Objective: To investigate the association of Parkinson disease (PD) with education and occupations using a case-control study design. Methods: The authors used the medical records-linkage system of the Rochester Epide...Objective: To investigate the association of Parkinson disease (PD) with education and occupations using a case-control study design. Methods: The authors used the medical records-linkage system of the Rochester Epidemiology Project to identify all subjects who developed PD in Olmsted County, MN, from 1976 through 1995. Each incident case was matched by age (±1 year) and sex to a general population control. The authors collected information about education and occupations using two independent sources of data: a review of the complete medical records in the system and a telephone interview. Occupations were coded using the 1980 Standard Occupational Classification. Results: Subjects with 9 or more years of education were at increased risk of PD (OR = 2.0; 95%CI = 1.1 to 3.6; p = 0.02), and there was a trend of increasing risk with increasin g education (test for linear trend, p = 0.02; medical records data). Physicians were at significantly increased risk of PD using both sources of occupational data. By contrast, four occupational groups showed a significantly decreased risk of PD using one source of data: construction and extractive workers (e.g., miner s, oil well drillers), production workers (e.g., machine operators, fabricators), metal workers, and engineers. These associations with increased or decreased risk did not change noticeably after adjustment for education. Conclusion: Subjects with higher education and physicians have an increased risk of Parkinson disease (PD), while subjects with some occupations presumed to involve high physical activity have a decreased risk of PD.展开更多
Background: Dementia can be caused by severe niacin insufficiency, but it is unknown whether variation in intake of niacin in the usual diet is linked to neu rodegenerative decline. We examined whether dietary intake ...Background: Dementia can be caused by severe niacin insufficiency, but it is unknown whether variation in intake of niacin in the usual diet is linked to neu rodegenerative decline. We examined whether dietary intake of niacin was associated with incident Alzheimer’ s disease (AD) and cognitive decline in a large, prospective study. Methods: This study was conducted in 1993- 2002 in a geographically defined Chicago community of 6158 residents aged 65 years and older. Nutrient intake was determined by food frequency questionnaire. Four cognitive tests were admi nistered to all study participants at 3 year intervals in a 6 year follow up. A total of 3718 participants had dietary data and at least two cognitive assessments for analyses of cognitive change over a median 5.5 years. Clinical evaluations were performed on a stratified random sample of 815 participants initially unaffected by AD, and 131 participants were diagnosed with 4 year incident AD by standardised criteria. Results: Energy adjusted niacin intake had a protective effect on development of AD and cognitive decline. In a logistic regression model, relative risks (95% confidence intervals) for incident AD from lowest to highest quintiles of total niacin intake were: 1.0 (referent) 0.3 (0.1 to 0.6), 0.3 (0.1 to 0.7), 0.6 (0.3 to 1.3), and 0.3 (0.1 to 0.7) adjusted for age, sex, race, education, and ApoE e4 status. Niacin intake from foods was also inversely associated with AD (p for linear trend = 0.002 in the adjusted model). In an adjusted random effects model, higher food intake of niacin was associated with a slower annual rate of cognitive decline, by 0.019 standardised units (SU) per natural log increase in intake (mg) (p=0.05). Stronger associations were observed in analyses that excluded participants with a history of cardiovascular disease (β =0.028 SU/year; p=0.008), those with low baseline cognitive scores (β =0.023 SU/year; p =0.02), or those with fewer than 12 years’ education (β =0.035 SU/year; p=0.002)Conclusion: Dietary niacinmay protect against AD and age related cognitive decline.展开更多
Background: Evidence does not support the view that Parkinson disease (PD) rep resents an accelerated aging process; however, the additional contribution of ag ing to the severity of different motor signs in patients ...Background: Evidence does not support the view that Parkinson disease (PD) rep resents an accelerated aging process; however, the additional contribution of ag ing to the severity of different motor signs in patients with PD is not known. T his knowledge may have implications for clinical trials of neuroprotective agent s in PD. Objective: To investigate the contribution of aging to the severity of the different motor signs of idiopathic PD. Setting: Center for Parkinson Diseas e and Other Movement Disorders of the Columbia University Medical Center and a n eurology clinic that primarily served individuals from the Washington Heights-I nwood community in New York City. Patients: Sample of patients with a wide range of disease duration and age. Design: Cross-sectional clinic-based study. Pati ents with PD were evaluated using the Unified Parkinson Disease Rating Scale (UP DRS). The total UPDRS motor score was divided into 6 motor domains (tremor, rigi dity, bradykinesia, facial expression, speech, and axial impairment) and 2 subsc ores that represented predominantly dopaminergic (subscore A: tremor, rigidity, bradykinesia, and facial expression) and nondopaminergic (subscore B: speech and axial impairment) deficiency. Analyses were performed using linear regression models with the UPDRS motor domains and subscores as the outcomes. The variation (adjusted R2)of the outcome variables explained by the inclusion o f disease duration in the models, adjusting for sex, years of education, levodop a dosage, and use of other antiparkinsonian medications, was calculated. The add itional variation explained by adding age at examination to the models was used to gauge the contribution of aging to each motor domain and subscore of the UPDR S. Results: A total of 451 patients participated in the study. Mean age at exami nation was 62.0 years (SD, 12.6 years; median, 62.0 years; range, 18-93 years), and mean disease duration was 7.2 years (SD, 5.9 years; median, 5.6 years; rang e, 0.1-41.6 years). The additional variation of the outcome variable explained by including age in the models was higher for subscore B (14.3%; 95%confidence interval [CI], 9.9%-20.4%) than subscore A (4.7%; 95%CI, 2.0%-9.1%). Among the 6 motor domains, the additional variation of the outcome variable explai ned by including age in the models was highest for axial impairment (13.6%; 95 %CI, 9.4%-19.6%). Conclusion: Axial (gait and postural) impairment in PD may result from the combined effect of the disease and the aging process on nondopa minergic subcortical structures.展开更多
Objective: Bacterial vaginosis has been associated with hormonal factors and sexual practices; however, the cause is unclear, and the notion that bacterial vaginosis is a sexually transmitted infection is still debate...Objective: Bacterial vaginosis has been associated with hormonal factors and sexual practices; however, the cause is unclear, and the notion that bacterial vaginosis is a sexually transmitted infection is still debated. To investigate whether bacterial vaginosis is associated with specific sexual practices or instead has features in common with a sexually transmitted infection, we compared behavioral associations in women with bacterial vaginosis to women with vaginal candidiasis. Methods: Women with symptoms of abnormal vaginal discharge or odor who attended Melbourne Sexual Health Centre between July 2003 and August 2004 were eligible for enrollment in the study. Information on demographics and behavioral and contraceptive practices were collected by self- completed questionnaire. Participants were tested for bacterial vaginosis, Candida spp (microscopy and culture), and sexually transmitted infections. Statistical comparisons were made between women with and without bacterial vaginosis and women with and without candidiasis, using univariate and multivariate analysis. Results: A total of 342 women were enrolled in the study; 157 were diagnosed with bacterial vaginosis, 51 had candidiasis by microscopy, and 95 had candidiasis by culture. Bacterial vaginosis was associated with indicators of high- risk sexual behavior such as a new sexual partner and greater number of male partners in the last year, increased number of lifetime sexual partners, less than 13 years of education, a past history of pregnancy, and smoking (P < .05). Candidiasis was not associated with these risk behaviors and was instead related to practices such as receptive anal and oral sex and douching. Conclusion: The association between bacterial vaginosis and practices that are associated with sexually transmitted infections, in contrast to those observed with candidiasis, suggests a possible sexually transmitted cause.展开更多
文摘Objective: To investigate the association of Parkinson disease (PD) with education and occupations using a case-control study design. Methods: The authors used the medical records-linkage system of the Rochester Epidemiology Project to identify all subjects who developed PD in Olmsted County, MN, from 1976 through 1995. Each incident case was matched by age (±1 year) and sex to a general population control. The authors collected information about education and occupations using two independent sources of data: a review of the complete medical records in the system and a telephone interview. Occupations were coded using the 1980 Standard Occupational Classification. Results: Subjects with 9 or more years of education were at increased risk of PD (OR = 2.0; 95%CI = 1.1 to 3.6; p = 0.02), and there was a trend of increasing risk with increasin g education (test for linear trend, p = 0.02; medical records data). Physicians were at significantly increased risk of PD using both sources of occupational data. By contrast, four occupational groups showed a significantly decreased risk of PD using one source of data: construction and extractive workers (e.g., miner s, oil well drillers), production workers (e.g., machine operators, fabricators), metal workers, and engineers. These associations with increased or decreased risk did not change noticeably after adjustment for education. Conclusion: Subjects with higher education and physicians have an increased risk of Parkinson disease (PD), while subjects with some occupations presumed to involve high physical activity have a decreased risk of PD.
基金supported by funds from the 'National Project on Management and Treatment of Severe Mental Illness'the 'National Fund for Equalizing Public Health Services'
文摘Background: Dementia can be caused by severe niacin insufficiency, but it is unknown whether variation in intake of niacin in the usual diet is linked to neu rodegenerative decline. We examined whether dietary intake of niacin was associated with incident Alzheimer’ s disease (AD) and cognitive decline in a large, prospective study. Methods: This study was conducted in 1993- 2002 in a geographically defined Chicago community of 6158 residents aged 65 years and older. Nutrient intake was determined by food frequency questionnaire. Four cognitive tests were admi nistered to all study participants at 3 year intervals in a 6 year follow up. A total of 3718 participants had dietary data and at least two cognitive assessments for analyses of cognitive change over a median 5.5 years. Clinical evaluations were performed on a stratified random sample of 815 participants initially unaffected by AD, and 131 participants were diagnosed with 4 year incident AD by standardised criteria. Results: Energy adjusted niacin intake had a protective effect on development of AD and cognitive decline. In a logistic regression model, relative risks (95% confidence intervals) for incident AD from lowest to highest quintiles of total niacin intake were: 1.0 (referent) 0.3 (0.1 to 0.6), 0.3 (0.1 to 0.7), 0.6 (0.3 to 1.3), and 0.3 (0.1 to 0.7) adjusted for age, sex, race, education, and ApoE e4 status. Niacin intake from foods was also inversely associated with AD (p for linear trend = 0.002 in the adjusted model). In an adjusted random effects model, higher food intake of niacin was associated with a slower annual rate of cognitive decline, by 0.019 standardised units (SU) per natural log increase in intake (mg) (p=0.05). Stronger associations were observed in analyses that excluded participants with a history of cardiovascular disease (β =0.028 SU/year; p=0.008), those with low baseline cognitive scores (β =0.023 SU/year; p =0.02), or those with fewer than 12 years’ education (β =0.035 SU/year; p=0.002)Conclusion: Dietary niacinmay protect against AD and age related cognitive decline.
文摘Background: Evidence does not support the view that Parkinson disease (PD) rep resents an accelerated aging process; however, the additional contribution of ag ing to the severity of different motor signs in patients with PD is not known. T his knowledge may have implications for clinical trials of neuroprotective agent s in PD. Objective: To investigate the contribution of aging to the severity of the different motor signs of idiopathic PD. Setting: Center for Parkinson Diseas e and Other Movement Disorders of the Columbia University Medical Center and a n eurology clinic that primarily served individuals from the Washington Heights-I nwood community in New York City. Patients: Sample of patients with a wide range of disease duration and age. Design: Cross-sectional clinic-based study. Pati ents with PD were evaluated using the Unified Parkinson Disease Rating Scale (UP DRS). The total UPDRS motor score was divided into 6 motor domains (tremor, rigi dity, bradykinesia, facial expression, speech, and axial impairment) and 2 subsc ores that represented predominantly dopaminergic (subscore A: tremor, rigidity, bradykinesia, and facial expression) and nondopaminergic (subscore B: speech and axial impairment) deficiency. Analyses were performed using linear regression models with the UPDRS motor domains and subscores as the outcomes. The variation (adjusted R2)of the outcome variables explained by the inclusion o f disease duration in the models, adjusting for sex, years of education, levodop a dosage, and use of other antiparkinsonian medications, was calculated. The add itional variation explained by adding age at examination to the models was used to gauge the contribution of aging to each motor domain and subscore of the UPDR S. Results: A total of 451 patients participated in the study. Mean age at exami nation was 62.0 years (SD, 12.6 years; median, 62.0 years; range, 18-93 years), and mean disease duration was 7.2 years (SD, 5.9 years; median, 5.6 years; rang e, 0.1-41.6 years). The additional variation of the outcome variable explained by including age in the models was higher for subscore B (14.3%; 95%confidence interval [CI], 9.9%-20.4%) than subscore A (4.7%; 95%CI, 2.0%-9.1%). Among the 6 motor domains, the additional variation of the outcome variable explai ned by including age in the models was highest for axial impairment (13.6%; 95 %CI, 9.4%-19.6%). Conclusion: Axial (gait and postural) impairment in PD may result from the combined effect of the disease and the aging process on nondopa minergic subcortical structures.
文摘Objective: Bacterial vaginosis has been associated with hormonal factors and sexual practices; however, the cause is unclear, and the notion that bacterial vaginosis is a sexually transmitted infection is still debated. To investigate whether bacterial vaginosis is associated with specific sexual practices or instead has features in common with a sexually transmitted infection, we compared behavioral associations in women with bacterial vaginosis to women with vaginal candidiasis. Methods: Women with symptoms of abnormal vaginal discharge or odor who attended Melbourne Sexual Health Centre between July 2003 and August 2004 were eligible for enrollment in the study. Information on demographics and behavioral and contraceptive practices were collected by self- completed questionnaire. Participants were tested for bacterial vaginosis, Candida spp (microscopy and culture), and sexually transmitted infections. Statistical comparisons were made between women with and without bacterial vaginosis and women with and without candidiasis, using univariate and multivariate analysis. Results: A total of 342 women were enrolled in the study; 157 were diagnosed with bacterial vaginosis, 51 had candidiasis by microscopy, and 95 had candidiasis by culture. Bacterial vaginosis was associated with indicators of high- risk sexual behavior such as a new sexual partner and greater number of male partners in the last year, increased number of lifetime sexual partners, less than 13 years of education, a past history of pregnancy, and smoking (P < .05). Candidiasis was not associated with these risk behaviors and was instead related to practices such as receptive anal and oral sex and douching. Conclusion: The association between bacterial vaginosis and practices that are associated with sexually transmitted infections, in contrast to those observed with candidiasis, suggests a possible sexually transmitted cause.
