Mary E. Fischer

Dry Eye in the Beaver Dam Offspring Study: Prevalence, Risk Factors, and Health-Related Quality of Life

PURPOSE To estimate dry eye prevalence in the Beaver Dam Offspring Study (BOSS), including a young adult population, and investigate associated risk factors and impact on health-related quality of life. DESIGN Cohort study. METHODS The BOSS (2005-2008) is a study of aging in the adult offspring of the population-based Epidemiology of Hearing Loss Study cohort. Questionnaire data on health history, medication use, risk factors, and quality of life were available for 3275 participants. Dry eye was determined by self-report of frequency of symptoms and the intensity of those symptoms. Associations between dry eye and risk factors were analyzed using logistic regression. RESULTS The prevalence of dry eye in the BOSS was 14.5%: 17.9% of women and 10.5% of men. In a multivariate model, statistically significant associations were found with female sex (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.33-2.11), current contact lens use (OR, 2.01; 95% CI, 1.53-2.64), allergies (OR, 1.59; 95% CI, 1.22-2.08), arthritis (OR, 1.44; 95% CI, 1.12-1.85), thyroid disease (OR, 1.43; 95% CI, 1.02-1.99), antihistamine use (OR, 1.54; 95% CI, 1.18-2.02), and steroid use (OR, 1.54; 95% CI, 1.16-2.06). Dry eye was also associated with lower scores on the Medical Outcomes Study Short Form 36 (β = -3.9, P < .0001) as well as on the National Eye Institute 25-Item Visual Function Questionnaire (NEI VFQ-25) (β = -3.4, P < .0001) when controlling for age, sex, and comorbid conditions. CONCLUSIONS The prevalence of dry eye and its associated risk factors in the BOSS were similar to previous studies. In this study, dry eye was associated with lower quality of life on a health-related quality-of-life instrument and the vision-specific NEI VFQ-25.

Olfactory Impairment in an Adult Population: The Beaver Dam Offspring Study

The objective of this study was to determine the prevalence of olfactory impairment and associated risk factors and the effects of olfactory impairment on dietary choices and quality of life. Odor identification was measured in 2838 participants aged 21-84 years (mean 49 years) in the Beaver Dam Offspring Study. The overall prevalence of olfactory impairment was 3.8%, increased with age (from 0.6% in those<35 years to 13.9% among those≥65 years) and was more common in men than women. In a multivariate model age (odds ratio [OR]=1.48, 95% confidence interval [CI]=1.33, 1.64 for every 5-year increase), nasal polyps or deviated septum (OR=2.69, 95% CI=1.62, 4.48), ankle-brachial index<0.9 (OR=3.62, 95% CI=1.45, 9.01), and smoking (women only) (OR=2.43, 95% CI=1.19, 4.98 ever smoked vs. never) were associated with an increased odds of olfactory impairment, whereas higher household income, ≥

Determinants of Hearing Aid Acquisition in Older Adults

50,000 versus <

Multiple sensory impairment and quality of life

50,000 per year, was associated with a decreased odds of olfactory impairment (OR=0.48, 95% CI=0.31, 0.73). Participants with olfactory impairment were less likely to report that food tasted as good as it used to, or that they experienced food flavors the same. There was no association between olfactory impairment and general health-related quality of life, depressive symptoms, or dietary choices. The prevalence of olfactory impairment was low in this largely middle-aged cohort, and some factors associated with olfactory impairment are potentially modifiable.

The effects of delay in standard treatment due to induction chemotherapy in two randomized prospective studies

OBJECTIVES We determined factors associated with hearing aid acquisition in older adults. METHODS We conducted a population-based, prospective study that used information from 3 examinations performed on study participants as part of the Epidemiology of Hearing Loss Study (1993-2005). We included participants (n = 718; mean age = 70.5 years) who exhibited hearing loss at baseline or the first follow-up and had no prior history of hearing aid use. We defined hearing loss as a pure tone threshold average (PTA) at 0.5, 1, 2, and 4 kilohertz in the better ear of greater than 25 decibels Hearing Level. RESULTS The 10-year cumulative incidence of hearing aid acquisition was 35.7%. Associated factors included education (college graduate vs all others: hazard ratio [HR] = 2.5; 95% confidence interval [CI] = 1.5, 4.1), self-perception of hearing (poor vs good or better: HR = 2.5; 95% CI = 1.3, 5.0), score on a perceived hearing handicap inventory (+1 difference: HR = 1.1; 95% CI = 1.0, 1.1), and PTA (+ 5 dB difference: HR = 1.4; 95% CI = 1.2, 1.6). CONCLUSIONS The low rate of hearing aid ownership among older adults is a problem that still needs to be addressed.

Smoking, Central Adiposity, and Poor Glycemic Control Increase Risk of Hearing Impairment

Purpose: To evaluate the independent impact of vision, hearing, and olfactory impairment on quality of life. Methods: Subjects (n = 1854, mean age = 67 years) were participants in the 1998–2000 and 2003–05 examinations of the Epidemiology of Hearing Loss Study and Beaver Dam Eye Study, population-based, prospective studies set in Beaver Dam, Wisconsin. Sensory capacities were measured in 1998–2000 and quality of life was measured in 2003–05. Vision impairment was assessed using current binocular visual acuity and contrast sensitivity. Hearing impairment was defined by the pure tone threshold average and word recognition scores in competing message and olfaction was measured with the San Diego Odor Identification Test. The Short Form 36 Health Survey (SF-36) was used to assess quality of life. Results: Significant independent effects of vision impairment and hearing impairment on the SF-36 social functioning domain score were observed (P < 0.01). The adjusted mean social functioning score for participants with vision and hearing impairment was 5.9 units lower than the mean score in participants with no vision and hearing impairment. A significant independent effect of vision impairment was also observed for the physical functioning and mental health domains (P < 0.01). Olfaction impairment was not significantly associated with the SF-36 indices. Conclusions: Impairments in vision and hearing demonstrated independent effects on quality of life. The impact was observed for physical and emotional health (vision) and social functioning (vision and hearing). Evaluation and rehabilitation of sensory deficits may contribute to an improvement in functioning and well-being in the later years of life.

Factors Related to Fungiform Papillae Density: The Beaver Dam Offspring Study

It is often suggested that tumors will respond to induction chemotherapy and result in improved survival for patients with squamous cell carcinoma of the head and neck. Two regimens of induction chemotherapy were studied in separate randomized, prospective trials over the last 6 years. Eighty‐three patients with advanced disease were entered into the first study (43/chemotherapy; 40/control), and 60 into the second (27/chemotherapy; 33/control). Patient randomization was stratified by stage (III/IV) and site (oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, paranasal sinuses). The first study utilized bleomycin, Cytoxan,® methotrexate and 5‐fluorouracil in two cycles (one cycle if no tumor response), followed by standard treatment which consisted of combined irradiation and surgery or, in some instances, primary irradiation alone. The second study utilized cisplatin and 5‐fluorouracil in three cycles prior to standard treatment. An objective tumor response to chemotherapy was observed in 68% in the first study and 85% in the second. The patient survival in both studies @ 24 months in the first; @ 19 in the second) was better in the control than that in the experimental groups (43% to 31%; 69% to 46%). In the second study, the average length of delay of standard treatment was longer than in the first study (95 days vs. 66 days; P<.02). Results combining the P‐values of both studies indicate that the relative risk of having persistent disease was 2.9 times greater for patients who received chemotherapy. While toxicity to chemotherapy was not a factor in survival, the number of patients who withdrew from the studies and those who did not comply with treatment were greater in the chemotherapy groups. Except for new drug regimens of exceptional promise, it is recommended that future studies be designed so that chemotherapy is given concurrent with, or following the completion of standard treatment.

Long-term systemic inflammation and cognitive impairment in a population-based cohort

To determine associations between smoking, adiposity, diabetes mellitus, and other risk factors for cardiovascular disease (CVD) and the 15‐year incidence of hearing impairment (HI).

Taste intensity in the Beaver Dam Offspring Study.

The distribution of fungiform papillae density and associated factors were examined in the Beaver Dam Offspring Study. Data were from 2371 participants (mean age = 48.8 years, range = 21-84 years) with 1108 males and 1263 females. Fungiform papillae were highlighted with blue food coloring and the number of fungiform papillae within a standard 6-mm circle was counted. Whole mouth suprathreshold taste intensity was measured. The mean fungiform papillae density was 103.5 papillae/cm(2) (range = 0-212.2 papillae/cm(2)). For each 5-year increase in age, the mean fungiform papillae density was 2.8 papillae/cm(2) lower and the mean density for males was 10.2 papillae/cm(2) lower than for females. Smokers had significantly lower mean densities (former smokers: -5.1 papillae/cm(2); current smokers: -9.3 papillae/cm(2)) than nonsmokers, and heavy alcohol drinkers had a mean density that was 4.7 papillae/cm(2) lower than nonheavy drinkers. Solvent exposure was related to a significantly higher density (+6.8 papillae/cm(2)). The heritability estimate for fungiform papillae density was 40.2%. Propylthiouracil taster status, TAS2R38 haplotype, and perceived taste intensity were not related to density. In summary, wide variability in fungiform papillae density was observed and a number of related factors were found including the modifiable factors of smoking and alcohol consumption.

Self-Reported Hearing Difficulties Among Adults With Normal Audiograms: The Beaver Dam Offspring Study.

Evidence suggests inflammation is associated with cognitive impairment, but previous epidemiological studies have reported conflicting results.