Health symptoms during midlife in relation to menopausal transition: British prospective cohort study

Objective To characterise symptoms experienced by women during the transition into natural menopause, to classify women into distinct symptom profiles or trajectories, and to relate these profiles to sociodemographic factors and health behaviours

Variations of health check attendance in later life: results from a British birth cohort study

Background:Older adults are advised to attend a number of preventive health checks to preserve health andidentify risk factors for disease. Previous research has identified a number of health and social factors, labelled aspredisposing, enabling and need factors, using Andersen’s Behavioural Model of Health Service Use, that areassociated with health care utilisation. We aimed to assess associations between factors from childhood andadulthood, and health check attendance in later life in a British birth cohort study.Methods:For 2370 study members from the MRC National Survey of Health and Development (NSHD), healthcheck attendance was assessed at age 68. Study members were asked if they: attended blood pressure andcholesterol checks, had their eyes tested, received the influenza vaccine, attended colon cancer screening anddental checks. Health and social factors from childhood and adulthood were used in binomial regression models totest associations with health check attendance in men and women.Results:Health check attendance was high; 41% reported attending all six health checks within the recommendedtime frame. In multivariable models, being a non-smoker and having more health conditions in adulthood wereassociated with greater health check attendance in men and women. In women, childhood socioeconomicadvantage, being more physically active in midlife and previously attending screening procedures, and in men,greater self-organisation in adolescence and being married were associated with attending more health checks inlater life, following adjustments for childhood and adulthood factors.Conclusions:A number of predisposing, enabling and need factors from childhood and adulthood were found tobe associated with health check attendance at age 68, demonstrating the relevance of applying a life courseperspective to Andersen’s model in investigating health check attendance in later life. Health related factors werefound to be stronger correlates of health check attendance than socioeconomic factors

Objectively measured physical capability levels and mortality: systematic review and meta-analysis

Objective: To do a quantitative systematic review, including published and unpublished data, examining the associations between individual objective measures of physical capability (grip strength, walking speed, chair rising, and standing balance times) and mortality in community dwelling populations. Design: Systematic review and meta-analysis. Data sources: Relevant studies published by May 2009 identified through literature searches using Embase (from 1980) and Medline (from 1950) and manual searching of reference lists; unpublished results were obtained from study investigators. Study selection: Eligible observational studies were those done in community dwelling people of any age that examined the association of at least one of the specified measures of physical capability (grip strength, walking speed, chair rises, or standing balance) with mortality. Data synthesis: Effect estimates obtained were pooled by using random effects meta-analysis models with heterogeneity between studies investigated. Results: Although heterogeneity was detected, consistent evidence was found of associations between all four measures of physical capability and mortality; those people who performed less well in these tests were found to be at higher risk of all cause mortality. For example, the summary hazard ratio for mortality comparing the weakest with the strongest quarter of grip strength (14 studies, 53 476 participants) was 1.67 (95% confidence interval 1.45 to 1.93) after adjustment for age, sex, and body size (I2=84.0%, 95% confidence interval 74% to 90%; P from Q statistic <0.001). The summary hazard ratio for mortality comparing the slowest with the fastest quarter of walking speed (five studies, 14 692 participants) was 2.87 (2.22 to 3.72) (I2=25.2%, 0% to 70%; P=0.25) after similar adjustments. Whereas studies of the associations of walking speed, chair rising, and standing balance with mortality have only been done in older populations (average age over 70 years), the association of grip strength with mortality was also found in younger populations (five studies had an average age under 60 years). Conclusions: Objective measures of physical capability are predictors of all cause mortality in older community dwelling populations. Such measures may therefore provide useful tools for identifying older people at higher risk of death. With Contributions from Dr P.A. Bath, University of Sheffiel

Sustained heavy drinking over 25 years is associated with increased N-terminal-pro-B-type natriuretic peptides in early old age: Population-based cohort study.

UNLABELLED: Heavy alcohol consumption is associated with an increased risk of heart failure. We sought to investigate whether levels of NT-proBNP differ by alcohol consumption profiles, both current drinking as well as cumulative exposure to drinking over several decades in a general population sample. METHODS: Data on 2054 participants (49% male) were taken from the UK Medical Research Council National Survey for Health and Development, a longitudinal cohort study based on a nationally representative sample of births in 1946. Categories of long-term alcohol consumption were created based on consumption over 25 years of observations and compared with levels of NT-proBNP measured at mean age 63. RESULTS: We found that those who drank heavily (both currently and long-term) had higher levels of NT-proBNP than moderate drinkers, after adjusting for major confounders (age, sex, socio-economic position and smoking). As NT-proBNP has attracted attention as a biomarker for heart failure, this suggests a critical pathway through which heavy drinking may increase risk of this cardiovascular disease. When we looked at heavy drinkers who varied their intake over the decades, it was only the recently heavy group that had higher levels of NT-proBNP. Further work is needed to demonstrate whether effects are reversible upon cessation of heavy drinking, but this finding highlights the need to have repeated data to unpack dynamics over time. CONCLUSION: Our findings suggest heavy drinkers could be screened for NT-proBNP levels in order to identify those at high risk earlier in the clinical stages of heart failure and targeted for risk reduction strategies

Is birthweight associated with total and aggressive/lethal prostate cancer risks? A systematic review and meta-analysis

BACKGROUND: It has been hypothesised that intrauterine exposures are important for subsequent prostate cancer risk. Prior epidemiological studies have used birthweight as a proxy of cumulative intrauterine exposures to test this hypothesis, but results have been inconsistent partly because of limited statistical power. METHODS: We investigated birthweight in relation to prostate cancer in the Medical Research Council (MRC) National Survey of Health and Development (NSHD) using Cox proportional hazards models. We then conducted a meta-analysis of birthweight in relation to total and aggressive/lethal prostate cancer risks, combining results from the NSHD analysis with 13 additional studies on this relationship identified from a systematic search in four major scientific literature databases through January 2015. RESULTS: Random-effects models found that per kg increase in birthweight was positively associated with total (OR=1.02, 95% confidence interval (95% CI)=1.00, 1.05; I(2)=13%) and aggressive/lethal prostate cancer (OR=1.08, 95% CI=0.99, 1.19; I(2)=40%). Sensitivity analyses restricted to studies with birthweight extracted from medical records demonstrated stronger positive associations with total (OR=1.11, 95% CI=1.03, 1.19; I(2)=0%) and aggressive/lethal (OR=1.37, 95% CI=1.09, 1.74; I(2)=0%) prostate cancer. These studies heavily overlapped with those based in Nordic countries. CONCLUSIONS: This study provides evidence that heavier birthweight may be associated with modest increased risks of total and aggressive/lethal prostate cancer, which supports the hypothesis that intrauterine exposures may be related to subsequent prostate cancer risks

Pubertal maturation and affective symptoms in adolescence and adulthood: evidence from a prospective birth cohort

The higher prevalence of affective symptoms among women compared to men emerges in adolescence, and it has been associated with pubertal maturation. However, it remains unclear whether pubertal timing has long-term influences on affective symptoms. Using data from the British 1946 birth cohort, we investigated whether pubertal timing was associated with affective symptoms over the life course, distinguishing those with symptoms in adolescence only, symptoms in adulthood only, and symptoms in both adolescence and adulthood. In females, there was no evidence that early pubertal maturation was a risk factor for affective symptoms. However, those with particularly late menarche (≥15 years) showed a lower risk of adult-onset affective symptoms (OR = 0.54, 95% CI: 0.31, 0.95). This effect of late pubertal timing was not explained by a range of socio-behavioural factors. In contrast, in males, late pubertal timing was associated with increased risk of adolescent-onset affective symptoms that tracked into adulthood (OR = 2.10, 95% CI: 1.44, 3.06). This effect was partly explained by low pre-pubertal BMI. Sex-specific effects of pubertal timing on the long-term risk of affective symptoms might be due to different effects of gonadal hormonal on the CNS, as well as different social experiences during puberty