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1.
Arch Gerontol Geriatr ; 116: 105157, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37634304

RESUMO

OBJECTIVE: To investigate the association between kidney function with the risk of dementia and brain volumes. METHODS: A total of 452,996 UK Biobank participants with calculated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) were included. We utilized Cox proportional hazards regression models and restricted cubic spline analyses to examine the relationships between kidney function and the risk of all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VD). Additionally, we explored the correlations between kidney function and brain magnetic resonance indicators among 40,380 participants. RESULTS: During a median follow-up of 12 years, 5,258 incident ACD cases were identified. The deterioration of kidney function was associated with an increased risk of ACD. When compared to eGFR ≥ 90 ml/min/1.73 m², the highest risk increase was evident for eGFRcre < 30 ml/min/1.73 m² (adjusted HR = 2.372, 95% CI: 1.444-3.897, P < 0.001), with eGFRcys showing greater significance (adjusted HR = 3.045, 95% CI: 2.212-4.191, P < 0.001), especially in relation to AD. Compared to the ACR level in the range of 3-30 mg/mmol, the category of > 30 mg/mmol was associated with an increased risk of ACD (adjusted HR = 1.720, 95% CI: 1.350-2.190, P < 0.001). Moreover, the decline in kidney function was associated with the total brain volume atrophy and reduction in certain subcortical areas. CONCLUSIONS: Our study indicates that diminished kidney function, as evidenced by a drop in eGFR and aggravated proteinuria, elevates dementia risk. Associated brain structural changes further underpin this connection from a neuro-pathophysiological perspective.


Assuntos
Doença de Alzheimer , Insuficiência Renal Crônica , Humanos , Bancos de Espécimes Biológicos , Fatores de Risco , Taxa de Filtração Glomerular/fisiologia , Doença de Alzheimer/complicações , Rim , Encéfalo/diagnóstico por imagem , Reino Unido/epidemiologia , Creatinina
2.
J Affect Disord ; 345: 419-426, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-37852586

RESUMO

OBJECTIVE: To examine the association between depression and the risk of incident irritable bowel syndrome (IBS). METHODS: We included 98,564 participants free of IBS in the UK biobank. Depression was defined by self-report and Hospital Episode Statistics. The main outcome was incident IBS. Cox proportional hazards regression models and two-sample mendelian randomization were performed to estimate the risk of incident IBS. RESULTS: Among 98,564 participants, 8770 (8.9 %) participants had a depression diagnosis at baseline. During a median of 12.9-year follow-up, 224 cases of incident IBS were identified in patients with depression (2.0 per 1000 person-years), compared with 1625 cases in reference individuals (1.5 per 1000 person-years). After adjustment, the hazard ratio of incident IBS associated with depression was 1.26 (95 % CI: 1.01-1.41). Sensitivity analysis indicated similar results. The two-sample mendelian randomization based on the inverse variance weighted method provided evidence for the harmful role of depression in an increased risk of IBS with an OR of 1.57 (95 % CI: 1.24-1.99). LIMITATIONS: Depression was mainly measured by self-report online CIDI-SF in the current study, rather than the gold diagnostic criteria including clinical structured interview, which might lead to potential measurement error. Lifestyle behaviors might change during the long-term follow-up, and time-varying covariates (i.e., smoking and alcohol status) may bias the estimate. CONCLUSIONS: Depression is associated with an increased risk of incident IBS. Further studies are warranted to confirm the role of depression on incident IBS and elucidate the underlying mechanisms.


Assuntos
Transtorno Depressivo Maior , Síndrome do Intestino Irritável , Humanos , Transtorno Depressivo Maior/complicações , Síndrome do Intestino Irritável/epidemiologia , Síndrome do Intestino Irritável/genética , Estudos de Coortes , Análise da Randomização Mendeliana , Bancos de Espécimes Biológicos , Reino Unido/epidemiologia , Fatores de Risco
3.
J Affect Disord ; 345: 70-77, 2024 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-37863366

RESUMO

BACKGROUND: Despite the known health costs of persistent depression, there is no established service framework for the treatment of this disorder and a lack of long-term outcome data to inform commissioning. To address this gap, we report the long-term clinical effectiveness of a randomised controlled trial (RCT) testing a specialist, collaborative model of care for people with persistent moderate to severe unipolar depression. METHODS: A multicentre, pragmatic, single-blind, parallel-group randomised controlled trial comparing outcomes from a Specialist Depression Service (SDS) offering collaborative treatment with cognitive behavioural therapy (CBT) and pharmacotherapy for 12 months with treatment as usual (TAU) for persistent, moderate-severe depression in UK secondary care. Participants were initially assessed at baseline, 3, 6, 9, 12, and 18 months, with primary endpoints (17-item Hamilton Depression Rating Scale [HDRS17], and a Global Assessment of Functioning [GAF]) reported elsewhere (Morriss et al., 2016). Additional long-term, post-treatment, follow-up was made at 24 and 36 months with outcomes presented here. CLINICALTRIALS: gov (NCT01047124) and ISRCTN registration (ISRCTN 10963342). RESULTS: At 24 months there remained a statistically significant between-group difference in HDRS17-2.69 (-5.14, -0.23) and a non-significant improvement in GAF 2.85 (-1.23, 6.94), both favouring the SDS. Simple statistics are presented at 36 months, due to attrition, showing higher continued response and remission vs TAU across all measures. LIMITATIONS: Potential bias through loss to follow-up, particularly beyond 24 months. CONCLUSIONS: Compared with standard secondary care, SDS management of persistent moderate-severe depression, produced long-term clinical benefits, sustained following treatment completion, suggesting a model for future specialist care.


Assuntos
Terapia Cognitivo-Comportamental , Transtorno Depressivo Maior , Humanos , Depressão/terapia , Atenção Secundária à Saúde , Transtorno Depressivo Maior/terapia , Resultado do Tratamento , Reino Unido , Análise Custo-Benefício
4.
Sci Total Environ ; 906: 167607, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37806575

RESUMO

Exposure to pollen and fungal spores can trigger asthma/allergic symptoms and affect health. Rising temperatures from climate change have been associated with earlier seasons and increasing intensity for some pollen, with weaker evidence for fungal spores. It is unclear whether climate change has resulted in changes in the exposure-response function between temperature and pollen/fungal spore concentrations over time. This study examined associations between temperature and pollen/fungal spores in different time periods and assessed potential adaptation using the longest pollen/fungal spore dataset in existence (52 years). Daily concentrations of pollen (birch and grass) and fungal spores (Cladosporium, Alternaria, Sporobolomyces and Tilletiopsis) collected between April and October from Derby (1970-2005) and Leicester (2006-2021), UK, were analysed. Cumulative seasonal concentrations (seasonal integral) and start-of-season were calculated and linked to seasonal mean temperatures (Tmeans) using generalized additive models. Daily concentrations were evaluated against daily Tmean with distributed lagged nonlinear models. Models were adjusted for precipitation, relative humidity, long-term trend and location. Seasonal and daily analyses were respectively stratified into two periods (1970-1995, 1997-2021) and five decades. Warmer seasonal Tmeans were associated with higher seasonal integral for birch, Cladosporium and Alternaria, as well as earlier start-of-season for birch, grass and Cladosporium. There were indications of changing associations with temperature in the recent decades. A warmer January was associated with higher seasonal integral for grass in 1997-2021, but not in 1970-1995. In 2000-2021, daily concentrations of birch pollen tended to remain at higher levels, vs. decrease during 1990s, when Tmean was between 13 and 15 °C. Our study suggests higher temperatures experienced in recent decades are associated with higher overall abundance of some pollen/fungal spores, which may increase future disease burdens of allergies. The changing responses of some pollen to higher temperatures over time may indicate adaptation to increasing temperatures and should be considered in climate change mitigation and adaptation planning.


Assuntos
Alérgenos , Pólen , Esporos Fúngicos , Temperatura , Inglaterra , Poaceae , Estações do Ano , Reino Unido , Betula , Cladosporium , Alternaria
7.
Vet Rec ; 193 Suppl 1: 7-8, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37921348

RESUMO

While population control remains a key priority for the UK's leading dog welfare charities, it must increasingly be balanced with concerns about the possible health impact of castration.


Assuntos
Instituições de Caridade , Orquiectomia , Animais , Cães , Masculino , Orquiectomia/veterinária , Controle da População , Reino Unido , Humanos
8.
Anaesthesia ; 78(12): 1442-1452, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37920932

RESUMO

We report the results of the Royal College of Anaesthetists' 7th National Audit Project organisational baseline survey sent to every NHS anaesthetic department in the UK to assess preparedness for treating peri-operative cardiac arrest. We received 199 responses from 277 UK anaesthetic departments, representing a 72% response rate. Adult and paediatric anaesthetic care was provided by 188 (95%) and 165 (84%) hospitals, respectively. There was no paediatric intensive care unit on-site in 144 (87%) hospitals caring for children, meaning transfer of critically ill children is required. Remote site anaesthesia is provided in 182 (92%) departments. There was a departmental resuscitation lead in 113 (58%) departments, wellbeing lead in 106 (54%) and departmental staff wellbeing policy in 81 (42%). A defibrillator was present in every operating theatre suite and in all paediatric anaesthesia locations in 193 (99%) and 149 (97%) departments, respectively. Advanced airway equipment was not available in: every theatre suite in 13 (7%) departments; all remote locations in 103 (57%) departments; and all paediatric anaesthesia locations in 23 (15%) departments. Anaesthetic rooms were the default location for induction of anaesthesia in adults and children in 148 (79%) and 121 (79%) departments, respectively. Annual updates in chest compressions and in defibrillation were available in 149 (76%) and 130 (67%) departments, respectively. Following a peri-operative cardiac arrest, debriefing and peer support programmes were available in 154 (79%) and 57 (29%) departments, respectively. While it is likely many UK hospitals are very well prepared to treat anaesthetic emergencies including cardiac arrest, the survey suggests this is not universal.


Assuntos
Anestésicos , Parada Cardíaca , Adulto , Criança , Humanos , Inquéritos e Questionários , Hospitais , Reino Unido
13.
BMJ Open ; 13(11): e072304, 2023 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-37923350

RESUMO

OBJECTIVES: Describe experiences of countries with networks of care's (NOCs') financial arrangements, identifying elements, strategies and patterns. DESIGN: Descriptive using a modified cross-case analysis, focusing on each network's financing functions (collecting resources, pooling and purchasing). SETTING: Health systems in six countries: Argentina, Australia, Canada, Singapore, the United Kingdom and the USA. PARTICIPANTS: Large-scale NOCs. RESULTS: Countries differ in their strategies to implement and finance NOCs. Two broad models were identified in the six cases: top-down (funding centrally designed networks) and bottom-up (financing individual projects) networks. Despite their differences, NOCs share the goal of improving health outcomes, mainly through the coordination of providers in the system; these results are achieved by devoting extra resources to the system, including incentives for network formation and sustainability, providing extra services and setting incentive systems for improving the providers' performance. CONCLUSIONS: Results highlight the need to better understand the financial implications and alternatives for designing and implementing NOCs, particularly as a strategy to promote better health in low- and middle-income settings.


Assuntos
Financiamento da Assistência à Saúde , Humanos , Reino Unido , Argentina , Austrália , Canadá , Singapura
14.
Front Endocrinol (Lausanne) ; 14: 1259475, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37929032

RESUMO

Objective: To investigate whether prior cholecystectomy is associated with incident osteoporosis. Background: Cholecystectomy may have consequences involving abnormal metabolism. Studies investigating the association between prior cholecystectomy and osteoporosis have yielded inconsistent results. Methods: In total, 17,603 UK Biobank participants underwent cholecystectomy, and 35,206 matched controls were included in this study. They were followed up for incident osteoporosis, which was determined using ICD-10 codes (M80-82). The association between cholecystectomy and osteoporosis was assessed using Cox proportional regression modeling. The association between osteoporosis risk and cholecystectomy was further analyzed across age, sex, serum vitamin D level, and body mass index (BMI) categories. Results: Within a median follow-up period of 13.56 years, 3,217 participants were diagnosed with osteoporosis. After adjustment for relevant confounders, prior cholecystectomy was associated with a 1.21 times higher risk of osteoporosis in women (hazard ratio (HR): 1.21 [95% CI, 1.12-1.31], p < 0.001) and a 1.45 times higher risk in men (HR: 1.45 [95% CI, 1.10-1.90], p = 0.007). In women, the association was stronger for patients who were aged 40-55 years, with BMI < 18.5 kg/m2, and vitamin D between 30 and 50 nmol/ml. No significant interactions between cholecystectomy and income level, education level, presence of hypertension, or diabetes were identified in either sex. Conclusions: Our findings indicated that people who underwent cholecystectomy had a higher risk of developing osteoporosis after adjustment for potential confounders. Our findings suggest that awareness of the risk of osteoporosis in patients with a history of cholecystectomy is merited.


Assuntos
Bancos de Espécimes Biológicos , Osteoporose , Masculino , Humanos , Feminino , Estudos Prospectivos , Osteoporose/epidemiologia , Osteoporose/etiologia , Vitamina D , Colecistectomia/efeitos adversos , Reino Unido/epidemiologia
15.
Hepatol Commun ; 7(11)2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37930150

RESUMO

BACKGROUND: HE is a common neurologic complication in cirrhosis associated with substantial disease and economic burden. HE symptoms are nonspecific and there are limited ways of identifying patients with cirrhosis at high risk of later developing HE. A risk score was previously developed to identify patients at risk of developing HE in a predominately male US cohort. Here, we evaluated the performance of the HE risk scores in a UK cohort study. METHODS: Health care records from Clinical Practice Research Datalink and linked Hospital Episode Statistics were used to select patients with cirrhosis who were diagnosed with HE, confirmed by a diagnosis code for HE or a rifaximin-α prescription. The index date was the date of incident cirrhosis. The study period was from January 2003 to June 2019. RESULTS: A total of 40,809 patients with cirrhosis were selected in the UK cohort, of whom 59% were male. A total of 1561 patients were diagnosed with HE. Applying the UK cohort to the baseline sensitivity risk cutoff (≥-11) from the US cohort provided a sensitivity of 92% and a negative predictive value of 99%. Within a longitudinal model, applying a sensitivity cutoff of ≥-3 to this cohort gave a sensitivity of 89% and a negative predictive value of 99%. CONCLUSIONS: Using data from the UK, the previously developed HE risk scores were found to be reliable for selecting those most likely to progress to HE in patients with liver cirrhosis. Despite the HE risk scores originally being estimated using the data from a predominately male US cohort, the scores were validated and found to be generalizable to female patients.


Assuntos
Encefalopatia Hepática , Humanos , Masculino , Feminino , Encefalopatia Hepática/diagnóstico , Encefalopatia Hepática/epidemiologia , Encefalopatia Hepática/etiologia , Estudos de Coortes , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Fatores de Risco , Fibrose , Reino Unido/epidemiologia
16.
BMC Public Health ; 23(1): 2177, 2023 11 07.
Artigo em Inglês | MEDLINE | ID: mdl-37932741

RESUMO

BACKGROUND: The relation of social deprivation with single cardiometabolic disease (CMD) was widely investigated, whereas the association with cardiometabolic multi-morbidity (CMM), defined as experiencing more than two CMDs during the lifetime, is poorly understood. METHODS: We analyzed 345,417 UK Biobank participants without any CMDs at recruitment to study the relation between social deprivation and four CMDs including type II diabetes (T2D), coronary artery disease (CAD), stroke and hypertension. Social deprivation was measured by Townsend deprivation index (TDI), and CMM was defined as occurrence of two or more of the above four diseases. Multivariable Cox models were performed to estimate hazard ratios (HRs) per one standard deviation (SD) change and in quartile (Q1-Q4, with Q1 as reference), as well as 95% confidence intervals (95% CIs). RESULTS: During the follow up, 68,338 participants developed at least one CMD (median follow up of 13.2 years), 16,225 further developed CMM (median follow up of 13.4 years), and 18,876 ultimately died from all causes (median follow up of 13.4 years). Compared to Q1 of TDI (lowest deprivation), the multivariable adjusted HR (95%CIs) of Q4 (highest deprivation) among participants free of any CMDs was 1.23 (1.20 ~ 1.26) for developing one CMD, 1.42 (1.35 ~ 1.48) for developing CMM, and 1.34 (1.27 ~ 1.41) for all-cause mortality. Among participants with one CMD, the adjusted HR (95%CIs) of Q4 was 1.30 (1.27 ~ 1.33) for developing CMM and 1.34 (1.27 ~ 1.41) for all-cause mortality, with HR (95%CIs) = 1.11 (1.06 ~ 1.16) for T2D patients, 1.07 (1.03 ~ 1.11) for CAD patients, 1.07 (1.00 ~ 1.15) for stroke patients, and 1.24 (1.21 ~ 1.28) for hypertension patients. Among participants with CMM, TDI was also related to the risk of all-cause mortality (HR of Q4 = 1.35, 95%CIs 1.28 ~ 1.43). CONCLUSIONS: We revealed that people living with high deprived conditions would suffer from higher hazard of CMD, CMM and all-cause mortality.


Assuntos
Diabetes Mellitus Tipo 2 , Hipertensão , Acidente Vascular Cerebral , Humanos , Diabetes Mellitus Tipo 2/epidemiologia , Fatores de Risco , Multimorbidade , Bancos de Espécimes Biológicos , Estudos de Coortes , Morbidade , Hipertensão/epidemiologia , Privação Social , Acidente Vascular Cerebral/epidemiologia , Reino Unido/epidemiologia
17.
J Orthop Surg Res ; 18(1): 846, 2023 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-37940977

RESUMO

AIMS: Frozen shoulder and proximal humeral fracture can cause pain, stiffness and loss of function. The impact of these symptoms on patients can be measured using the comprehensively validated, 12-item Oxford Shoulder Score (OSS). Evidence suggests that pain and function may have a differential impact on patients' experience of shoulder conditions, and this may be important for clinical management. We therefore explored the factor structure of the OSS within the UK FROST and PROFHER trial populations. METHODS: We performed exploratory factor analysis (EFA), followed by confirmatory factor analysis (CFA), on baseline UK FROST data from 490 of the 503 trial participants. Data at 6 months post-randomisation were used for 228 of the 250 participants for the PROFHER trial. RESULTS: UK FROST factor extraction results, using Velicer's Minimum Average Partial and Horn's Parallel Analysis tests, suggested a unifactorial solution, but two factors were weakly indicated by the less reliable 'Kaiser's eigenvalue > 1' and scree tests. We explored this further using EFA. Eight items (2 to 7, 9 and 10) loaded onto a 'Function' factor, three on a 'Pain' factor (1, 8 and 12) and item 11 cross-loaded. However, one- and two-factor models were rejected in CFA. Factor extraction of PROFHER data at 6 months demonstrated a single first-order factor solution, which was also subsequently rejected in CFA. CONCLUSION: Insufficient evidence was found, within the constraints of the data available, to support the use of 'Pain' and 'Function' sub-scales of the OSS in either patient population.


Assuntos
Fraturas do Ombro , Ombro , Humanos , Resultado do Tratamento , Fixação de Fratura/métodos , Fraturas do Ombro/diagnóstico , Dor , Reino Unido/epidemiologia
18.
Lancet Healthy Longev ; 4(11): e591-e599, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37924840

RESUMO

BACKGROUND: Although the long-term health effects of COVID-19 are increasingly recognised, the societal restrictions during the COVID-19 pandemic hold the potential for considerable detriment to cognitive and mental health, particularly because major dementia risk factors-such as those related to exercise and dietary habits-were affected during this period. We used longitudinal data from the PROTECT study to evaluate the effect of the pandemic on cognition in older adults in the UK. METHODS: For this longitudinal analysis, we used computerised neuropsychology data from individuals aged 50 years and older participating in the PROTECT study in the UK. Data were collected from the same participants before the COVID-19 pandemic (March 1, 2019-Feb 29, 2020) and during its first (March 1, 2020-Feb 28, 2021) and second (March 1, 2021-Feb 28, 2022) years. We compared cognition across the three time periods using a linear mixed-effects model. Subgroup analyses were conducted in people with mild cognitive impairment and in people who reported a history of COVID-19, and an exploratory regression analysis identified factors associated with changes in cognitive trajectory. FINDINGS: Pre-pandemic data were included for 3142 participants, of whom 1696 (54·0%) were women and 1446 (46·0%) were men, with a mean age of 67·5 years (SD 9·6, range 50-96). Significant worsening of executive function and working memory was observed in the first year of the pandemic across the whole cohort (effect size 0·15 [95% CI 0·12-0·17] for executive function and 0·51 [0·49-0·53] for working memory), in people with mild cognitive impairment (0·13 [0·07-0·20] and 0·40 [0·36-0·47]), and in people with a history of COVID-19 (0·24 [0·16-0·31] and 0·46 [0·39-0·53]). Worsening of working memory was sustained across the whole cohort in the second year of the pandemic (0·47; 0·44-0·49). Regression analysis indicated that cognitive decline was significantly associated with reduced exercise (p=0·0049; executive function) and increased alcohol use (p=0·049; working memory) across the whole cohort, as well as depression (p=0·011; working memory) in those with a history of COVID-19 and loneliness (p=0·0038; working memory) in those with mild cognitive impairment. In the second year of the pandemic, reduced exercise continued to affect executive function across the whole cohort, and associations were sustained between worsening working memory and increased alcohol use (p=0·0040), loneliness (p=0·042), and depression (p=0·014) in those with mild cognitive impairment, and reduced exercise (p=0·0029), loneliness (p=0·031) and depression (p=0·036) in those with a history of COVID-19. INTERPRETATION: The COVID-19 pandemic resulted in a significant worsening of cognition in older adults, associated with changes in known dementia risk factors. The sustained decline in cognition highlights the need for public health interventions to mitigate the risk of dementia-particularly in people with mild cognitive impairment, in whom conversion to dementia within 5 years is a substantial risk. Long-term intervention for people with a history of COVID-19 should be considered to support cognitive health. FUNDING: National Institute for Health and Care Research.


Assuntos
COVID-19 , Disfunção Cognitiva , Demência , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pandemias , COVID-19/epidemiologia , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Reino Unido/epidemiologia
20.
BMC Med ; 21(1): 384, 2023 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-37946218

RESUMO

BACKGROUND: Components of social connection are associated with mortality, but research examining their independent and combined effects in the same dataset is lacking. This study aimed to examine the independent and combined associations between functional and structural components of social connection and mortality. METHODS: Analysis of 458,146 participants with full data from the UK Biobank cohort linked to mortality registers. Social connection was assessed using two functional (frequency of ability to confide in someone close and often feeling lonely) and three structural (frequency of friends/family visits, weekly group activities, and living alone) component measures. Cox proportional hazard models were used to examine the associations with all-cause and cardiovascular disease (CVD) mortality. RESULTS: Over a median of 12.6 years (IQR 11.9-13.3) follow-up, 33,135 (7.2%) participants died, including 5112 (1.1%) CVD deaths. All social connection measures were independently associated with both outcomes. Friends/family visit frequencies < monthly were associated with a higher risk of mortality indicating a threshold effect. There were interactions between living alone and friends/family visits and between living alone and weekly group activity. For example, compared with daily friends/family visits-not living alone, there was higher all-cause mortality for daily visits-living alone (HR 1.19 [95% CI 1.12-1.26]), for never having visits-not living alone (1.33 [1.22-1.46]), and for never having visits-living alone (1.77 [1.61-1.95]). Never having friends/family visits whilst living alone potentially counteracted benefits from other components as mortality risks were highest for those reporting both never having visits and living alone regardless of weekly group activity or functional components. When all measures were combined into overall functional and structural components, there was an interaction between components: compared with participants defined as not isolated by both components, those considered isolated by both components had higher CVD mortality (HR 1.63 [1.51-1.76]) than each component alone (functional isolation 1.17 [1.06-1.29]; structural isolation 1.27 [1.18-1.36]). CONCLUSIONS: This work suggests (1) a potential threshold effect for friends/family visits, (2) that those who live alone with additional concurrent markers of structural isolation may represent a high-risk population, (3) that beneficial associations for some types of social connection might not be felt when other types of social connection are absent, and (4) considering both functional and structural components of social connection may help to identify the most isolated in society.


Assuntos
Doenças Cardiovasculares , Isolamento Social , Humanos , Estudos Prospectivos , Bancos de Espécimes Biológicos , Estudos de Coortes , Reino Unido/epidemiologia
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