Publications by authors named "Rachel S Newson"

24 Publications

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A systematic literature review and network meta-analysis feasibility study to assess the comparative efficacy and comparative effectiveness of pneumococcal conjugate vaccines.

Hum Vaccin Immunother 2019 19;15(11):2713-2724. Epub 2019 Jun 19.

ICON plc, Houten, The Netherlands.

: No head-to-head studies are currently available comparing pneumococcal non-typeable protein D conjugate vaccine (PHiD-CV) with 13-valent pneumococcal conjugate vaccine (PCV-13). This study explored the feasibility of using network meta-analysis (NMA) to conduct an indirect comparison of the relative efficacy or effectiveness of the two vaccines.: A systematic literature search was conducted for published randomized controlled trials (RCTs) and non-RCT studies reporting data on vaccine efficacy or effectiveness against invasive pneumococcal disease in children aged <5 years receiving 7-valent pneumococcal conjugate vaccine (PCV-7), PHiD-CV or PCV-13. Study quality was evaluated using published scales. NMA feasibility was assessed by considering whether a connected network could be constructed by examining published studies for differences in study or patient characteristics that could act as potential treatment effect modifiers or confounding variables.: A total of 26 publications were included; 2 RCTs (4 publications), 7 indirect cohort studies, and 14 case-control studies (15 publications). Study quality was generally good. The RCTs could not be connected in a network as there was no common comparator. The studies differed considerably in design, dose number, administration schedules, and subgroups analyzed. Reporting of exposure status and subject characteristics was inconsistent.: NMA to compare the relative efficacy or effectiveness of PHiD-CV and PCV-13 is not feasible on the current evidence base, due to the absence of a connected network across the two RCTs and major heterogeneity between studies. NMA may be possible in future if sufficient RCTs become available to construct a connected network.
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http://dx.doi.org/10.1080/21645515.2019.1612667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930063PMC
May 2020

The comparative efficacy and safety of herpes zoster vaccines: A network meta-analysis.

Vaccine 2019 05 11;37(22):2896-2909. Epub 2019 Apr 11.

ICON plc, De Molen 84, Houten 3995 AX, the Netherlands.

Background: We estimated the relative efficacy and safety of vaccines for prevention of herpes zoster (HZ) using network meta-analysis (NMA) based on evidence from randomized controlled trials.

Methods: A systematic literature review evaluated two different HZ vaccines: adjuvanted recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL), with different formulations assessed. Detailed feasibility assessment indicated that a NMA was feasible for efficacy (incidence of HZ and postherpetic neuralgia [PHN]) and safety (serious adverse events [SAE] and reactogenicity [injection-site reactions, systemic reaction]) outcomes. Primary analyses included frequentist NMAs with fixed effects for efficacy outcomes, due to limited data availability, and both fixed and random effects for safety and reactogenicity outcomes. As age is a known effect modifier of vaccine efficacy (VE), VE analyses were stratified by age.

Results: RZV demonstrated significantly higher HZ efficacy than ZVL in adults ≥60 years of age (YOA) (VE = 0.92 (95% confidence interval [95%CI]: 0.88, 0.94), VE = 0.51 (95%CI: 0.44, 0.57)) and adults ≥70 YOA (VE = 0.91 (95%CI: 0.87, 0.94), VE = 0.37 (95%CI: 0.25, 0.48)). Similarly, RZV demonstrated significantly higher PHN efficacy than ZVL in adults ≥60 YOA (VE = 0.89 (95%CI: 0.70, 0.96), VE = 0.66 (95%CI: 0.48, 0.78)) and adults ≥70 YOA (VE = 0.89 (95%CI: 0.69, 0.96), VE = 0.67 (95%CI: 0.44, 0.80)). RZV was associated with significantly more injection-site and systemic reactions compared to most formulations of ZVL and placebo, however definitions and data collection procedures differed across the included studies. There were no statistically significant differences found between RZV and any formulation of ZVL or placebo for SAEs.

Conclusion: RZV is significantly more effective in reducing HZ and PHN incidence in adults ≥60 YOA, compared with ZVL. As anticipated with an adjuvanted vaccine, RZV results in more reactogenicity following immunization. No differences in SAEs were found between RZV and ZVL.
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http://dx.doi.org/10.1016/j.vaccine.2019.04.014DOI Listing
May 2019

Dietary Impact of Adding Potassium Chloride to Foods as a Sodium Reduction Technique.

Nutrients 2016 Apr 21;8(4):235. Epub 2016 Apr 21.

Unilever R&D Vlaardingen, Olivier van Noortlaan 120, Vlaardingen 3133 AT, The Netherlands.

Potassium chloride is a leading reformulation technology for reducing sodium in food products. As, globally, sodium intake exceeds guidelines, this technology is beneficial; however, its potential impact on potassium intake is unknown. Therefore, a modeling study was conducted using Dutch National Food Survey data to examine the dietary impact of reformulation (n = 2106). Product-specific sodium criteria, to enable a maximum daily sodium chloride intake of 5 grams/day, were applied to all foods consumed in the survey. The impact of replacing 20%, 50% and 100% of sodium chloride from each product with potassium chloride was modeled. At baseline median, potassium intake was 3334 mg/day. An increase in the median intake of potassium of 453 mg/day was seen when a 20% replacement was applied, 674 mg/day with a 50% replacement scenario and 733 mg/day with a 100% replacement scenario. Reformulation had the largest impact on: bread, processed fruit and vegetables, snacks and processed meat. Replacement of sodium chloride by potassium chloride, particularly in key contributing product groups, would result in better compliance to potassium intake guidelines (3510 mg/day). Moreover, it could be considered safe for the general adult population, as intake remains compliant with EFSA guidelines. Based on current modeling potassium chloride presents as a valuable, safe replacer for sodium chloride in food products.
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http://dx.doi.org/10.3390/nu8040235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848703PMC
April 2016

Serum vitamin B12 is inversely associated with periodontal progression and risk of tooth loss: a prospective cohort study.

J Clin Periodontol 2016 Jan 18;43(1):2-9. Epub 2016 Jan 18.

Unit of Periodontology, University Medicine, Ernst-Moritz-Arndt University Greifswald, Greifswald, Germany.

Aim: The aim of this study was to investigate the association of serum vitamin B12 with the progression of periodontitis and risk of tooth loss in a prospective cohort study.

Materials And Methods: In the Study of Health in Pomerania, 1648 participants were followed from 2002-2006 to 2008-2012 (mean duration 5.9 years). Serum vitamin B12 was measured by chemiluminescent enzyme immunoassay. Probing pocket depth (PD) and clinical attachment loss (CAL) were measured to reflect periodontal status on a half-mouth basis at each survey cycle. Tooth numbers are based upon a full-mouth tooth count.

Results And Conclusions: In multivariate regression models, baseline vitamin B12 was inversely associated with changes in mean PD (Ptrend = 0.06) and mean CAL (Ptrend = 0.01), and risk ratios of tooth loss (TL; Ptrend = 0.006) over time. Compared to participants in the highest vitamin B12 quartile, those in the lowest quartile had 0.10 mm (95%CI: 0.03, 0.17; Pdifference = 0.007) greater increase in mean PD, 0.23 mm (95%CI: 0.09, 0.36; Pdifference = 0.001) greater increase in mean CAL and a relative risk of 1.57 (95%CI: 1.22, 2.03; Pdifference < 0.001) for TL. Stratified analyses showed stronger associations between vitamin B12 and changes in mean CAL among never smokers (Pinteraction = 0.058). Further studies are needed to understand the potential mechanisms of these findings.
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http://dx.doi.org/10.1111/jcpe.12483DOI Listing
January 2016

Serum α-Tocopherol Has a Nonlinear Inverse Association with Periodontitis among US Adults.

J Nutr 2015 May 11;145(5):893-9. Epub 2015 Feb 11.

Unilever Research and Development, Vlaardingen, The Netherlands;

Background: Previous experimental models suggest that vitamin E may ameliorate periodontitis. However, epidemiologic studies show inconsistent evidence in supporting this plausible association.

Objective: We investigated the association between serum α-tocopherol (αT) and γ-tocopherol (γT) and periodontitis in a large cross-sectional US population.

Methods: This study included 4708 participants in the 1999-2001 NHANES. Serum tocopherols were measured by HPLC and values were adjusted by total cholesterol (TC). Periodontal status was assessed by mean clinical attachment loss (CAL) and probing pocket depth (PPD). Total periodontitis (TPD) was defined as the sum of mild, moderate, and severe periodontitis. All measurements were performed by NHANES.

Results: Means ± SDs of serum αT:TC ratio from low to high quartiles were 4.0 ± 0.4, 4.8 ± 0.2, 5.7 ± 0.4, and 9.1 ± 2.7 μmol/mmol. In multivariate regression models, αT:TC quartiles were inversely associated with mean CAL (P-trend = 0.06), mean PPD (P-trend < 0.001), and TPD (P-trend < 0.001) overall. Adjusted mean differences (95% CIs) between the first and fourth quartile of αT:TC were 0.12 mm (0.03, 0.20; P-difference = 0.005) for mean CAL and 0.12 mm (0.06, 0.17; P-difference < 0.001) for mean PPD, whereas the corresponding OR for TPD was 1.65 (95% CI: 1.26, 2.16; P-difference = 0.001). In a dose-response analysis, a clear inverse association between αT:TC and mean CAL, mean PPD, and TPD was observed among participants with relatively low αT:TC. No differences were seen in participants with higher αT:TC ratios. Participants with γT:TC ratio in the interquartile range showed a significantly lower mean PPD than those in the highest quartile.

Conclusions: A nonlinear inverse association was observed between serum αT and severity of periodontitis, which was restricted to adults with normal but relatively low αT status. These findings warrant further confirmation in longitudinal or intervention studies.
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http://dx.doi.org/10.3945/jn.114.203703DOI Listing
May 2015

Web-based self-assessment health tools: who are the users and what is the impact of missing input information?

J Med Internet Res 2014 Sep 26;16(9):e215. Epub 2014 Sep 26.

Nutrition & Health Department, Unilever Research & Development, Vlaardingen, Netherlands.

Background: Web-based health applications, such as self-assessment tools, can aid in the early detection and prevention of diseases. However, there are concerns as to whether such tools actually reach users with elevated disease risk (where prevention efforts are still viable), and whether inaccurate or missing information on risk factors may lead to incorrect evaluations.

Objective: This study aimed to evaluate (1) evaluate whether a Web-based cardiovascular disease (CVD) risk communication tool (Heart Age tool) was reaching users at risk of developing CVD, (2) the impact of awareness of total cholesterol (TC), HDL-cholesterol (HDL-C), and systolic blood pressure (SBP) values on the risk estimates, and (3) the key predictors of awareness and reporting of physiological risk factors.

Methods: Heart Age is a tool available via a free open access website. Data from 2,744,091 first-time users aged 21-80 years with no prior heart disease were collected from 13 countries in 2009-2011. Users self-reported demographic and CVD risk factor information. Based on these data, an individual's 10-year CVD risk was calculated according to Framingham CVD risk models and translated into a Heart Age. This is the age for which the individual's reported CVD risk would be considered "normal". Depending on the availability of known TC, HDL-C, and SBP values, different algorithms were applied. The impact of awareness of TC, HDL-C, and SBP values on Heart Age was determined using a subsample that had complete risk factor information.

Results: Heart Age users (N=2,744,091) were mostly in their 20s (22.76%) and 40s (23.99%), female (56.03%), had multiple (mean 2.9, SD 1.4) risk factors, and a Heart Age exceeding their chronological age (mean 4.00, SD 6.43 years). The proportion of users unaware of their TC, HDL-C, or SBP values was high (77.47%, 93.03%, and 46.55% respectively). Lacking awareness of physiological risk factor values led to overestimation of Heart Age by an average 2.1-4.5 years depending on the (combination of) unknown risk factors (P<.001). Overestimation was greater in women than in men, increased with age, and decreased with increasing CVD risk. Awareness of physiological risk factor values was higher among diabetics (OR 1.47, 95% CI 1.46-1.50 and OR 1.74, 95% CI 1.71-1.77), those with family history of CVD (OR 1.22, 95% CI 1.22-1.23 and OR 1.43, 95% CI 1.42-1.44), and increased with age (OR 1.05, 95% CI 1.05-1.05 and OR 1.07, 95% CI 1.07-1.07). It was lower in smokers (OR 0.52, 95% CI 0.52-0.53 and OR 0.71, 95% CI 0.71-0.72) and decreased with increasing Heart Age (OR 0.92, 95% CI 0.92-0.92 and OR 0.97, 95% CI 0.96-0.97) (all P<.001).

Conclusions: The Heart Age tool reached users with low-moderate CVD risk, but with multiple elevated CVD risk factors, and a heart age higher than their real age. This highlights that Web-based self-assessment health tools can be a useful means to interact with people who are at risk of developing disease, but where interventions are still viable. Missing information in the self-assessment health tools was shown to result in inaccurate self-health assessments. Subgroups at risk of not knowing their risk factors are identifiable and should be specifically targeted in health awareness programs.
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http://dx.doi.org/10.2196/jmir.3146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211033PMC
September 2014

Behaviour change for better health: nutrition, hygiene and sustainability.

BMC Public Health 2013 21;13 Suppl 1:S1. Epub 2013 Mar 21.

Unilever Research and Development, Olivier van Noortlaan 120, 3133 AT Vlaardingen, the Netherlands.

As the global population grows there is a clear challenge to address the needs of consumers, without depleting natural resources and whilst helping to improve nutrition and hygiene to reduce the growth of noncommunicable diseases. For fast-moving consumer goods companies, like Unilever, this challenge provides a clear opportunity to reshape its business to a model that decouples growth from a negative impact on natural resources and health. However, this change in the business model also requires a change in consumer behaviour. In acknowledgement of this challenge Unilever organised a symposium entitled 'Behaviour Change for Better Health: Nutrition, Hygiene and Sustainability'. The intention was to discuss how consumers can be motivated to live a more healthy and sustainable lifestlye in today's environment. This article summarises the main conclusions of the presentations given at the symposium. Three main topics were discussed. In the first session, key experts discussed how demographic changes - particularly in developing and emerging countries - imply the need for consumer behaviour change. The second session focused on the use of behaviour change theory to design, implement and evaluate interventions, and the potential role of (new or reformulated) products as agents of change. In the final session, key issues were discussed regarding the use of collaborations to increase the impact and reach, and to decrease the costs, of interventions. The symposium highlighted a number of key scientific challenges for Unilever and other parties that have set nutrition, hygiene and sustainability as key priorities. The key challenges include: adapting behaviour change approaches to cultures in developing and emerging economies; designing evidence-based behaviour change interventions, in which products can play a key role as agents of change; and scaling up behaviour change activities in cost-effective ways, which requires a new mindset involving public-private partnerships.
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http://dx.doi.org/10.1186/1471-2458-13-S1-S1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605264PMC
May 2013

Anxiety disorders and salivary cortisol levels in older adults: a population-based study.

Psychoneuroendocrinology 2013 Feb 7;38(2):300-5. Epub 2012 Jul 7.

Research Center O3, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands.

Context: The hypothalamic-pituitary-adrenal (HPA) axis is one of the body's main systems that controls response to stress. It acts through the hormone cortisol. While the dysregulation of cortisol has been associated with anxiety disorders, the evidence is inconsistent. Moreover, only a few small studies have assessed this relationship in older adults.

Objective: To determine whether in adults aged 65 years and over there is a difference in daily cortisol pattern between those with and without an anxiety disorder.

Methods: The study population comprised 1788 older adults from a population-based cohort. The Munich version of the Composite International Diagnostic Interview was used to diagnose anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, agoraphobia and panic disorder). The cortisol awakening response and total cortisol secretion over the day were calculated from cortisol levels in four saliva samples taken over the course of one day (at awakening, 30min after awakening, at 1700h, at bedtime).

Results: Older adults with an anxiety disorder (n=145, median duration since first symptoms 41 years) had a lower cortisol awakening response (p=0.02) than those without such a disorder (n=1643). This association was most prominent in those with generalized anxiety disorder (p=0.008), but was not associated with the extent of chronicity of anxiety disorders.

Conclusion: Older adults from the general population with long-lasting anxiety disorders had a lower cortisol awakening response than those without. This is consistent with the notion that chronic anxiety may result in downregulation of HPA-axis activity. Longitudinal studies are needed to confirm this mechanism.
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http://dx.doi.org/10.1016/j.psyneuen.2012.06.006DOI Listing
February 2013

Anxiety disorders and comorbid depression in community dwelling older adults.

Int J Methods Psychiatr Res 2011 Sep;20(3):157-68

O3 Research Centre, Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands.

Anxiety disorder is a common psychiatric problem during late-life, and frequently co-occurs with depression. High comorbidity between anxiety and depression may partly be explained by the definition of the disorders and the assessment of both disorders with one instrument at the same time. The current study investigates the relation of current and past depression with anxiety disorders in the Rotterdam Study, a large population-based cohort study of older adults in the Netherlands (n study population = 5565). DSM-IV anxiety disorder was ascertained with the Munich version of the Composite International Diagnostic Interview. DSM-IV depression was diagnosed with the Schedules for Clinical Assessment of Neuropsychiatry (SCAN) on a different day. Past depression was assessed from general practitioners' records, self-report, and a prior SCAN interview. Of the 457 persons with an anxiety disorder, 11.6% had a comorbid major depression, and another 6.3% had other depressive syndromes. However, 49.3% of persons with an anxiety disorder experienced or had in the past experienced a depressive episode. Our study suggests that comorbid depression in older adults with anxiety disorders may be less prevalent than previously suggested. However, the relation of current anxiety disorders with past depression is substantial.
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http://dx.doi.org/10.1002/mpr.344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878519PMC
September 2011

One risk assessment tool for cardiovascular disease, type 2 diabetes, and chronic kidney disease.

Diabetes Care 2012 Apr 14;35(4):741-8. Epub 2012 Feb 14.

Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.

Objective: Individuals at high risk for chronic cardiometabolic disease (cardiovascular disease [CVD], type 2 diabetes, and chronic kidney disease [CKD]) share many risk factors and would benefit from early intervention. We developed a nonlaboratory-based risk-assessment tool for identification of people at high cardiometabolic disease risk.

Research Design And Methods: Data of three population-based cohorts from different regions of the Netherlands were merged. Participants were 2,840 men and 3,940 women, white, aged 28-85 years, free from CVD, type 2 diabetes, and CKD diagnosis at baseline. The outcome was developing cardiometabolic disease during 7 years follow-up.

Results: Age, BMI, waist circumference, antihypertensive treatment, smoking, family history of myocardial infarction or stroke, and family history of diabetes were significant predictors, whereas former smoking, history of gestational diabetes, and use of lipid-lowering medication were not. The models showed acceptable calibration (Hosmer and Lemeshow statistics, P > 0.05) and discrimination (area under the receiver operating characteristic [ROC] curve 0.82 [95% CI 0.81-0.83] for women and 0.80 [0.78-0.82] for men). Discrimination of individual outcomes was lowest for diabetes (area under the ROC curve 0.70 for men and 0.73 for women) and highest for CVD mortality (0.83 for men and 0.85 for women).

Conclusions: We demonstrate that a single risk stratification tool can identify people at high risk for future CVD, type 2 diabetes, and/or CKD. The present risk-assessment tool can be used for referring the highest risk individuals to health care for further (multivariable) risk assessment and may as such serve as an important part of prevention programs targeting chronic cardiometabolic disease.
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http://dx.doi.org/10.2337/dc11-1417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3308277PMC
April 2012

Association between serum cholesterol and noncardiovascular mortality in older age.

J Am Geriatr Soc 2011 Oct 21;59(10):1779-85. Epub 2011 Sep 21.

Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.

Objectives: To clarify the association between cholesterol and noncardiovascular mortality and to evaluate how this association varies across age groups.

Design: Prospective population-based cohort study.

Setting: Rotterdam, the Netherlands.

Participants: Adults aged 55 to 99 (N = 5,750).

Measurements: Participants were evaluated for total cholesterol and subfractions and followed for mortality for a median of 13.9 years. Total cholesterol and its subfractions were evaluated in relation to noncardiovascular mortality. Cox regression analyses were conducted in the total sample and within age-groups (55-64, 65-74, 75-84, ≥85).

Results: Age- and sex-adjusted analyses showed that each 1-mmol/L increase in total cholesterol was associated with an approximately 12% lower risk of noncardiovascular mortality (hazard ratio (HR) = 0.88, 95% confidence interval (CI) = 0.84-0.92, P < .001). Age group-specific analyses demonstrated that this association reached significance after the age of 65 and increased in magnitude across each subsequent decade. This was driven largely by non-high-density lipoprotein cholesterol (non-HDL-C) (HR = 0.89, 95% CI 0.85-0.93, P < .001) and was partly attributable to cancer mortality. Conversely, HDL-C was not significantly associated with noncardiovascular mortality (HR = 0.92, 95% CI 0.79-1.07, P = .26).

Conclusion: Higher total cholesterol was associated with a lower risk of noncardiovascular mortality in older adults. This association varied across the late-life span and was stronger in older age groups. Further research is required to examine the mechanisms underlying this association.
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http://dx.doi.org/10.1111/j.1532-5415.2011.03593.xDOI Listing
October 2011

Is positive affect associated with survival? A population-based study of elderly persons.

Am J Epidemiol 2011 Jun 31;173(11):1298-307. Epub 2011 Mar 31.

Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.

Study results on the association of positive affect with survival are conflicting. This disagreement potentially arises from poor control for health or negative affect and for the various age groups studied. The authors examined if positive affect predicts survival; whether this association is preserved after controlling for negative affect, socioeconomic status, lifestyle, and health; and whether this association varies with age. The study is set within the population-based Rotterdam Study (1997-2007) and included 4,411 participants aged 61 years or older, followed for on average 7.19 (standard deviation = 2.20) years. Positive affect was not consistently associated with survival across all ages. A significant interaction of positive affect with age on survival (P = 0.02) was found. Subsequent age stratification revealed that positive affect independently predicted survival in elderly persons aged <80 years (per affect score, hazard ratio = 0.96, 95% confidence interval: 0.93, 0.99) but not in those aged ≥80 years in fully adjusted models (hazard ratio = 1.00, 95% confidence interval: 0.96, 1.04). In the oldest old, the association was partly explained by differences in baseline health. In conclusion, the results suggest that there may be an association of positive affect with survival in the younger and middle old but not in the oldest old in whom perception of positive affect is more likely to be determined by health.
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http://dx.doi.org/10.1093/aje/kwr012DOI Listing
June 2011

The prevalence and characteristics of complicated grief in older adults.

J Affect Disord 2011 Jul 12;132(1-2):231-8. Epub 2011 Mar 12.

Department of Epidemiology, Erasmus University Medical Centre, The Netherlands.

Background: Complicated grief is a prolongation of the normal grieving process with distinct characteristics. It impairs mental and physical health and can potentially greatly impact the quality of life of sufferers and their families. The prevalence and characteristics of complicated grief in the general population are currently unclear. The aims of the present study were therefore to evaluate the prevalence of complicated grief in a population-based cohort, examine the overlap between anxiety and depression and identify common bereavement-related and socio-demographic characteristics.

Methods: Based within the Rotterdam Study, 5741 older adults were evaluated. Complicated grief was assessed with a 17-item Inventory of Complicated Grief.

Results: Prevalence within the general population was 4.8%. Current grief was reported by 1089 participants, and of these 277 (25.4%) were diagnosed with complicated grief. Inflated anxiety and depression rates were documented in people with complicated grief, but the vast majority remained free from co-morbidity. Time since bereavement and relationship to deceased, particularly when the source was a spouse or child, were predictive of complicated grief. People with complicated grief were older, had a lower level of education, and more cognitive impairment.

Conclusions: The prevalence of complicated grief in older adults in the general population was noteworthy. Several factors were predictive of complicated grief and it was demonstrated as a separate condition to anxiety and depression. These findings highlight the need for prevention, diagnosis and treatment options for older adults with complicated grief and for recognition of complicated grief as a distinct diagnosis.
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http://dx.doi.org/10.1016/j.jad.2011.02.021DOI Listing
July 2011

Short and long-term effects of smoking on cortisol in older adults.

Int J Psychophysiol 2011 May 17;80(2):157-60. Epub 2011 Feb 17.

Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.

We investigated concurrent as well as long-term effects of smoking on cortisol. The population consisted of 2508 elderly adults. Current smokers, as opposed to former smokers, had higher basal cortisol levels and higher morning increases of cortisol. Overall, pack-years was related to morning cortisol rise, but this was accounted for by current smokers. Time since quitting was positively associated with a greater decline in daytime cortisol indicating that the effects of smoking remit. This suggests that smoking has short-term, rather than long-term, consequences on cortisol secretion patterns.
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http://dx.doi.org/10.1016/j.ijpsycho.2011.02.007DOI Listing
May 2011

Epidemiological fallacies of modern psychiatric research.

Nord J Psychiatry 2011 Sep 8;65(4):226-37. Epub 2010 Dec 8.

Department of Epidemiology, Erasmus University Medical Centre, The Netherlands.

Background: Psychiatric epidemiology is an important cornerstone of research in psychiatry and integral for the treatment and care of people suffering from psychiatric disorders. However, psychiatric epidemiology is a difficult science, which is often beset with methodological problems.

Aims: In light of this, the current review sought to explore 13 of the common methodological issues in psychiatric epidemiology.

Methods: Many methodological problems result from misunderstandings. As such, we sought to highlight these problems, provide evidence to counteract the myths surrounding these problems and subsequently provide recommendations to overcome these problems. To highlight and clarify these issues, examples are provided from current psychiatric literature.

Results: Areas discussed in the review include problems with: taxonometry of disorders, sole reliance on self-reports, single-question diagnoses, baseline participation rates, measurement of lifetime prevalence, inconsistency of multiple informants, selection of covariates, testing of interactions, correction for multiple testing, the intermittent measurement of disorders during follow-up, evaluation of causal associations, data invalidation related to loss from follow-up and the publication of negative findings.

Conclusion: Many methodological myths prevail in the area of epidemiology and this review endeavoured to elucidate and clarify these. This review was developed as a teaching tool for students, clinicians and researchers.
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http://dx.doi.org/10.3109/08039488.2010.539268DOI Listing
September 2011

Atherosclerosis and incident depression in late life.

Arch Gen Psychiatry 2010 Nov;67(11):1144-51

Department of Epidemiology, Erasmus University Medical Centre, the Netherlands.

Context: Depression is a prominent concern for older adults; therefore, it is important to identify causal mechanisms so that prevention and treatment strategies can be developed. The vascular depression hypothesis proposes that vascular factors precede the onset of depression in older adults. However, although cross-sectional associations have been established, owing to a lack of objective assessments and longitudinal data, the validity and temporal nature of this relationship is unclear.

Objective: To examine whether atherosclerosis, an asymptomatic subclinical indicator of vascular burden, increases the risk of developing depression in older adults.

Design: Prospective, population-based study.

Setting: Set within the Rotterdam study, participants were assessed on objective measures of generalized atherosclerosis at baseline (1997-1999) and followed up for an average of 6 years for incident depression.

Participants: The baseline sample consisted of 3564 participants (56% female) with a mean age of 72 years who initially did not have depression or dementia.

Main Outcome Measures: Depression was categorized into symptoms or syndromes and assessed in a multidimensional manner from physician and mental health specialist reports, pharmacy records (antidepressant usage), a clinical interview, and self-report.

Results: During 21 083 person-years, 429 incidents of depressive symptoms and 197 incidents of depressive syndromes occurred. Individual atherosclerotic measures and a composite measure were not predictive of incident depressive symptoms (composite measure hazard ratio, 0.93; 95% confidence interval, 0.83-1.05) or incident depressive syndromes (composite measure hazard ratio, 0.97; 95% confidence interval, 0.81-1.16). An a priori power analysis indicated a sufficient sample size (α = .05; 0.95 power).

Conclusions: Atherosclerosis does not appear to increase the risk of incident depression in older adults. These findings do not support the vascular depression hypothesis and, alternatively, taking findings from prior studies into account, suggest either that depression contributes to vascular burden or that both result from an underlying biological substrate.
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http://dx.doi.org/10.1001/archgenpsychiatry.2010.142DOI Listing
November 2010

Predicting survival and morbidity-free survival to very old age.

Age (Dordr) 2010 Dec 1;32(4):521-34. Epub 2010 Jun 1.

Department of Epidemiology, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, Netherlands.

As life expectancy continually increases, it is imperative to identify determinants of survival to the extreme end of the lifespan and more importantly to identify factors that increase the chance of survival free of major morbidities. As such, the current study assessed 45 common disease factors as predictors of survival and morbidity-free survival to age 85 years. Within the Rotterdam Study, a population-based cohort, we evaluated morbidity-free participants who were able to attain age 85 within the study duration (n = 2,008). Risk factors were assessed at baseline (1990-1993), and mortality and morbidities were then collected continuously until mortality or the occurrence of their 85th birthday (average time of 7.9 years). Risk factors included demographic and lifestyle variables, health and morbidity indicators and physiological makers. Major morbidities examined included dementia, cancer, cerebrovascular accident, heart failure and myocardial infarction. Logistic regression analyses demonstrated that many of the variables were independently predictive for survival and for morbidity-free ageing to 85 years. These included being female, absence of left ventricular abnormalities, stable body weight, unimpaired instrumental activities of daily living, lower C-RP levels and higher levels of femoral neck bone mineral density and albumin. Relative to non-survival, predictors were stronger for morbidity-free survival than for total survival or survival with morbidity. This suggests that lifespan and healthy survival to older age can be relatively well predicted. Understanding predictors of a long and healthy lifespan is vital for developing primary and secondary preventions to help improve the quality of life of older adults and for reducing the financial burden of the rapidly escalating ageing population.
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http://dx.doi.org/10.1007/s11357-010-9154-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980598PMC
December 2010

The role of design issues in work-related fatal injury in Australia.

J Safety Res 2008 13;39(2):209-14. Epub 2008 Mar 13.

School of Public Health, University of Sydney NSW 2006, Australia.

Problem: This study aimed to provide an assessment of the contribution of design to the occurrence of fatal work-related injuries in Australia.

Methods: The Australian National Coroners' Information System was the data source for fatal injuries. Deaths resulting from workplace injuries on or between 1 July 2000 and 30 June 2002 were included.

Results: Seventy seven (37%) of the 210 identified workplace fatalities definitely or probably had design-related issues involved. In another 29 (14%), the circumstances were suggestive that design issues were involved. The most common scenarios involved problems with rollover protective structures and/or associated seat belts; inadequate guarding; lack of residual current devices; inadequate fall protection; failed hydraulic lifting systems in vehicles and mobile equipment; and inadequate protection mechanisms on mobile plant and vehicles.

Summary: Design is a significant contributor to work-related fatal injury in Australia. There is considerable scope for preventing serious work-related injury through improving design of plant, equipment, and vehicles used for work-related purposes.
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http://dx.doi.org/10.1016/j.jsr.2008.02.024DOI Listing
August 2008

Relationship between fitness and cognitive performance in younger and older adults.

Psychol Health 2008 ;23(3):369-86

a School of Psychology, Flinders University , Adelaide , Australia.

The present study investigated the association between cardiorespiratory fitness and cognitive ageing. An extreme groups comparison design compared the performance of 24 young low-fitness adults, 24 young high-fitness adults, 24 older low-fitness adults and 24 older high-fitness adults on a comprehensive neuropsychological battery. A series of ANCOVAs demonstrated that younger adults performed better than older adults on most cognitive tasks. Additionally, across both age groups high-fitness adults performed at a higher level than low-fitness adults on tasks of basic abilities, i.e., simple reaction time, attention, working memory and processing speed. However, there were no differences between the fitness groups in terms of performance on higher-order fluid abilities, i.e., executive function and memory. These findings suggest that the relationship between fitness and cognitive ageing is domain specific.
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http://dx.doi.org/10.1080/08870440701421545DOI Listing
October 2014

Factors that promote and prevent exercise engagement in older adults.

J Aging Health 2007 Jun;19(3):470-81

School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.

Objective: This study aimed to (a) identify factors that motivate or prevent older Australians from exercising; (b) determine how these factors differ as a function of age, gender, and exercise level; and (c) examine how they relate to intentions to exercise in the future.

Method: In all, 217 older adults (aged 63 to 86) completed a questionnaire in their own home. Participants rated various motivators and barriers to exercise and indicated future intention to exercise.

Results: Health concerns were the strongest motivators to exercise, whereas physical ailments were the most common barrier to exercise. Older Australians were fairly motivated to exercise and experienced few barriers to exercise. Age, gender, and exercise level differentiated between reported motivators and barriers, which in turn were associated with future intentions to exercise.

Discussion: Reasons that promote and prevent exercise engagement are quite varied and depend on personal factors. Exercise intervention programs for older adults should incorporate these factors.
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http://dx.doi.org/10.1177/0898264307300169DOI Listing
June 2007

The nature of subjective cognitive complaints of older adults.

Int J Aging Hum Dev 2006 ;63(2):139-51

School of Psychology, Flinders University, Adelaide, Australia.

The current study investigated the nature of subjective cognitive complaints of older adults in relation to a broad array of individual cognitive functions known to decline with age. A 60-item questionnaire was developed to examine: (1) whether older adults experience problems with these cognitive functions (problems with cognition); (2) the extent to which these problems have changed over time (changes in cognition); and (3) whether these cognitive decrements interfere with their daily functioning (difficulties with cognition). The cognitive functions examined were attention, processing speed, working memory, executive function, and memory. One hundred eight-two community-dwelling adults (aged 65-92 years) completed the questionnaire. While participants reported problems with, and changes in, each cognitive function, working memory was recorded as most problematic and demonstrated the most change. Yet, although older adults experience problems with cognition and report changes in cognitive functioning over time, these did not necessarily produce difficulties in daily life. This points to the existence of support mechanisms that may assist older adults in cognitively demanding situations.
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http://dx.doi.org/10.2190/1EAP-FE20-PDWY-M6P1DOI Listing
January 2007

Cardiorespiratory fitness as a predictor of successful cognitive ageing.

J Clin Exp Neuropsychol 2006 Aug;28(6):949-67

School of Psychology, Flinders University, Adelaide, SA 5001, Australia.

This study examined whether cardiorespiratory fitness influences cognitive ageing and whether this influence is domain specific. A cross-sectional design comprising 25 young (18-30 years), 25 young-old (65-74 years), 25 middle-old (75-84 years) and 25 old-old adults (85-92 years) compared the relationship between cardiorespiratory fitness (VO(2max)) and measures of processing resources (attention, working memory, speed) and higher-order cognitive functions (executive function, memory). Fitness was a strong predictor of cognition and accounted for more variance in processing resources than in higher-order functions. This suggests that cardiorespiratory fitness may have a selective protective effect against age-associated cognitive decline.
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http://dx.doi.org/10.1080/13803390591004356DOI Listing
August 2006

The influence of physical and cognitive activities on simple and complex cognitive tasks in older adults.

Exp Aging Res 2006 Jul-Sep;32(3):341-62

School of Psychology, Flinders University, Adelaide, Australia.

This study examined the relative benefits of physical and cognitive activities on simple and complex cognitive task performance in older adults. Participants were 24 young (18-27 years), 24 young-old (65-74 years), 24 middle-old (75-84 years), and 24 old-old (85-92 years) adults. Participants recorded the amount of time engaged in physically and cognitively stimulating activities as well as the effort exerted during these activities. They also completed a simple and complex version of a visual imagery task. Age-related declines were evident in activity and imagery performance. Both physical and cognitive activities were related to better cognitive performance. Furthermore, cognitive activity was a stronger predictor than physical activity of the complex, but not the simple task. However, within each activity domain there were no significant differences between performance on the simple and complex task. These results suggest that physical and cognitive stimulation are useful in protecting against cognitive decline with age, but that they may exert their influence via different paths.
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http://dx.doi.org/10.1080/03610730600699134DOI Listing
December 2006

General lifestyle activities as a predictor of current cognition and cognitive change in older adults: a cross-sectional and longitudinal examination.

J Gerontol B Psychol Sci Soc Sci 2005 May;60(3):P113-20

School of Psychology, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia.

General lifestyle activities were examined as a predictor of current cognition and cognitive change over a 6-year interval in older adults. Participants were drawn from a population-based longitudinal study, and they completed the Adelaide Activities Profile and a battery of tests measuring cognition and sensory functioning. Hierarchical regression analyses revealed that, after sensory functioning was controlled for, activity was a significant predictor of current levels of speed, picture naming, incidental recall, and verbal fluency, and of cognitive change in speed, picture naming, and incidental recall. Commonality analyses demonstrated that activity accounted for a notable amount of the total variance in cognition, and that there was prominent overlap in shared variance between activity and age, and between sensory functioning and age. These findings suggest that engaging in general lifestyle activities may help to promote successful cognitive aging.
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http://dx.doi.org/10.1093/geronb/60.3.p113DOI Listing
May 2005