Deborah L. Wingard

New onset and persistent symptoms of post-traumatic stress disorder self reported after deployment and combat exposures: prospective population based US military cohort study

Objective To describe new onset and persistence of self reported post-traumatic stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars in Iraq and Afghanistan. Design Prospective cohort analysis. Setting and participants Survey enrolment data from the millennium cohort (July 2001 to June 2003) obtained before the wars in Iraq and Afghanistan. Follow-up (June 2004 to February 2006) data on health outcomes collected from 50 184 participants. Main outcome measures Self reported post-traumatic stress disorder as measured by the posttraumatic stress disorder checklist—civilian version using Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria. Results More than 40% of the cohort were deployed between 2001 and 2006; between baseline and follow-up, 24% deployed for the first time in support of the wars in Iraq and Afghanistan. New incidence rates of 10-13 cases of post-traumatic stress disorder per 1000 person years occurred in the millennium cohort. New onset self reported post-traumatic stress disorder symptoms or diagnosis were identified in 7.6-8.7% of deployers who reported combat exposures, 1.4-2.1% of deployers who did not report combat exposures, and 2.3-3.0% of non-deployers. Among those with self reported symptoms of post-traumatic stress disorder at baseline, deployment did not affect persistence of symptoms. Conclusions After adjustment for baseline characteristics, these prospective data indicate a threefold increase in new onset self reported post-traumatic stress disorder symptoms or diagnosis among deployed military personnel who reported combat exposures. The findings define the importance of post-traumatic stress disorder in this population and emphasise that specific combat exposures, rather than deployment itself, significantly affect the onset of symptoms of post-traumatic stress disorder after deployment.

Does Childhood Personality Predict Longevity

Key models relating personality and health predict that personality in childhood is indicative of later health and longevity. Longevity predictions are tested using data derived from the 7-decade longitudinal study initiated by L. M. Terman 1921 (L. M. Terman & M. H. Oden, 1947). Variables representing major dimensions of personality are used in statistical survival analyses of longevity in 1,178 males and females. Conscientiousness in childhood was clearly related to survival in middle to old age. This finding (a) establishes that childhood personality is related to survival decades into the future, (b) confirms the validity of the conscientiousness dimension in conceptualizing personality, and (c) points to likely and unlikely pathways linking personality to health. Contrary to expectation, cheerfulness (optimism and sense of humor) was inversely related to longevity, suggesting a possible need for reconceptualization of its health relevance.

Suspected Nonalcoholic Fatty Liver Disease and Mortality Risk in a Population-based Cohort Study

OBJECTIVE:Case series suggest that nonalcoholic fatty liver disease (NAFLD) is associated with increased all-cause and cardiovascular mortality. The current study compared the survival of subjects with and without suspected NAFLD in a population-based cohort, and placed the finding in the context of previously published case series.METHODS:Primary analysis assessed mortality for NHANES-III participants with and without suspected NAFLD using the National Death Index. Suspected NAFLD was based upon unexplained ALT elevation. The Olmsted County and Cleveland Clinic case series were also used for comparison. Survivals were compared using Proportional Hazards Model and direct age standardization.RESULTS:The NHANES cohort included 980 with and 6,594 subjects without suspected NAFLD. Over a mean of 8.7 yr, suspected NAFLD had a hazards ratio of 1.37 (95% CI 0.98–1.91) for all-cause mortality. In the 45–54 age group, suspected NAFLD had significantly higher all-cause (4.40 95% CI 1.27–13.23) and cardiovascular mortality (8.15, 95% CI 2.00–33.20) after adjusting for conventional cardiovascular risk factors. The age-standardized rate per 10,000 per year was 129 (95% CI 118–140) for the NHANES non-NAFLD cohort, 154 (95% CI 116–198) for the NHANES suspected NAFLD cohort, 214 (95% CI 157–279) for the Olmsted County series, and 426 (95% CI 298–573) for the Cleveland Clinic series.CONCLUSION:The magnitude of mortality risk in NAFLD depends on the setting and method of ascertainment. Suspected NAFLD in the 45–54 age group is a strong independent risk factor for cardiovascular death and warrants further cardiovascular risk management guidelines.

Childhood conscientiousness and longevity: health behaviors and cause of death.

: Previous research showed that conscientiousness (social dependability) in childhood predicted longevity in an archival prospective cohort study of bright children first studied by Terman in the 1920s (H. S. Friedman et al., 1993). Possible behavioral mechanisms for this robust association are now examined by gathering cause of death information and by considering the possible mediating influences of drinking alcohol, smoking, and overeating. Survival analyses (N = 1,215) suggest that the protective effect of conscientiousness is not primarily due to accident avoidance and cannot be mostly explained by abstinence from unhealthy substance intake. Conscientiousness may have more wide-ranging effects on health-relevant activities.

Sarcopenia in elderly men and women: the Rancho Bernardo study.

BACKGROUND Sarcopenia risk factors are poorly understood. METHODS This study examines sarcopenia prevalence and risk factors in community-dwelling men (694) and women (1006) aged 55-98 years (mean=73) who attended a 1988-1992 Rancho Bernardo Study clinic visit. Height, weight, muscle strength, fat-free mass (FFM), fat mass by bioelectric impedance analysis, and grip strength were measured; alcohol and medication use, smoking, and physical activity were ascertained. RESULTS Mean FFM was 43.5 kg for women and 61.7 kg for men. Sarcopenia, defined as FFM of > or =2.0 standard deviations below the gender-specific mean of a young reference population, was present in 6.0% overall. Prevalence increased dramatically from 4% of men and 3% of women aged 70-75 to 16% of men and 13% of women aged 85 and older. Both men and women with sarcopenia had a significantly lower fat mass and body mass index than those without sarcopenia. Men with sarcopenia were twice as likely to have fallen in the past year compared with those without sarcopenia. Grip strength, but not quadriceps strength, was lower in men and women with sarcopenia. Physically active women were about half as likely to have sarcopenia, but no association was found in men. Few men and women were current smokers, but they were more likely to have sarcopenia. Comorbidities (heart disease, diabetes, pulmonary disease, arthritis, cancer) and medications (thyroid hormones, corticosteroids, and hormone replacement therapy) were not associated with sarcopenia. CONCLUSIONS Sarcopenia increases with age. This study also identified lack of physical activity and current smoking as reversible risk factors for sarcopenia.

Psychosocial and Behavioral Predictors of Longevity The Aging and Death of the "Termites"

Impulsive, undercontrolled personalities and major family stresses are known predictors of impaired adjustment, but long-term health effects are unclear. In an archival prospective cohort design, we followed up on L. M. Termans (Terman & Oden, 1947) sample of gifted children by collecting and coding death certificates for the half of the sample that is now dead. Statistical survival analyses were used to predict longevity and cause of death as a function of parental divorce during childhood, unstable marriage patterns in adulthood, childhood personality, adult adjustment, and possible mediating health behaviors. Psychosocial factors emerged as important risks for premature mortality.

Progression of Peripheral Arterial Disease Predicts Cardiovascular Disease Morbidity and Mortality

OBJECTIVES The purpose of this study was to examine the association of progressive versus stable peripheral arterial disease (PAD) with the risk of future cardiovascular disease (CVD) events. BACKGROUND An independent association between PAD, defined by low values of the ankle-brachial index (ABI), and future CVD risk has been demonstrated. However, the prognostic significance of declining versus stable ABI has not been studied. METHODS We recruited 508 subjects (59 women, 449 men) from 2 hospital vascular laboratories in San Diego, California. ABI and CVD risk factors were measured at Visit 2 (1990 to 1994). ABI values from each subjects earliest vascular laboratory examination (Visit 1) were abstracted from medical records. Mortality and morbidity were tracked for 6 years after Visit 2 using vital statistics and hospitalization data. RESULTS In multivariate models adjusted for CVD risk factors, very low (<0.70) and, in some cases, low (0.70 < or = ABI <0.90) Visit 2 ABIs were associated with significantly elevated all-cause mortality, CVD mortality, and combined CVD morbidity/mortality at 3 and 6 years. Decreases in ABI of more than 0.15 between Visit 1 and Visit 2 were significantly associated with an increased risk of all-cause mortality (risk ratio [RR]: 2.4) and CVD mortality (RR: 2.8) at 3 years, and CVD morbidity/mortality (RR: 1.9) at 6 years, independent of Visit 2 ABI and other risk factors. CONCLUSIONS Progressive PAD (ABI decline >0.15) was significantly and independently associated with increased CVD risk. Patients with decreasing ABI may be candidates for more intensive cardiovascular risk factor management.

Is Insulin Really a Heart Disease Risk Factor

I n the U.S., the most common cause of death in adults with diabetes is coronary heart disease (1). While this is also true in adults without diabetes, heart disease is at least twice as common in patients with diabetes. The excess risk occurs with both insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). Adults with diabetes are more likely than those without diabetes to have hypertension and dyslipidemia (low levels of high-density lipoprotein, high levels of triglycerides, and small dense low-density lipoprotein [LDL]), but some of the increased risk of heart disease associated with diabetes appears to be independent of these factors.

Sociodemographic and psychosocial factors in childhood as predictors of adult mortality.

OBJECTIVES Childhood sociodemographic, psychosocial, and environmental factors are often assumed to affect adult health and longevity. These relationships were prospectively tested by using the 7-decade Terman Life Cycle Study of Children With High Ability (n = 1285). METHODS Parental socioeconomic status, childhood health, objective childhood stressors (e.g., death or divorce of parents), and childhood personality were considered as potential predictors in hazard regression analyses of longevity through 1991. RESULTS Parental divorce during childhood predicted decreased longevity, with sex controlled. Other potential social predictors failed to show significant associations with longevity. Three dimensions of childhood personality--conscientiousness, lack of cheerfulness, and permanency of mood (males only)--predicted increased longevity. The effects of parental divorce and childhood personality were largely independent and did not account for any of the gender difference in mortality. CONCLUSIONS A small number of childhood factors significantly predicted mortality across the life span in this sample. Further research should focus on how these psychosocial factors influence longevity.

GHb Is a Better Predictor of Cardiovascular Disease Than Fasting or Postchallenge Plasma Glucose in Women Without Diabetes: The Rancho Bernardo Study

OBJECTIVE To examine the relation between GHb, fasting plasma glucose (FPG), postchallenge plasma glucose (PCPG), and mortality from cardiovascular disease (CVD) and ischemic heart disease (IHD) in older adults. RESEARCH DESIGN AND METHODS A community-based study of 1,239 nondiabetic older adults followed for an average of 8 years, from baseline (1984–1987) to 1993. RESULTS GHb, but not FPG or PCPG, was significantly related to CVD and IHD mortality in women but not men. The age-adjusted relative hazard for those in the highest quintile of GHb (≥ 6.7%) compared with women with lower levels was 2.37 for fatal CVD (95% CI = 1.30−4.31, P = 0.005) and 2.43 for IHD (95% CI = 1.12−5.25, P = 0.024). This association persisted after adjustment for all covariates (age, systolic blood pressure, BMI, LDL, HDL, triglycerides, cigarette smoking, antihypertensive medication use, and estrogen use). GHb was significantly associated with LDL and HDL levels in women, but the association between GHb and CVD or IHD persisted after adjustment for these lipoproteins. CONCLUSIONS We concluded that GHb is a better predictor of CVD and IHD mortality than FPG or PCPG in women without diabetes; no single measure of glycemia was predictive in men. The reason for the sex difference is unexplained.