Lisa Sullivan

Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study

OBJECTIVE: To determine the independent effects of obesity and hypertension on cognitive functioning.METHODS: Using a prospective design, male (n=551) and female (n=872) participants of the Framingham Heart Study were classified by presence or absence of obesity and hypertension based on data collected over an 18-y surveillance period. All subjects were free from dementia, stroke, and clinically diagnosed cardiovascular disease up to the time of cognitive testing. Statistical models were adjusted for age, education, occupation, cigarette smoking, alcohol consumption, total cholesterol, and a diagnosis of type II diabetes. Body mass index status (nonobese or obese) and blood pressure status (normotensive or hypertensive) were then related to cognitive performance (learning, memory, executive functioning, and abstract reasoning) on tests administered 4–6u2009y later.RESULTS: Adverse effects of obesity and hypertension on cognitive performance were observed for men only. Obese and hypertensive men performed more poorly than men classified as either obese or hypertensive, and the best performance was observed in nonobese, normotensive men.CONCLUSIONS: The adverse effects of obesity and hypertension in men are independent and cumulative with respect to cognitive deficit.

An adaptation of the Framingham coronary heart disease risk function to European Mediterranean areas

Aim: To determine whether the Framingham function accurately predicts the 10 year risk of coronary disease and to adapt this predictive method to the characteristics of a Spanish population. Method and Results: A Framingham function for predicting 10 year coronary deaths and non-fatal myocardial infarction was applied to the population of the province of Gerona, Spain, where the cumulated incidence rate of myocardial infarction has been determined since 1988 by a specific registry. The prevalence of cardiovascular risk factors in this region of Spain was established in 1995 by a cross sectional study on a representative sample of 1748 people. The number of cases estimated by the Framingham function for 10 year coronary deaths and non-fatal myocardial infarction was compared with that observed. The Framingham function estimated 2425 coronary heart disease cases in women and 1181 were observed. In men, 9919 were estimated and 3706 were observed. Recalibrating the Framingham equations to the event rate and the prevalence of the risk factors in Gerona led to estimates very close to the number of cases observed in Gerona men and women. Conclusions: The Framingham function estimates more than doubled the actual risk of coronary disease observed in north east Spain. After calibration, the Framingham function became an effective method of estimating the risk in this region with low coronary heart disease incidence.

A Parallel and Distributed Processing Model of Joint Attention, Social-Cognition and Autism

The impaired development of joint attention is a cardinal feature of autism. Therefore, understanding the nature of joint attention is central to research on this disorder. Joint attention may be best defined in terms of an information‐processing system that begins to develop by 4–6 months of age. This system integrates the parallel processing of internal information about ones own visual attention with external information about the visual attention of other people. This type of joint encoding of information about self and other attention requires the activation of a distributed anterior and posterior cortical attention network. Genetic regulation, in conjunction with self‐organizing behavioral activity, guides the development of functional connectivity in this network. With practice in infancy the joint processing of self–other attention becomes automatically engaged as an executive function. It can be argued that this executive joint attention is fundamental to human learning as well as the development of symbolic thought, social cognition and social competence throughout the life span. One advantage of this parallel and distributed‐processing model of joint attention is that it directly connects theory on social pathology to a range of phenomena in autism associated with neural connectivity, constructivist and connectionist models of cognitive development, early intervention, activity‐dependent gene expression and atypical ocular motor control.

Framingham Stroke Risk Profile and Lowered Cognitive Performance

Background and Purpose— The primary objective of this work was to describe the relationships between 10-year risk for stroke and multiple measures of cognitive performance for a large community-based sample of individuals who were free of clinical stroke and dementia at the time of risk assessment. Methods— Participants were 1011 men and 1164 women from the Framingham Offspring Study. The Framingham Stroke Risk Profile was used to assess 10-year risk of stroke. Using a cross-sectional design, we assessed 10-year risk of stroke, the predictor variable, and cognitive performance, the outcome variable, at examination 7 of the Framingham Offspring Study. Multivariable linear regression models were used to relate 10-year risk of stroke to cognitive tests measuring multiple domains of cognitive functioning. Results— With statistical adjustment for age, education, sex, and other correlates of both stroke and cognitive ability, an inverse association between increments in 10-year risk of stroke and cognitive performance level was observed for tests indexing visual-spatial memory, attention, organization, scanning, and abstract reasoning. Conclusions— In stroke- and dementia-free individuals, higher 10-year risk for stroke is associated with performance decrements in multiple cognitive domains.

Validation of an Atrial Fibrillation Risk Algorithm in Whites and African Americans

BACKGROUNDnWe sought to validate a recently published risk algorithm for incident atrial fibrillation (AF) in independent cohorts and other racial groups.nnnMETHODSnWe evaluated the performance of a Framingham Heart Study (FHS)-derived risk algorithm modified for 5-year incidence of AF in the FHS (n = 4764 participants) and 2 geographically and racially diverse cohorts in the age range 45 to 95 years: AGES (the Age, Gene/Environment Susceptibility-Reykjavik Study) (n = 4238) and CHS (the Cardiovascular Health Study) (n = 5410, of whom 874 [16.2%] were African Americans). The risk algorithm included age, sex, body mass index, systolic blood pressure, electrocardiographic PR interval, hypertension treatment, and heart failure.nnnRESULTSnWe found 1359 incident AF events in 100 074 person-years of follow-up. Unadjusted 5-year event rates differed by cohort (AGES, 12.8 cases/1000 person-years; CHS whites, 22.7 cases/1000 person-years; and FHS, 4.5 cases/1000 person-years) and by race (CHS African Americans, 18.4 cases/1000 person-years). The strongest risk factors in all samples were age and heart failure. The relative risks for incident AF associated with risk factors were comparable across cohorts and race groups. After recalibration for baseline incidence and risk factor distribution, the Framingham algorithm, reported in C statistic, performed reasonably well in all samples: AGES, 0.67 (95% confidence interval [CI], 0.64-0.71); CHS whites, 0.68 (95% CI, 0.66-0.70); and CHS African Americans, 0.66 (95% CI, 0.61-0.71). Risk factors combined in the algorithm explained between 47.0% (AGES) and 63.6% (FHS) of the population-attributable risk.nnnCONCLUSIONSnRisk of incident AF in community-dwelling whites and African Americans can be assessed reliably by routinely available and potentially modifiable clinical variables. Seven risk factors accounted for up to 64% of risk.

Baseline Levels, and Changes Over Time in Body Mass Index and Fasting Insulin, and Their Relationship to Change in Metabolic Trait Clustering

BACKGROUNDnMultiple abnormal metabolic traits are found together or cluster within individuals more often than is predicted by chance. The individual and combined role of adiposity and insulin resistance (IR) on metabolic trait clustering is uncertain. We tested the hypothesis that change in trait clustering is a function of both baseline level and change in these measures.nnnMETHODSnIn 2616 nondiabetic Framingham Offspring Study participants, body mass index (BMI) and fasting insulin were related to a within-person 7-year change in a trait score of 0-4 Adult Treatment Panel III metabolic syndrome traits (hypertension, high triglycerides, low high-density lipoprotein cholesterol, hyperglycemia).nnnRESULTSnAt baseline assessment, mean trait score was 1.4 traits, and 7-year mean (SEM) change in trait score was +0.25 (0.02) traits, P<0.0001. In models with BMI predictors only, for every quintile difference in baseline BMI, the 7-year trait score increase was 0.14 traits, and for every quintile increase in BMI during 7-year follow-up, the trait score increased by 0.3 traits. Baseline level and change in fasting insulin were similarly related to trait score change. In models adjusted for age-sex-baseline cluster score, 7-year change in trait score was significantly related to both a 1-quintile difference in baseline BMI (0.07 traits) and fasting insulin (0.18 traits), and to both a 1-quintile 7-year increase in BMI (0.21 traits) and fasting insulin (0.18 traits).nnnCONCLUSIONSnChange in metabolic trait clustering was significantly associated with baseline levels and changes in both BMI and fasting insulin, highlighting the importance of both obesity and IR in the clustering of metabolic traits.

Joint Attention in Preschool Children: Is it a Meaningful Measure?

The goal of this study was to evaluate the degree to which measuring joint attention an aspect of social attention, is meaningful for the learning and development of preschool children. Joint attention refers to the executive capacity to coordinate visual attention with another person. This pivotal skill begins to develop from 6 to 18 months of age and continues to be refined and coordinated throughout individual developmental trajectories. In this study joint attention was measured in forty-three 4 to 5-year-olds asked to coordinate their attention with that of an unfamiliar adult during a social attention word learning task. The results revealed that there were individual differences in joint attention for children in this age group which suggests that this may be a meaningful construct to measure. These data contribute to a small but growing literature on the potential utility of joint attention theory and measurement in preschool aged children to further our understanding of social attention coordination in classroom contexts.

Accessibility of Segmented Reading Comprehension Passages for Students with Disabilities

This study explores factors that affect the accessibility of reading comprehension assessments for students with disabilities in grade 8 public school classrooms. The study consisted of assessing students using reading comprehension passages that were broken down into shorter “segments” or “chunks” in order to assess the validity and effectiveness of segmenting and the reliability of assessment in segmenting. The results of the segmenting study indicated that: (1) segmenting did not affect reading performance of students without disabilities; suggesting that it does not compromise the validity of reading assessment; (2) segmenting did not affect reading performance of students with disabilities; and (3) the segmented version had a higher reliability for students with disabilities without affecting the reliability for students without disabilities.

Academic Language and Literacy in Every Setting (ALLIES+): Strengthening the STEM Learning Ecosystem

In this chapter, we describe a professional development project, Academic Language and Literacy in Every Subject (ALLIES+), with the overarching goal of developing, implementing and testing a professional development model focused on how science content and learning activities can be modified to improve academic conversations in classroom and expanded learning settings. Our professional development model had four unique elements to foster participants’ ability to create and implement innovative lessons and instructional strategies to meet the needs of English learners (ELs) in science classes: (1) sessions were designed in collaboration with the district and aligned with the district’s strategic goals; (2) teachers and district instructional leaders worked side-by-side learning how to implement ALLIES+ practices in support of ELs’ academic-language development; (3) teachers and expanded learning educators were provided with time to rehearse new instructional practices in a low-risk environment; and, (4) ongoing inquiry was sustained over time focusing teachers’ attention on experimenting with new practices, engaging in cycles of inquiry, discussing and adapting lessons plans, and analyzing student work. Findings from this study suggest that models of professional development designed around the key, research-based practices of effective professional development, can positively impact teacher knowledge and practice. This professional development model provided time for teachers and expanded learning staff to learn how to use the practices in support of academic language and science learning through explicit modeling, individual and collaborative experimentation, and expert and peer mentoring.