentary behaviour in the UK in 2016-2017 were £0.8 billion, which included expenditure on CVD (£424 million), type 2 diabetes (£281 million), colon cancer (£30 million), lung cancer (£19 million) and endometrial cancer (£7 million). After adjustment for potential double-counting, the estimated total was £0.7 billion. If prolonged sedentary behaviour was eliminated, 69 276 UK deaths might have been avoided in 2016. CONCLUSIONS: In this conservative estimate of direct healthcare costs, prolonged sedentary behaviour causes a considerable burden to the NHS in the UK. This estimate may be used by decision makers when prioritising healthcare resources and investing in preventative public health programmes.

15.
Soc Psychiatry Psychiatr Epidemiol ; 54(9): 1079-1088, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30863870

RESUMO

PURPOSE: Loneliness may have different cultural meanings in different countries. This may manifest as differing levels of Social Asymmetry-the discrepancy between loneliness and social isolation. Since loneliness is thought to be low in Sweden relative to more southerly countries, we hypothesised that more number of individuals would also fall into the "discordant robust" category of Social Asymmetry, i.e. that more individuals in Sweden would have lower loneliness levels relative to social isolation than in Ireland. We also explored the clinical relevance of Social Asymmetry in both countries, by examining its association with cognitive functioning. METHODS: We derived Social Asymmetry metrics in two representative cohort studies: the Irish Longitudinal Study on Ageing (TILDA) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Data pertaining to a dementia-free sample of 4565 Irish participants and 3042 Swedish participants, all aged over 60 years, were analysed using a multilevel modelling approach, with country as a higher-order variable. RESULTS: Contrary to the expected, more individuals in Ireland were "discordant robust" than in Sweden. We also found evidence for superior performance in global cognitive functioning among those in the "discordant robust" category relative to those in the discordant susceptible (i.e. those with higher levels of loneliness than social isolation) category, ß = 0.61, p < .001, across both countries. CONCLUSIONS: Irish older adults may be more robust to the impact of social isolation on loneliness than those in the Swedish cohort. Social Asymmetry was related to cognitive functioning in both countries, suggesting that Social Asymmetry is a clinically relevant construct.

16.
J Clin Periodontol ; 46(3): 266-275, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30712268

RESUMO

OBJECTIVE: To investigate whether there was an association between chronic periodontitis (CP) and reduced respiratory function. METHODS: A group of dentate 58- to 72-year-old men in Northern Ireland had a comprehensive periodontal examination. Parallel to the periodontal examination, participants completed questionnaires gathering information on their medical history, social circumstances, demographic background and tobacco use. A physical examination assessed anthropometric measures. Fasting blood samples were obtained and analysed for high-sensitivity C-reactive protein (hs-CRP). Spirometry measures were performed using a wedge bellows spirometer (Vitalograph S Model). The primary outcome variable of interest was the percentage predicted forced expiratory volume in one-second (% predicted FEV1 ). Analysis included multiple linear regression with adjustment for various confounders and a regression-based mediation analysis. RESULTS: A total of 1,380 men were included in the analysis. The mean age was 63.7 years (SD 3.0). Multiple linear regression analysis showed that a doubling in mean clinical attachment loss (CAL) equated to a -3.33% (95% CI: -4.80, -1.86), p < 0.001 change in % predicted FEV1 after adjustment for all other potential confounding variables. Systemic inflammation, as measured by hs-CRP, only accounted for a minor mediating pathway effect (9%). CONCLUSIONS: In this homogenous group of dentate men, CP was significantly associated with a reduced respiratory function.

17.
Stroke ; 50(3): 610-617, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30786848

RESUMO

Background and Purpose- NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a risk factor for atrial fibrillation and a marker of cardiac function used in the detection of heart failure. Given the link between cardiac dysfunction and stroke, NT-proBNP is a candidate marker of stroke risk. Our aim was to evaluate the association of NT-proBNP with stroke and to determine the predictive value beyond a panel of established risk factors. Methods- Based on the Biomarkers for Cardiovascular Risk Assessment in Europe-Consortium, we analyzed data of 58 173 participants (50% men; mean age 52 y) free of stroke from 6 community-based cohorts. NT-proBNP measurements were performed in the central Biomarkers for Cardiovascular Risk Assessment in Europe laboratory. The outcomes considered were total stroke and subtypes of stroke (ischemic/hemorrhagic). Results- During a median follow-up time of 7.9 years, we observed 1550 stroke events (1176 ischemic). Increasing quarters of the NT-proBNP distribution were associated with increasing risk of stroke ( P for trend <0.0001; multivariable Cox regression analysis adjusted for risk factors and cardiac diseases). Individuals in the highest NT-proBNP quarter (NT-proBNP >82.2 pg/mL) had 2-fold (95% CI, 75%-151%) greater risk of stroke than individuals in the lowest quarter (NT-proBNP <20.4 pg/mL). The association remained unchanged when adjusted for interim coronary events during follow-up, and though it was somewhat heterogeneous across cohorts, it was highly homogenous according to cardiovascular risk profile or subtypes of stroke. The addition of NT-proBNP to a reference model increased the C-index discrimination measure by 0.006 ( P=0.0005), yielded a categorical net reclassification improvement of 2.0% in events and 1.4% in nonevents and an integrated discrimination improvement of 0.007. Conclusions- In European individuals free of stroke, levels of NT-proBNP are positively associated with risk of ischemic and hemorrhagic stroke, independently from several other risk factors and conditions. The addition of NT-proBNP to variables of established risk scores improves prediction of stroke, with a medium effect size.

18.
BMC Res Notes ; 12(1): 12, 2019 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-30635016

RESUMO

OBJECTIVE: Reducing sedentary behaviour (SB) might improve the health of older adults. However, we know little about how objectively measured SB impacts on self-rated health in older adults. We aimed to explore the associations between objectively measured SB and self-rated health in English older adults. RESULTS: A random sub-sample of older adults (≥ 65 years old) from the 2008 Health Survey for England wore an ActiGraph GT1M accelerometer for 7 days. Self-rated health was measured using an item from the General Health Questionnaire. Linear regression and analysis of covariance were used to test the associations between percentage time spent in SB and mean daily minutes in SB and self-rated health (very good/good; fair; bad/very bad), adjusting for covariates. Valid accelerometry datasets were returned by 578 individuals. Significant negative associations between percentage time and mean daily minutes in SB and self-rated health were found. In particular, individuals spending reduced percentages of time being sedentary had higher self-rated health. In conclusion, SB appears to be associated with self-rated health in older people independently from MVPA. If longitudinal research could determine how changes in SB influence self-rated health as individuals' age, this might be an important lifestyle variable to target for health improvement.


Assuntos
Nível de Saúde , Comportamento Sedentário , Autorrelato/estatística & dados numéricos , Acelerometria , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Inglaterra , Feminino , Humanos , Masculino
19.
Lancet ; 392(10158): 1647-1661, 2018 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-30497795

RESUMO

BACKGROUND: Previous studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile. METHODS: We extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters. FINDINGS: The leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791-15 875] in Blackpool to 6888 [6145-7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD. The population attributable fractions for all-cause YLLs for individual major risk factors varied across Upper-Tier Local Authorities. Life expectancy and YLLs have improved more slowly since 2010 in all UK countries compared with 1990-2010. In nine of 150 Upper-Tier Local Authorities, YLLs increased after 2010. For attributable YLLs, the rate of improvement slowed most substantially for cardiovascular disease and breast, colorectal, and lung cancers, and showed little change for Alzheimer's disease and other dementias. Morbidity makes an increasing contribution to overall burden in the UK compared with mortality. The age-standardised UK DALY rate for low back and neck pain (1795 [1258-2356]) was higher than for ischaemic heart disease (1200 [1155-1246]) or lung cancer (660 [642-679]). The leading causes of ill health (measured through YLDs) in the UK in 2016 were low back and neck pain, skin and subcutaneous diseases, migraine, depressive disorders, and sense organ disease. Age-standardised YLD rates varied much less than equivalent YLL rates across the UK, which reflects the relative scarcity of local data on causes of ill health. INTERPRETATION: These estimates at local, regional, and national level will allow policy makers to match resources and priorities to levels of burden and risk factors. Improvement in YLLs and life expectancy slowed notably after 2010, particularly in cardiovascular disease and cancer, and targeted actions are needed if the rate of improvement is to recover. A targeted policy response is also required to address the increasing proportion of burden due to morbidity, such as musculoskeletal problems and depression. Improving the quality and completeness of available data on these causes is an essential component of this response. FUNDING: Bill & Melinda Gates Foundation and Public Health England.

20.
Ophthalmic Physiol Opt ; 38(6): 574-583, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30575074

RESUMO

PURPOSE: To compare diagnostic accuracy of confocal infrared reflectance (IR), with and without optical coherence tomography (OCT), to colour fundus photography (CFP) in the Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) Study. METHODS: Cross-sectional observational study of participants in NICOLA. CFP, IR and IR/OCT of 640 eyes were graded for hard, soft and reticular pseudodrusen; geographic atrophy; choroidal neovascularisation; naevus; epiretinal membrane; and haemorrhages. Test characteristics (sensitivity and specificity) for each imaging modality with respect to each retinal feature were calculated. RESULTS: With CFP as the reference standard, sensitivity of IR by itself ranged from 75% for RPD to 93.5% for hard drusen and specificity was above 90% for all features except hard drusen (71.7%). For IR combined with OCT, sensitivity ranged from 80% for choroidal neovascularisation to 96.5% for hard drusen. When IR alone was the reference standard, CFP sensitivity was high for naevi (97.5%) but reduced markedly for epiretinal membrane (48.5%). When the combination of IR and OCT was the reference standard, sensitivity for CFP was least for epiretinal membrane (31.5%), low for geographic atrophy and reticular pseudodrusen (77.8% and 76.2% respectively) and high for all other lesion types. CONCLUSION: Our findings support the use of confocal IR with OCT as a screening tool for a variety of features of macular disease in community optometric practice.


Assuntos
Macula Lutea/patologia , Microscopia Confocal/métodos , Fotografação/métodos , Doenças Retinianas/diagnóstico , Tomografia de Coerência Óptica/métodos , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes
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