Aim
World‐wide, approximately 14% of children have prevalent asthma. As most bone accrual occurs in childhood, and data suggest a detrimental role in bone from asthma and/or medications, we ...investigated whether asthma was associated with radiologically confirmed fractures in a large cohort of children.
Methods
Data from the Barwon Asthma Study (2005), a population‐based, cross‐sectional survey of all children attending 91 primary schools in the Barwon Statistical Division, were linked to the Geelong Osteoporosis Study Fracture Grid (2006–2007), a fracture register encompassing the Barwon Statistical Division (n = 16 438; 50.5% boys; aged 3.5–13.6 years). Asthma, ascertained from parent‐reported symptoms using the International Study of Asthma and Allergies in Childhood questionnaire, was categorised as: (i) recent wheeze; and number of (ii) recent wheezy episodes; (iii) doctor visits for wheeze symptoms; and (iv) doctor visits for asthma check‐ups. Using logistic regression analyses, stratified by sex and adjusted for age and medication use, we determined whether asthma was associated with radiologically confirmed fractures.
Results
In total, 961 fractures were observed among 823 Barwon Asthma Study participants (5.9% of total sample; 61.1% boys). Recent wheeze and 1–3 recent wheezy episodes were associated with increased odds of fracture in boys (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.03–1.55; OR 1.40, 95% CI 1.12–1.77, respectively), but not girls (OR 1.03, 95% CI 0.78–1.37; OR 0.67, 95% CI 0.38–1.19). Results were independent of age, and sustained after adjustment for medication.
Conclusions
Independent of age, asthma was associated with fracture for boys, but not girls. There is an imperative for strategies to promote bone health among children with asthma.
Bipolar disorder (BD) is associated with significant psychological and physical comorbidity. Yet little is known about the bone health of individuals with BD. Thus, we aimed to investigate the ...association between BD and bone health in a population-based sample of women.
Women with a history of BD (cases; n = 117) were recruited from public and private health care settings and controls, without BD, were drawn from the Geelong Osteoporosis Study (n = 909). BD was identified using a semi-structured clinical interview (SCID-I/NP). Bone mineral density (BMD) was measured at the spine, femoral neck and total body using dual energy x-ray absorptiometry, and bone quality by quantitative heel ultrasound and included the following parameters: Speed of Sound (SOS), Broadband Ultrasound Attenuation (BUA) and Stiffness Index (SI). Weight and height were measured and information on medication use and lifestyle was obtained.
Adjusted mean BMD among the cases was 4.3% lower at the hip and 1.6% lower at the total body compared to controls. Age was an effect modifier at the spine. Among women <50 years, mean spine BMD for cases was 3.5% lower than controls. No differences in spine BMD for those ≥50 years were detected. Cases also had a 1.0%, 3.2% and 7.8% lower adjusted mean SOS, BUA and SI compared to controls, respectively.
Course, chronicity and recovery of BD were not explored in relation to bone health.
These data suggest BD is associated with low bone quantity and quality in women. Replication and research into underlying mechanisms is warranted.
•Compromised bone health has been associated with several physical and mental health disorders.•BD was associated with reduced bone quantity and quality•Replication and research into underlying mechanisms are warranted.
Previously we have demonstrated an association between maternal serum 25-hydroxyvitamin D (25(OH)D) during pregnancy and knee-heel length in offspring at birth. However, it is unknown whether ...maternal serum 25(OH)D is associated with bone measures in childhood. Thus, we aimed to examine associations between 25(OH)D at two stages of pregnancy and offspring bone measures at 11 years.
Women were recruited from a single antenatal clinic in Victoria, Australia before 16 weeks gestation and provided two serum samples to determine 25(OH)D status at recruitment and 28–32 weeks gestation. Children and their mothers were followed up at 11 years of age. Children undertook dual energy X-ray absorptiometry scans at the lumbar spine and total body.
Maternal 25(OH)D at recruitment (before 16 weeks gestation) was positively associated with the children's bone mineral content and density in boys, but not girls. In boys, a 10 nmol/L (4 ng/mL) increase in maternal 25(OH)D was associated with a median 0.5 g (95% CI 0.1,0.8) and 0.009 g/cm2 (95% CI 0.001,0.017) increase in bone mineral content and density at the spine, respectively, and a median 0.006 g/cm2 (95% CI 0.001,0.011) increase in at the total body. There was no sustained associations with 25(OH)D at the later timepoint (28–32 weeks) with any outcome.
At age 11 years, maternal 25(OH)D levels during early pregnancy, but not late were positively associated with bone measures in boys, but not girls.
•Maternal 25(OH)D in early pregnancy was associated with offspring bone measures at 11 years in a sexually dimorphic manner•Maternal 25(OH)D in early pregnancy was positively associated with bone density and content in boys, but not girls.•There were no clear maternal 25(OH)D cutpoints, though there appeared to be greater effect in those with 25(OH)D <28nmol/L
Objectives
To examine associations of education and occupation with handgrip strength (HGS), lower limb strength (LLS) and appendicular lean mass (ALM).
Methods
Measures of HGS, LLS and ALM ...(dual‐energy X‐ray absorptiometry) were ascertained at baseline in 1090 adults (50‐80 years, 51% women), ~3 and 5 years. Education and occupation were self‐reported, the latter categorised as high‐skilled white collar (HSWC), low‐skilled white collar (LSWC) or blue collar. Separate general estimating equations were performed.
Results
The highest education group had greater HGS than the middle (0.33 psi) and lowest (0.48 psi) education groups, and 0.34 kg greater ALM than the lowest education group. HGS was 0.46 psi greater for HSWC than LSWC groups. Compared to LSWC groups, LLS was 5.38 and 7.08 kg greater in HSWC and blue‐collar groups. Blue‐collar and HSWC groups each had ~ 0.60‐0.80kg greater ALM than LSWC.
Conclusion
Progressive muscle loss can be prevented by targeted intervention; thus, we suggest clinical attention be directed towards specific social groups.
We aimed to examine dietary patterns and their longitudinal associations with socio-demographic and lifestyle factors in older adults.
A cohort of 1098 participants aged 50-80 years were followed for ...5 years. Dietary intake was assessed at baseline, 2.6 and 5 years using a validated food frequency questionnaire. Dietary patterns were identified at baseline using exploratory factor analysis and pattern scores for each calculated using the weighted sum score method. Associations of dietary pattern scores with participants' characteristics were assessed using linear mixed-effects models.
The three dietary patterns identified and the food groups of which they were predominantly composed were as follows: a healthy dietary pattern (vegetables, fruits, nuts, and whole grains); a western dietary pattern (pizza, hamburgers, chips, and potatoes); and a meat and vegetable dietary pattern (red meat, fish, poultry, vegetables, potatoes, and legumes). Being a man, unemployed, a current smoker, less educated, and residing in a socially disadvantaged area were associated with lower healthy dietary pattern scores, but these differences lessened over time, except in current smokers (p < 0.03 for interactions with time). Being a man was associated with higher, but being a current smoker with lower western dietary pattern scores (β = 8.0, 95% CI: 5.3,10.7 and - 6.7: - 10.1,- 3.3, respectively). For the meat and vegetable dietary pattern, being a man and a current smoker were associated with lower scores (β = - 24.9, 95% CI: - 44.9,- 4.9 and - 66.8: - 98.3,- 35.3, respectively), while being unemployed was associated with higher scores but this difference lessened over time (p = 0.018 for interaction with time).
In older adults, men, smokers, and those experiencing social disadvantage could be target groups for interventions to improve diets.
•Personality disorder (PD) frequently co-occurs with mood disorders.•A systematic review and meta-analysis was undertaken to examine the role of PD in randomised controlled trials (RCTs) of ...pharmacological interventions for mood disorders.•PD does not appear to clearly affect pharmacological treatment or remission outcomes of co-occurring mood disorders.•There is a lack of studies on bipolar disorder which examine the role of PD in relation to treatment outcomes.
Personality disorder (PD) may affect the efficacy of pharmacological interventions for mood disorders, but the extent to which this occurs is uncertain. We aimed to examine the available published evidence concerning the role of PD in pharmacological treatment outcomes of randomised controlled trials (RCTs) for adults with mood disorders (i.e. depressive and bipolar spectrum disorders).
A systematic search of Cochrane Central Register of Controlled Clinical Trials, PubMed, EMBASE, PsycINFO, CINAHL Complete, and Google Scholar databases was undertaken to identify studies of interest. Data were independently extracted by two reviewers. The Cochrane Risk of Bias tool was used to assess methodological quality and risk of bias. A random effects model was utilised and statistical heterogeneity was assessed using the I2 statistic. This systematic review was registered with PROSPERO (CRD42018089279) and the protocol is published.
The search yielded 11,640 studies. Subsequent to removing duplicates, 9657 studies were screened at title and abstract stage and 1456 were assessed at full-text stage. Eighteen studies met criteria for inclusion in this review. Meta-analysis did not reveal a significant difference between groups for treatment outcome (standardised mean difference 0.22 -0.09, 0.54; I2: 69%, p=0.17) and remission (risk ratio 0.84 0.64, 1.11; I2: 51%, p=0.22).
This review was limited by lack of studies on bipolar disorder.
PD comorbidity does not appear to affect treatment efficacy of pharmacological interventions for adults with mood disorders.
Cancer is a leading burden of disease in Australia and worldwide, with incidence rates varying with age, sex and geographic location. As part of the Ageing, Chronic Disease and Injury study, we aimed ...to map the incidence rates of primary cancer diagnoses across western Victoria and investigate the association of age, accessibility/remoteness index of Australia (ARIA) and area-level socioeconomic status (SES) with cancer incidence.
Data on cancer incidence in the study region were extracted from the Victorian Cancer Registry (VCR) for men and women aged 40+ years during 2010-2013, inclusive. The age-adjusted incidence rates (per 10,000 population/year), as well as specific incidence for breast, prostate, lung, bowel and melanoma cancers, were calculated for the entire region and for the 21 Local Government Areas (LGA) that make up the whole region. The association of aggregated age, ARIA and SES with cancer incidence rates across LGAs was determined using Poisson regression.
Overall, 15,120 cancer cases were identified; 8218 (54%) men and 6902 women. For men, the age-standardised rate of cancer incidence for the whole region was 182.1 per 10,000 population/year (95% CI 177.7-186.5) and for women, 162.2 (95% CI: 157.9-166.5). The incidence of cancer (overall) increased with increasing age for men and women. Geographical variations in cancer incidence were also observed across the LGAs, with differences identified between men and women. Residents of socioeconomically disadvantaged and less accessible areas had higher cancer incidence (p < 0.001).
Cancer incidence rates varied by age, sex, across LGAs and with ARIA. These findings not only provide an evidence base for identifying gaps and assessing the need for services and resource allocation across this region, but also informs policy and assists health service planning and implementation of preventative intervention strategies to reduce the incidence of cancer across western Victoria. This study also provides a model for further research across other geographical locations with policy and clinical practice implications, both nationally and internationally.
Personality disorder (PD), outcomes of diverse comorbid physical health conditions, and the associated burden on health service resources have seldom been studied at a population level. Consequently, ...there is limited evidence that might inform a public health approach to managing PD and associated mental and physical disability. A review was conducted of population-based studies examining the prevalence of PD and associations between physical comorbidities and service utilization. The prevalence of any PDs were common (4.4% −21.5%) among populations spanning England, Wales, Scotland, Western Europe, Norway, Australia, and the United States. Preliminary evidence supports associations between PDs from Clusters A and B and physical comorbidities, namely cardiovascular diseases and arthritis. PD appears to increase health care utilization, particularly in primary care. In order to facilitate rational population health planning, further population studies are required.
Critical illness may be associated with increased bone turnover and loss of bone mineral density (BMD). Prospective evidence describing long-term changes in BMD after critical illness is needed to ...further define this relationship.
To measure the change in BMD and bone turnover markers (BTMs) in subjects 1 year after critical illness compared with population-based control subjects.
We studied adult patients admitted to a tertiary intensive care unit (ICU) who required mechanical ventilation for at least 24 hours. We measured clinical characteristics, BTMs, and BMD during admission and 1 year after ICU discharge. We compared change in BMD to age- and sex-matched control subjects from the Geelong Osteoporosis Study.
Sixty-six patients completed BMD testing. BMD decreased significantly in the year after critical illness at both femoral neck and anterior-posterior spine sites. The annual decrease was significantly greater in the ICU cohort compared with matched control subjects (anterior-posterior spine, -1.59%; 95% confidence interval, -2.18 to -1.01; P < 0.001; femoral neck, -1.20%; 95% confidence interval, -1.69 to -0.70; P < 0.001). There was a significant increase in 10-year fracture risk for major fractures (4.85 ± 5.25 vs. 5.50 ± 5.52; P < 0.001) and hip fractures (1.57 ± 2.40 vs. 1.79 ± 2.69; P = 0.001). The pattern of bone resorption markers was consistent with accelerated bone turnover.
Critically ill individuals experience a significantly greater decrease in BMD in the year after admission compared with population-based control subjects. Their bone turnover biomarker pattern is consistent with an increased rate of bone loss.
Identification of sarcopenia in lower- and middle-income countries (LMICs) is limited by access to technologies that assess muscle mass. We investigated associations between two functional measures ...of sarcopenia, grip strength and gait speed (GS), with functional disability in adults from six LMICs. Data were extracted from the World Health Organization (WHO) Study on global AGEing and adult health Wave 1 (2007–2010) for adults (≥ 65 years) from China, Mexico, Ghana, India, Russia and South Africa (
n
= 10,892, 52.8% women). We calculated country-specific prevalence of low grip strength, slow GS (≤ 0.8 m/s), and both measures combined. Using multivariable negative binomial regression, we separately assessed associations between low grip strength, slow GS, and both measures combined, with the WHO Disability Assessment Schedule 2.0, accounting for selected socioeconomic factors. In women, low grip strength ranged from 7 in South Africa to 51% in India; in men, it ranged from 17 in Russia to 51% in Mexico. Country-specific proportions of slow GS ranged from 77 in Russia, to 33% in China. The concomitant presence of both was the lowest in South Africa and the highest in India (12.3% vs. 33%). Independent of age, those with both low grip strength and slow GS had between 1.2- and 1.5-fold worse functional disability scores, independent of comorbidities, low education, and low wealth (all country-dependent). Low grip strength, slow GS, and the combination of both, were all associated with higher levels of functional disability, thus indicating these objective measures offer a reasonably robust estimate for potential poor health outcomes.
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