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  • 1.
    Axelsson, K. F.
    et al.
    Department of Orthopaedic Surgery, Skaraborg Hospital, Skövde, Sweden.
    Wallander, M.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Johansson, H.
    Institute for Health and Ageing, Catholic University of Australia, Melbourne, VIC, Australia.
    Lundh, Dan
    School of Bioscience, University of Skövde, Skövde, Sweden.
    Lorentzon, M.
    Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Hip fracture risk and safety with alendronate treatment in the oldest-old2017In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 282, no 6, p. 546-559Article in journal (Refereed)
    Abstract [en]

    Background. There is high evidence for secondary prevention of fractures, including hip fracture, with alendronate treatment, but alendronate's efficacy to prevent hip fractures in the oldest-old (80 years old), the population with the highest fracture risk, has not been studied.

    Objective. To investigate whether alendronate treatment amongst the oldest-old with prior fracture was related to decreased hip fracture rate and sustained safety.

    Methods. Using a national database of men and women undergoing a fall risk assessment at a Swedish healthcare facility, we identified 90 795 patients who were 80 years or older and had a prior fracture. Propensity score matching (four to one) was then used to identify 7844 controls to 1961 alendronate-treated patients. The risk of incident hip fracture was investigated with Cox models and the interaction between age and treatment was investigated using an interaction term.

    Results. The case and control groups were well balanced in regard to age, sex, anthropometrics and comorbidity. Alendronate treatment was associated with a decreased risk of hip fracture in crude (hazard ratio (HR) 0.62 (0.49-0.79), P < 0.001) and multivariable models (HR 0.66 (0.51-0.86), P < 0.01). Alendronate was related to reduced mortality risk (HR 0.88 (0.82-0.95) but increased risk of mild upper gastrointestinal symptoms (UGI) (HR 1.58 (1.12-2.24). The alendronate association did not change with age for hip fractures or mild UGI.

    Conclusion. In old patients with prior fracture, alendronate treatment reduces the risk of hip fracture with sustained safety, indicating that this treatment should be considered in these high-risk patients.

  • 2. Hooshmand, Babak
    et al.
    Solomon, Alina
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Rusanen, Minna
    Hänninen, Tuomo
    Leiviskä, Jaana
    Winblad, Bengt
    Laatikainen, Tiina
    Soininen, Hilkka
    Kivipelto, Miia
    Associations between serum homocysteine, holotranscobalamin, folate and cognition in the elderly: a longitudinal study2012In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 271, no 2, p. 204-212Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the associations between serum homocysteine (tHcy), holotranscobalamin (holoTC, the biologically active fraction of vitamin B12) and folate and cognitive functioning in a longitudinal population-based study of Finnish elderly subjects.

    Subjects and design: tHcy, holoTC and folate were measured at baseline in 274 dementia-free subjects aged 65-79years from the Cardiovascular Risk Factors, Aging and Dementia study. Subjects were re-examined 7years later, and global cognition, episodic memory, executive functioning, verbal expression and psychomotor speed were assessed.

    Results: Higher baseline tHcy levels were associated with poorer performance in global cognition, relative difference: 0.90 [95% confidence interval (CI) 0.81-0.99]; episodic memory: 0.87 (95% CI 0.77-0.99); executive functions: 0.86 (95% CI 0.75-0.98); and verbal expression: 0.89 (95% CI 0.81-0.97) at follow-up. Increased holoTC levels were related to better performance on global cognition: 1.09 (95% CI 1.00-1.19); executive functions: 1.11 (95% CI 1.01-1.21); and psychomotor speed: 1.13 (95% CI 1.01-1.26). After excluding 20 cases of incident dementia, increased tHcy remained associated with poorer performance in episodic memory, execution functions and verbal expression. Higher holoTC levels tended to be related to better performance in executive functions and psychomotor speed, while elevated serum folate concentrations were significantly related to higher scores in global cognition and verbal expression tests.

    Conclusions: tHcy, holoTC and folate levels are related to cognitive performance 7years later even in nondemented elderly subjects. Randomized trials are needed to determine the impact of vitamin B12 and folate supplementation on preventing cognitive decline in the elderly.

  • 3. Jonasson, L
    et al.
    Tompa, Andrea
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ. Biomedical Platform.
    Wikby, Anders
    Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Expansion of peripheral CD8+ T cells in patients with coronary artery disease: relation to cytomegalovirus infection.2003In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 254, no 5, p. 472-478Article in journal (Refereed)
  • 4.
    Kulmala, Jenni
    et al.
    Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Solomon, Alina
    Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Ngandu, Tiia
    Karolinska Institute Alzheimer Disease Research Center, Stockholm, Sweden.
    Rantanen, Taina
    Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Laatikainen, Tiina
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
    Soininen, Hilkka
    Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
    Tuomilehto, Jaakko
    Center for Vascular Prevention, Danube-University Krems, Krems, Austria.
    Kivipelto, Miia
    Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
    Association between mid- to late life physical fitness and dementia: evidence from the CAIDE study2014In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 276, no 3, p. 296-307Article in journal (Refereed)
    Abstract [en]

    Objectives

    This study investigated the association between perceived physical fitness at midlife, changes in perceived fitness during the three decades from mid- to late life, and dementia risk.

    Design

    Prospective cohort study.

    Setting

    Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) study.

    Subjects

    Subjects were selected from four independent, random samples of population-based cardiovascular surveys and were first examined in 1972, 1977, 1982, or 1987, when they were on average 50 years old. The CAIDE target population included 3,559 individuals. A random sample of 2,000 individuals still alive in 1997 was drawn for re-examinations (performed in 1998 and 2005–2008) that consisted of cognitive assessments, with 1,511 subjects participating in at least one re-examination. Dementia diagnoses were also confirmed from national registers for the entire target population.

    Main outcome measure

    All-cause dementia.

    Results

    Poor physical fitness at midlife was associated with increased dementia risk in the entire target population [hazard ratio (HR), 1.5; 95% confidence interval (CI), 1.1–2.0]. In participants, odds ratio (OR) was 2.0 (95% CI, 0.9–4.0). This association was significant in apolipoprotein E ε4 allele (APOEε4) non-carriers (OR, 4.3; 95% CI, 1.4–13.3), men (HR, 1.8; 95% CI, 1.1–3.0), and people with chronic conditions (HR, 2.9; 95% CI, 1.3–6.6). A decline in fitness after midlife was also associated with dementia (OR, 3.0; 95% CI, 1.7–5.1), which was significant among both men and women and more pronounced in APOEε4 carriers (OR, 4.4; 95% CI, 2.1–9.1).

    Conclusions

    Perceived poor physical fitness reflects a combination of biological and lifestyle-related factors that can increase dementia risk. A simple question about perceived physical fitness may reveal at-risk individuals who could benefit from preventive interventions.

  • 5. Nyberg, Solja
    et al.
    Heikkilä, Katriina
    Fransson, Eleonor
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Alfredsson, Lars
    De Bacquer, Dirk
    Bjorner, Jakob
    Bonenfant, Sébastien
    Borritz, Marianne
    Burr, Hermann
    Casini, Annalisa
    Clays, Els
    Dragano, Nico
    Erbel, Raimund
    Geuskens, Goedele
    Goldberg, Marcel
    Hooftman, Wendela
    Houtman, Irene
    Jöckel, Karl-Heinz
    Knutsson, Anders
    Koskenvuo, Markku
    Leineweber, Constanze
    Lunau, Thorsten
    Madsen, Ida
    Magnusson Hanson, Linda
    Marmot, Michael
    Nielsen, Martin
    Nordin, Maria
    Oksanen, Tuula
    Pentti, Jaana
    Rugulies, Reiner
    Siegrist, Johannes
    Suominen, Sakari
    Vahtera, Jussi
    Virtanen, Marianna
    Westerholm, Peter
    Westerlund, Hugo
    Zins, Marie
    Ferrie, Jane
    Theorell, Töres
    Steptoe, Andrew
    Hamer, Mark
    Singh-Manoux, Archana
    Batty, David
    Kivimäki, Mika
    Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies2012In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 272, no 1, p. 65-73Article in journal (Refereed)
    Abstract [en]

    Background:  Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses.

    Objectives:  To examine the association between job strain and body mass index (BMI) in a large adult population.

    Methods:  We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161,746 participants (49% men, mean age 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n=42,222).

    Results:  A total of 86,429 participants were of normal weight (BMI 18.5–24.9 kg/m2), 2149 were underweight (BMI <18.5 kg/m2), 56,572 overweight (BMI 25.0–29.9 kg/m2) and 13,523 class I (BMI 30–34.9 kg/m2) and 3073 classes II/III (BMI >35 kg/m2) obese. In addition, 27,010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain among underweight (odds ratio 1.12, 95% confidence interval [CI] 1.00 to 1.25), obese class I (odds ratio 1.07, 95% CI 1.02 to 1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01 to 1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up.

    Conclusions:  In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a ‘U’-shaped cross-sectional association between job strain and BMI. These associations were relatively modest, therefore it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.

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