Donna Kritz-Silverstein

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.

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.

Does Hyperinsulinemia Preserve Bone

OBJECTIVE Obesity and NIDDM are each associated with increased bone mineral density (BMD). We therefore hypothesize that hyperinsulinemia is an osteogenic factor. RESEARCH DESIGN AND METHODS Subjects consisted of 411 men and 559 women aged 50–89 years who were participants in the Rancho Bernardo Heart and Chronic Disease Study and were not diabetic by history or oral glucose tolerance test. Fasting and 2-h postchallenge insulin were measured by radioimmunoassay. Bone mineral density was measured at the midshaft radius with single photon absorptiometry and at the lumbar spine and hip with dual energy X-ray absorptiometry. RESULTS Multiple regression analyses indicated that among men, a significant insulin-BMD association at the hip was no longer apparent after adjusting for covariates. Among women, fasting insulin was significantly and positively associated with bone density of the radius and spine (P < 0.05), independent of age, BMI, waist-hip ratio, postmenopausal estrogen use, age at menopause, thiazide use, family history of diabetes, current cigarette smoking, and exercise. Each 10 μU/ml increase in fasting insulin was associated with an increase of 0.33 and 0.57 g/cm2 of the radius and spine, respectively. CONCLUSIONS Hyperinsulinemia may be responsible for part of the observed association of both diabetes and obesity with BMD in women.

Isoflavones and cognitive function in older women: the SOy and Postmenopausal Health In Aging (SOPHIA) Study.

ObjectiveThis study examines the effects of a dietary supplement of isoflavones on cognitive function in postmenopausal women. DesignParticipants for this 6-month, double-blind, randomized, placebo-controlled clinical trial were women who were in good health, were postmenopausal at least 2 years, and were not using estrogen replacement therapy. Between July 24, 2000, and October 31, 2000, 56 women aged 55 to 74 years were randomized; 2 in the placebo group and 1 in the active treatment group did not complete the 6-month evaluation, and none withdrew because of adverse effects. Women randomized to active treatment (n = 27) took two pills per day, each containing 55 mg of soy-extracted isoflavones (110 mg total isoflavones per day; Healthy Woman: Soy Menopause Supplement, Personal Products Company, McNeil-PPC Inc., Skillman, NJ, USA). Women assigned to placebo (n = 26) took two identical-appearing pills per day containing inert ingredients. Cognitive function tests administered at baseline and follow-up included the following: Trails A and B, category fluency, and logical memory and recall (a paragraph recall test assessing immediate and delayed verbal memory). ResultsAt baseline, all women were cognitively intact; there were no significant differences by treatment assignment in age, education, depressed mood, or cognitive function (all P values > 0.10). Compliance was 98% and 97%, respectively, in the placebo and treatment groups; all women took at least 85% of their pills. The women in the treatment group did consistently better, both as compared with their own baseline scores and as compared with the placebo group responses at 6 months. Comparisons of percentage change in cognitive function between baseline and follow-up showed greater improvement in category fluency for women on active treatment as compared with the case of those on placebo (P = 0.02) and showed (nonsignificantly) greater improvement on the two other tests of verbal memory and Trails B. ConclusionThese results suggest that isoflavone supplementation has a favorable effect on cognitive function, particularly verbal memory, in postmenopausal women.

Birth Weight, Adult Weight, and Girth as Predictors of the Metabolic Syndrome in Postmenopausal Women: The Rancho Bernardo Study

OBJECTIVE Recent studies have demonstrated an association between low birth weight and chronic and metabolic disorders in adulthood such as type 2 diabetes, hypertension, and dyslipidemia. These disorders tend to cluster in a condition known as the metabolic syndrome (syndrome X). Only two studies have reported an association of birth weight to the metabolic syndrome. The present study is distinguished as the only study to focus on postmenopausal women. RESEARCH DESIGN AND METHODS Subjects were 303 community-dwelling, postmenopausal Caucasian women aged 50–84 years. Metabolic and anthropometric variables were measured at a clinic visit; birth weight was assessed by self-report on a mailed questionnaire. RESULTS The metabolic syndrome, defined as the simultaneous presence of hypertension, dyslipidemia, and abnormal glucose tolerance, was present in 7.9% of these women. Compared with women in the highest birth weight tertile (8.1–13.0 lb, mean 9.4 lb), those in the lowest birth weight tertile (2.5–6.8 lb, mean 5.5 lb) exhibited an increased prevalence (12.0 vs. 4.3%, P < 0.05) and 2.41 times the risk (95% CI 1.06–5.51) of developing the metabolic syndrome. Women with a heavy birth weight had an increased risk of adult obesity. Nevertheless, women in the lowest birth weight tertile who became adults in the highest tertile of BMI (>25.2 kg/m2) or waist circumference (>80.7 cm) had the highest prevalence of the metabolic syndrome (∼30%). CONCLUSIONS Low birth weight coupled with adult obesity is a strong determinant of the metabolic syndrome in postmenopausal women.

The postmenopausal estrogen/progestin interventions study: primary outcomes in adherent women

OBJECTIVE To assess the efficacy of unopposed estrogen, and three estrogen/progestin regimens on selected heart disease risk factors among adherent women and to contrast those results with efficacy among all women in the PEPI study. DESIGN A 3-year, multicenter, randomized, double-blinded, placebo-controlled clinical trial. PARTICIPANTS A total of 847 healthy postmenopausal women aged 45 to 64 years of age with no known contraindication to hormone therapy, who attended their 36 month clinical visit. INTERVENTION Participants were randomized in equal numbers to one of the following treatments: (1) placebo; (2) conjugated equine estrogen (CEE) 0.625 mg daily; (3) CEE 0.625 daily plus medroxyprogesterone acetate (MPA) 10 mg, days 1-12; (4) CEE 0.625 daily plus MPA 2.5 mg daily; or (5) CEE 0.625 daily plus micronized progesterone (MP) 200 mg, days 1-12. ANALYSIS Analyses are based on adherent women, where adherence is defined as taking at least 80% of pills at each 6-month visit. RESULTS Adherence rates were high in all groups except women with a uterus assigned to unopposed CEE. The difference in HDL-C levels resulting from the CEE vs. CEE+MP was approximately three times larger than in the intent-to-treat analyses, reaching statistical significance (P < 0.05). In each active treatment, LDL-C decreased 10-15%. Triglycerides increased 15-20% in each opposed CEE arm and over 25% in the CEE only arm; this difference was not statistically significant. Fibrinogen increased by 7% among placebo adherers, but decreased or remained fairly stable among the active arm adherers. Systolic blood pressure increased 3-5% in all treatment arms. Women adherent to the CEE+MPA arms had twice the increase of 2 h glucose levels as women adherent to CEE only, or CEE+MP (8-9% vs. 3-4%). Two-hour insulin levels decreased 3-12% for all arms. The patterns of change for fibrinogen, SBP, 2 h glucose and insulin were similar to those from the intent-to-treat analyses. CONCLUSIONS In analyses limited to adherent women, all active treatments, compared to placebo, continued to have similar and favorable effects on LDL-cholesterol and fibrinogen and no significant effects on blood pressure or insulin levels. Given the overall high adherence rates in PEPI, the results are similar to the intent-to-treat analyses, as expected. Only the trend of HDL-C to have a larger increase in the CEE only arm (in the intent-to-treat analyses) gained statistical significance in analyses restricted to adherers.

The effect of parity on the later development of non-insulin-dependent diabetes mellitus or impaired glucose tolerance.

To determine the effect of parity on the later development of non-insulin-dependent diabetes mellitus or impaired glucose tolerance, we studied a population-based sample of 1186 women at least 40 years of age; those who had been given a diagnosis of diabetes mellitus before the age of 40 or who had insulin-dependent diabetes mellitus were excluded from the study. On the basis of the World Health Organizations criteria, 714 had normal glucose tolerance, 326 had impaired glucose tolerance, and 146 had non-insulin-dependent diabetes mellitus (NIDDM). After adjustment for age, obesity, and family history of diabetes, increased parity was associated with a significantly increased risk of both NIDDM (odds ratio, 1.16 [95 percent confidence interval, 1.04 to 1.29] per pregnancy) and impaired glucose tolerance (odds ratio 1.10 [95 percent confidence interval, 1.01 to 1.19] per pregnancy). Obesity, whether estimated by means of the body-mass index or the waist-hip ratio, was significantly associated with an increased risk of both NIDDM and impaired glucose tolerance, but this factor did not explain the association between parity and diabetes or impaired glucose tolerance; neither the maximal lifetime body-mass index nor the waist-hip ratio was significantly associated with parity in this cohort. We conclude that there is a slight increase in the risk of NIDDM or impaired glucose tolerance with increasing parity many years after childbearing and that this association is not explained by obesity.

A community-based study of menopause symptoms and estrogen replacement in older women

This study examines the symptoms after a natural menopause recalled by women aged 50-89 years. We determined the frequency and clustering of symptoms, the effect of age on symptoms, and the relation of symptoms to the use of estrogen therapy in a cross-sectional, community-based study of 589 Caucasian, middle- to upper-middle-class women from Rancho Bernardo, California. At the time of menopause, 55% of the women reported that they felt life was getting better and 57% were more cheerful. The most frequently recalled symptoms were hot flushes (74%), propensity to weight gain (45%), night sweats (35%), tiredness (32%), and insomnia (28%). Irritability was reported by one-fourth, depression by one-fifth. Nearly 11% reported anxiety about looking older. The recalled prevalence of hot flushes, irritability, weepiness and tiredness did not vary by current age, but younger women were significantly more likely than older women to have experienced night sweats, visible flushes, depression, anxiety about looking older and insomnia. Principal components factor analysis yielded four main independent factors: psychological symptoms (21% of the variance), vasomotor symptoms (14%), positive feelings (11%), and negative self-image (8%). The four symptom groupings suggest different causal mechanisms. Forty-two percent reported past, and 27% reported current use of estrogen therapy. Both past and current hormone users were significantly more likely to report menopause symptoms than non-users. Estrogen use was not associated with positive feelings or self-image at the time of menopause. Although three-quarters experienced symptoms, the majority of women reported positive feelings about menopause.

Prior Assault and Posttraumatic Stress Disorder After Combat Deployment

Background: Factors that make people vulnerable to or resilient against posttraumatic stress disorder (PTSD) following overwhelming stress are not well understood. The objective of this study was to prospectively examine the relation between prior assault and new-onset PTSD symptoms in a large US military cohort deployed in the wars in Iraq and Afghanistan. Methods: Data on exposures and health outcomes were collected in the Millennium Cohort study at enrollment (July 2001 to June 2003) and follow-up (June 2004 to February 2006) from over 55,000 participants. Of these, 5324 were deployed in Iraq and Afghanistan, reported combat exposures, and were free of PTSD at baseline (881 women and 4443 men). We used multivariable logistic regression analysis to model the odds of new-onset PTSD in relation to prior assault. Results: New-onset PTSD symptoms or diagnosis among deployers reporting combat exposures occurred in 22% of women who reported prior assault and 10% not reporting prior assault. Among men reporting prior assault, rates were 12% and 6%, respectively. Adjusting for baseline factors, the odds of new-onset PTSD symptoms was more than 2-fold higher in both women and men who reported assault prior to deployment. Conclusions: Prior assault appears to confer increased vulnerability for, rather than resilience against, PSTD symptoms among military professionals deployed to recent combat operations.

A Prospective Study of Albuminuria and Cognitive Function in Older Adults The Rancho Bernardo Study

Chronic kidney disease is a risk factor for cognitive impairment. Albuminuria is an early manifestation of chronic kidney disease and a marker of endothelial dysfunction and vascular risk. Results of prior studies of albuminuria and cognitive function are contradictory. The authors studied 1,345 community-dwelling women and men in southern California (mean age, 75 years) at a 1992-1996 research clinic visit, when urine albumin/creatinine ratio (ACR) was measured in spot morning urine and cognitive function was evaluated by using the Mini-Mental State Examination Trail-Making Test B, and category fluency test. An ACR of > or =30 mg/g was found in 17% of women and 15% of men in 1992-1996. Analysis of covariance was used to compare cognitive function score by categorical ACR. Between 1999 and 2002, 759 participants returned for repeat cognitive function testing. For men, but not women, baseline albuminuria, but not estimated glomerular filtration rate, was associated with reduced cognitive function at follow-up on all tests (Ps < 0.05). An ACR of > or =30 mg/g was associated with greater annual decline in Mini-Mental State Examination and category fluency scores. Albuminuria may be an easily measured marker predicting future cognitive function decline. Results imply a common underlying mechanism affecting the renal and cerebral microvasculature.