The apolipoprotein E ε4 (APOE ε4) allele is a genetic risk factor for Alzheimer disease. Recently... more The apolipoprotein E ε4 (APOE ε4) allele is a genetic risk factor for Alzheimer disease. Recently, depression has also become recognized as a risk factor for dementia. However, the possible effect of the APOE genotype on the association between depression and dementia is unexamined.
Background: Previous research in AD has focused only on individual dietary components. Composite ... more Background: Previous research in AD has focused only on individual dietary components. Composite dietary patterns may better capture dietary habits since they can integrate possible interactive effects of individual components. The MeDi is such a composite pattern that has been related to lower risk for cardiovascular disease, several forms of cancer and overall mortality. Objectives: To investigate the association between MeDi and AD risk. Methods: A community cohort of elderly in New York were evaluated with the same standardized neurological and neuropsychological measures every ϳ1.5 years: 226 subjects were diagnosed with AD at first evaluation (prevalent), 262 developed AD during 4 (Ϯ 3.0; 0.8 -13.9) years of follow-up (incident) and 1794 subjects never became demented. MeDi, measured by a 0-9 point scale with higher score indicating higher adherence, was the main predictor in logistic regression and Cox models. All models were adjusted for cohort (year 1992 vs. 1999), age, gender, ethnicity, education, APOE genotype, caloric intake and body mass index. Results: In GEE analyses performed in a subset of 390 subjects with repeated dietary assessments, adherence to MeDi was stable over time. Non-demented subjects had significantly higher adherence to the MeDi (4.40 Ϯ 1.7), as compared to AD subjects (4.05, Ϯ 1.7; p Ͻ 0.001). In cross-sectional analyses, as compared to subjects in the lower MeDi adherence tertile, subjects in the middle tertile had a lower risk of prevalent AD (OR; 0.51 [0.33-0.80]; p ϭ 0.003), while subjects at the highest tertile had an even lower risk (0.32 [0.18-0.56]; p Ͻ 0.001). In longitudinal analyses, as compared to subjects in the lowest MeDi tertile, subjects in the middle tertile had an HR for incident AD of 0.85 (0.63-1.16) and those at the highest tertile an HR of 0.60 (0.42-0.87; p for trend 0.007). Conclusions: Higher adherence to MeDi is associated with a significant reduction in AD risk. The association is not an artifact of changing dietary habits after AD clinical onset. It may be the result of the composite-interactive effect of the MeDi's individual components and it may occur via oxidative stress, inflammation, and / or vascular mechanisms.
Alzheimer disease (AD), few data are available on the relation between plasma cholesterol levels ... more Alzheimer disease (AD), few data are available on the relation between plasma cholesterol levels and diminished cognitive function in non-demented women. In particular, subtle decrements in cognitive function strongly predict eventual development of AD, thus better understanding early risk factors for poor cognition may be important to effective AD prevention.
We investigated the association between MRI detected brain lesions and levels of endogenous sex h... more We investigated the association between MRI detected brain lesions and levels of endogenous sex hormones in Japanese-American men aged 74-95 years.
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008
Background. Although evidence is accumulating for a protective effect of late life physical activ... more Background. Although evidence is accumulating for a protective effect of late life physical activity on the risk of dementia, the findings are inconsistent, especially in men. We examined the association of late life physical activity and the modifying effect of physical function with future risk of dementia in a well-characterized cohort of elderly men participating in the Honolulu-Asia Aging Study (HAAS).
Epidural hematoma (EDH) is a major traumatic brain injury and a potentially life-threatening cond... more Epidural hematoma (EDH) is a major traumatic brain injury and a potentially life-threatening condition, with the mortality rate in the young age group varying across studies. The aim of this analysis was to investigate the magnitude of traumatic EDH in young patients aged 0 year to 24 years in Queensland, Australia. Study patients presented to the emergency department of 14 public hospitals participating in the Queensland Trauma Registry during 2005 to 2007 and were diagnosed and admitted for treatment of EDH. Age group comparisons were performed for demographic, injury, treatment, operation details, and outcome-related variables. We identified 224 young patients with traumatic EDH. The most frequent cause of injury was a fall in the 0 year to 9 years age groups and road traffic crash in those aged 10 years to 24 years. Almost 81% of the EDH cases were due to accidental injury, 17% due to assault, with the remainder due to self-harm and undetermined intent. Skull fracture was present in 75% of the study patients. Neurosurgical operations were performed on 40%. The overall Injury Severity Score adjusted in-hospital mortality rate was 4.8%. The odds of in-hospital mortality was 2.5 (95% confidence interval, 0.8-8.2) compared with older patients (25-64 years). The results indicate that the Injury Severity Score adjusted in-hospital mortality rates for young patients with EDH were 4.8%. Given the limited information on morbidity resulting from EDH, further analysis to examine modifiable factors for better management and to evaluate survivor's long-term health outcomes via a longitudinal follow-up study is warranted.
There are few published data for the magnitude of injury-related health problems in indigenous pe... more There are few published data for the magnitude of injury-related health problems in indigenous people such as Aboriginal and Torres Strait Islanders. The objective of our study was to compare the characteristics and outcomes of injury in the indigenous population to the non-indigenous population, who are living in Queensland, Australia. Participants were injured patients who presented to the emergency department for treatment and admitted to 15 public hospitals participating in the Queensland Trauma Registry (QTR) during 2003-2005. Amongst 38,036 injured patients, 1847 patients were identified as indigenous and 35,530 as non-indigenous. Compared to the non-indigenous group, the indigenous group was significantly younger with no difference by gender. The injury severity score (ISS) and percentage of major injury (ISS > or = 16) were lower in the indigenous group. Indigenous patients had a significantly higher percentage of penetrating type injuries compared to non-indigenous (19.5% vs. 12.5%). The age- and injury severity-adjusted mortality rate was also significantly higher in indigenous. In age-stratified logistic regression analysis, the injury severity-adjusted odds for mortality was 3.0 times higher [95% confidence interval (95% CI): 1.6-5.5] in the indigenous, compared to the non-indigenous group, in 40-64-year olds, whilst increased odds in other age groups were not statistically significant. Our results indicate that middle-aged indigenous patients are more likely to die due to injury compared to non-indigenous patients. This suggests that strategies are required to improve outcomes particularly in the most affected injury patient group.
Background Assault-related injury is a devastating consequence of violence and is a prominent cau... more Background Assault-related injury is a devastating consequence of violence and is a prominent cause of morbidity and mortality in young age. However, reliable data sources are scarce and there has been a paucity of studies examining possible predisposing factors on the incidence of assault-related injury. Aims To examine the effect of gender, indigenous status and remoteness to health services on sustaining assault-related injuries in patients aged 17 years and under in Queensland, Australia. Methods Logistic regression analyses were conducted using data from the state-wide trauma registry from 2005 to 2008. Results 282 assault-related injury cases were identified. Indigenous females were at the highest risk of sustaining assault-related injuries (OR: 15.3, 95% CI 8.17 to 28.6), followed by Indigenous males (OR: 6.55, 95% CI 3.60 to 11.9) and non-indigenous males (OR: 2.82, 95% CI 1.78 to 4.47). Adolescent males aged between 13-17 years were at a significantly higher risk than adolescent females of assault-related injury (OR: 2.11, 95% CI 1.34 to 3.31). For nonindigenous people, living in a regional area was associated with a lower risk of assault-related injury compared to major cities (OR: 0.59, 95% CI 0.44 to 0.78). Indigenous people were at higher risk of sustaining an assault-related injury than non-indigenous people in regional areas (OR: 4.8, 95% CI 3.14 to 7.42) and in remote areas (OR: 10.1, 95% CI 2.64 to 38.69). Contribution to the Field The current study provides evidence of interaction effects among the predisposing factors of interest and the likelihood of sustaining assault-related injury. Identifying these interactions is important for the development of effective preventive measures and trauma management plans focusing on high-risk groups who are most likely to sustain assault-related injuries in young age.
Background: Diabetes and the apolipoprotein E ε4 allele (APOE ε4) increase the risk for Alzheimer... more Background: Diabetes and the apolipoprotein E ε4 allele (APOE ε4) increase the risk for Alzheimer disease (AD). We hypothesize that APOE ε4 may modify the risk for AD in individuals with diabetes.
The apolipoprotein E ε4 (APOE ε4) allele is a genetic risk factor for Alzheimer disease. Recently... more The apolipoprotein E ε4 (APOE ε4) allele is a genetic risk factor for Alzheimer disease. Recently, depression has also become recognized as a risk factor for dementia. However, the possible effect of the APOE genotype on the association between depression and dementia is unexamined.
There are few published data for the magnitude of injury-related health problems in indigenous pe... more There are few published data for the magnitude of injury-related health problems in indigenous people such as Aboriginal and Torres Strait Islanders. The objective of our study was to compare the characteristics and outcomes of injury in the indigenous population to the non-indigenous population, who are living in Queensland, Australia. Participants were injured patients who presented to the emergency department for treatment and admitted to 15 public hospitals participating in the Queensland Trauma Registry (QTR) during 2003-2005. Amongst 38,036 injured patients, 1847 patients were identified as indigenous and 35,530 as non-indigenous. Compared to the non-indigenous group, the indigenous group was significantly younger with no difference by gender. The injury severity score (ISS) and percentage of major injury (ISS > or = 16) were lower in the indigenous group. Indigenous patients had a significantly higher percentage of penetrating type injuries compared to non-indigenous (19.5% vs. 12.5%). The age- and injury severity-adjusted mortality rate was also significantly higher in indigenous. In age-stratified logistic regression analysis, the injury severity-adjusted odds for mortality was 3.0 times higher [95% confidence interval (95% CI): 1.6-5.5] in the indigenous, compared to the non-indigenous group, in 40-64-year olds, whilst increased odds in other age groups were not statistically significant. Our results indicate that middle-aged indigenous patients are more likely to die due to injury compared to non-indigenous patients. This suggests that strategies are required to improve outcomes particularly in the most affected injury patient group.
The apolipoprotein E ε4 (APOE ε4) allele is a genetic risk factor for Alzheimer disease. Recently... more The apolipoprotein E ε4 (APOE ε4) allele is a genetic risk factor for Alzheimer disease. Recently, depression has also become recognized as a risk factor for dementia. However, the possible effect of the APOE genotype on the association between depression and dementia is unexamined.
Background: Previous research in AD has focused only on individual dietary components. Composite ... more Background: Previous research in AD has focused only on individual dietary components. Composite dietary patterns may better capture dietary habits since they can integrate possible interactive effects of individual components. The MeDi is such a composite pattern that has been related to lower risk for cardiovascular disease, several forms of cancer and overall mortality. Objectives: To investigate the association between MeDi and AD risk. Methods: A community cohort of elderly in New York were evaluated with the same standardized neurological and neuropsychological measures every ϳ1.5 years: 226 subjects were diagnosed with AD at first evaluation (prevalent), 262 developed AD during 4 (Ϯ 3.0; 0.8 -13.9) years of follow-up (incident) and 1794 subjects never became demented. MeDi, measured by a 0-9 point scale with higher score indicating higher adherence, was the main predictor in logistic regression and Cox models. All models were adjusted for cohort (year 1992 vs. 1999), age, gender, ethnicity, education, APOE genotype, caloric intake and body mass index. Results: In GEE analyses performed in a subset of 390 subjects with repeated dietary assessments, adherence to MeDi was stable over time. Non-demented subjects had significantly higher adherence to the MeDi (4.40 Ϯ 1.7), as compared to AD subjects (4.05, Ϯ 1.7; p Ͻ 0.001). In cross-sectional analyses, as compared to subjects in the lower MeDi adherence tertile, subjects in the middle tertile had a lower risk of prevalent AD (OR; 0.51 [0.33-0.80]; p ϭ 0.003), while subjects at the highest tertile had an even lower risk (0.32 [0.18-0.56]; p Ͻ 0.001). In longitudinal analyses, as compared to subjects in the lowest MeDi tertile, subjects in the middle tertile had an HR for incident AD of 0.85 (0.63-1.16) and those at the highest tertile an HR of 0.60 (0.42-0.87; p for trend 0.007). Conclusions: Higher adherence to MeDi is associated with a significant reduction in AD risk. The association is not an artifact of changing dietary habits after AD clinical onset. It may be the result of the composite-interactive effect of the MeDi's individual components and it may occur via oxidative stress, inflammation, and / or vascular mechanisms.
Alzheimer disease (AD), few data are available on the relation between plasma cholesterol levels ... more Alzheimer disease (AD), few data are available on the relation between plasma cholesterol levels and diminished cognitive function in non-demented women. In particular, subtle decrements in cognitive function strongly predict eventual development of AD, thus better understanding early risk factors for poor cognition may be important to effective AD prevention.
We investigated the association between MRI detected brain lesions and levels of endogenous sex h... more We investigated the association between MRI detected brain lesions and levels of endogenous sex hormones in Japanese-American men aged 74-95 years.
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2008
Background. Although evidence is accumulating for a protective effect of late life physical activ... more Background. Although evidence is accumulating for a protective effect of late life physical activity on the risk of dementia, the findings are inconsistent, especially in men. We examined the association of late life physical activity and the modifying effect of physical function with future risk of dementia in a well-characterized cohort of elderly men participating in the Honolulu-Asia Aging Study (HAAS).
Epidural hematoma (EDH) is a major traumatic brain injury and a potentially life-threatening cond... more Epidural hematoma (EDH) is a major traumatic brain injury and a potentially life-threatening condition, with the mortality rate in the young age group varying across studies. The aim of this analysis was to investigate the magnitude of traumatic EDH in young patients aged 0 year to 24 years in Queensland, Australia. Study patients presented to the emergency department of 14 public hospitals participating in the Queensland Trauma Registry during 2005 to 2007 and were diagnosed and admitted for treatment of EDH. Age group comparisons were performed for demographic, injury, treatment, operation details, and outcome-related variables. We identified 224 young patients with traumatic EDH. The most frequent cause of injury was a fall in the 0 year to 9 years age groups and road traffic crash in those aged 10 years to 24 years. Almost 81% of the EDH cases were due to accidental injury, 17% due to assault, with the remainder due to self-harm and undetermined intent. Skull fracture was present in 75% of the study patients. Neurosurgical operations were performed on 40%. The overall Injury Severity Score adjusted in-hospital mortality rate was 4.8%. The odds of in-hospital mortality was 2.5 (95% confidence interval, 0.8-8.2) compared with older patients (25-64 years). The results indicate that the Injury Severity Score adjusted in-hospital mortality rates for young patients with EDH were 4.8%. Given the limited information on morbidity resulting from EDH, further analysis to examine modifiable factors for better management and to evaluate survivor's long-term health outcomes via a longitudinal follow-up study is warranted.
There are few published data for the magnitude of injury-related health problems in indigenous pe... more There are few published data for the magnitude of injury-related health problems in indigenous people such as Aboriginal and Torres Strait Islanders. The objective of our study was to compare the characteristics and outcomes of injury in the indigenous population to the non-indigenous population, who are living in Queensland, Australia. Participants were injured patients who presented to the emergency department for treatment and admitted to 15 public hospitals participating in the Queensland Trauma Registry (QTR) during 2003-2005. Amongst 38,036 injured patients, 1847 patients were identified as indigenous and 35,530 as non-indigenous. Compared to the non-indigenous group, the indigenous group was significantly younger with no difference by gender. The injury severity score (ISS) and percentage of major injury (ISS > or = 16) were lower in the indigenous group. Indigenous patients had a significantly higher percentage of penetrating type injuries compared to non-indigenous (19.5% vs. 12.5%). The age- and injury severity-adjusted mortality rate was also significantly higher in indigenous. In age-stratified logistic regression analysis, the injury severity-adjusted odds for mortality was 3.0 times higher [95% confidence interval (95% CI): 1.6-5.5] in the indigenous, compared to the non-indigenous group, in 40-64-year olds, whilst increased odds in other age groups were not statistically significant. Our results indicate that middle-aged indigenous patients are more likely to die due to injury compared to non-indigenous patients. This suggests that strategies are required to improve outcomes particularly in the most affected injury patient group.
Background Assault-related injury is a devastating consequence of violence and is a prominent cau... more Background Assault-related injury is a devastating consequence of violence and is a prominent cause of morbidity and mortality in young age. However, reliable data sources are scarce and there has been a paucity of studies examining possible predisposing factors on the incidence of assault-related injury. Aims To examine the effect of gender, indigenous status and remoteness to health services on sustaining assault-related injuries in patients aged 17 years and under in Queensland, Australia. Methods Logistic regression analyses were conducted using data from the state-wide trauma registry from 2005 to 2008. Results 282 assault-related injury cases were identified. Indigenous females were at the highest risk of sustaining assault-related injuries (OR: 15.3, 95% CI 8.17 to 28.6), followed by Indigenous males (OR: 6.55, 95% CI 3.60 to 11.9) and non-indigenous males (OR: 2.82, 95% CI 1.78 to 4.47). Adolescent males aged between 13-17 years were at a significantly higher risk than adolescent females of assault-related injury (OR: 2.11, 95% CI 1.34 to 3.31). For nonindigenous people, living in a regional area was associated with a lower risk of assault-related injury compared to major cities (OR: 0.59, 95% CI 0.44 to 0.78). Indigenous people were at higher risk of sustaining an assault-related injury than non-indigenous people in regional areas (OR: 4.8, 95% CI 3.14 to 7.42) and in remote areas (OR: 10.1, 95% CI 2.64 to 38.69). Contribution to the Field The current study provides evidence of interaction effects among the predisposing factors of interest and the likelihood of sustaining assault-related injury. Identifying these interactions is important for the development of effective preventive measures and trauma management plans focusing on high-risk groups who are most likely to sustain assault-related injuries in young age.
Background: Diabetes and the apolipoprotein E ε4 allele (APOE ε4) increase the risk for Alzheimer... more Background: Diabetes and the apolipoprotein E ε4 allele (APOE ε4) increase the risk for Alzheimer disease (AD). We hypothesize that APOE ε4 may modify the risk for AD in individuals with diabetes.
The apolipoprotein E ε4 (APOE ε4) allele is a genetic risk factor for Alzheimer disease. Recently... more The apolipoprotein E ε4 (APOE ε4) allele is a genetic risk factor for Alzheimer disease. Recently, depression has also become recognized as a risk factor for dementia. However, the possible effect of the APOE genotype on the association between depression and dementia is unexamined.
There are few published data for the magnitude of injury-related health problems in indigenous pe... more There are few published data for the magnitude of injury-related health problems in indigenous people such as Aboriginal and Torres Strait Islanders. The objective of our study was to compare the characteristics and outcomes of injury in the indigenous population to the non-indigenous population, who are living in Queensland, Australia. Participants were injured patients who presented to the emergency department for treatment and admitted to 15 public hospitals participating in the Queensland Trauma Registry (QTR) during 2003-2005. Amongst 38,036 injured patients, 1847 patients were identified as indigenous and 35,530 as non-indigenous. Compared to the non-indigenous group, the indigenous group was significantly younger with no difference by gender. The injury severity score (ISS) and percentage of major injury (ISS > or = 16) were lower in the indigenous group. Indigenous patients had a significantly higher percentage of penetrating type injuries compared to non-indigenous (19.5% vs. 12.5%). The age- and injury severity-adjusted mortality rate was also significantly higher in indigenous. In age-stratified logistic regression analysis, the injury severity-adjusted odds for mortality was 3.0 times higher [95% confidence interval (95% CI): 1.6-5.5] in the indigenous, compared to the non-indigenous group, in 40-64-year olds, whilst increased odds in other age groups were not statistically significant. Our results indicate that middle-aged indigenous patients are more likely to die due to injury compared to non-indigenous patients. This suggests that strategies are required to improve outcomes particularly in the most affected injury patient group.
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