Carol E. Baker

Familial resemblance of bone mineral density (BMD) and calcaneal ultrasound attenuation : The BMD in Mothers and Daughters Study

The familial resemblance in bone mineral density (BMD) and calcaneal broadband ultrasound attenuation (BUA) was examined in 207 mother‐daughter pairs. Mothers were participants in the Study of Osteoporotic Fractures. Three groups of daughters were recruited based on their maternal history of “fracture,” “low BMD” without fracture (< 0.58 g/cm2, t‐score < −2.5), and “normal BMD” without fracture (> 0.67 g/cm2, t‐score > −1.6). Data on other potentially heritable factors known to influence BMD and BUA were also collected. BMD was measured at the hip, spine, whole body, and calcaneus. Calcaneal BUA was assessed using the Walker‐Sonix UBA 575. Total hip and femoral neck BMD were significantly lower (5.0–8.0%, p < 0.017) among daughters, in particular premenopausal daughters, of mothers with established osteoporosis (“fracture” or “low BMD”) compared with daughters of mothers at lower risk of osteoporosis (“normal BMD”). BUA did not differ across daughter groups. Lifestyle characteristics (dietary calcium, smoking, physical activity) were not highly correlated in mothers and daughters. Height, weight, and body composition were significantly correlated within mother‐daughter pairs and could be a potential mechanism by which BMD is inherited. Among pre‐ and postmenopausal daughters, heritability estimates ranged from 50–63% and 34–48%, respectively. Heritability for calcaneal BUA (53%) was evident among postmenopausal daughters only. In conclusion, familial association in BMD was strongest among premenopausal daughters. Estimates of heritability suggest that maternal BMD and BUA are important independent predictors of BMD and BUA among daughters, reinforcing the importance of prevention and early intervention among women with a positive family history of osteoporosis. (J Bone Miner Res 1999;14: 102–110)

Studies of the epidemiology of dementia: Comparisons between developed and developing countries

By the year 2025, 68% of the world’s population aged 65 and above, nearly 277 million people, will be residing in developing countries. The less industrialized nations have been the least studied to date, and may yield significant new information about the etiology and risk factors for Alzheimer’s disease (AD) and other dementias. Although it is readily apparent that cross- national and cross- cultural comparisons are desirable, these can be meaningful only if based on comparable methodology. In this work we will discuss some general conceptual and methodological issues regarding epidemiological studies of dementia in developing countries. The topics discussed include community- based screening for dementia, screening instruments and their application in cross- cultural studies, steps in standardization of new or modified neuropsychological tests, and some special considerations in studying uneducated/illiterate populations. (Aging Clin. Exp. Res. 6: 307- 321, 1994)

The Effectiveness of Inflatable Pressure Splints on Motor Function in Stroke Patients

The effectiveness of inflatable pressure splints was assessed by comparing upper extremity function in 18 subjects with hemiplegia. Matched pairs of subjects were randomly assigned to a splint or non-splint treatment condition. The splinted group had the splint applied for 30 minutes, 5 days a week, for 3 weeks, while the non-splint group received no treatment. Analysis of variance with repeated measures showed no statistically significant differences in mean change in upper extremity sensation, pain, and motor function from week 0 to week 3 between the splint and non-splint groups. These results are consistent with a previous finding in which a shorter treatment time period of 1 week was used. Suggestions for further research are discussed.

The Development and Validation of the Vestibular Activities and Participation Measure

OBJECTIVES To develop and validate a new self-report outcome measure named the Vestibular Activities and Participation (VAP) for people with vestibular disorders to examine their activities and participation according to the International Classification of Functioning Disability and Health. DESIGN Delphi iterative survey for the development of the VAP and validation study. SETTING Tertiary balance clinic. PARTICIPANTS A panel of worldwide experts (n=17) in vestibular dysfunction participated in the development of the VAP, and patients (N=58) with vestibular disorders were enrolled in the validation of the VAP. INTERVENTION Not applicable. MAIN OUTCOME MEASURES For the development of the VAP, an Internet-based survey of 55 activities and participation items was presented to the panel of experts and the percentage agreement per item was calculated. For the validation of the VAP, the VAP was completed twice to examine the test-retest reliability, the World Health Organization Disability Assessment Schedule II (WHODAS II) was used to examine the concurrent validity with the VAP, and the Dizziness Handicap Inventory (DHI) was used to examine the convergent validity of the VAP. RESULTS After 2 rounds of the Delphi technique, the VAP was developed. The VAP total score had excellent test-retest reliability (intraclass correlation coefficient=.95; confidence interval=.91-.97) and good to excellent agreement per item indicated by the unweighted kappa (.41-.80) and the weighted kappa (.58-.94). The minimum detectable change at 95% confidence level of the VAP score was .58. The VAP had strong correlation (ρ=.70; P<.05) with the WHODAS II and moderate to strong correlations (ρ=.54-.74) with the DHI subscale and total scores. After adjustment for age, we found sex and self-reported imbalance to be independent explanatory variables of the transformed VAP total score. CONCLUSIONS The VAP measure was developed to examine the disabling effect of vestibular disorders on peoples activities and participation based on a standardized framework (the International Classification of Functioning Disability and Health). The VAP demonstrated excellent reliability and was validated with external instruments in people with vestibular disorders.

Practical issues in cognitive screening of elderly illiterate populations in developing countries. The Indo-US Cross-National Dementia Epidemiology Study

The study of the epidemiology of dementia, specifically Alzheimer’s disease, in developing countries requires specialized instruments and personnel. Cultural and sub-cultural differences among populations are highly relevant to the design of such instruments. Over and above the cultural issues, it is widely recognized that low education and illiteracy pose considerable challenges to reliable and valid cognitive screening. The overall objectives of the Indo-US Cross-National Dementia Epidemiology Study were: a) to determine the prevalence and incidence of, and risk factors for, Alzheimer’s and other dementias in a defined Indian community; and b) to compare these results with those found in a defined American community. To achieve these epidemiological objectives, our first task was to develop, systematically and empirically, suitable cognitive and activities assessment screening instruments for use in India, which would 1) be culturally fair, psychometrically sound, and valid for a population with little or no education; 2) be optimally sensitive and specific for dementia; and 3) allow not only the identification but also the more detailed characterization of dementia, and of normal and abnormal cognitive aging. In this paper we address the practical issues involved in the development and administration of the modified cognitive screening battery in our rural Indian context.

Youth and culture: A seventeen nation study of perceived problems and coping strategies

JANICE T. GIBSON, MARVIN J. WESTWOOD, F. ISHU ISHIYAMA, WILLIAM A. BORGEN, SUSAN M. SHOWALTER, QASEM AL-SARRAF, SEMIHA A. ATAKAN, ISAURA R.F. GUIMARES, A. LINA GUISTI-ORTIZ, MARGARET ROBERTSON, BENJAMIN SHAFRIR, PETER DE WEERDT, GUNDELINA A. VELAZCO, CAROL E. BAKER, MARIA DIKAIOU, TATIANA GABAY, LINA KASHYUP, ILONA LEE, MARIA E. FELCE DI PAULA, HILLMAN NGUNANGWA & NINA F. TALYZINA University of Pittsburgh, School of Education, Forbes Quadrangle, Pittsburgh, PA 15260, USA

Correlates of bone mineral density among postmenopausal women of African Caribbean ancestry: Tobago women's health study

Population dynamics predict a drastic growth in the number of older minority women, and resultant increases in the number of fractures. Low bone mineral density (BMD) is an important risk factor for fracture. Many studies have identified the lifestyle and health-related factors that correlate with BMD in Whites. Few studies have focused on non-Whites. The objective of the current analyses is to examine the lifestyle, anthropometric and health-related factors that are correlated with BMD in a population based cohort of Caribbean women of West African ancestry. We enrolled 340 postmenopausal women residing on the Caribbean Island of Tobago. Participants completed a questionnaire and had anthropometric measures taken. Hip BMD was measured by DXA. We estimated volumetric BMD by calculating bone mineral apparent density (BMAD). BMD was >10% and >25% higher across all age groups in Tobagonian women compared to US non-Hispanic Black and White women, respectively. In multiple linear regression models, 35-36% of the variability in femoral neck and total hip BMD respectively was predicted. Each 16-kg (one standard deviation (SD)) increase in weight was associated with 5% higher BMD; and weight explained over 10% of the variability of BMD. Each 8-year (1 SD) increase in age was associated with 5% lower BMD. Current use of both thiazide diuretics and oral hypoglycemic medication were associated with 4-5% higher BMD. For femoral neck BMAD, 26% of the variability was explained by a multiple linear regression model. Current statin use was associated with 5% higher BMAD and a history of breast feeding or coronary heart disease was associated with 1-1.5% of higher BMAD. In conclusion, African Caribbean women have the highest BMD on a population level reported to date for women. This may reflect low European admixture. Correlates of BMD among Caribbean women of West African ancestry were similar to those reported for U.S. Black and White women.