Nicole M. Gatto

Metabolic syndrome and cognitive function in healthy middle-aged and older adults without diabetes.

ABSTRACT Objective: Few studies have addressed whether the metabolic syndrome (MetS) and its individual components are associated with cognitive function in middle-aged and older populations, as well as whether specific areas of cognition are more affected than others. We examined the cross-sectional association between MetS and six areas of cognitive function in healthy cognitively intact adults without diabetes (n = 853, mean age 61 years) randomized in two intervention trials. Methods: The National Cholesterol Education Program (NCEP) criteria were used to identify subjects with MetS. Cognitive function was assessed with a neuropsychological battery. A principal components analysis was used to extract five uncorrelated factors interpreted to represent five areas of cognition, and a measure of global cognition was calculated. Results: MetS was weakly but non-significantly associated with lower verbal learning (β = −.14 [SE(β) = 0.09], p = .15). As the number of MetS criteria increased, scores on global cognition (p trend = .01), verbal learning (p trend = .06) and semantic memory (p trend = .04) decreased. Hypertension was the only MetS risk factor that was independently correlated with lower verbal learning (β = −.17 [SE(β)  = 0.08], p = .04), semantic memory (β = −.26 [SE(β) = 0.08], p = .001) and global cognition (β = −.15 [SE(β) = 0.07], p = .04). Conclusion: This study adds to the evidence of an association between MetS and lower cognitive function among healthy middle-aged and older adults without CVD and diabetes, as well as confirms the correlation between hypertension and lower cognition.

Serum Organochlorines and Breast Cancer: A Case-Control Study among African-American Women

This population-based case–control study of African-American women (355 breast cancer case patients, 327 controls) examined the association between breast cancer and circulating levels of PCBs and dichlorodiphenyldichloroethene (DDE), a metabolite of DDT. Case patients were diagnosed with invasive breast carcinoma and interviewed between June 1995 and July 1998, and control subjects were identified by random digit dialing methods. Serum levels of DDE and total PCBs were adjusted for total lipid content. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable unconditional logistic regression methods. Effect modification by tumor receptor status and cancer treatment was investigated. Breast cancer risk was not associated with increasing quintiles of lipid-adjusted PCBs or DDE (highest versus lowest quintile adjusted for age, body mass index (BMI) and breastfeeding for DDE: OR = 1.02, 95% CI = (0.61, 1.72), p-trend = 0.74; for PCBs: OR = 1.01, 95% CI = (0.63, 1.63), p-trend = 0.56). Risk did not differ by strata of BMI, breastfeeding, parity, menopausal status or tumor receptor status. This study, the largest study of African-American women to date, does not support a role of DDE and total PCBs in breast cancer risk at the levels measured.

Subclinical atherosclerosis is weakly associated with lower cognitive function in healthy hyperhomocysteinemic adults without clinical cardiovascular disease.

Atherosclerosis is the most common pathologic process underlying cardiovascular disease (CVD). It is not well known whether subclinical atherosclerosis is an independent risk factor for lower cognitive function among individuals without clinically evident CVD.

Retinal microvascular abnormalities and cognitive function in Latino adults in Los Angeles.

Purpose: Retinal vessels may provide a readily accessible surrogate approach to study vascular disease in brain small vessels. Previous epidemiologic studies of retinal microvascular abnormalities and cognition have not included large numbers of Latinos who have a high prevalence of diabetes and hypertension. Methods: We used data from 809 elderly Latino participants in the Los Angeles Latino Eye Study (LALES) to assess whether retinal vessel caliber and microvascular abnormalities are cross-sectionally associated with lower cognitive function. Cognitive screening was conducted with the Cognitive Abilities Screening Instrument-Short form (CASI-S) and in-depth testing with the Spanish English Neuropsychological Assessment Scales (SENAS). Retinal photographs were used to identify retinopathy signs and measure retinal vessel caliber. Results: A total of 65.8% had high blood pressure, 34.5% had diabetes; self-reported diagnoses of heart attack, heart failure, angina and stroke were rare. Retinal calibers and any retinopathy were not associated with the CASI-S, total SENAS or any SENAS cognitive factors assessed as continuous variables. The odds of a low CASI-S score were two times higher in subjects with generalized arteriolar narrowing (OR = 2.04, 95% CI = 1.14, 3.66), and one and half times as high in those with both generalized arteriolar narrowing and retinopathy signs (OR = 1.49, 95% CI = 0.47, 4.75) though this result was based on only four cases with both risk factors and confidence limits were wide and included the null. Conclusion: Retinal microvasculature imaging may provide insights into small blood vessel influences on cognition in Latino populations. Additional studies in diverse populations and prospective settings are needed.

Decreased rate of obstetrical anal sphincter laceration is associated with change in obstetric practice

A study was conducted to describe the rate of obstetrical anal sphincter laceration in a large cohort of women and to identify the characteristics associated with this complication. Data from all vaginal deliveries occurring between January 1996 and December 2004 at one institution were used to compare women with and without anal sphincter lacerations. Among 16,667 vaginal deliveries, 1,703 (10.2%) anal sphincter lacerations occurred. Regression models suggested that episiotomy (OR 1.36; 95% CI 1.16, 1.58), vacuum delivery (OR 3.19; 95% CI 2.69, 3.79), and forceps delivery (OR 2.79; 95% CI 1.94, 4.02) were each associated with the increased risk of anal sphincter laceration. Year of delivery was associated with a decreased risk of anal sphincter laceration (OR 0.94; 95% CI 0.92, 0.96) with the rate of laceration decreasing from 11.2% to 7.9% during the study period. Episiotomy and operative vaginal delivery are significant, modifiable risk factors. Changes in obstetric practice may have contributed to the dramatic reduction in anal sphincter laceration during the study period.

Subpar Utilization of Dental Care Among Americans With a History of Stroke

Persons with poor oral hygiene are prone to periodontitis, an inflammatory gum disease independently linked to stroke. Regular dental examinations allow for early detection and treatment of oral conditions associated with the risk of further vascular events. Little is known about patterns of dental care among persons at risk for stroke. We assessed the prevalence and independent predictors of at least one visit to the dentist within the preceding 12 months among stroke survivors in the United States using data from the National Health Interview Survey (NHIS) 2006 survey. The 24,275 adults who completed the survey self-reported a total of 706 strokes, for an incidence of 3%. The rate of at least one visit to the dentist over the previous year among stroke survivors (mean age, 67 ± 15 years) was 46%. Factors independently associated with visiting the dentist were female sex (odds ratio [OR], 1.83; 95% confidence interval [CI], 1.31-2.57), being married (OR, 1.95; 95% CI, 1.37-2.77), having a high school or greater education (OR, 2.11; 95% CI, 1.51-2.93), and having contact with a primary care doctor in the previous year (OR, 1.74; 95% CI, 1.04-2.93). Factors independently associated with not visiting the dentist were black race (OR, 0.63; 95% CI, 0.43-0.92) and the presence of a significant medical comorbidity (OR, 0.69; 95% CI, 0.48-0.97). In 2006, less than half of stroke survivors in the United States received dental care, leaving substantial room for improvement. Stroke survivors need education about the importance of regular dental care, particularly minority groups.

Measured posterior annuloplasty for repair of non-ischemic mitral regurgitation. A single unit follow-up.

UNLABELLED The aim of this report is to evaluate short- and long-term outcomes of annuloplasty method of our choice: measured posterior annuloplasty (MPA). MPA is a piece of a Duran ring cut to the length of free-edge of anterior mitral leaflet (AML) and anchored with multiple pledgeted U-sutures from trigone to trigone into the posterior annulus. MATERIAL AND METHODS From 1988 to 2000, 103 consecutive patients with non-ischemic mitral regurgitation were scheduled preoperatively to be repaired by MPA. RESULTS Preoperative mitral valve regurgitation (MR) grade was 3.8+/-0.5 and decreased to 0.1+/-0.3 (P<0.0001) after repair. One patient was converted to insertion of mechanical prosthesis after grade 3 MR persisted after septal myectomy and MPA. Three patients needed instant revision of the repair one due to SAM and two due to stenosis. No patient had a stenosis or unacceptable (>1) MR after the procedure. There was one operative death (1.0%) and 3 hospital/30-day deaths (2.9%). Sixteen patients (16.3%) expired during the follow-up to 91 months (mean 57.4+/-19.5, median 60 months) none due to failure of MPA. There were no reoperations due to failure of MPA. Three patients had a reoperation, one for dehiscence of reconstruction after P2 resection and two patients due to progression of anterior leaflet degeneration and calcification with 4+ MR. New York Heart Association (NYHA) functional classification decreased from 2.3+/-0.8 to 1.4+/-0.6 (P<0.0001) and only one patient had an increase from II to III. Eighty-eight patients (96.7%) were in NYHA class I-II. Ten patients had an increase of MR from 0 to trace or 1 and one from 0 to 2. Two patients were diagnosed with mild stenosis without need of reoperation. CONCLUSIONS MPA is a durable and stable alternative for repair of non-ischemic mitral regurgitation of different etiologies. The technique gives an objective measure of the length of the band and no patient is left with a significant MR or mitral valve stenosis (MS). First-time success rate is very high and instant repairs few and minor. Freedom of MPA related reoperations is 100%.

Patterns of Influenza Vaccination among Stroke Survivors

Background: Influenza remains a leading cause of vaccine-preventable death in the USA. Vaccination rates in the eligible general population are well below targets, and rates in stroke survivors are unknown. Methods: We assessed the prevalence and independent predictors of influenza vaccination among stroke survivors using the National Health Interview Survey (NHIS) 2006 survey. Results: There were a total of 706 self-reported strokes (3%) out of a total of 24,275 adults completing the survey (mean age 67 ± 15 years). The prevalence of influenza vaccination over the previous year among stroke survivors was 54.3%. Factors independently associated with vaccination were increasing age (odds ratio = 1.04 per year, 95% CI: 1.02–1.06), Black race (odds ratio = 0.52, 95% CI: 0.33–0.82 compared to white race), and health insurance coverage (odds ratio = 3.5, 95% CI: 1.37–9.05). Conclusions: In 2006, only about half the stroke survivors in the USA received influenza vaccinations, leaving substantial room for improvement. Targeting stroke survivors in minority groups or without health insurance coverage may help bridge this gap.