Search

Social determinants of health (SDoH) are environmental conditions that influence health outcomes. As olfactory dysfunction (OD) in older individuals is associated with increased morbidity and mortality, we sought to investigate the impact of specific SDoH on olfactory function.A cross-sectional analysis of the Health, Aging and Body Composition Study, a US population-based epidemiologic cohort study, was performed. Olfactory function was assessed utilizing both a self-report and a psychophysical olfactory test (CC-SIT test). Multivariable logistic regressions were performed to examine associations between specific SDoH with self-reported anosmia (sOD) and objective anosmia (oOD) as assessed by psychophysical testing. Differences in sensitivity and specificity were evaluated with sample tests for equality of proportions.Of 2219 participants, 13% had oOD and 18% had objective hyposmia; only 10% had sOD. Individuals identifying as Black race had higher odds of oOD (odds ratio [OR]:1.41, 95% confidence interval [CI]:1.02-1.95), while females and those reporting family incomes ≥$50,000 had lower odds of oOD (OR: 0.46, CI:0.34-0.62; OR:0.52, CI:0.29-0.93), adjusting for covariates. No specific SDoH was significantly associated with sOD. The sensitivity and specificity of sOD for oOD was 23.1% and 92.0%, respectively. sOD had greater sensitivity in females than males (30.8% vs. 18.8%, p = 0.030), while specificity varied significantly depending on family income (range: 90.0%-94.8%, p = 0.033).Utilizing a large population-based study, we find disparities in the prevalence and self-recognition of OD among individuals of different gender, race, and income levels. Further effort is needed to evaluate factors propagating these disparities and to raise awareness of OD across all patient populations.

Preventive behaviors have played an essential role in coping with COVID-19 and may continue to exerting a crucial impact on pandemic control in the future. This study aimed to evaluate the effectiveness of social-cognitive factors on maintenance of COVID-19 preventive behaviors based on a dual-process model, which encompasses a reasoned path via the intention to maintain and a social reaction path via the willingness to stop. We collected a probability sample of 472 community-dwelling adults. Social-cognitive factors, behavioral tendencies, and preventive behaviors of COVID-19 were measured. The results supported that the dual-process framework could account for individual differences in preventive behaviors. Self-efficacy and response cost significantly explained the intention to maintain preventive behaviors, while favorability of risk image and subjective norm significantly explained the willingness to stop preventive behaviors. Our findings proposed strategies for promoting individuals' maintenance of preventive behaviors during a pandemic. The development of prevention policies may focus on two paths: strengthening the intended path by enhancing self-efficacy and decreasing response cost of preventive behaviors and monitoring and improving social influences, such as risk prototype and subjective norm, which can reduce the willingness to stop preventive behaviors.

Studies investigating the associations between genetic or environmental factors and Parkinson's disease (PD) have uncovered a number of factors shared with cardiovascular disease, either as risk factors or manifestations of cardiovascular disease itself. Older age, male sex, and possibly type 2 diabetes are examples. On the other hand, coffee consumption and physical activity are each associated with a lower risk of both PD and cardiovascular disease. This observation raises questions about the underlying pathophysiological links between cardiovascular disease and PD. There is evidence for common mechanisms in the areas of glucose metabolism, cellular stress, lipid metabolism, and inflammation. On the other hand, smoking and total/low-density lipoprotein cholesterol appear to have opposite associations with cardiovascular disease and PD. Thus, it is uncertain whether the treatment of cardiovascular risk factors will impact on the onset or progression of PD. The available data suggest that a nuanced approach is necessary to manage risk factors such as cholesterol levels once the associations are better understood. Ultimately, the choice of therapy may be tailored to a patient's comorbidity profile. This review presents the epidemiological evidence for both concordant and discordant associations between cardiovascular disease and PD, discusses the cellular and metabolic processes that may underlie these links, and explores the implications this has for patient care and future research. © 2019 International Parkinson and Movement Disorder Society.

BACKGROUND: Renewable resources have been considered for producing many advanced materials. In this respect, silver‐doped carbon‐based materials with a low loading capacity and high antibacterial activity can also be generated via environmentally friendly routes and from renewable resources. RESULTS: Silver‐doped carbon fibers were prepared from wood and cotton fibers via complexation and reduction reactions for depositing silver on the fibers and subsequently via carbonization of the loaded fibers. Silver loading before carbonization enhanced the stability of silver on the carbonized fibers, decreased silver loss (from 30 to 12%) and lowered the silver loading (5.66%) needed to achieve excellent antibacterial activity. However, wood‐based silver‐doped carbon fibers performed better than cotton‐based carbon fibers with respect to loss of antibacterial activity (12% at a silver loading of 5.66% versus 24% at a silver loading of 7.97% in 800 h respectively). These results are attributed to more uniformity in the distribution of silver nanoparticles in the porous structure of wood fibers than in cotton fibers. CONCLUSION: The wood‐based carbon fibers exhibited better antibacterial activity and stronger affinity for maintaining silver and lower required silver loadings, and the sequence of silver loading and carbonization was crucial in developing silver‐loaded carbon fibers with good antibacterial performance. © 2019 Society of Chemical Industry

Background In the face of the global pandemic of coronavirus disease-2019 (COVID-19), people's adherence to precautionary behavioral measures (e.g. social distancing) largely influences the effectiveness of those measures in containing the spread of the coronavirus. The present study aims at testing the applicability of the health belief model (HBM) and generalised social beliefs (i.e. social axioms) to explore strategies for promoting adherence to COVID-19 precautionary measures. Methods We conducted a telephone survey with a two-step stratified random sampling method and obtained a probability sample of 616 adults in Macao, China (18-87 years old; 60.9% women) in April 2020. Results Our participants showed stronger adherence to some COVID-19 precautionary measures (e.g. face mask wearing; 96.4%) but not others (e.g. social distancing; 42.3%). Their adherence to those measures was found to be significantly associated with four HBM factors and two social axioms, after controlling for gender, age, and years of education. Conclusions The HBM and the generalised social beliefs of social cynicism and reward for application can be applied to understanding adherence to precautionary measures against COVID-19. Strategies based on beliefs were proposed to facilitate the promotion of precautionary measures.

BACKGROUND Circulating cholesterol levels have been linked to PD, but not directly to brain physiology. OBJECTIVE To assess whether brain cholesterol metabolism is related to PD. METHODS Sixty PD patients and 64 controls were recruited from an academic movement disorder clinic (2009-2012). Thirty-five PD patients and 33 controls returned approximately 36 months later. Fasting plasma (S)24-OH-cholesterol (brain-derived cholesterol metabolite) and 27-OH-cholesterol (peripheral cholesterol metabolite) were quantified. Odds ratios for PD were derived from logistic regression models, adjusting for potential confounders. Relationships between the oxysterols and clinical measurements were explored using Spearman correlation coefficients. RESULTS Mean age of PD subjects was 63.8 ± 8.3 years and disease duration was 5.0 ± 5.4 years. Plasma (S)24-OH-cholesterol levels were inversely associated with the odds of having PD, with an odds ratio of 0.92 (95% confidence interval: 0.87-0.97) for each 1-ng/mL increase (P = 0.004). Compared to the lowest tertile, the odds ratio was 0.34 (0.12-0.98) for the second tertile (P = 0.045) and 0.08 (0.02-0.31) for the highest tertile (P < 0.001). Higher (S)24-OH-cholesterol levels also were correlated with better sense of smell (r = 0.35; P = 0.01). No significant associations were found between clinical measures and 27-OH-cholesterol, a peripheral cholesterol metabolite. Furthermore, (S)24-OH-cholesterol levels were stable over time, whereas 27-OH-cholesterol decreased with time in both cases and controls. CONCLUSIONS Results indicate that plasma (S)24-OH-cholesterol (possibly reflecting brain cholesterol metabolism) is inversely linked to PD, is relatively stable over time, and may serve as a new biomarker for PD. Further investigation is necessary to determine the mechanistic and clinical implications. © 2019 International Parkinson and Movement Disorder Society.

Background Accurate prediction of preterm birth (PTB) is still difficult, mostly because of the multifactorial etiology of PTB. Previous studies have been mostly focused on the prediction of PTB in symptomatic women or those presenting with threatened preterm labor. We aimed to study whether complete blood count (CBC) parameters at 20‐30 weeks of pregnancy can predict asymptomatic PTB. Methods In this retrospective case‐control study, the preterm and term delivery groups were matched by propensity score‐matched (PSM) analysis. Baseline data and the CBC parameters examined at 20‐30 weeks of gestation were recorded. Results The combined marker of neutrophil‐to‐lymphocyte ratio (NLR), hemoglobin (HGB), and platelet distribution width (PDW) accurately predicts PTB at a cutoff value of 0.25, with sensitivity and specificity of 88.6% and 40.5% and negative and positive predictive value of 97.9% and 10.2%, respectively. Conclusion The combined marker of CBC parameters can supplement other markers to predict PTB about 10 weeks in advance. This combined marker had a very high negative predictive value for PTB. Therefore, in subjects with normal combined marker value, further screening tests for PTB may be eliminated unless clinical suspicion is high.

AIM Double-balloon enteroscopy (DBE) is a useful tool for the evaluation and treatment of small bowel disease. Limited clinical data are available regarding the indications, clinical findings and safety associated with the use of DBE in children. The aim of this study is to investigate the utility and safety of DBE in children. METHODS A total of 72 DBE procedures were performed on 61 children at the Sixth Affiliated Hospital, Sun Yat-sen University, between 1 April 2013 and 31 December 2017. The clinical data were analysed retrospectively. RESULTS DBE was attempted 72 times in 61 children (45 boys and 16 girls) of an age range between 6 and 14 years (mean age: 11.9 years). The most common indication for DBE was occult gastrointestinal bleeding and abdominal pain. The positive rate of abnormal findings was 77.5% (55/72). Most children showed non-specific enteritis and Crohn's disease. Eight children underwent successful therapeutic enteroscopy. No serious complication was observed in any child in this case series. CONCLUSION DBE can be a useful diagnostic and therapeutic tool for small bowel disorders in children.

Introduction We tested the hypothesis that poor sense of smell is associated with lower cognitive function and higher mild cognitive impairment (MCI) prevalence. Methods Olfaction, measured by the Sniffin' Sticks test, was categorized as olfactory impairment (OI) (score ≤6) or no OI (score >6). MCI was adjudicated based on review of a neuropsychological examination. Linear regression estimated the mean difference in cognitive factor scores, and log-binomial regression quantified MCI prevalence among participants with versus without OI. Results Participants with OI had lower mean factor scores (memory: −0.27 standard deviation [SD], 95% confidence interval [CI]: −0.35 to −0.19; language: −0.24 SD, 95% CI: −0.30 to −0.17; executive function/processing speed: −0.09 SD, 95% CI: −0.12 to −0.06; and general cognitive performance: −0.25 SD, 95% CI: −0.30 to −0.20). OI was also associated with MCI (n = 204; prevalence ratio = 1.56, 95% CI: 1.37, 1.78). Discussion An impaired sense of smell may serve as a readily accessible early marker of neurodegeneration and improve upon the prevailing delayed diagnoses and underascertainment of MCI/dementia.

Objective Using a large U.S. claims database (MarketScan), we investigated the controversy surrounding the role of statins in Parkinson's disease (PD). Methods We performed a retrospective case-control analysis. First, we identified 2322 incident PD cases having a minimum of 2.5 years of continuous enrollment prior to earliest diagnosis code or prescription of antiparkinson medication. A total of 2322 controls were then matched individually by age, gender, and a follow-up window to explore the relationship of statin use with incident PD. Results Statin usage was significantly associated with PD risk, with the strongest associations being for lipophilic (odds ratio = 1.58, P < .0001) versus hydrophilic (odds ratio = 1.19, P = .25) statins, statins plus nonstatins (odds ratio = 1.95, P < .0001), and for the initial period after starting statins (

Recent population studies suggest an intriguing inverse relationship between several types of cancer and neurodegenerative diseases, including Alzheimer's disease. Understanding the intersection of the underlying biology for these two distinct families of diseases with one another may offer novel approaches to identify new therapeutic approaches and possible opportunities to repurpose existing drug candidates. The Alzheimer's Association and the Alzheimer's Drug Discovery Foundation convened a one-day workshop to delve into this discussion. Workshop participants outlined research focus areas, potential collaborations, and partnerships for future action.

Background Low vitamin D levels are common among patients with Parkinson's disease (PD). Experimental evidence further suggests that vitamin D may be protective against PD. The objective of this study was to prospectively assess the association between serum 25-hydroxyvitamin D and PD among 12,762 participants of the Atherosclerosis Risk in Communities Study cohort. Methods Serum samples were collected in 1990-1992, and 25-hydroxyvitamin D was measured by liquid chromatography mass spectrometry. A total of 67 incident PD cases were identified through December 31, 2008. The median length of follow-up was 17 years. We used Cox proportional hazards models to obtain hazard ratios and 95% confidence intervals, adjusting for age, sex, and race. We did not find any association between serum 25-hydroxyvitamin D concentrations and PD risk, regardless of how serum 25-hydroxyvitamin D was modeled. Compared with participants with serum 25-hydroxyvitamin D < 20 ng/mL, the hazards ratio for PD was 1.05 (95% confidence interval, 0.58-1.90) for 20-30 ng/mL and 1.14 (95% confidence interval, 0.59- 2.23) for ≥30 ng/mL. Similar results were obtained in sensitivity analyses that included white participants only and that were stratified by the length of follow-up. Conclusion This prospective study lends no support to the hypothesis that vitamin D may reduce the risk of PD. © 2016 International Parkinson and Movement Disorder Society

Solar energy is an abundant clean and renewable energy source that has found wide uses in many energy‐intensive applications. It is normally transformed into other forms for certain applications, and light‐to‐heat conversion is one of the most common and efficient ways to utilize solar power. Previous reviews mostly focus on the solar‐driven evaporation for desalination, but few mention other applications in which the photothermal materials play a vital role. Herein, a Review regarding the sustainable uses of photothermal devices beyond desalination is presented. The recent developments of photothermal materials and progress on their applications in wastewater treatment, oil‐spill cleanup, moisture capture, energy harvesting during evaporation, sterilization, deicing, etc. are summarized. Herein, the working principles as well as property requirements in these applications are discussed and also the challenges with opportunities in future research are presented.

Previous findings on the association of statins, plasma lipids, and Parkinson's disease (PD) are confounded by the fact that statins also affect lipid profiles. We prospectively examined plasma lipids and statin use in relation to PD in the Atherosclerosis Risk in Communities (ARIC) Study. Statin use and plasma lipids were assessed at baseline (visit 1, 1987-89) and at three triennial visits thereafter (visits 2-4) until 1998. Potential PD cases were identified from multiple sources and validated where possible. The primary analysis was limited to incident PD cases diagnosed between 1998 and 2008. Odds ratios and 95% confidence intervals were derived from multivariate logistic regression models. Statin use was rare at baseline (0.57%) but increased to 11.2% at visit 4. During this time frame, total-cholesterol levels decreased, particularly among statin users. Fifty-six PD cases were identified after 1998. Statin use before 1998 was associated with significantly higher PD risk after 1998 (odds ratio = 2.39, 95% confidence interval 1.11-5.13) after adjusting for total cholesterol and other confounders. Conversely, higher total cholesterol was associated with lower risk for PD after adjustment for statin usage and confounders. Compared with the lowest tertile of average total cholesterol, the odds ratios for PD were 0.56 (0.30-1.04) for the second and 0.43 (0.22-0.87) for the third tertile (Ptrend = 0.02). Statin use may be associated with a higher PD risk, whereas higher total cholesterol may be associated with lower risk. These data are inconsistent with the hypothesis that statins are protective against PD. © 2015 International Parkinson and Movement Disorder Society

Previous epidemiological studies have generated inconsistent results regarding the associations between dietary fat intakes and risk for Parkinson's disease (PD). We therefore prospectively examined these associations in the National Institutes of Health–American Association of Retired Persons (NIH-AARP) Diet and Health Study. A 124-item food frequency questionnaire was administered at baseline in1995 to 1996, and PD diagnosis was self-reported at the follow-up survey in 2004 to 2006. A total of 1,087 cases with a PD diagnosis between 2000 and 2006 and 299,617 controls were included in the analyses. Overall, intakes of fats and other macronutrients were not associated with PD risk. However, we found a weak positive association between n-6 polyunsaturated fatty acids (PUFA) and the risk for PD. After adjusting for potential confounders, the odds ratio (OR) and 95% confidence interval (CI) between extreme quintiles of n-6 PUFA intake was 1.23 (95% CI = 1.02-1.49, P for trend = 0.02). A similar association was observed for the intake of linoleic acid. Results were similar among men and among women. Our study suggests that fat intake in general is not related to the risk for PD. The weak positive association between intake of n-6 PUFA and PD risk needs further investigation. © 2014 International Parkinson and Movement Disorder Society

Objective Olfactory dysfunction is the most common pre-motor symptom in Parkinson's disease (PD), and smoking is known to be associated with lower risk of PD. This study tested the hypothesis that smoking is associated with better olfaction in PD. Methods Smoking history was obtained from 76 PD subjects (22 with a history of smoking [smokers], 54 who never smoked [nonsmokers]), and 70 controls (17 smokers, 53 nonsmokers). Olfaction was assessed using the 40-item University of Pennsylvania Smell Identification Test (UPSIT). The olfactory scores between groups and subgroups were compared using analysis of covariance with adjustment for age, gender, and monoamine oxidase B (MAO-B) inhibitor usage. Results Overall the olfactory score was lower in PD compared with controls (olfactory scores: 21.5 vs. 33.5, P

The objective of this study was to examine the associations of reproductive factors and exogenous hormone use with risk of Parkinson's disease (PD) among postmenopausal women. The study comprised 119,166 postmenopausal women aged 50 to 71 years in the NIH-AARP Diet and Health Study, who completed a baseline questionnaire in 1995-1996 and a follow-up survey in 2004-2006. A total of 410 self-reported PD diagnoses were identified between 1995 and 2006. Multivariate odds ratios (ORs) and 95% confidence intervals (CIs) were derived from logistic regression models. PD risk was not significantly associated with female reproductive factors including age at menarche, age at first live birth, parity, and age at menopause. For example, compared with women with natural menopause at age 50 to 54 years, the ORs were 1.18, (95% CI, 0.78-1.79) for women with natural menopause aged

Background: The epidemiological evidence on head injury and the risk of Parkinson's disease (PD) has been inconsistent. Methods: We examined the relation between previous hospitalization for head injury and PD using a population-based nested case-control design based on the Swedish National Patient Register from 2001 until 2007, including 18,648 PD cases and 93,240 controls, randomly selected from the general population. Exposure was defined as hospitalization for head injury between 1987 and index date. Results: Overall, previous hospitalization resulting from head injury was associated with an increased risk of PD; this association appeared to be largely explained by head injuries experienced recently, especially within 1 year before PD ascertainment. Conclusions: Our results do not provide convincing evidence for a causal relationship between head injury later in life and PD. © 2012 Movement Disorder Society

Protoplast fusion is an important technique for engineering microbial strains. It has been used to combine genes from different organisms to create new strains with desired properties. This investigation was aimed to construct a new strain with an ability of degrading chlorophenols efficiently by protoplast fusion between Pseudomonas putida and Psathyrella candolleana. Twenty recombinant strains were screened and used to degrade pentachlorophenol (PCP) synthetic wastewater in order to determine their capabilities of chlorophenol degradation. To rapidly and accurately measure PCP content in synthetic wastewater after treatment by different strains, a new method quantifying PCP was proposed based on derivative spectroscopy. Chlorophenol biodegradability of different strains could be measured rapidly according to the new method. The results showed that PCP degradation % of four recombinant strains viz., Xz 6-1, Xz 6-3, Xz 6-5, Xz 8-2 were 78.98%, 69.12%, 31.40%, 46.26%, respectively, and that of parent strain (Pseudomonas putida.) was 57.27%, which indicated that the degradation % of Xz 6-1 is the highest and improved by 21.71% compared with Pseudomonas putida. Furthermore, the colony morphologies and microscopic feature of Xz 6-1 and Pseudomonas putida were compared in this article. © 2012 American Institute of Chemical Engineers Environ Prog, 32: 443–448, 2013

We investigated whether the use of calcium channel blockers (CCBs) was associated with a reduced risk of Parkinson's disease (PD) in two large prospective cohorts: the Nurses' Health Study (NHS) and Health Professionals' Follow-Up Study (HPFS). Cox proportional hazards models were used to estimate relative risks (RRs) and 95% confidence intervals (CIs) to assess the association between use of CCBs and risk of PD adjusting for potential confounders. We identified 514 incident cases of PD during follow-up. No association between baseline use of CCBs (RR = 1.18, 95% CI: 0.73-1.92), frequency of use or duration of use of CCBs and PD risk was observed (P > 0.2 for all). These findings do not support a role for CCBs in providing neuroprotection against development of PD.

A new method is proposed for the determination of chroma in pulping effluent, using ratio spectrum-derivative spectrophotometry. The ratio derivative value at 366 nm was used to calculate chroma, which is not affected by pH value and suspended substance in pulping effluent, so the procedure does not require adjusting the pH value and removing the suspended substance before the detection of chroma. The test procedures were simplified and the error caused by human factors was reduced. The method has high precision and accuracy with a relative difference is within ±5% when the chroma of samples is in the range of 50―390 color unit. The new method was satisfactorily applied for the determination of chroma in pulping effluent.

Department of Oral Pathology, Schoolof Stomatology, Wuhan University, Wuhan, ChinaOBJECTIVE: To examine the association of oral squa-mous cell carcinoma with human papillomavirus (HPV)using quantum dots (QD) in situ hybridization (ISH).METHODS: Expression of HPV16⁄18 was analyzed in arepresentative collection of 21 oral squamous cell carci-nomas by tissue microarrays. The presence of HPV16⁄18high risk was detected by applying QDISH which iscompared with conventional ISH.RESULTS: Seven cases out of 21 (33.3%) were positive forQDISH while 1 out of 21 (4.8%) was positive for ISH, al-though all of HPV DNA were localized in the nuclei in thespinous and basal cell layer of the epithelium. The dif-ference between these two methods was significant(P < 0.05).CONCLUSIONS: These results demonstrate that theQD might be an efficient method for determination ofHPV infection and HPV-associated oral squamous cellcarcinoma.J Oral Pathol Med (2009) 38: 668–671Keywords: HPV16⁄18; oral squamous cell carcinoma; QD in situhybridization; tissue microarray

To determine if reproductive factors or exogenous estrogen are associated with risk of Parkinson's disease (PD), we conducted a prospective study with 22 years of follow-up among postmenopausal participants in the Nurses' Health Study. Relative risks (RRs) and 95% confidence intervals (CIs) of PD were estimated from a Cox proportional hazards model adjusting for potential confounders. Risk of PD was not significantly associated with any of the reproductive factors measured or exogenous estrogen use. Use of postmenopausal hormones, however, may modify the associations of smoking and caffeine intake with PD risk. The inverse relation between smoking and PD risk was attenuated among ever users of postmenopausal hormones (P for interaction = 0.05). Similar results were obtained for caffeine (P for interaction = 0.09). In exploratory analyses, women using progestin-only hormones were found to have an increased PD risk, but this result was based on a very small number of cases (n = 4). In this large longitudinal study, we found no evidence of a beneficial effect of exogenous or endogenous estrogens on risk of PD. The use of postmenopausal hormone use may interact with other risk factors, but findings are preliminary and need confirmation in other populations.

OBJECTIVES: To investigate whether indicators of obesity are associated with functional disabilities in elderly American women and men. DESIGN: Cross-sectional. SETTING: National Health and Nutrition Examination Survey (NHANES) 1999 to 2004, United States. PARTICIPANTS: One thousand six hundred eighty-four elderly (aged >60) women and 1,611 elderly men. MEASUREMENTS: Functional disabilities. RESULTS: In women, body mass index (BMI) and waist circumference were each related to higher prevalence of all measures of disabilities. Compared with the lowest quartile of waist circumference, the multivariate odds ratios (ORs) of the highest quartile for having difficulties in functional domains were 2.4 (95% confidence interval (CI) = 1.6-3.6) for activities of daily living, 2.3 (95% CI = 1.6-3.3) for instrumental activities of daily living, 2.6 (95% CI = 1.6-4.1) for leisure and social activities, 4.8 (95% CI = 3.4-6.9) for lower extremity mobility, and 2.9 (95% CI = 2.1-4.0) for general physical activity. In men, these associations were moderate; the corresponding ORs were 1.2 (95% CI = 0.8-2.0), 1.3 (95% CI= 0.9-2.1), 2.1 (95% CI = 1.2-3.7), 1.8 (95% CI = 1.2-2.7), and 2.1 (95% CI = 1.5-2.8), respectively. Similar results were obtained for BMI. These associations could not be explained by the presence of major chronic conditions. When adjusted simultaneously, waist circumference appeared to be a better predictor than BMI of disability in women. CONCLUSION: The results suggest that indicators of obesity are related to functional disabilities in elderly Americans J. Am Geriatr Soc. 56:689-694, 2008. Americans.

The purpose of this study was to investigate associations between recreational physical activity and Parkinson's disease (PD) risk. We prospectively followed 143,325 participants in the Cancer Prevention Study II Nutrition Cohort from 1992 to 2001 (mean age at baseline = 63). Recreational physical activity was estimated at baseline from the reported number of hours per week on average spent performing light intensity activities (walking, dancing) and moderate to vigorous intensity activities (jogging/running, lap swimming, tennis/racquetball, bicycling/stationary bike, aerobics/calisthenics). Incident cases of PD (n = 413) were confirmed by treating physicians and medical record review. Relative risks (RR) were estimated using proportional hazards models, adjusting for age, gender, smoking, and other risk factors. Risk of PD declined in the highest categories of baseline recreational activity. The RR comparing the highest category of total recreational activity (menor = 23 metabolic equivalent task-hours/week [MET-h/wk], womenor = 18.5 MET-h/wk) to no activity was 0.8 (95% CI: 0.6, 1.2; P trend = 0.07). When light activity and moderate to vigorous activity were examined separately, only the latter was found to be associated with PD risk. The RR comparing the highest category of moderate to vigorous activity (menor = 16 MET-h/wk, womenor = 11.5 MET-h/wk) to the lowest (0 MET-h/wk) was 0.6 (95% CI: 0.4, 1.0; P trend = 0.02). These results did not differ significantly by gender. The results were similar when we excluded cases with symptom onset in the first 4 years of follow-up. Our results may be explained either by a reduction in PD risk through moderate to vigorous activity, or by decreased baseline recreational activity due to preclinical PD.

We prospectively examined associations between perceived imbalance and Parkinson's disease (PD) risk in the Health Professional Follow-up Study (HPFS), and Nurses' Health Study (NHS). We included 39,087 men and 82,299 women free of PD at baseline (1990) in the current analyses. We documented 449 incident PD cases during 12 years follow-up. Subjects who reported difficulty with balance before 1990 (baseline) were 1.8 more times likely to develop PD, relative to those who reported no balance difficulty (pooled multivariate RR = 1.8; 95% CI: 1.3, 2.5; P < 0.0001). When we further examined associations between perceived imbalance at baseline and PD onset during different time periods, we found a significant elevation of PD risk only during the first 4 years of follow-up. This result suggests that the imbalance may in some cases be an early sign of PD, and may represent the onset of motor symptoms although they have not been clinically recognized.

We investigated whether telomere length was associated with the risk of Parkinson’s disease (PD) in a case-control study (96 cases and 172 age-matched controls) nested within the Health Professionals Follow-up Study. Relative ratio of telomere repeat copy number to single-gene copy number in peripheral blood leukocytes was determined by quantitative real time PCR. Men with shorter telomeres had a lower PD risk (multivariate adjusted relative risk for the lowest vs. the highest quartile 0.33; 95% confidence interval: 0.12–0.90). Our results suggest that, contrary to telomere attrition observed in several aging-related diseases, shorter telomeres are not associated with an increased risk of PD.

Parkinson's disease (PD) patients have higher mortality than individuals without PD. However, most of the previous studies were based on prevalent cases and few examined the potential effects of duration and smoking on the survival of PD patients. We compared the survival experience of 288 men with incident PD diagnosed between 1986 and 2000 with that of 51,012 men free of PD in the Health Professionals Follow-up Study. As of January 2002, 92 deaths occurred among PD cases and 8,485 among men without PD. After controlling for age, men with PD had 60% higher mortality than those without PD (95% CI: 1.3-2.0). PD mortality was strongly related to disease duration: compared with men without PD, the age-adjusted relative risk for PD patients was 1.1 during the first 5 years from diagnosis, 2.3 from 5 to 10 years, and 3.5 after 10 years (P 30 pack-years vs. never smokers, relative risk, 2.0; P < 0.0001 for trend), but this association was not observed among PD patients (RR: 1.0; P = 0.95 for trend). This study confirms that PD patients have a higher mortality than individuals without PD and that the excess mortality increases with disease duration. However, smoking seems to impose little additional risk among PD patients in this large cohort of health professionals.

We investigated whether nonsteroidal antiinflammatory drug use was associated with a lower risk for Parkinson's disease (PD) in a large cohort of US men and women. PD risk was lower among ibuprofen users than nonusers. Compared with nonusers, the relative risks were 0.73 for users of fewer than 2 tablets/week, 0.72 for 2 to 6.9 tablets/week, and 0.62 for 1 or more tablets/day (p trend = 0.03). No association was found between the use of aspirin, other nonsteroidal antiinflammatory drugs, or acetaminophen and PD risk. The results suggest that ibuprofen use may delay or prevent the onset of PD.

Cigarette smoking and caffeine consumption are associated with a decreased incidence of Parkinson's disease (PD). This inverse association may result from neuroprotective effects of cigarette smoke and caffeine, or from a disinclination of future PD patients to engage in habituating behaviors. We investigated the association between consumption of alcoholic beverages, another potentially habituating behavior, and risk of PD in two large prospective cohorts Nurses' Health Study, and Health Professionals' Follow-up Study. We detected 415 new cases of PD during follow-up. Compared with nondrinkers at baseline, the relative rate (95% confidence interval) was 1.0 (0.8-1.3) for drinkers of less than 5 gm/day, 1.0 (0.8-1.4) for 5 to less than 15 gm/day, 1.1 (0.8-1.6) for 15 to less than 30 gm/day, and 0.7 (0.5-1.2) for 30 gm/day or more (p for trend = 0.45). Consumption of wine or liquor was not associated with the incidence of PD. Compared with those who consumed beer less than once per month, the relative rate (95% confidence interval) was 0.7 (0.5-0.9) for one to three drinks of beer per month, and 0.7 (0.5, 0.9) for one or more drinks of beer per week. The risk of PD was similar in individuals who usually consume moderate amounts of alcohol and in abstainers.

We prospectively examined the changes of body weight among 468 individuals with Parkinson's disease (PD) before and after the diagnosis. The average weight of PD patients was stable until shortly before the diagnosis (p for trend = 0.2) and then declined (p for trend < 0.0001). Interestingly, PD patients tended to increase their energy intakes as their weights decreased (p for trend < 0.002). In conclusion, weight loss in PD patients appears to be a continuous process that starts several years before the diagnosis and is not caused by reduced energy intake.

Diet may play a causative role in Parkinson's disease (PD), but potential associations between diet and PD risk rarely have been assessed in prospective studies. We investigated associations between food intakes and PD risk in two large prospective cohorts in which 210 incident PD cases in men and 184 in women were documented. A positive association was found between dairy intake and PD risk in men (relative risk [RR] comparing extreme categories, 1.8; p trend = 0.004), but not in women (RR, 1.1; p trend = 0.9). No other food groups were associated with PD risk in either men or women. Further analyses among men showed significant positive associations with PD risk for intakes of several dairy foods as well as dairy calcium (RR, 1.5; p trend = 0.02), dairy vitamin D (RR, 1.6; p trend = 0.004), dairy protein (RR, 1.6; p trend = 0.01), and lactose (RR, 1.8; p trend = 0.002), but not dairy fat (RR, 1.1; p trend = 0.4). Intakes of calcium, vitamin D, and protein from other dietary or supplemental sources were not related to PD risk in men. Our results suggest that higher intake of dairy products may increase the risk of PD in men; however, this finding needs further evaluation, and the underlying active components need to be identified.

Our first publication in Movement Disorders1 reporting an “association” between lower cholesterol and Parkinson’s disease (PD) noted the limitations of case-control analysis. It cautioned the readers that “we could not make a causal inference between LDL-C, and/or statin use and risk of PD”1. To reduce the possibility of reserve causality, we subsequently studied a prospective cohort2 and found a similar association. Similar findings were also reported in two other prospective cohorts3;4. Interestingly, Scigliano and colleagues themselves found “the association of untreated IPD with reduced vascular diseases risk(s)” including higher cholesterol5. There has been one inconsistent report6 in which the cases were identified from a National Insurance Register that entitles patients to medication free of charge. Therefore, the overall evidence to date favors an association between higher cholesterol and lower PD occurrence. The three prospective cohorts cited above2–4 have generated some useful insight on PD etiology. Rigorous diagnostic criteria7 were applied in the Honolulu Asia Aging Study, and of 25 cases that had autopsy, PD was confirmed pathologically in 21. Further, the age of onset in any study population is bounded by its age distribution. The average age at cholesterol assay in the Honolulu cohort was 77 years old2,thus it is not surprising that the onset of incident cases was also higher in this cohort. Given the consistency of this association across prospective studies, it seems to us that more, not less, research should be conducted to understand the nature of this finding and its medical ramifications, if any. Thus, we disagree with Scigliano et al.’s notion that future studies should simply be abandoned. It is both inconsistent with the weight of available evidence, and contrary to the scientific method.