Large Representative Population Sample Research Articles

General and math vocabulary contributions to early numeracy skills in a large population-representative sample

There are well-documented associations between numeracy development in preschool age children and general and math vocabulary, literacy, and executive functions. However, the studies have largely included small samples of children with parents with either predominantly low or higher socioeconomic background (SES); further, few studies have included measures of all these domains in the same analyses. In this current study, we examined how general vocabulary, math vocabulary, rhyme detection and three measures of executive functions are associated with numeracy development in a population representative sample of 2,931 Danish children 3–5 years (51% male, 89% white). Multi-level regressions controlling for child age and, sex, and in some analyses also parental education and income confirmed that general vocabulary (β = 0.16), math language (β = 0.17), rhyme detection (β = 0.14), attention shifting (β = 0.09), inhibitory control (β = 0.05), and working memory (β = 0.09) each are associated with numeracy after controlling for covariates when estimated in the same model. Analyses of extreme performance (low-high) suggests a much closer and symmetrical connection between math language and numeracy compared to that between general vocabulary and numeracy. Interestingly, family SES is weakly but significantly related to all measures, most strongly for the vocabulary measures, but does not influence the pattern of results from regression analyses. In conclusion, both general vocabulary and mathematics-specific vocabulary contribute substantially to early numeracy skills. Rhyme detection and executive functions are also associated with numeracy skills, but with a lower magnitude.

The Social Determinants of Emotional and Behavioral Problems in Adolescents Experiencing Early Puberty

PurposeEarlier pubertal timing is an important predictor of emotional and behavioral problems during adolescence. The current study undertook a comprehensive investigation of whether the social environment can buffer or amplify the associations between pubertal timing and emotional and behavioral problems. MethodsResearch questions were examined in the Adolescent Brain Cognitive Development (ABCD) Study, a large population representative sample in the United States. We examined interactions between pubertal timing and the shared effects of a range of proximal and distal social environmental influences (i.e., parents, peers, schools, neighborhoods, socioeconomic status) in 10- to 13-year-olds. ResultsResults revealed significant interaction between timing and proximal social influences (i.e., the “microsystem”) in predicting emotional and behavioral problems. In general, adolescents with earlier pubertal timing and unfavorable (high levels of negative and low levels of positive) influences in the microsystem exhibited greater problems. Both males and females exhibited such associations for rule-breaking problems, while females alone exhibited associations for depressive problems. Results also illustrate the relative strength of each social context at moderating risk for emotional and behavioral problems in earlier versus later pubertal maturers. DiscussionThese findings highlight the importance of proximal social influences in buffering vulnerability for emotional and behavioral problems related to earlier puberty. Findings also illustrate the broad implications of latent environmental factors, reflecting common variance of multiple social influences that typically covary with one another.

Corticolimbic connectivity mediates the relationship between pubertal timing and mental health problems.

Undergoing puberty ahead of peers ('earlier pubertal timing') is an important risk factor for mental health problems during early adolescence. The current study examined pathways between pubertal timing and mental health via connectivity of neural systems implicated in emotional reactivity and regulation (specifically corticolimbic connections) in 9- to 14-year-olds. Research questions were examined in the Adolescent Brain Cognitive Development (ABCD) Study, a large population representative sample in the United States. Linear mixed models examined associations between pubertal timing and resting-state corticolimbic connectivity. Significant connections were examined as potential mediators of the relationship between pubertal timing and mental health (withdrawn depressed and rule-breaking) problems. Exploratory analyses interrogated whether the family environment moderated neural risk patterns in those undergoing puberty earlier than their peers. Earlier pubertal timing was related to decreased connectivity between limbic structures (bilateral amygdala and right hippocampus) and the cingulo-opercular network, left amygdala and somatomotor (mouth) network, as well as between the left hippocampus and ventral attention network and visual network. Corticolimbic connections also mediated the relationship between earlier pubertal timing and increased withdrawn depressed problems (but not rule-breaking problems). Finally, parental acceptance buffered against connectivity patterns that were implicated in withdrawn depressed problems in those undergoing puberty earlier than their peers. Findings highlight the role of decreased corticolimbic connectivity in mediating pathways between earlier pubertal timing and withdrawn depressed problems, and we present preliminary evidence that the family environment may buffer against these neural risk patterns during early adolescence.

What factors are associated with advance care planning in community-dwelling older people? Data from TILDA.

To assess advance care planning (ACP) in a large population-representative sample of older people. At Wave 4 of the Irish Longitudinal Study on Ageing, participants were asked: Have you made your wishes/preferences known about the kind of care that you would like to receive in the event of serious illness? One quarter (1153/4831) had discussed ACP. Of those, 90% had discussed with family/friends, 10% documented ACP in writing, while 2% had discussed with a healthcare professional. Age ≥ 80years [OR 1.63 (1.31-2.02)], female sex [OR 1.58 (1.37-1.83)], higher educational attainment [OR 1.42 (1.18-1.71)], poorer self-rated health [OR 1.67 (1.06-2.62)] and lower levels of religiosity [OR 1.50 (1.02-2.19)] were independently associated with ACP. Only one in four older people had discussed ACP informally, while less than 3% have ACP documented in writing. Further work is required to educate the public and healthcare professionals regarding treatment choices at end-of-life.

The prevalence and characteristics of misophonia in Ankara, Turkey: population-based study.

Misophonia is defined as significant distress (anger, distress or disgust) when exposed to certain sounds that would not affect most people, such as lip smacking or gum chewing. Although misophonia is common, the aetiology, prevalence and effective treatments are largely unknown. Based on our proposed diagnostic criteria, we examined the prevalence of misophonia and its relationship with clinical and demographic variables in a large representative population sample. We used a household sample (N = 541) of all residents aged >15 years, living in 300 homes randomly selected in Ankara city centre, Turkey. All participants were assessed at their homes by trained interviewers, for sociodemographic variables, misophonic sounds and related factors, using a semi-structured interview (the Misophonia Interview Schedule) developed for the current research. The current misophonia diagnosis prevalence was 12.8% (n = 69 of 541), although 427 (78.9%) participants reported at least one sound that was distressing. The mean number of misophonic sounds was 8.6 (s.d. 8.9, range 0-44); the figure was 17.6 in those with misophonia compared with 7.3 in those without misophonia. Of those with misophonia, only 5.8% contacted services for their condition. Predictors of misophonia diagnosis included younger age, family history of misophonia and previous contact with mental health services. Our study showed that misophonia is common in the general population, may cause significant disruption in daily life and is undertreated. Although more evidence is needed to classify misophonia as a psychiatric disorder, our findings support others who claim that the condition belongs to the group of mental disorders.

'Wish to die' is independently associated with cardiovascular mortality in later life. Data from TILDA.

There is an established bidirectional relationship between mental and heart health in later life but the link between wish to die (WTD) and cardiovascular mortality is less well-defined. This is a longitudinal study examining the association between WTD and mortality over 9-year follow-up in a large population-representative sample of older adults. Individual-level survey data was linked to official death registration data, divided into cardiovascular and noncardiovascular causes. WTD was defined as answering affirmatively when asked 'In the last month, have you felt that you would rather be dead?' Regression models were used to obtain hazard ratios for the association between WTD at Wave 1 and mortality. Kaplan-Meier plots were used to compare survival across groups. Just over 3% (275/8124) of participants reported WTD. Mortality data was available for 9% of participants (755/8124). WTD was significantly associated with all-cause mortality, with a hazard ratio of 1.41 (95% confidence interval [CI]: 1.00-1.99). Findings were attenuated and no longer significant after excluding participants with heart disease or depression/anxiety/other psychiatric illness. WTD was significantly associated with cardiovascular mortality (hazard ratio: 2.14 [95% CI: 1.21-3.78]), even after excluding participants with depression/anxiety/other illnesses but not heart disease. WTD was not associated with an increased risk of death due to non-cardiovascular causes. Older people who report a wish to die have double the risk of death from cardiovascular disease in the following 9 years, even when those with depression, anxiety or other mental health problems are excluded.

The Relationship Between Family Gambling Problems, Other Family Stressors, and Health Indicators in a Large Population-Representative Sample of Australian Adults.

Harms due to excessive gambling can be experienced by gamblers and those close to them. Family gambling problems (FGPs) are currently under-researched, particularly in population-representative samples. This study aimed to identify prevalence, risk factors, and the complex of stressors and health-related consequences associated with FGPs, as well as isolating the impact of FGPs on physical and psychological health problems. We analysed data from the National Health Survey 2011-13, a large (N = 15,475) nationally representative sample of Australian adults. Participants reported on the presence of 14 family stressors (including FGPs), self-assessed health status, and risky health behaviours. Psychological impact was measured by the Kessler Psychological Distress Scale-10, as well as several indicators of the presence of mental health problems. Overall, 1.7% of households reported a FGP. Interviewees in these households reported three times the number of other stressors than those without a FGP. In addition, they were around eight times more likely to be experiencing other addictions (drug and alcohol related problems) and stressors associated with socially deviant behaviours (trouble with police, abuse or violent crime, and witness to violence). Once age, gender, socioeconomic disadvantage, and other stressors were controlled for, FGPs significantly predicted lower self-assessed health and higher psychological distress. FGPs occur within a complex of other addictions and stressors, impacting the quality of life of people close to problem gambling. The findings are discussed in relation to their support for General Strain Theory (Agnew, Criminology 30:47-87, 1992).

Development and initial validation of the COVID Stress Scales

Research and clinical observations suggest that during times of pandemic many people exhibit stress- or anxiety-related responses that include fear of becoming infected, fear of coming into contact with possibly contaminated objects or surfaces, fear of foreigners who might be carrying infection (i.e., disease-related xenophobia), fear of the socio-economic consequences of the pandemic, compulsive checking and reassurance-seeking regarding possible pandemic-related threats, and traumatic stress symptoms about the pandemic (e.g., nightmares, intrusive thoughts). We developed the 36-item COVID Stress Scales (CSS) to measure these features, as they pertain to COVID-19. The CSS were developed to better understand and assess COVID-19-related distress. The scales were intentionally designed so they could be readily adapted for future pandemics. The CSS were developed and initially validated in population-representative samples from Canada (N = 3479) and the United States (N = 3375). A stable 5-factor solution was identified, corresponding to scales assessing COVID-related stress and anxiety symptoms: (1) Danger and contamination fears, (2) fears about economic consequences, (3) xenophobia, (4) compulsive checking and reassurance seeking, and (5) traumatic stress symptoms about COVID-19. The scales performed well on various indices of reliability and validity. The scales were intercorrelated, providing evidence of a COVID Stress Syndrome. The scales offer promise as tools for better understanding the distress associated with COVID-19 and for identifying people in need of mental health services.

Single-channel oximetry monitor versus in-lab polysomnography oximetry analysis: does it make a difference?

Objective: Portable oximetry has been shown to be a promising candidate for large-scale obstructive sleep apnea screening. In polysomnography (PSG), the gold standard OSA diagnosis test, the oxygen desaturation index (ODI) is usually computed from desaturation events occurring during sleep periods only, i.e. overnight desaturations occurring during or overlapping with a wake state are excluded. However, for unattended home oximetry, all desaturations are taken into account since no reference electroencephalogram is available for sleep staging. We aim to evaluate the hypothesis that the predictive power of oximetry for OSA screening is not impaired when reference sleep stages are not available. Approach: We used a PSG clinical database of 887 individuals from a representative São Paulo (Brazil) population sample. Using features derived from the oxygen saturation time series and demographic information, OxyDOSA, a published machine learning model, was trained to distinguish between non-OSA and OSA individuals using the ODI computed while including versus excluding overnight desaturations overlapping with a wake period, thus mimicking portable and PSG oximetry analyses, respectively. Main results: When excluding wake desaturations, the OxyDOSA model had an AUROC = 94.9 ± 1.6, Se = 85.9 ± 2.8, Sp = 90.1 ± 2.6 and F1 = 86.4 ± 2.7. When considering wake desaturations, the OxyDOSA model had an AUROC = 94.4 ± 1.6, Se = 88.0 ± 2.0, Sp = 87.7 ± 2.9 and F1 = 86.2 ± 2.4. Non-inferiority was demonstrated (p = 0.049) at a tolerance level of 3%. In addition, analysis of the desaturations excluded by PSG oximetry analysis suggests that up to 21% of the total number of desaturations might actually be related to apneas or hypopneas. Significance: This analysis of a large representative population sample provided strong evidence that the predictive power of oximetry for OSA screening using the OxyDOSA model is not impaired when reference sleep stages are not available. This finding motivates the usage of portable oximetry for OSA screening.

1608-P: Suboptimal Management of Diabetes in India: Findings from a Large Community-Based Study

Over the past few decades diabetes prevalence has rapidly increased across India. However, limited information is available on the levels of awareness, treatment and control, particularly in epidemiologically transitioning communities. We estimated the prevalence, awareness, treatment and control rates of diabetes in a large representative population sample aged ≥ 30 years, selected using a multistage cluster random sampling technique, residing in rural and urban areas of North and South India. Trained interviewers administered a questionnaire to collect data on socio-demographics, lifestyle characteristics and phlebotomists collected venous blood samples to estimate fasting plasma glucose (FPG) and HbA1C. Diabetes was defined as FPG ≥ 126 mg/dl or HbA1C ≥ 6.5% or self-report of physician diagnosis or being on treatment. Participants were considered to be aware of diabetes if they reported a diagnosis or being on treatment. Control was defined as HbA1C < 7%. In total 12243 participants (6208 in North and 6035 in South) were surveyed. The mean (±SD) age was 47.7 (±12.5) years. Women constituted 54%. The age-standardized prevalence of diabetes was 14.2 (95% CI: 13.6 - 14.9), with significant difference between urban (21.4%; 20.4-22.5) and rural (7.5%; 6.8-8.2) areas. Among those with diabetes, the awareness, treatment and control rates were 49.4% (46.6-52.2), 38.6% (35.9-41.3) and 12.6% (10.9-14.5) respectively. Compared to urban residents, rural counterparts were less likely to be aware (35% Vs. 55%), treated (26% Vs. 43%) and controlled (8% Vs. 14%). Similarly, patients in the lowest tertile of wealth index had lower awareness (33% Vs. 55%), treatment (22% Vs. 43%) and control rates (5% Vs. 15%) compared to those in the highest tertile. Despite a high burden, management of diabetes is sub-optimal in India. Health system strengthening to better manage diabetes with a focus on rural residents and the poor is imperative to stem the rising burden and improve diabetes related health outcomes. Disclosure S. Mohan: None. N.S. Venkateshmurthy: None. P. Jarhyan: None. G. Sharnngadharan: None.

Assessing Planning Ability Across the Adult Life Span in a Large Population-Representative Sample: Reliability Estimates and Normative Data for the Tower of London (TOL-F) Task.

The Tower of London (TOL) test has probably become the most often used task to assess planning ability in clinical and experimental settings. Since its implementation, efforts were made to provide a task version with adequate psychometric properties, but extensive normative data are not publicly available until now. The computerized TOL-Freiburg Version (TOL-F) was developed based on theory-grounded task analyses, and its psychometric adequacy has been repeatedly demonstrated in several studies but often with small and selective samples. In the present study, we now report reliability estimates and normative data for the TOL-F stratified for age, sex, and education from a large population-representative sample collected in the Gutenberg Health Study in Mainz, Germany (n=7703; 40-80 years). The present data confirm previously reported adequate indices of reliability (>.70) of the TOL-F. We also provide normative data for the TOL-F stratified for age (5-year intervals), sex, and education (low vs. high education). Together, its adequate reliability and the representative age-, sex-, and education-fair normative data render the computerized TOL-F a suitable diagnostic instrument to assess planning ability. (JINS, 2019, 25, 520-529).

Inverse association between serum antioxidant levels and inflammatory markers is moderated by adiposity: a report based on a large representative population sample of American adults.

We examined the association between plasma antioxidant levels and markers of inflammation, including C-reactive protein (CRP) and fibrinogen (FG) in US adults. National Health and Nutrition Examination Survey participants examined between 2001 and 2002 were included, if data on CRP or FG levels. Serum vitamins A and E, two retinyl esters, and six carotenoids were measured using HPLC with photodiode array detection. Multivariable-adjusted linear regression analyses accounted for the survey design and sample weights. A total of 784 eligible participants were included; 47·5 % (n 372) were men. In multivariable linear regression models, serum α-carotene, trans-β-carotene, cis-β-carotene, β-cryptoxanthin, combined lutein/zeaxanthin, trans-lycopene, retinyl palmitate, α-tocopherol, retinol and 25-hydroxy vitamin D were negatively associated with serum CRP (P3 mg/l, decreased with increasing levels of antioxidants (α-carotene, trans-β-carotene, cis-β-carotene, vitamins A and E). Furthermore, we found a moderate impact of adiposity on the link between antioxidants and CRP. Our results suggest that the lower the antioxidants levels, the higher the inflammatory burden, based on CRP and FG levels. Adiposity moderately affects this association. Furthermore, an inverse relationship between CVD risk and antioxidant levels was observed. This finding suggests that reduced levels of vitamins with antioxidant properties may predispose to increased CVD risk.

Development and Validation of a Parenting Scale Short Form (PS-8) in a Representative Population Sample

Early mental and behavioral disorders are significant predictors of psychopathologies in adulthood. Parenting behavior (e.g., overreactivity and laxness) influences the development of behavioral problems in children. It is thus often assessed in therapeutic settings, as well as in the context of intervention studies. The aim of this study was to develop a short form of the Parenting Scale (PS), PS-8, and to evaluate its psychometric properties. Based on data from a large pre-school survey, an eight-item short form scale was compiled. The short version was presented to a large representative population sample (N = 539 parents, n = 312 mothers, n = 227 fathers). Psychometric properties were assessed and measurement invariance tests performed. The internal consistency of both PS-8 subscales as well as the mean score were satisfactory. Strict measurement invariance could be confirmed for parental age, gender and age*gender interaction, as well as for the child’s age, gender, and gender*age interaction, allowing unbiased comparison of means, correlation coefficients, path coefficients as well as undistorted screening decisions between the aforementioned groups. Furthermore, the PS-8 mean score was associated with self-rating measures of related constructs (parental anxiety and depression). Hence, the PS-8 presents a reliable, valid and economical tool to assess dysfunctional parenting behavior and can thus be effectively applied within the frameworks of clinical studies, epidemiological research, or related research areas. In future research the convergent validity of the PS-8 with child behavior questionnaires should be assessed.

Dietary Acid Load and Potassium Intake Associate with Blood Pressure and Hypertension Prevalence in a Representative Sample of the German Adult Population.

Diets rich in fruits and vegetables, like the Dietary Approaches to Stop Hypertension (DASH)-diet, are usually characterized by high potassium intake and reduced dietary acid load, and have been shown to reduce blood pressure (BP). However, the relevance of potential renal acid load (PRAL) for BP has not been compared with the relevance to BP of urinary biomarker (K-urine)- and dietary food frequency questionnaire (K-FFQ)-based estimates of potassium intake in a general adult population sample. For 6788 participants (aged 18–79 years) of the representative German Health-Interview and Examination Survey for Adults (DEGS1), associations of PRAL, K-urine, and K-FFQ with BP and hypertension prevalence were cross-sectionally examined in multivariable linear and logistic regression models. PRAL was significantly associated with higher systolic BP (p = 0.0002) and higher hypertension prevalence (Odds ratio [OR] high vs. low PRAL = 1.45, p = 0.0004) in models adjusted for age, sex, body mass index (BMI), estimated sodium intake, kidney function, relevant medication, and further important covariates. Higher estimates of K-FFQ and K-urine were related to lower systolic BP (p = 0.04 and p < 0.0001) and lower hypertension prevalence (OR = 0.82, p = 0.04 and OR = 0.77, p = 0.02) as well as a lower diastolic BP (p = 0.03 and p = 0.0003). Our results show, for the first time in a comparative analysis of a large representative population sample, significant relationships of BP and hypertension prevalence with questionnaire- and biomarker-based estimates of potassium intake and with an estimate of dietary acid load.

Evolutionary and Social Cognitive Models of Jealousy: A Population-Representative Study

Jealousy is a cause of relationship difficulties and failure. Evolutionary models propose that men are more jealous about sexual infidelity than emotional infidelity, and women are more jealous in response to emotional infidelity. In contrast, social cognitive models propose that jealousy is influenced by social and cultural factors. The 3 aims of the study reported here were use a hypothetical jealousy-evoking scenario to explore: (1) sex differences in responses in a large population representative sample; (2) how heterosexual adults’ responses varied according to demographic variables, sexual history, and attitudes toward infidelity; (3) how sexual identity influenced responses. Population-representative sample of 20,093 Australian residents aged 16–69. Data were weighted to match the population described in the national census. Telephone interviews covered various aspects of sexual behavior, sexual attitudes, and sexual health. Within this, interviewees responded to a validated hypothetical jealousy-evoking scenario. There was some support for the evolutionary model among heterosexual respondents: women were more likely to than men to report that emotional infidelity would be more distressing or upsetting than sexual infidelity. However, among some age groups results opposite to those proposed by the evolutionary model were found. In relation to the second aim, a range of demographic, experiential, and attitudinal variables other than sex were also significantly related to heterosexual adults’ responses to the hypothetical scenario. In relation to the third aim, the analyses revealed sex differences opposite to those predicted by evolutionary models.

Variations in cognitive abilities across the life course: Cross-sectional evidence from Understanding Society: The UK Household Longitudinal Study

BackgroundPopulations worldwide are aging. Cognitive decline is an important precursor of dementia, illness and death and, even within the normal range, is associated with poorer performance on everyday tasks. However, the impact of age on cognitive function does not always receive the attention it deserves. MethodsWe have explored cross-sectional associations of age with five cognitive tests (word recall, verbal fluency, subtraction, number sequence, and numerical problem solving) in a large representative sample of over 40,000 men and women aged 16 to 100 living in the UK. ResultsWomen performed better on word recall tests and men had higher scores for subtraction, number sequence and numerical problem solving. However, age-cognition associations were generally similar in both genders. Mean word recall and number sequence scores decreased from early adulthood with steeper declines from the mid-60s onwards Verbal fluency, subtraction and numerical problem solving scores remained stable or increased from early to mid-adulthood, followed by approximately linear declines from around age 60. Performance on all tests was progressively lower in respondents with increasingly worse self-rated health and memory. Age-related declines in word recall, verbal fluency and number sequence started earlier in those with the worst self-rated health. There was no compelling evidence for age dedifferentiation (that the general factor of cognitive ability changes in strength with age). ConclusionsWe have confirmed previously observed patterns of cognitive aging using a large representative population sample.

Genetic influences on heart rate variability

Heart rate variability (HRV) is the variation of cardiac inter-beat intervals over time resulting largely from the interplay between the sympathetic and parasympathetic branches of the autonomic nervous system. Individual differences in HRV are associated with emotion regulation, personality, psychopathology, cardiovascular health, and mortality. Previous studies have shown significant heritability of HRV measures. Here we extend genetic research on HRV by investigating sex differences in genetic underpinnings of HRV, the degree of genetic overlap among different measurement domains of HRV, and phenotypic and genetic relationships between HRV and the resting heart rate (HR). We performed electrocardiogram (ECG) recordings in a large population-representative sample of young adult twins (n=1060 individuals) and computed HRV measures from three domains: time, frequency, and nonlinear dynamics. Genetic and environmental influences on HRV measures were estimated using linear structural equation modeling of twin data. The results showed that variability of HRV and HR measures can be accounted for by additive genetic and non-shared environmental influences (AE model), with no evidence for significant shared environmental effects. Heritability estimates ranged from 47 to 64%, with little difference across HRV measurement domains. Genetic influences did not differ between genders for most variables except the square root of the mean squared differences between successive R-R intervals (RMSSD, higher heritability in males) and the ratio of low to high frequency power (LF/HF, distinct genetic factors operating in males and females). The results indicate high phenotypic and especially genetic correlations between HRV measures from different domains, suggesting that >90% of genetic influences are shared across measures. Finally, about 40% of genetic variance in HRV was shared with HR. In conclusion, both HR and HRV measures are highly heritable traits in the general population of young adults, with high degree of genetic overlap across different measurement domains.

Zero-Inflated Models for Identifying Relationships Between Body Mass Index and Gastroesophageal Reflux Symptoms: A Nationwide Population-Based Study in China.

That obesity leads to gastroesophageal reflux is a widespread notion. However, scientific evidence for this association is limited, with no rigorous epidemiological approach conducted to address this question. This study examined the relationship between body mass index (BMI) and gastroesophageal reflux symptoms in a large population-representative sample from China. We performed a cross-sectional study in an age- and gender-stratified random sample of the population of five central regions in China. Participants aged 18-80years completed a general information questionnaire and a Chinese version of the Reflux Disease Questionnaire. The zero-inflated Poisson regression model estimated the relationship between body mass index and gastroesophageal reflux symptoms. Overall, 16,091 (89.4%) of the 18,000 eligible participants responded. 638 (3.97%) and 1738 (10.81%) experienced at least weekly heartburn and weekly acid regurgitation, respectively. After adjusting for potential risk factors in the zero-inflated part, the frequency [odds ratio (OR) 0.66, 95% confidence interval (95% CI) 0.50-0.86, p=0.002] and severity (OR 0.66, 95% CI 0.50-088, p=0.004) of heartburn in obese participants were statistically significant compared to those in normal participants. In the Poisson part, the frequency of acid regurgitation, overweight (OR 1.10, 95% CI 1.01-1.21, p=0.038) and obesity (OR 1.19, 95% CI 1.04-1.37, p=0.013) were statistically significant. BMI was strongly and positively related to the frequency and severity of gastroesophageal reflux symptoms. Additionally, gender exerted strong specific effects on the relationship between BMI and gastroesophageal reflux symptoms. The severity and frequency of heartburn were positively correlated with obesity. This relationship was presented distinct in male participants only.

Understanding the covariation of tics, attention-deficit/hyperactivity, and obsessive-compulsive symptoms: A population-based adult twin study.

Chronic tic disorders (TD), attention-deficit/hyperactivity-disorder (ADHD), and obsessive-compulsive disorder (OCD) frequently co-occur in clinical and epidemiological samples. Family studies have found evidence of shared familial transmission between TD and OCD, whereas the familial association between these disorders and ADHD is less clear. This study aimed to investigate to what extent liability of tics, attention-deficit/hyperactivity, and obsessive-compulsive symptoms is caused by shared or distinct genetic or environmental influences, in a large population-representative sample of Swedish adult twins (n = 21,911). Tics, attention-deficit/hyperactivity, and obsessive-compulsive symptoms showed modest, but significant covariation. Model fitting suggested a latent liability factor underlying the three phenotypes. This common factor was relatively heritable, and explained significantly less of the variance of attention-deficit/hyperactivity symptom liability. The majority of genetic variance was specific rather than shared. The greatest proportion of total variance in liability of tics, attention-deficit/hyperactivity, and obsessive-compulsive symptoms was attributed to specific non-shared environmental influences. Our findings suggest that the co-occurrence of tics and obsessive-compulsive symptoms, and to a lesser extent attention-deficit/hyperactivity symptoms, can be partly explained by shared etiological influences. However, these phenotypes do not appear to be alternative expressions of the same underlying genetic liability. Further research examining sub-dimensions of these phenotypes may serve to further clarify the association between these disorders and identify more genetically homogenous symptom subtypes. © 2016 Wiley Periodicals, Inc.

Profile of the Immune and Inflammatory Response in Individuals With Prediabetes and Type 2 Diabetes.

The inflammatory and immune systems are altered in type 2 diabetes. Here, the aim was to profile the immune and inflammatory response in subjects with prediabetes and diabetes in a large population-representative sample. In total, 15,010 individuals were analyzed from the population-based Gutenberg Health Study. Glucose status was classified according to HbA1c concentration and history of diagnosis. All samples were analyzed for white blood cells (WBCs), granulocytes, lymphocytes, monocytes, platelets, C-reactive protein (CRP), albumin, fibrinogen, and hematocrit. Interleukin-18 (IL-18), IL-1 receptor antagonist (IL-1RA), and neopterin concentrations were determined in a subcohort. In total, 7,584 men and 7,426 women were analyzed (range 35-74 years), with 1,425 and 1,299 having prediabetes and diabetes, respectively. Biomarkers showed varying dynamics from normoglycemic via subjects with prediabetes to subjects with diabetes: 1) gradual increase (WBCs, granulocytes, monocytes, IL-1RA, IL-18, and fibrinogen), 2) increase with subclinical disease only (lymphocytes and CRP), 3) increase from prediabetes to diabetes only (neopterin), and 4) no variation with glucose status (hematocrit). The strongest relative differences were found for CRP, IL-1RA, and fibrinogen concentrations. Several inflammatory and immune markers were associated with the glucose status independent from cardiovascular risk factors and comorbidities, varied with disease severity and the presence of disease-specific complications in the diabetes subcohort. The inflammatory and immune biomarker profile varies with the development and progression of type 2 diabetes. Markers of inflammation and immunity enable differentiation between the early preclinical and clinical phases of the disease, disease complications, and progression.