Posttraumatic stress disorder (PTSD) is associated with self‐reported difficulties navigating the social and physical world and may also be associated with risk of functional limitations. The Short ...Physical Performance Battery (SPPB), an objective functional assessment, was administered during monitoring exams between January and December 2015 to a consecutive sample of 1,268 rescue workers, volunteers, and other responders who had aided in response, recovery, and cleanup efforts at the World Trade Center (WTC) in New York after the September 11, 2011 attacks. Data were linked with diagnostic and longitudinal data from the WTC monitoring study. Multivariable analyses were used to examine predictors of functional limitations. Prevalence estimates weighted to the general responder population revealed a relatively high prevalence of functional limitations, SPPB ≤ 9; 16.0%, 95% CI 13.7, 18.4. Current PTSD was associated with a twofold increased risk of functional limitations after controlling for predisposing factors, trauma severity, behavioral factors, and WTC‐related medical conditions, adjusted risk ratio (aRR) = 2.11, 95% CI 1.48, 3.01. Exposure to ergonomic risk factors at the WTC also increased the risk of functional impairments, aRR = 1.34 95% CI 1.05, 1.70. Longitudinal results suggest that individuals with current functional limitations experienced high baseline PTSD severity, B = 2.94, SE = 1.33, and increasing PTSD symptom severity, B = 0.29, SE = 0.10, since September 11, 2001. This study identified a cross‐sectional relationship between functional limitations and PTSD and a worsening of PTSD symptoms in persons who eventually demonstrated functional limitations. Results highlight the potential role of chronic PTSD in functional limitations.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
Limitaciones funcionales en operadores del World Trade Center
El trastorno de estrés postraumático (TEPT) se asocia con dificultades auto‐reportadas al explorar el mundo social y físico y también puede estar asociado con el riesgo de limitaciones funcionales. La Baterìa Breve de Desempeño Fìsico (SPPB, por sus siglas en inglés), una evaluación funcional objetiva, se administró durante los exámenes de monitoreo entre enero y diciembre de 2015 a una muestra consecutiva de 1.268 trabajadores de rescate, voluntarios y otros operadores quienes ayudaron en respuesta, recuperación y esfuerzos de limpieza en el World Trade Center (WTC) en Nueva York después de los ataques del 11 de septiembre de 2011. Los datos se relacionaron con datos diagnósticos y longitudinales del estudio de monitoreo del WTC. Los análisis multivariantes se utilizaron para examinar los predictores de limitaciones funcionales. Las estimaciones de prevalencia ponderadas a la población operadora general reveló una prevalencia relativamente alta de limitaciones funcionales, SPPB ≤ 9; 16,0%, IC del 95% 13,7, 18,4. El TEPT actual se asoció con un riesgo dos veces mayor de limitaciones funcionales después de controlar los factores predisponentes, la gravedad del trauma, los factores comportamentales y las condiciones médicas asociadas al WTC, Razón de Riesgo Ajustado (aRR) = 2,11, IC del 95% 1,48, 3,01. La exposición a factores de riesgo ergonómicos en el WTC también aumentaron el riesgo de deterioros funcionales, aRR = 1,34 IC del 95% 1,05, 1,70. Los resultados longitudinales sugieren que los individuos con limitaciones funcionales actuales experimentaron alta severidad basal de TEPT, B = 2.94, SE = 1.33, y el aumento de la gravedad de los síntomas de TEPT, B = 0,29, SE = 0,10, desde el 11 de septiembre de 2001. Este estudio identificó una relación transaccional entre las limitaciones funcionales y el TEPT y un empeoramiento de los síntomas de TEPT en personas que eventualmente demuestran limitaciones funcionales. Los resultados destacan el rol potencial del TEPT crónico en las limitaciones funcionales.
抽象
Traditional and Simplified Chinese s by AsianSTSS
Functional limitations in World Trade Center responders 14 years after the disaster: Implications of chronic posttraumatic stress disorder
Traditional Chinese
標題: 世界貿易中心事件的搜救者14年後的身體功能障礙:慢性創傷後壓力症的影響
撮要: 創傷後壓力症(PTSD)跟個人就日常面對社交困難作出的自評有關, 亦可能跟身體功能障礙的風險有關。「簡短身體功能量表(Short Physical Performance Battery, SPPB)」是客觀的身體功能評估工具。本研究從2011年9月11日紐約世界貿易中心(WTC)遇襲事件裡, 協作搜救、治療和清理工作的人士當中找尋樣本。我們以序貫抽樣法, 取得由1,268名拯救人員、義工和其他搜救者組成的樣本, 並於2015年1至12月進行的監察評估裡, 對樣本採用「簡短身體功能量表」進行測量。我們把取得的數據, 與WTC監察研究中的診斷和縱貫數據作結合分析。我們採用多變量分析, 檢視身體功能障礙的預測變量。我們基於一般反應人口作普遍率估計, 發現身體功能障礙普遍率較高 (SPPB ≤ 9; 16.0%, 95% CI 13.7, 18.4)。我們因應誘因、創傷嚴重度、行為因素、與WTC事件相關的醫療情況作對照試驗後, 發現當前PTSD跟身體功能障礙的風險提升兩倍有關(已調節的相對風險率, aRR = 2.11, 95% CI 1.48, 3.01)。於WTC事件暴露於人體工學風險因素, 亦會提升功能受損的風險(aRR = 1.34 95% CI 1.05, 1.70)。縱貫研究結果反映, 有當前身體功能障礙的人士, 自2001年9月11日起, 有高水平的PTSD嚴重度基線(B = 2.94, SE = 1.33), PTSD症狀嚴重度亦有提升(B = 0.29, SE = 0.10)。研究發現了身體功能障礙跟PTSD的橫斷關係, 而日後有身體功能障礙的樣本其PTSD症狀會惡化。結果反映慢性PTSD對身體功能障礙的潛在影響。
Simplified Chinese
标题: 世界贸易中心事件的搜救者14年后的身体功能障碍:慢性创伤后压力症的影响
撮要: 创伤后压力症(PTSD)跟个人就日常面对社交困难作出的自评有关, 亦可能跟身体功能障碍的风险有关。「简短身体功能量表(Short Physical Performance Battery, SPPB)」是客观的身体功能评估工具。本研究从2001年9月11日纽约世界贸易中心(WTC)遇袭事件里, 协作搜救、治疗和清理工作的人士当中找寻样本。我们以序贯抽样法, 取得由1,268名拯救人员、义工和其他搜救者组成的样本, 并于2015年1至12月进行的监察评估里, 对样本采用「简短身体功能量表」进行测量。我们把取得的数据, 与WTC监察研究中的诊断和纵贯数据作结合分析。我们采用多变量分析, 检视身体功能障碍的预测变量。我们基于一般反应人口作普遍率估计, 发现身体功能障碍普遍率较高 (SPPB ≤ 9; 16.0%, 95% CI 13.7, 18.4)。我们因应诱因、创伤严重度、行为因素、与WTC事件相关的医疗情况作对照试验后, 发现当前PTSD跟身体功能障碍的风险提升两倍有关(已调节的相对风险率, aRR = 2.11, 95% CI 1.48, 3.01)。于WTC事件暴露于人体工学风险因素, 亦会提升功能受损的风险(aRR = 1.34 95% CI 1.05, 1.70)。纵贯研究结果反映, 有当前身体功能障碍的人士, 自2001年9月11日起, 有高水平的PTSD严重度基线(B = 2.94, SE = 1.33), PTSD症状严重度亦有提升(B = 0.29, SE = 0.10)。研究发现了身体功能障碍跟PTSD的横断关系, 而日后有身体功能障碍的样本其PTSD症状会恶化。结果反映慢性PTSD对身体功能障碍的潜在影响。
Summary
Aging is a major risk factor for chronic disease in the human population, but there are little human data on gene expression alterations that accompany the process. We examined human ...peripheral blood leukocyte in‐vivo RNA in a large‐scale transcriptomic microarray study (subjects aged 30–104 years). We tested associations between probe expression intensity and advancing age (adjusting for confounding factors), initially in a discovery set (n = 458), following‐up findings in a replication set (n = 240). We confirmed expression of key results by real‐time PCR. Of 16 571 expressed probes, only 295 (2%) were robustly associated with age. Just six probes were required for a highly efficient model for distinguishing between young and old (area under the curve in replication set; 95%). The focused nature of age‐related gene expression may therefore provide potential biomarkers of aging. Similarly, only 7 of 1065 biological or metabolic pathways were age‐associated, in gene set enrichment analysis, notably including the processing of messenger RNAs (mRNAs); P < 0.002, false discovery rate (FDR) q < 0.05. This is supported by our observation of age‐associated disruption to the balance of alternatively expressed isoforms for selected genes, suggesting that modification of mRNA processing may be a feature of human aging.
The discovery of effective interventions to prevent or delay disability in older persons is a public health priority. Most likely to benefit from such interventions are frail individuals who are not ...yet disabled and those with early disability who are at high risk of progression. In spite of this frail older persons have often been excluded from research on the assumption that they would not tolerate testing or benefit from treatment. The Interventions on Frailty Working Group developed recommendations to screen, recruit, evaluate, and retain frail older persons in clinical trials.
Specific recommendations are:
Eligibility screening should include a multistage process, to quickly exclude those who are too well and those who are too sick.
Inclusion criteria should target those most likely to benefit, be meaningful to clinicians, and reflect advancements in the frailty research area.
Disability outcome measures should include self‐reported, objective, and proxy measures. Strategies to improve retention and compliance and to monitor their effectiveness should be an integral part of the study design.
Estimation of cost and sample size should contemplate high dropout rates and interference bycompeting outcomes.
Additional research is needed to refine criteria for screening frail older persons, identify objective measures of disability that are reliable and valid in frail older persons, and improve the informed consent process for high‐risk participants, recognizing that research in this subgroup is essential to improving their health outcomes.
While the relationship between total cholesterol (TC) and cardiovascular disease (CVD) progressively weakens with aging, several studies have shown that low TC is associated with increased mortality ...in older individuals. However, the possible additive/synergic contribution of the two most important cholesterol rich fractions (LDL-C and HDL-C) to mortality risk has not been previously investigated. Our study aimed to investigate the relationship between baseline LDL-C and HDL-C, both separately and combined, and 9-years mortality in a sample of community dwelling older individuals from the InCHIANTI study.
1044 individuals over 64 years were included. CVD and cancer mortality were defined by ICD-9 codes 390-459 and 140-239, respectively. LDL-C <130 mg/dL (3.36 mmol/L) was defined as "optimal/near optimal". Low HDL-C was defined as <40/50 mg/dL (1.03/1.29 mmol/L) in males/females, respectively. Nine-years mortality risk was calculated by multivariate Cox proportional hazards model. We found that, compared to subjects with high LDL-C and normal HDL-C (reference group), total mortality was significantly increased in subjects with optimal/near optimal LDL-C and low HDL-C (H.R.:1.58; 95%CI:1.11-2.25). As regards the specific cause of death, CVD mortality was not affected by LDL-C/HDL-C levels, while cancer mortality was significantly increased in all subjects with optimal/near optimal LDL-C (with normal HDL-C: H.R.: 2.49; with low HDL-C: H.R.: 4.52). Results were unchanged after exclusion of the first three years of follow-up, and of subjects with low TC (<160 g/dL-4.13 mmol/L).
Our findings suggest that, in community dwelling older individuals, the combined presence of optimal/near optimal LDL-C and low HDL-C represents a marker of increased future mortality.
The aging-suppressor gene klotho encodes a single-pass transmembrane protein that in mice is known to extend life span when overexpressed and resemble accelerated aging when expression is disrupted. ...It is not known whether there is a relationship between plasma levels of secreted klotho protein and longevity in humans.
We measured plasma klotho in 804 adults, greater than or equal to 65 years, in the InCHIANTI study, a longitudinal population-based study of aging in Tuscany, Italy.
During 6 years of follow-up, 194 (24.1%) of the participants died. In a multivariate Cox proportional hazards model, adjusting for age, sex, education, body mass index, physical activity, total cholesterol, high-density lipoprotein cholesterol, cognition, 25-hydroxyvitamin D, parathyroid hormone, serum calcium, mean arterial pressure, and chronic diseases, participants in the lowest tertile of plasma klotho (<575 pg/mL) had an increased risk of death compared with participants in the highest tertile of plasma klotho (>763 pg/mL; hazards ratio 1.78, 95% confidence interval 1.20-2.63).
In older community-dwelling adults, plasma klotho is an independent predictor of all-cause mortality. Further studies are needed to elucidate the potential biological mechanisms by which circulating klotho could affect longevity in humans.
To determine the association between a previously validated frailty phenotype and the development of new-onset dependence in activities of daily living, independent of hospitalizations and other ...established predictors of disability.
Seven hundred and forty-nine women enrolled in the Women’s Health and Aging Study-I who were independent in all activities in daily living when enrolled in the cohort.
Assessments and interviews were conducted through home visits at 6-month intervals for 3 years. Frailty was classified using a validated phenotype (≥3 of the following: weight loss, exhaustion, slow walking, sedentariness, and weak grip), and hospitalizations were identified by self-report. Grouped-time proportional hazard models assessed associations among frailty, hospitalization, and the development of dependence in activities in daily living, adjusting for other factors.
Twenty-five percent of the cohort (186/749) were frail at baseline; 56% (104/186) of frail versus 20% (23/117) of nonfrail women developed dependence in activities in daily living (P <.001). In multivariate analysis, frailty was independently associated with the development of dependence in activities in daily living (hazard ratio HR = 2.2; 95% confidence interval CI: 1.4 to 3.6), adjusting for hospitalization status, age, race, education, baseline functional status, cognition, depressive symptoms, number of chronic diseases, and self-reported health status. Additionally, a dose-response relationship existed between the number of frailty criteria that a woman had and the hazard of subsequent dependence in activities in daily living.
Frailty, conceptualized as an underlying vulnerability, and hospitalization, which marks an acute deterioration in health, were strongly and independently associated with new-onset dependence in activities in daily living. Additional research is needed to determine if dependence can be minimized by targeting resources and programs to frail older persons.
Adherence to a Mediterranean-style diet is associated with a lower risk for mortality, cognitive decline, and dementia. Whether adherence to a Mediterranean-style diet protects against age-related ...frailty is unclear. Therefore, our objective was to examine the association between a Mediterranean-style diet with the risk of frailty in community-dwelling older persons. We conducted longitudinal analyses using data from 690 community-living persons (≥65 y) who were randomly selected from a population registry in Tuscany, Italy. Participants of the Invecchiare in Chianti study of aging completed the baseline examination in 1998-2000 and were re-examined at least once over 6 y. Adherence to a Mediterranean-style diet (scored 0-9, modeled categorically as ≤3, 4-5, and ≥6) was computed from the European Prospective Investigation into Cancer and nutrition FFQ previously validated in this cohort. Frailty was defined as having at least 2 of the following criteria: poor muscle strength, feeling of exhaustion, low walking speed, and low physical activity. After a 6-y follow-up, higher adherence (score ≥6) to a Mediterranean-style diet was associated with lower odds of developing frailty OR = 0.30 (95% CI: 0.14, 0.66) compared with those with lower adherence (score ≤3). A higher adherence to a Mediterranean-style diet at baseline was also associated with a lower risk of low physical activity (OR = 0.62; 95% CI: 0.40, 0.96) and low walking speed OR = 0.48 (95% CI: 0.27, 0.86) but not with feelings of exhaustion and poor muscle strength. In community-dwelling older adults, higher adherence to a Mediterranean-style diet was inversely associated with the development of frailty.
Background.
As the number of older adults in the United States rises, maintaining functional independence among older Americans has emerged as a major clinical and public health priority. Older ...people who lose mobility are less likely to remain in the community; demonstrate higher rates of morbidity, mortality, and hospitalizations; and experience a poorer quality of life. Several studies have shown that regular physical activity improves functional limitations and intermediate functional outcomes, but definitive evidence showing that major mobility disability can be prevented is lacking. A Phase 3 randomized controlled trial is needed to fill this evidence gap.
Methods.
The Lifestyle Interventions and Independence for Elders (LIFE) Study is a Phase 3 multicenter randomized controlled trial designed to compare a supervised moderate-intensity physical activity program with a successful aging health education program in 1,600 sedentary older persons followed for an average of 2.7 years.
Results.
LIFE's primary outcome is major mobility disability, defined as the inability to walk 400 m. Secondary outcomes include cognitive function, serious fall injuries, persistent mobility disability, the combined outcome of major mobility disability or death, disability in activities of daily living, and cost-effectiveness.
Conclusions.
Results of this study are expected to have important public health implications for the large and growing population of older sedentary men and women.
We examined whether physical activity in early adulthood, late midlife, and old age as well as cumulative physical activity history are associated with changes in physical functioning and mortality ...in old age.
Data are from participants aged 65 years or older enrolled in the InCHIANTI study who were followed up from 1998-2000 to 2007-2008 (n = 1,149). At baseline, participants recalled their physical activity levels at ages 20-40, 40-60, and in the previous year, and they were categorized as physically inactive, moderately active, and physically active. Physical performance was assessed with the Short Physical Performance Battery and self-reported mobility disability was evaluated at the 3-, 6- and 9-year follow-up. Mortality follow-up was assessed until the end of 2010.
Physical inactivity at baseline was associated with greater decline in Short Physical Performance Battery score (mean 9-year change: -2.72, 95% CI: -3.08, -2.35 vs -0.98, 95% -1.57, -0.39) and greater rate of incident mobility disability (hazard ratio 4.66, 95% CI 1.14-19.07) and mortality (hazard ratio 2.18, 95% CI 1.01-4.70) compared to physically active participants at baseline. Being physically active throughout adulthood was associated with smaller decline in physical performance as well as with lower risk of incident mobility disability and premature death compared with those who had been less active during their adult life.
Higher cumulative physical activity over the life course was associated with less decline in physical performance and reduced rate of incident mobility disability and mortality in older ages.
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