Scott Lunos

Psychosocial Distress and Stroke Risk in Older Adults

Background and Purpose— To investigate the association of psychosocial distress with risk of stroke mortality and incident stroke in older adults. Methods— Data were from the Chicago Health and Aging Project, a longitudinal population-based study conducted in 3 contiguous neighborhoods on the south side of Chicago, IL. Participants were community-dwelling black and non-Hispanic white adults, aged 65 years and older (n=4120 for stroke mortality; n=2649 for incident stroke). Psychosocial distress was an analytically derived composite measure of depressive symptoms, perceived stress, neuroticism, and life dissatisfaction. Cox proportional hazards models examined the association of distress with stroke mortality and incident stroke over 6 years of follow-up. Results— Stroke deaths (151) and 452 incident strokes were identified. Adjusting for age, race, and sex, the hazard ratio (HR) for each 1-SD increase in distress was 1.47 (95% confidence interval [CI]=1.28–1.70) for stroke mortality and 1.18 (95% CI=1.07–1.30) for incident stroke. Associations were reduced after adjustment for stroke risk factors and remained significant for stroke mortality (HR=1.29; 95% CI=1.10–1.52) but not for incident stroke (HR=1.09; 95% CI=0.98–1.21). Secondary analyses of stroke subtypes showed that distress was strongly related to incident hemorrhagic strokes (HR=1.70; 95% CI=1.28–2.25) but not ischemic strokes (HR=1.02; 95% CI=0.91–1.15) in fully adjusted models. Conclusions— Increasing levels of psychosocial distress are related to excess risk of both fatal and nonfatal stroke in older black and white adults. Additional research is needed to examine pathways linking psychosocial distress to cerebrovascular disease risk.

Effects of a Home-Based Walking Intervention on Mobility and Quality of Life in People With Diabetes and Peripheral Arterial Disease: A randomized controlled trial

OBJECTIVE Determine the efficacy of a home-based walking intervention to improve walking ability and quality of life in people with diabetes and peripheral arterial disease (PAD). RESEARCH DESIGN AND METHODS We conducted a randomized, controlled, single-blind trial within university-affiliated clinics in our local community. We randomized 145 participants (45 women) with diabetes and PAD to our intervention—a 6-month behavioral intervention targeting levels of readiness to engage in routine walking for exercise—versus attention control. Our primary outcome was 6-month change in maximal treadmill walking distance. Secondary outcomes included 3-month change in maximal walking distance, lower limb function (i.e., walking impairment scores), quality of life (Medical Outcomes Short Form Survey), exercise behaviors, depressive symptoms, and self-efficacy at 3 and 6 months. RESULTS The mean age of participants was 66.5 (SD 10.1) years. Intervention and control groups did not differ significantly in 6-month change in maximal treadmill walking distance (average [SE] 24.5 [19.6] meters vs. 39.2 [19.6] meters; P = 0.60). Among secondary outcomes, for the intervention and control groups, respectively, average walking speed scores increased by 5.7 [2.2] units and decreased by 1.9 [2.8] units (P = 0.03); the mental health quality of life subscale score increased by 3.2 [1.5] and decreased by 2.4 [1.5] units (P = 0.01). CONCLUSIONS A home-based walking intervention did not improve walking distance but did improve walking speed and quality of life in people with diabetes and PAD. Clinicians should consider recommending home-based walking therapy for such patients.

A retrospective study evaluating frequency and risk factors of osteonecrosis of the jaw in 576 cancer patients receiving intravenous bisphosphonates

ObjectiveTo evaluate the frequency, risk factors, and clinical presentation of bisphosphonate (BP)-related osteonecrosis of the jaw (BRONJ). Study DesignWe performed a retrospective analysis of 576 patients with cancer treated with intravenous pamidronate and/or zoledronate between January, 2003 and December, 2007 at the University of Minnesota Masonic Cancer Center and Park Nicollet Institute. ResultsEighteen of 576 identified patients (3.1%) developed BRONJ including 8 of 190 patients (4.2%) with breast cancer, 6 of 83 patients (7.2%) with multiple myeloma, 2 of 84 patients (2.4%) with prostate cancer, 1 of 76 patients (1.3%) with lung cancer, 1 of 52 patients (1.9%) with renal cell carcinoma, and in none of the 73 patients with other malignancies. Ten patients (59%) developed BRONJ after tooth extraction, whereas 7 (41%) developed it spontaneously (missing data for 1 patient). The mean number of BP infusions (38.1±19.06 infusions vs. 10.5±12.81 infusions; P<0.001) and duration of BP treatment (44.3±24.34 mo vs. 14.6±18.09 mo; P<0.001) were significantly higher in patients with BRONJ compared with patients without BRONJ. Multivariate Cox proportional hazards regression analysis showed that diabetes [hazard ratio (HR)=3.40; 95% confidence interval (CI), 1.14-10.11; P=0.028], hypothyroidism (HR=3.59; 95% CI, 1.31-9.83; P=0.013), smoking (HR=3.44; 95% CI, 1.28-9.26; P=0.015), and higher number of zoledronate infusions (HR=1.07; 95% CI, 1.03-1.11; P=0.001) significantly increased the risk of developing BRONJ. ConclusionsIncreased cumulative doses and long-term BP treatment are the most important risk factors for BRONJ development. Type of BP, diabetes, hypothyroidism, smoking, and prior dental extractions may play a role in BRONJ development.

Neighborhood Cohesion Is Associated With Reduced Risk of Stroke Mortality

Background and Purpose— Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence. Methods— Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence. Results— Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5). Conclusions— Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.

Marathon related cardiac arrest risk differences in men and women

Objective To determine the incidence of sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in men and women. Design Retrospective cohort study. Setting Two popular urban 42 km marathons. Participants 1982 to 2009 finishers. Assessment of risk factors Race records were assessed for finishers, age distribution and cardiac events by sex. Main outcome measures The SCA/SCD incidence for all (total), male and female finishers. Results There were 548 092 finishers with women finishers increasing from 10% to 40% over the first 18 years and remaining near 40% for the last decade. There were 14 SCA events (1 woman, 13 men) with seven successful resuscitations yielding an all finishers SCA rate of 2.6 per 100 000 finishers. The SCA rates (per 100 000) for men and women were 3.4 (95% CI: 1.8 to 5.9) and 0.6 (95% CI: 0.0 to 3.3), respectively (p=0.079). The male SCA rate for the 2000–2009 decade was 4.6 per 100 000 finishers (95% CI: 1.8 to 9.5). Eleven of 13 men were >39 years old. The OR of a man experiencing SCA compared with woman was 5.7. Conclusions As the number of women participating in these two marathons has increased, the difference between the mens and total SCA and SCD incidence has increased for men, especially >39 years old, from coronary artery disease with mens incidence for SCA of 1 in 22 000 and SCD at 1 in 50 000 finishers over past decade.

Depressive Symptoms and Cardiovascular Mortality in Older Black and White Adults: Evidence for a Differential Association by Race

Background— An emerging body of research suggests that depressive symptoms may confer an “accelerated risk” for cardiovascular disease (CVD) in blacks compared with whites. Research in this area has been limited to cardiovascular risk factors and early markers; less is known about black-white differences in associations with important clinical end points. Methods and Results— The authors examined the association between depressive symptoms and overall CVD mortality, ischemic heart disease (IHD) mortality, and stroke mortality in a sample of 6158 (62% black; 61% female) community-dwelling older adults. Cox proportional hazards models were used to model time-to-CVD, IHD, and stroke death over a 9- to 12-year follow-up. In race-stratified models adjusted for age and sex, elevated depressive symptoms were associated with CVD mortality in blacks (hazard ratio [HR], 1.95; 95% confidence interval [CI], 1.61 to 2.36; P<0.001) but were not significantly associated with CVD mortality in whites (HR, 1.26; 95% CI, 0.95 to 1.68; P=0.11; race by depressive symptoms interaction, P=0.03). Similar findings were observed for IHD mortality (black: HR, 1.99; 95% CI, 1.49 to 2.64; P<0.001; white: HR, 1.28; 95% CI, 0.86 to 1.89; P=0.23) and stroke mortality (black: HR, 2.08; 95% CI, 1.32 to 3.27; P=0.002; white: HR, 1.32; 95% CI, 0.69 to 2.52; P=0.40). Findings for total CVD mortality and IHD mortality were attenuated but remained significant after adjusting for standard risk factors. Findings for stroke were reduced to marginal significance. Conclusions— Elevated depressive symptoms were associated with multiple indicators of CVD mortality in older blacks but not in whites. Findings were not completely explained by standard risk factors. Efforts aimed at reducing depressive symptoms in blacks may ultimately prove beneficial for their cardiovascular health.

Patterns of self-selected smoking cessation attempts and relapse by menstrual phase

Clinical studies are emerging which suggest that sex hormones may play a role in quit attempts and relapse. The present study aim is to determine if menstrual phase plays a role on a second self-selected quit attempt and subsequent relapse during a twenty-six week follow-up. Participants (n=138) were 29.7+/-6.5 years old and smoked 16.1+/-4.8 cigarettes per day. Participants were more likely to self-select a second quit date during the Follicular (F) phase (59.4%) than Luteal (L) phase (40.6%, p=0.033) and were also more likely to relapse during the F phase than the L phase (59.7% vs. 40.3%, p=0.043, respectively). Those who self-selected to quit in the L phase experienced a significantly longer time to relapse than those who chose the F phase (median of 3 days vs. 2 days, respectively; Hazard Ratio=1.599, p-value=0.014). This confirms previous work suggesting quit dates in the F phase are associated with worse smoking cessation outcomes. Additional research is needed to investigate how this relationship may vary with the use of pharmacotherapy.

Matrix metalloproteinase-9 expression in alveolar extraction sockets of Zoledronic acid-treated rats.

PURPOSE The use of nitrogen-containing bisphosphonates (n-bis) is associated with necrosis of the jaws, also known as bisphosphonate-related osteonecrosis of the jaws (BRONJ); however, the pathophysiology is unknown. Matrix metalloproteinase-9 (MMP-9) expression is essential for normal bone healing and is also required for angiogenesis. N-bis alters MMP-9 expression in vitro and in vivo; therefore, we hypothesized that n-bis alters MMP-9 expression during oral wound healing after tooth extraction. MATERIALS AND METHODS A total accumulated dose of 2.25 mg/kg (n = 20) of Zoledronic acid (ZA) Zometa or saline (control, n = 20) was administered to Sprague-Dawley male rats. Next, both groups had maxillary molar teeth extracted. Rats were sacrificed at postoperative day 1, 3, 7, or 21. Western blotting or multiplex ELISA was used to evaluate proteins of interest. Real-time polymerase chain reaction was used to assess the relative quantities of target gene mRNA. MMP-9 enzymatic activity was assessed by zymography. RESULTS The ZA group showed a statistically significant reduction in bone mineralization rate 21 days after tooth extraction compared with the control group (Student t test, P = .005). Moreover, ZA-treated animals showed a statistically significant increase in MMP-9-specific mRNA at postoperative days 3 (P = .003), 7 (P < .0001), and 21 (P < .0001) and protein on postoperative days 3 (P = .005) and 7 (P < .0001). MMP-9 enzymatic activity was also increased in ZA-treated rats compared with control animals (Student t test, P = .014). We also evaluated the extraction sockets for the presence of tissue inhibitor of MMP-1 (TIMP1), which is an inhibitor of MMP-9 enzymatic activity. TIMP1-specific mRNA and protein were not significantly altered by ZA treatment at the times tested (P > .05). Receptor of NF-κB ligand (RANKL) is known to regulate the expression of MMP-9; we therefore assessed the RANKL expression in our experimental oral wound-healing model. The ZA-treated animals had significantly increased RANKL mRNA at postoperative days 3 (P = .02) and 21 (P = .004), while the protein expression was significantly increased at postoperative days 1 (P < .0001), 7 (P = .02), and 21 (P = .03) compared with the control group. CONCLUSIONS ZA reduced bone mineralization within tooth extraction sockets, suggesting aberrant bone healing. ZA increases the amount and enzymatic activity of MMP-9, while apparently not altering the amount of TIMP1 within extraction sockets. RANKL is increased in ZA-treated rats, which suggests that increased MMP-9 expression is due, in part, to augmented RANKL expression.

Severity of withdrawal symptomatology in follicular versus luteal quitters: The combined effects of menstrual phase and withdrawal on smoking cessation outcome

Women are at an increased risk of relapse after a smoking cessation attempt. While the reasons for this phenomenon are not fully understood, recent research indicates that both the menstrual cycle and negative symptomatology may play a role. The goal of this study was to describe the association between withdrawal symptoms during attempted smoking cessation, and to investigate the impact of these symptoms on smoking cessation outcomes as defined by 7-day point prevalence at 14 and 30 days. Negative symptoms associated with the premenstrual period were also assessed. Participants (n = 202) were 29.8 (SD +/- 6.6) years old and smoked 16.6 (SD +/- 5.6) cigarettes per day. They were randomly assigned to quit smoking in the follicular (n = 106) or luteal (n = 96) menstrual phase. We observed several significantly more severe premenstrual and withdrawal symptoms in the luteal phase. Regardless of quit phase, most withdrawal symptoms were associated with an increased risk of relapse at 14 and 30 days post quit date. Participants attempting to quit smoking in the follicular phase who had higher levels of Anger and Craving were more likely to relapse to smoking at 14-days (OR = 2.00, p-value = 0.026; OR = 2.63, p-value = 0.006; respectively). These data suggest that the menstrual cycle may play a role in smoking cessation outcome, as well as in the symptomatology experienced during a cessation attempt.

Influence of dental resin material composition on cross-polarization-optical coherence tomography imaging

Abstract. The purpose of this study was to investigate cross-polarization-optical coherence tomography (CP-OCT) signal attenuation through different resin material compositions. Four distinct composite systems were used: Filtek supreme ultra (FSU) (3M ESPE), IPS empress direct (EMD) (Ivoclar Vivadent), estelite sigma quick (SQK) (Tokuyama Dental), and Z100 (3M ESPE). Cross-sectional images of different composite-demineralized phantoms (n=108) were collected using a 1310-nm intraoral cross-polarization swept source OCT (CP-OCT) imaging system. %T quantified the CP-OCT signal attenuation. Scanning electron microscopy, transmission electron microscopy, and energy-dispersive x-ray spectrometer chemical analysis was utilized to determine how different matrix/filler compositions affected attenuation of the near infrared (NIR) signal. CP-OCT imaging of dental resin composites showed enormous variation in signal attenuation. For each of our composite systems, there was not a consistent attenuation difference in the NIR signal for A to D shades. The four composites had similar measured backscattering values but attenuated the overall signal to different degrees. When comparing the A2 shades between the four different composite systems, the order of highest to lowest of %T was EMD>Z100, FSU>SQK (ANOVA, Tukey, p<0.0001). As a result, we demonstrate the importance of understanding how the constituents of composite materials affect CP-OCT signal attenuation.