Middle-aged Adult Population Research Articles

After CLASS – Is a voluntary public insurance program a realistic way to meet the long-term support and service needs of adults with disabilities?

BackgroundThe CLASS Act, which was part of the Affordable Care Act of 2010, established a voluntary personal assistance services (PAS) insurance program. However, concerns about enrollment and adverse selection led to repeal of the CLASS Act in 2013. ObjectivesTo estimate the number of middle-aged adults interested in purchasing PAS insurance, the sociodemographic, socioeconomic and disability attributes of this population, and the maximum monthly premium they would be willing to pay for such coverage. MethodsA total of 13,384 adults aged 40–65 answered questions about their interest in PAS insurance in the 2011 Sample Adult National Health Interview Survey. We applied survey weights for the U.S. population and conducted logistic regression analyses to identify personal factors associated with interest in paying for the CLASS program. ResultsAn estimated 25.8 million adults aged 40–65 (26.7%) said they would be interested in paying for a public insurance program to cover PAS benefits. However, interest in PAS insurance varied by age, race, ethnicity, region, income, disability status, and family experience with ADL assistance. Only 1.6 million adults aged 40–65 (1.8%) said they would be willing to pay $100 per month or more for coverage. ConclusionsWhile more than a quarter of the middle-aged adult population said they were interested in PAS insurance, actual participation would be highly dependent on premium rates. The current lack of publicly subsidized insurance for long-term care and personal assistance services remains a serious gap in the disability service system.

Concordance with DASH diet and blood pressure change: results from the Framingham Offspring Study (1991-2008).

Concordance with the Dietary Approaches to Stop Hypertension (DASH) diet has been shown to reduce blood pressure (BP) in short-term intervention studies, but long-term effects are unclear. We evaluated the association of DASH diet concordance with BP trajectories and incidence of hypertension, in 2187 men and women (mean age 52.5 years at baseline) participating in the Framingham Offspring cohort. Diet and BP were assessed from 1991 to 2008, with a median follow-up time of 13.4 years. DASH scores (ranging from 0 for worst to 10 for best concordance with DASH diet) were calculated by summing 10 food components that comprise the DASH diet pattern, including fruits and vegetables, low-fat dairy products, lean meat, and plant-based protein. Mixed-effect and Cox regression models were applied, to assess the association of DASH diet concordance with BP longitudinal change and with incidence of hypertension, respectively. All analyses were adjusted for age, sex, smoking status, history of diabetes, BMI, and physical activity. Overall, SBP increased by 0.34 mmHg and DBP by 0.10 mmHg annually, in the Framingham Offspring cohort. Every unit increase in the DASH score resulted in a modest increase in SBP of 0.054 mmHg/year (P = 0.028). No associations were observed between DASH diet concordance and DBP or incidence of hypertension. Long-term concordance with the DASH diet was not associated with a decreasing BP trajectory over time, or with decreased incidence of hypertension, in this population of middle-aged adults.

Association of macrolides with overall mortality and cardiac death among patients with various infections: A meta-analysis

BackgroundA large body of evidences suggested that macrolide therapy could improve the survival of patients with various infections. While in the same time, macrolides are known to increase fatal arrhythmogenic risks and cause cardiac death. To assess the risks and benefits of macrolide therapy, we systematically reviewed all studies of macrolide use, cardiac death and mortality among patients with various infections. MethodsWe searched Pubmed, Embase and Cochrane library and reviewed reference lists from 1980 through April 2015. Studies were included if they compared macrolides to other antibiotics in adults with various infections. The outcome measures were the overall mortality and the risk of cardiac death. ResultsOverall, macrolide use was associated with a statistically significant mortality reduction compared with nonmacrolide use (OR: 0.65, 95% CI: 0.46–0.92). There was no difference in the risk of cardiac death between macrolide and nonmacrolide regimes (OR: 1.43, 95% CI: 0.86–2.40). In subgroup analyses, macrolide use was found to be associated with the decreased risk of mortality in a population of older individuals (age>48years, OR: 0.69; 95% CI: 0.66–0.72). While in a general population of young and middle-aged adults, the use of macrolide-based regimens could not decrease the risk of death from any cause (age<48years, OR: 0.42; 95% CI: 0.02–11.01). As for cardiac death, macrolide use was found to be associated with increased risk of cardiac death in a population of older individuals (age>48years, OR: 1.99; 95% CI: 1.53–2.59). ConclusionDespite the potential cardiotoxic effects, there is a net benefit associated with macrolide use in older patients with various infections and macrolide use except roxithromycin was found to be associated with increased risk of cardiac death in a population of adults aged > 48 years.

Ten-Year Trends (2000-2010) of Overweight and Obesity Prevalence among the Young and Middle-Aged Adult Population of the Balearic Islands, a Mediterranean Region

Background and Aims: This article aimed at assessing the 10-year trends (2000-2010) in the prevalence of overweight and obesity among the Balearic Islands' adult population. Methods: Body mass index (BMI, kg/m²) for young (18-35 year-olds) and middle-aged (36-55 year-olds) adults living in the Balearics was calculated. Data represented 1,089 people during 1999-2000 and 1,081 people during 2009-2010. The BMI categories were as follows: normal weight (18.5 < 25), overweight (25.0 < 30) and obese (≥30). Results: Weighted frequency estimates and logistic regression analysis were used to calculate overweight and obesity trends. While the prevalence of overweight and obesity mostly remained stable over the 2000-2010 period, the prevalence of obesity increased from 5.1 to 8.3% in young adults (aged 18-35), a 1.66-fold increase in prevalence (95% CI 1.02-2.70) over the study period. Conclusions: Total overweight and obesity prevalence remained stable in the Balearic adult population; however, a rising prevalence of obesity has been observed in young adults, which suggests a need to develop and change current strategies in order to reverse the current trends in obesity among this age group.

Abstract P160: Ankle-Brachial Index and Fracture Hospitalization in Middle-Aged Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Background: Several studies indicate that lower extremity peripheral artery disease (PAD), commonly defined by an ankle-brachial index (ABI) &lt;0.9, can increase the risk of bone fracture via its impact on physical function and mobility. Because the majority of prior studies are limited to older white male populations (age ≥65 years), uncertainty remains regarding this association in non-whites, women, and younger individuals. Methods: We studied 15,160 ARIC participants (age 45-64 years in 1987-1989) whose ABI was measured in a randomly selected leg at baseline. Hip or lower extremity fracture-related diagnostic codes were identified through active surveillance of hospitalizations. We used Cox proportional hazards to estimate the independent association between ABI including high ABI (≥1.4), a condition shown in PAD with vascular stiffness, and incident fracture hospitalization, adjusting for potential confounders. Results: There were 668 hip or lower extremity fracture hospitalizations during a median follow-up of 22 years. In the crude model, there was a dose-response relationship between low ABI and fracture risk (Table). However, only ABI 0.9-1.1 remained statistically significant after demographic adjustment compared to normal ABI (1.1-1.4) and inclusion of other covariates rendered this association non-significant. The results were largely consistent among most demographic and clinical subgroups, but we observed increased risk of fracture in low ABI (&lt;0.9) among those with history of cardiovascular disease and high ABI (≥1.4) in men, in the fully adjusted model. Conclusion: An independent association of ABI with increased risk of hip or lower extremity fracture hospitalization was not that evident overall in our biracial population of middle-aged adults. However, ABI may contribute to increased risk of fracture in subgroups, warranting further investigation.

Síndrome de apnea/hipopnea obstructiva del sueño y su asociación con las enfermedades cardiovasculares

IntroductionThe Obstructive Sleep Apnea Hypopnea Syndrome has gained importance has gained importance in recent years, with an estimated prevalence in population of middle-aged adults around 4 and 2% in men and women respectively, and that given its frequency constitutes a public health problem. ObjectiveTo show, after a thorough analysis of the available literature, the association between the Obstructive Sleep Apnea Hypopnea Syndrome and cardiovascular diseases. MethodA narrative review was made from the literature found at the most recognized databases. Fifty nine studies published in the last thirty years were included and reports and case series were excluded. ConclusionsThe Obstructive Sleep Apnea Hypopnea Syndrome is recognized today as a global public health problem. Latin America, specifically Colombia, requires prospective cohort studies that serve as a guideline for the continent's population and that could indicate possible differences compared to the international community regarding early diagnosis and treatment, and its impact in cardiovascular outcomes of these patients.

Prevalence and risk factors of arthritis in a middle-aged and older Chinese population: the China health and retirement longitudinal study.

The aims of this study were to estimate the prevalence of arthritis and to identify risk factors of arthritis in a middle-aged and older Chinese adult population. The China Health and Retirement Longitudinal Study (CHARLS) national survey data were used to estimate overall arthritis prevalence and prevalence by age and gender groups taking into account the complex survey design and response rate. The PROC SURVEYLOGISTIC procedure (SAS 9.3; SAS Institute, Cary, NC, USA) was applied to identify factors associated with arthritis using the CHARLS national survey data. Significant factors were further evaluated in the longitudinal CHARLS pilot study. The overall prevalence of arthritis among middle-aged and older Chinese adults was 31.4% (95% CI 30.3, 32.4). Prevalence increased with age. Females had a higher prevalence of arthritis than males in each age group. In the cross-sectional analysis, age, gender, education, BMI, sleep duration, vigorous physical activity and self-reported doctor-diagnosed chronic lung disease, hypertension, chronic liver disease, cardiovascular disease, stroke, chronic kidney disease and chronic digestive disease were associated with arthritis. Age, gender, vigorous physical activity and cardiovascular disease were confirmed to be risk factors of arthritis in the longitudinal analysis. Participants with cardiovascular disease were 1.67 times (95% CI 1.02, 2.74) more likely to have self-reported arthritis in a 4-year period of follow-up in the CHARLS pilot study. Middle-aged and older Chinese adults had a high prevalence of arthritis. Cardiovascular disease is a novel risk factor for arthritis in this population.

Transportation in an Age-Diverse Society

In our rapidly diversifying society the needs of sometimes vastly different populations must be considered. The current population is made up of a greater number of older adults, “Baby Boomers” and younger adults “Millenials” than the current middle aged-adult population. These two generations have consistently forced change on many fronts, and will continue to do so, particularly in the area of transportation. This panel is intended to address transportation research and design needs in our ever-diversifying society, from driver-interface (DVI) design to public transportation needs, from increased safety systems to the integration of technology for our navigation of various forms of transportation. Specifically, needs that might require researchers to consider the design of systems to address the sometimes conflicting abilities, desires, cultural and demographic factors, and personal goals related to age groups separated by anywhere from 20 to 60 years in age. Panelists included have a broad range of expertise working with technology, transportation, and both older and younger adult population groups.

A dose-ranging study of MF59®-adjuvanted and non-adjuvanted A/H1N1 pandemic influenza vaccine in young to middle-aged and older adult populations to assess safety, immunogenicity, and antibody persistence one year after vaccination

Background During development of an A/H1N1 pandemic influenza vaccine, this study was performed to identify the antigen and adjuvant content which would provide optimal antibody response and persistence in adults and the elderly. Dose-sparing strategies, such as inclusion of adjuvants, are critical in ensuring the widest possible population coverage in the event of an influenza pandemic, despite a limited global capacity for vaccine manufacture.Methods Healthy subjects aged 18−64 years (n = 1240) and ≥65 years (n = 1352) were vaccinated with 1 of 8 investigational vaccine formulations varying in antigen quantity (3.75 µg to 30 µg of hemagglutinin) and MF59® adjuvant (none, half dose, or full dose). All subjects received 2 vaccine doses administered 3 weeks apart. Antibody response was assessed by hemagglutination inhibition assay 1 and 3 weeks after administration of first and second doses. Antibody persistence was assessed after 6 and 12 mo. Vaccine safety was monitored over 12 mo.Results All 8 investigational A/H1N1 vaccine formulations were well tolerated, and rapidly induced high antibody titers which met all of the Center for Biologics Evaluation and Research (CBER) and Committee for Medicinal Products for Human Use (CHMP) licensure criteria 3 weeks after one dose. The highest antibody titers were observed in participants vaccinated with higher quantities of antigen and adjuvant.Conclusion A single vaccine dose containing 3.75 µg of A/California/7/2009 (H1N1) antigen with MF59 adjuvant was identified as optimal for young to middle-aged (18−64 years) and older (≥65 years) adult populations.

Relationship Between Hematocrit Level and Cardiovascular Risk Factors in a Community-Based Population.

This study aimed to determine the relationship between hematocrit (HCT) levels and cardiovascular risk factors in a community-based population of middle-aged adults. From April 2011 to February 2012, a total of 1,884 middle-aged adults were selected from a community-based population in China. Blood and urine samples were collected for routine blood and urine tests, and measurement of plasma glucose and lipid levels. Baseline information including traditional cardiovascular risk factors was obtained by standard questionnaire to analyze. We evaluated the distribution of the HCT values for middle-aged adults with or without cardiovascular risk factors. There were 548 males and 1,336 females in this study. The mean age of all subjects was 54.7 ± 6.7 years. There were 1,209 subjects with risk factors and 675 without risk factors. The HCT levels in subjects with risk factors were higher than those without risk factors (P = 0.005). According to a simplified tool for evaluation of the 10-year risk of ischemic cardiovascular diseases (CVDs) in Chinese populations, all subjects were divided into four groups: the ultralow-risk group (1,367, 72.6%), low-risk group (232, 12.3%), intermediate-risk group (201, 10.7%), and high-risk/ultrahigh-risk group (84, 4.4%). Compared with HCT levels in the ultralow-risk group, significant differences were found in the low-risk, intermediate-risk, and high-risk/ultrahigh-risk groups (all P < 0.05). Our results indicate that elevated HCT levels may be positively associated with cardiovascular risk factors. Thus, the combination of HCT values and cardiovascular risk factors may enable early diagnosis of CVDs.

Exploring the lived experiences of middle-aged males diagnosed with chronic kidney disease

The majority of studies addressing chronic kidney disease (CKD) have been quantitative. The lived experiences of patients with early stage CKD have not been explored in the literature. Due to the lack of symptoms during the early stages of CKD, the progress of this disease is often ignored. This study explores the lived experiences of middle-aged males diagnosed with CKD. Research focuses on the work experiences, interpersonal relationships, and dietary habits of this group. This qualitative study used a narrative research method with purposive sampling. Ten middle-aged male patients were interviewed. We employed the 3 strategies of member checks, peer review, and debriefing in order to enhance the trustworthiness of the data analysis. Four major themes were identified: (1) keeping the same life pace as usual with concerns of deterioration; (2) continuing to support their family and play the role of father; (3) hoping to participate in family and friend relationships despite the illness; and (4) being challenged to maintain a healthy diet. Although the physical status of participants was similar to the general middle-aged adult population, participants were concerned regarding disease deterioration. The results of this study suggest that health professionals: (1) provide appropriate information based on patients' personality, particularly at the first onset or apparent deterioration of the disease; (2) offer specialized healthcare information to patients relevant to their career choices; and (3) understand CKD-patient difficulties in daily life such as eating out habits and challenges faced in maintaining a healthy diet. Results may provide important information to healthcare providers in education planning and implementation and support programs for patients and families.

Response to Letter to the Editor from Dr. Safer et al. regarding the article “Age-related changes in body composition in a sample of Czech women aged 18–89 years: a cross-sectional study,” published in European Journal of Nutrition

We appreciate that Dr. Umut Safer and his colleagues considered our study [1] interesting and recommended it to readers of the European Journal of Nutrition. With regards to the letter from Safer et al. about our recent publication, our responses to the letter are as follows. In the Letter to the Editor, Safer et al. argued that pretesting preparation is necessary to maximize the accuracy of the direct segmental multi-frequency bioelectrical impedance analysis (BIA). We agree with this statement and guarantee that all participants were asked to fast for 2 h, to avoid any vigorous physical activity for at least 48 h before the procedure, and to urinate or defecate before the measurements were taken. To comply with the standard conditions of measurement, we excluded those who use diuretics or are undergoing diuretic therapy. Safer et al. have noted in their letter that we calculated fat-free mass (FFM) by an equation based on total body water (TBW) measurement, but this was not referenced. We would like to respond to this comment. In ‘‘Methods,’’ we described the principles for estimate body composition via BIA. According to Thibault et al. [2], the measurement of total body impedance allows estimation of TBW, and, by assuming that TBW is constant, FFM which contains body water. InBody 720 (Biospace Co., Ltd.; Seoul, Korea) estimates FFM by dividing TBW by constant. TBW was estimated from area, volume, length, impedance, and a constant proportion. In contrast to single-frequency devices, InBody 720 uses multiple-frequency technology which improves the estimation of FFM, and, hence, body fat, by determining intracellular and extracellular water. Finally, Safer et al. highlighted that validity of segmental multi-frequency BIA was referenced by the study of Ling et al. [3] that describes Korean middle-aged adult population. We dare to disagree with this statement because the study sample of the study mentioned above includes participants from Leiden Longevity Study (Netherlands). Although Mally et al. [4] reported that actual BIA equations should be revised, we have to point out that the authors of the study used single-frequency device (Tanita BC-418 MA) and the study participants were over 60 years old. And hence, this conclusion should not be generalized for all BIA devices and all age groups.

Use of Azithromycin and Death from Cardiovascular Causes

BackgroundAzithromycin use is associated with an increased risk of death from cardiovascular causes among patients at high baseline risk. Whether azithromycin confers a similar risk in the unselected general population is unknown.MethodsWe conducted a nationwide historical cohort study involving Danish adults (18 to 64 years of age), linking registry data on filled prescriptions, causes of death, and patient characteristics for the period from 1997 through 2010. We estimated rate ratios for death from cardiovascular causes, comparing 1,102,050 episodes of azithromycin use with no use of antibiotic agents (matched in a 1:1 ratio according to propensity score, for a total of 2,204,100 episodes) and comparing 1,102,419 episodes of azithromycin use with 7,364,292 episodes of penicillin V use (an antibiotic with similar indications; analysis was conducted with adjustment for propensity score).ResultsThe risk of death from cardiovascular causes was significantly increased with current use of azithromycin (defined as a 5-day treatment episode), as compared with no use of antibiotics (rate ratio, 2.85; 95% confidence interval [CI], 1.13 to 7.24). The analysis relative to an antibiotic comparator included 17 deaths from cardiovascular causes during current azithromycin use (crude rate, 1.1 per 1000 person-years) and 146 during current penicillin V use (crude rate, 1.5 per 1000 person-years). With adjustment for propensity scores, current azithromycin use was not associated with an increased risk of cardiovascular death, as compared with penicillin V (rate ratio, 0.93; 95% CI, 0.56 to 1.55). The adjusted absolute risk difference for current use of azithromycin, as compared with penicillin V, was −1 cardiovascular death (95% CI, −9 to 11) per 1 million treatment episodes.ConclusionsAzithromycin use was not associated with an increased risk of death from cardiovascular causes in a general population of young and middle-aged adults. (Funded by the Danish Medical Research Council.)

Prevalence and risk factors of chronic kidney disease in middle-aged and older adults in Shanghai Pudong New District

Objective To investigate the prevalence and risk factors of chronic kidney disease (CKD) in middle-aged and older adult population in Shanghai Pudong New District.Methods Two thousand residents aged 45 years and above were randomly selected for questionnaire survey and health check-up in Shanghai Pudong New District from July 2006 to October 2010.The laboratory examinations were also performed including the urine routine,urinary protein to creatinine ratio,serum creatinine,blood glucose and lipids.The glomerular filtration rate (eGFR) was estimated by simplified Chinese MDRD (modification of Diet in Renal Disease) equation.SPSS 13.0 statistical software was used for statistical analysis.Results Among 1905 residents who completed survey and examinations,the adjusted prevalence of albuminuria was 12.0％ (95％ CI:0.105-0.135) and of eGFR less than 60 ml · min-1 · 1.73 m-2 was 1.9％ (95 ％ CI: 0.172-0.213).The prevalence of CKD was 12.6％ (95 ％ CI: 0.112-0.142).Logistic regression analysis revealed that age (OR =1.043),hypertension (OR =2.272),diabetes mellitus (OR =1.233)and hyperuricemia (OR =1.003)were independently associated with CKD.Conclusions The prevalence of CKD in adult residents (≥45 years) from Shanghai Pudong New District is high.It is necessary to carry out early screening and to intervene risk factors of CKD in middle-aged and older residents. Key words: Nephrosis; Prevalence; Risk factor

A Review on Advanced Atrioventricular Block in Young or Middle‐Aged Adults

Complete atrioventricular block is a relatively uncommon arrhythmia that is nonetheless increasingly seen in elderly people of developed countries, due to the increase in life expectancy. Congenital and degenerative etiologies are the most commonly seen among young and old patients, respectively. However, scientific literature is surprisingly scarce regarding the etiology of complete atrioventricular block in the asymptomatic otherwise healthy young and middle-aged adult population. Coronary artery disease, autoimmune disorders such as systemic lupus erythematosus or rheumatoid arthritis, history of acute or chronic infectious or hypersensitivity myocarditis, infiltrative processes, hypothyroidism, congenital cardiopathies such as left ventricular noncompaction or Ebstein anomaly, lamin A/C mutations, and pathologic hypervagotony and idiopathic degenerative scleroatrophy of the atrioventricular junctional specialized tissue (Lenegre-Lev disease) are among the most frequent etiologies of complete atrioventricular block in young or middle-aged adults. To our knowledge, no comprehensive review on the specificities of the investigation warranted in this age group has ever been developed, nor have the implications of particular diagnoses on treatment modalities been appropriately addressed. We aim at reviewing the most frequent differential diagnoses of advanced atrioventricular block in otherwise healthy asymptomatic or mildly symptomatic young or middle-aged adults and their impact on therapeutic options. Additionally, we suggest a diagnostic algorithm that may be helpful in this group of patients.

Abstract P223: Larger Effect Sizes of Established BMI Genetic Variants During Adolescence, a Vulnerable Period of Weight Gain

In the past five years genome-wide association studies (GWAS) have identified common genetic loci associated with body mass index (BMI) mainly in European middle-aged adult populations. The influence of these loci in adolescence, a period of risk for weight gain, and whether there are different associations across adolescent groups at highest risk (e.g., ethnic minority populations), remains largely unknown. We examined whether obesity susceptibility loci identified from previous GWAS in adults were associated with BMI in an ethnically diverse adolescent cohort. Using 8918 participants from the National Longitudinal Study of Adolescent Health, or Add Health (aged 12-21 years in 1996, 52.6 % female), we assessed the association of 43 SNPs, selected based on statistical significance in previous GWAS, with BMI across four ethnic US subpopulations (5,296 European Americans, EA, 1,815 African Americans, AfA, 1,356 Hispanic Americans, HA, and 451 Asian Americans, AsA). Buccal cells from participants were extracted and genotyped using TaqMan (sample call rate: 97.5%, SNP call rate: 100%). Inverse normal transformed BMI residuals, adjusted for gender and age, were used in ethnicity-stratified models with SNPs in PLINK, assuming an additive model. An inverse-variance-weighted meta-analysis was used to combine results across the 4 ethnic groups. Average BMI across all ethnic groups was 23.6±5.2 kg/m2, ranging from 22.6±5.2 kg/m2 in AsA to 24.3±5.8 kg/m2 in AfA. The effect estimates for all 43 SNPs were directionally consistent across ethnicity with previously published results. Of the 43 SNPs, 20 were associated with BMI at p&lt;0.05 in the meta-analysis (17 in EA, 7 in AfA, 4 in HA, and 5 in AsA). Based on t-test comparisons, 16 of the 20 SNPs had larger and 2 loci had smaller effect sizes (p&lt;0.05) in the Add Health adolescent sample than published effect sizes for BMI in adults. Only FTO (rs9939609) showed significant heterogeneity across ethnicity (p=0.01 for I2=73.5). TMEM18 (rs6548238, meta-analysis p-value p=1.32E-10), had one of the largest differences in effect size compared to middle-aged European adults (Willer et al 2009) with a per allele increase of 0.70±0.11 kg/m2 in this sample versus 0.26±0.07 kg/m2 in adults (beta[SE] difference = 0.44[0.08]; p=1.4E-08). Variants associated with BMI in adults were also associated with BMI in adolescents, with some comparatively larger effects during this vulnerable period. R01HD057194

The effect of leisure activity golf practice on motor imagery: an fMRI study in middle adulthood

Much is known about practice-induced plasticity of the motor system. But it is not clear how a physical training influences the mental rehearsal of the practiced task and its associated hemodynamic responses. In the present longitudinal study with two measurement time-points, we used the method of functional magnetic resonance imaging (fMRI) and a motor imagery task, in order to explore the dynamic neuro-functional changes induced by a highly complex physical training. The 11 golf novices between the age of 40 and 60 years practiced the motor training as leisure activity. Additionally, data from an age and sex-matched control group without golf training was collected. As a main result, we demonstrate that changes between the two measurement time-points were only found in the golf novice group. The golf novices showed a decrease in hemodynamic responses during the mental rehearsal of the golf swing in non-primary motor areas after the 40 h of golf practice. Thus, the results indicate that a complex physical leisure activity induces functional neuroplasticity in the seldom studied population of middle-aged adults, and that this effect is evident during mental rehearsal of the practiced task. This finding supports the idea that (a) a skill improvement is associated with a modified activation pattern in the associated neuronal network that can be identified during mental rehearsal of the practiced task, and that (b) a strict training protocol is not necessary to induce functional neuroplasticity.

Enfermedad arterial periférica asintomática estimada mediante el índice tobillo-brazo en pacientes con infección por el VIH: prevalencia y factores de riesgo asociados

Human immunodeficiency virus (HIV) infection has been associated with a higher risk of subclinical atherosclerosis and cardiovascular events. Peripheral arterial disease (PAD) is a good marker of systemic atherosclerosis and a powerful predictor of cardiovascular morbidity and mortality. The objective of this study was to determine the prevalence of asymptomatic PAD and associated risk factors in HIV-infected people. Cross-sectional study was conducted on all consecutive HIV-positive patients older than 20 years without symptoms of intermittent claudication who attended our clinic between November 2008 and December 2009. PAD was assessed by measuring the ankle-brachial index (ABI) at rest. To define PAD, an ABI ≤ 0.90 was used. Main epidemiological and clinical characteristics of the HIV infection and cardiovascular risk factors (CVRF) were recorded. Two hundred and five patients were evaluated (66.8% male), with a mean age of 41 years and there was a median of 2 CVRF (63.9% smokers). Prevalence of asymptomatic PAD (ABI ≤ 0.90) was 6.3% (n=13). There was only 1 patient with a high ABI (>1.40). In the multivariate analysis, factors significantly associated with PAD were overweight (adjusted odds ratio [ORadj] 4.21; 95% confidence interval [CI] 1.00-18.78), obesity (ORadj 5.76; 95% CI 1.17-28.37) and clinical stage C of HIV infection (ORadj 2.95; 95% CI 1.00-9.83). Prevalence of asymptomatic PAD in a relatively young HIV-infected cohort is similar to that observed in the uninfected middle-aged adult population. Overweight, obesity and advanced clinical stage of HIV infection (AIDS-defining conditions) were identified as independent risk factors for PAD.

Accuracy of direct segmental multi-frequency bioimpedance analysis in the assessment of total body and segmental body composition in middle-aged adult population

Body composition measurement is a valuable tool for assessing nutritional status and physical fitness in a variety of clinical settings. Although bioimpedance analysis (BIA) can easily assess body composition, its accuracy remains unclear. We examined the accuracy of direct segmental multi-frequency BIA technique (DSM-BIA) in assessing different body composition parameters, using dual energy X-ray absorptiometry (DEXA) as a reference standard. A total of 484 middle-aged participants from the Leiden Longevity Study were recruited. Agreements between DSM-BIA and DEXA for total and segmental body composition quantification were assessed using intraclass correlation coefficients and Bland-Altman plots. Excellent agreements were observed between both techniques in whole body lean mass (ICC female=0.95, ICC men=0.96), fat mass (ICC female=0.97, ICC male=0.93) and percentage body fat (ICC female=0.93, ICC male=0.88) measurements. Similarly, Bland-Altman plots revealed narrow limits of agreements with small biases noted for the whole body lean mass quantification but relatively wider limits for fat mass and percentage body fat quantifications. In segmental lean muscle mass quantification, excellent agreements between methods were demonstrated for the upper limbs (ICC female≥0.91, ICC men≥0.87) and lower limbs (ICC female≥0.83, ICC male≥0.85), with good agreements shown for the trunk measurements (ICC female=0.73, ICC male=0.70). DSM-BIA is a valid tool for the assessments of total body and segmental body composition in the general middle-aged population, particularly for the quantification of body lean mass.

Dopamine Receptors

Essential hypertension, which affects 25% of the middle-aged adult population, constitutes a major risk factor for stroke, myocardial infarction, and heart and kidney failure.1 The kidney, vasculature, and nervous system govern the long-term control of blood pressure by regulating sodium homeostasis and peripheral resistance; they, in turn, are influenced by numerous hormones and neural and humoral factors. These hormones and neural and humoral factors can be divided into 2 groups based on their effects on sodium excretion and vascular smooth muscle contractility. One group leads to natriuresis and vasodilation whereas the other causes sodium retention and vasoconstriction. The balance between those 2 groups keeps the blood pressure within the normal range. Hypertension may be caused not only by increased activity of prohypertensive systems (for example, the renin-angiotensin system [RAS] and sympathetic nervous system) but also by defects in antihypertensive systems that serve as counterregulatory mechanisms. Aberrations in these counterregulatory pathways, which include the dopaminergic pathway, may be involved in the pathogenesis of essential hypertension. Dopamine has been shown to be an important regulator of renal and hormonal function and, ultimately, blood pressure, through an independent, nonneural dopaminergic system.2 There is a difference in the synthesis and metabolism of dopamine in neural and nonneural cells (see following paragraphs). For example, dopamine synthesized in renal proximal tubule (RPT) cells is not converted into norepinephrine and epinephrine; it is transported across the basolateral and apical membranes and into the peritubular space and tubular lumen, respectively, where it acts on its receptors locally and in more distal nephron segments. Dopamine, by occupation of its specific receptors as well by direct or indirect interaction with other G protein–coupled receptors (for example, adenosine, angiotensin, endothelin, insulin, oxytocin, and vasopressin) and interaction with other hormones/humoral agents (for example, aldosterone, angiotensins, atrial natriuretic peptide, eicosanoids, insulin, …