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Background and Aims: Limited evidence exists on clinical management and longer-term survival after aneurysmal subarachnoid hemorrhage (aSAH) including sex differences. We aimed to determine sex differences in the association of optimal evidence-based care with survival. Method(s): We established a retrospective cohort (2010-2016) of all consecutive aSAH cases admitted to two comprehensive cerebrovascular centers in Australia. Survival at one year was obtained by linking cases with the National Death Index. We documented 4 indicators of evidence-based aSAH processes of care: (1) imaging (CTwith CTA/DSA), (2) nimodipine, (3) aneurysm treatment (coiling/clipping) and, (4) antihypertensives in subset with systolic blood pressure (SBP) >=150mmHg and, we calculated 'optimal care' (e.g. received all eligible processes of care).We estimated (1) sex differences in processes of care using t-test/chi-square (2) association between processes of care and sex with 1-year mortality using cox-proportional hazard model adjusting for age, severity, co-morbidities and hospital network. Result(s): Among 575 participants (69% women), only 40% of patients received optimal care. There were no sex differences in processes of care. One-year mortality was 28% with no sex difference. Treatment of the aneurysm, receiving nimodipine and antihypertensive and, receiving 'optimal care' was associated with a lesser hazard of death at 12 months with no differences by sex when adjusted for age, comorbidities and hospital network (fig-1). Conclusion(s): Many people with aSAH do not receive evidence-based care, and this lack of optimal care may impact on their survival.

Background: There is limited research on the provision of evidence-based care and its association with outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Aim(s): We examined adherence to evidence-based care after aSAH and associations with survival and discharge destination. Also, factors associated with evidence-based care including age, sex, Charlson comorbidity index, severity scores, and delayed cerebral ischemia and infarction were examined for association with survival and discharge destination. Method(s): In a retrospective cohort (2010-2016) of all aSAH cases across two comprehensive cerebrovascular centres, we extracted 3 indicators of evidence-based aSAH care from medical records: (1) antihypertensives prior to aneurysm treatment, (2) nimodipine, and (3) aneurysm treatment (coiling/clipping). We defined 'optimal care' as receiving all eligible processes of care. Survival at 1 year was obtained by data linkage. We estimated (1) proportion of patients and characteristics associated with receiving processes of care, (2) associations between processes of care with 1-year mortality using cox-proportional hazard model and discharge destination with log binomial regression adjusting for age, sex, severity of aSAH, delayed cerebral ischemia and/or cerebral infarction and comorbidities. Sensitivity analyses explored effect modification of the association between processes of care and outcome by management type (active versus comfort measures). Result(s): Among 549 patients (69% women), 59% were managed according to the guidelines. Individual indicators were associated with lower 1-year mortality but not discharge destination. Optimal care reduced mortality at 1 year in univariable (HR 0.24 95% CI 0.17-0.35) and multivariable analyses (HR 0.51 95% CI 0.34-0.77) independent of age, sex, severity, comorbidities, and hospital network. Conclusion(s): Adherence to processes of care reduced 1-year mortality after aSAH. Many patients with aSAH do not receive evidenc

Background and Aims: Limited evidence exists on clinical management and longer-term survival after aneurysmal subarachnoid hemorrhage (aSAH) including sex differences. We aimed to determine sex differences in the association of optimal evidence-based care with survival. Method(s): We established a retrospective cohort (2010-2016) of all consecutive aSAH cases admitted to two comprehensive cerebrovascular centers in Australia. Survival at one year was obtained by linking cases with the National Death Index. We documented 4 indicators of evidence-based aSAH processes of care: (1) imaging (CTwith CTA/DSA), (2) nimodipine, (3) aneurysm treatment (coiling/clipping) and, (4) antihypertensives in subset with systolic blood pressure (SBP) >=150mmHg and, we calculated 'optimal care' (e.g. received all eligible processes of care).We estimated (1) sex differences in processes of care using t-test/chi-square (2) association between processes of care and sex with 1-year mortality using cox-proportional hazard model adjusting for age, severity, co-morbidities and hospital network. Result(s): Among 575 participants (69% women), only 40% of patients received optimal care. There were no sex differences in processes of care. One-year mortality was 28% with no sex difference. Treatment of the aneurysm, receiving nimodipine and antihypertensive and, receiving 'optimal care' was associated with a lesser hazard of death at 12 months with no differences by sex when adjusted for age, comorbidities and hospital network (fig-1). Conclusion(s): Many people with aSAH do not receive evidence-based care, and this lack of optimal care may impact on their survival.

Background: There is limited research on the provision of evidence-based care and its association with outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Aim(s): We examined adherence to evidence-based care after aSAH and associations with survival and discharge destination. Also, factors associated with evidence-based care including age, sex, Charlson comorbidity index, severity scores, and delayed cerebral ischemia and infarction were examined for association with survival and discharge destination. Method(s): In a retrospective cohort (2010-2016) of all aSAH cases across two comprehensive cerebrovascular centres, we extracted 3 indicators of evidence-based aSAH care from medical records: (1) antihypertensives prior to aneurysm treatment, (2) nimodipine, and (3) aneurysm treatment (coiling/clipping). We defined 'optimal care' as receiving all eligible processes of care. Survival at 1 year was obtained by data linkage. We estimated (1) proportion of patients and characteristics associated with receiving processes of care, (2) associations between processes of care with 1-year mortality using cox-proportional hazard model and discharge destination with log binomial regression adjusting for age, sex, severity of aSAH, delayed cerebral ischemia and/or cerebral infarction and comorbidities. Sensitivity analyses explored effect modification of the association between processes of care and outcome by management type (active versus comfort measures). Result(s): Among 549 patients (69% women), 59% were managed according to the guidelines. Individual indicators were associated with lower 1-year mortality but not discharge destination. Optimal care reduced mortality at 1 year in univariable (HR 0.24 95% CI 0.17-0.35) and multivariable analyses (HR 0.51 95% CI 0.34-0.77) independent of age, sex, severity, comorbidities, and hospital network. Conclusion(s): Adherence to processes of care reduced 1-year mortality after aSAH. Many patients with aSAH do not receive evidenc

Aim: To determine whether older adults with low muscle mass (sarcopenia) and strength (dynapenia), in the presence of osteoporosis/osteopenia, have an increased risk of fracture and mortality over 10 years, compared to those with low muscle or low bone mass alone or with neither condition. Method(s): 1032 participants (52% women; mean age 62.9+/-7.4 years) were studied at baseline, 2.5, 5 and 10 years. Mortality was ascertained from the death registry and fractures were self-reported. Baseline appendicular lean mass (ALM) was assessed using dual-energy X-ray absorptiometry and normalised to body mass index (BMI). Hand grip strength (HGS) was assessed by dynamometer. Osteosarcopenia and osteodynapenia were defined as having T-scores of the total hip and/or lumbar spine bone mineral density (BMD) < -1 combined with being in the lowest 20% of the sex-specific distribution for ALM/BMI or HGS respectively. Result(s): Incident fracture risk was significanlty higher in participants who were osteodynapenic (RR=2.07, 95% CI: 1.26-3.39), dynapenic alone (RR=1.74, 95% CI: 1.05-2.87), and osteopenic alone (RR=1.63, 95% CI: 1.15-2.31), compared to those without dynapenia or osteopenia. Mortality risk was significantly higher only in participants with osteosarcopenia (RR=1.49, 95% CI: 1.01-2.21) compared to those without sarcopenia or osteopenia. However, osteosarcopenia and osteodynapenia did not lead to a significantly greater fracture or mortality risk compared to having these conditions on their own. Conclusion(s): Osteopenia combined with low muscle mass or strength does not significantly increase the risk of fracture or mortality compared to having osteopenia or sarcopenia/dynapenia alone, suggesting that combined assessments may not add additional risk for fracture and mortality.

Aim: To determine whether older adults with low muscle mass (sarcopenia) and strength (dynapenia), in the presence of osteoporosis/osteopenia, have an increased risk of fracture and mortality over 10 years, compared to those with low muscle or low bone mass alone or with neither condition. Method(s): 1032 participants (52% women; mean age 62.9+/-7.4 years) were studied at baseline, 2.5, 5 and 10 years. Mortality was ascertained from the death registry and fractures were self-reported. Baseline appendicular lean mass (ALM) was assessed using dual-energy X-ray absorptiometry and normalised to body mass index (BMI). Hand grip strength (HGS) was assessed by dynamometer. Osteosarcopenia and osteodynapenia were defined as having T-scores of the total hip and/or lumbar spine bone mineral density (BMD) < -1 combined with being in the lowest 20% of the sex-specific distribution for ALM/BMI or HGS respectively. Result(s): Incident fracture risk was significanlty higher in participants who were osteodynapenic (RR=2.07, 95% CI: 1.26-3.39), dynapenic alone (RR=1.74, 95% CI: 1.05-2.87), and osteopenic alone (RR=1.63, 95% CI: 1.15-2.31), compared to those without dynapenia or osteopenia. Mortality risk was significantly higher only in participants with osteosarcopenia (RR=1.49, 95% CI: 1.01-2.21) compared to those without sarcopenia or osteopenia. However, osteosarcopenia and osteodynapenia did not lead to a significantly greater fracture or mortality risk compared to having these conditions on their own. Conclusion(s): Osteopenia combined with low muscle mass or strength does not significantly increase the risk of fracture or mortality compared to having osteopenia or sarcopenia/dynapenia alone, suggesting that combined assessments may not add additional risk for fracture and mortality.

Aim: To describe the associations of between-person and within-person variability in serum 25-hydroxyvitamin D (25(OH)D), physical activity (PA), and knee pain and dysfunction with muscle mass, strength, and muscle quality over 10 years in community-dwelling older adults. Method(s): Participants (N = 1033; 51% women; mean age 63 +/- 7.4 years) were measured at baseline, 2.5, 5, and 10 years. Lower limb lean mass (LLM) was assessed using dual energy X-ray absorptiometry, lower limb muscle strength (LMS) using a dynamometer, and lower limb muscle quality (LMQ) calculated as LMS/LLM. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. PA was measured using pedometers. Linear-mixed effect regression models, with adjustment for confounders, were used to estimate the association of within-person and between-person variability in PA, 25(OH)D, and WOMAC scores with muscle mass, strength, and muscle quality. Result(s): Both between-person and within-person increases in PA were associated with LLM, LMS, and LMQ (all P < 0.05). Within-person and between-person increases in knee pain and dysfunction were associated with LLS and LMQ, but not with LLM (all P < 0.05). Between-person effects showed that higher average 25(OH)D was associated with a higher 10-year average LLM, LMS, and LMQ (all P < 0.05), whereas within-person increases in average 25(OH)D were associated with a higher LMS and LMQ, but not with LLM. Conclusion(s): Variability in 25(OH)D, pain, and dysfunction within an individual over time is related to muscle changes in that individual. Increasing one's own PA level further increases muscle mass, strength, and quality supporting the clinical recommendation of promoting PA to reduce age-related muscle loss.

Objective To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. Methods We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n=20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. Results The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 x 10-8; and LINC00539/ZDHHC20, p = 5.82 x 10-9. Both have been associated with blood pressure (BP)-related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p[BI] = 9.38 x 10-25; p [SSBI] = 5.23 x 10-14 for hypertension), smoking (p[BI]= 4.4 x 10-10; p [SSBI] = 1.2 x 10 -4), diabetes (p[BI] = 1.7 x 10 -8; p [SSBI] = 2.8 x 10 -3), previous cardiovascular disease (p [BI] = 1.0 x 10-18; p [SSBI] = 2.3 x 10-7), stroke (p [BI] = 3.9 x 10-69; p [SSBI] = 3.2 x 10 -24), and MRI-defined white matter hyperintensity burden (p [BI]=1.43 x 10-157; p [SSBI] = 3.16 x 10-106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p <= 0.0022), without indication of directional pleiotropy. Conclusion In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significa

Background: Aneurysmal subarachnoid hemorrhage (aSAH) disproportionally affects women. The etiology of this is unclear, and the contribution of sex differences in aSAH risk factors is unknown. We aimed to identify sex differences in aSAH risk factors in a systematic review and meta-analysis. Method(s): A systematic search was conducted using the Pubmed, Scopus, Embase, and Medline databases from inception to November 2017 to identify studies that included aSAH risk factors stratified by sex. aSAH risk factors were assessed using meta-analysis with pooled odds ratios (OR) calculated for risk factors with at least 2 studies. Result(s): There were 34 eligible case-control studies; however, 15 did not report sex specific findings with 19 were included. Hypertension (men pooled ORadjusted 3.13 [95% CI 2.26-4.34]; women pooled ORadjusted 3.65 [95% CI 2.87-4.63], p=0.18), smoking (men pooled ORadjusted 2.96 [95% CI 1.68-5.21]; women pooled ORadjusted 3.11 [95% CI 1.21-7.97], p=0.95),family history of aSAH, increased systolic blood pressure, age, angiotensin-converting enzyme gene polymorphism and variation in a protease gene had the same odds for aSAH in both sexes. Alcohol intake (men pooled ORadjusted 1.50 [95% CI 1.04-2.17], women pooled ORadjusted 0.83 [95% CI 0.48-1.45], p=0.003), high alanine aminotransferase levels, and endothelial nitric oxide synthase gene variant were associated with higher odds of aSAH in men than women. Cold temperature, polymorphisms in factor XIII gene and genetic variation on chromosome 9p21 increased the odds of aSAH in women but not men. High aspartate aminotransferase levels were associated with a reduced risk in men while diabetes mellitus decreased the risk in women (men pooled ORadjusted 0.57 [95% CI 0.32- 1.01], women pooled ORadjusted 0.24 [95% CI 0.13-0.43], p=0.017). Conclusion(s): Except for alcohol intake and diabetes mellitus, the magnitude of aSAH risk associated with most common risk factors were similar for both sexes. We adv

Background: Aneurysmal subarachnoid hemorrhage (aSAH) affects women more than men, unlike other stroke types. We completed a systematic review and meta-analysis of risk factors associated with the occurrence of aSAH in women. Method(s): A systematic search was conducted using the Pubmed, Scopus, Embase, and Medline databases from inception to November 2017 to identify studies that included aSAH risk factors among women only or mentioned female sex as a risk factor. The risk factors were assessed using meta-analysis if reported by at least two studies. Result(s): Fourteen studies (10 case-control; 4 cohort) were included. Female sex was associated with higher odds or risk of aSAH in pooled estimates of cohort studies (HRadjusted 1.90, 95% CI 1.47-2.46) but not in case-control studies (ORadjusted 1.44, 95% CI 0.83-2.52). Menarche at an early age (age <12 years HRcrude 1.15 [95% CI 0.52-2.55], age <13 years ORadjusted 3.24 [95% CI 1.25-4.03]), pregnancy at >=26 years (ORadjusted 1.78 [95% CI 1.13-2.80]), use of contraceptive pills (RRcrude range, 5.3-6.5), nulligravidity (ORadjusted 4.23 [95% CI 1.05-7.56]), aSAH predilection area (RRcrude 1.81) and being divorced (RRcrude 1.89) increased the risk for aSAH in women. Parity moderately decreased the risk for aSAH (parity >3 HRcrude 1.21 [95% CI 0.68-2.14], parity=2 ORadjusted 0.87 [95% CI 0.64-1.19], parity >=5, ORadjusted 0.25 [95% CI 0.03-1.89]). Conclusion(s): A number of risk factors, primarily related to reproductive hormones, for aSAH were identified in women. These could be potential causes of higher incidence of aSAH in women compared to men. There is a need for further research focused on aSAH in order to explore the association of these risk factors with aSAH in women.

Objective To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. Methods We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n = 20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. Results The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10−8; and LINC00539/ZDHHC20, p = 5.82 × 10−9. Both have been associated with blood pressure (BP)–related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p[BI] = 9.38 × 10−25; p[SSBI] = 5.23 × 10−14 for hypertension), smoking (p[BI] = 4.4 × 10−10; p[SSBI] = 1.2 × 10−4), diabetes (p[BI] = 1.7 × 10−8; p[SSBI] = 2.8 × 10−3), previous cardiovascular disease (p[BI] = 1.0 × 10−18; p[SSBI] = 2.3 × 10−7), stroke (p[BI] = 3.9 × 10−69; p[SSBI] = 3.2 × 10−24), and MRI-defined white matter hyperintensity burden (p[BI] = 1.43 × 10−157; p[SSBI] = 3.16 × 10−106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p ≤ 0.0022), without indication of directional pleiotropy. Conclusion In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significant modifi

Aim: To describe the associations of between-person and within-person variability in serum 25-hydroxyvitamin D (25(OH)D), physical activity (PA), and knee pain and dysfunction with muscle mass, strength, and muscle quality over 10 years in community-dwelling older adults. Method(s): Participants (N = 1033; 51% women; mean age 63 +/- 7.4 years) were measured at baseline, 2.5, 5, and 10 years. Lower limb lean mass (LLM) was assessed using dual energy X-ray absorptiometry, lower limb muscle strength (LMS) using a dynamometer, and lower limb muscle quality (LMQ) calculated as LMS/LLM. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. PA was measured using pedometers. Linear-mixed effect regression models, with adjustment for confounders, were used to estimate the association of within-person and between-person variability in PA, 25(OH)D, and WOMAC scores with muscle mass, strength, and muscle quality. Result(s): Both between-person and within-person increases in PA were associated with LLM, LMS, and LMQ (all P < 0.05). Within-person and between-person increases in knee pain and dysfunction were associated with LLS and LMQ, but not with LLM (all P < 0.05). Between-person effects showed that higher average 25(OH)D was associated with a higher 10-year average LLM, LMS, and LMQ (all P < 0.05), whereas within-person increases in average 25(OH)D were associated with a higher LMS and LMQ, but not with LLM. Conclusion(s): Variability in 25(OH)D, pain, and dysfunction within an individual over time is related to muscle changes in that individual. Increasing one's own PA level further increases muscle mass, strength, and quality supporting the clinical recommendation of promoting PA to reduce age-related muscle loss.

Objective To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. Methods We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n=20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. Results The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 x 10-8; and LINC00539/ZDHHC20, p = 5.82 x 10-9. Both have been associated with blood pressure (BP)-related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p[BI] = 9.38 x 10-25; p [SSBI] = 5.23 x 10-14 for hypertension), smoking (p[BI]= 4.4 x 10-10; p [SSBI] = 1.2 x 10 -4), diabetes (p[BI] = 1.7 x 10 -8; p [SSBI] = 2.8 x 10 -3), previous cardiovascular disease (p [BI] = 1.0 x 10-18; p [SSBI] = 2.3 x 10-7), stroke (p [BI] = 3.9 x 10-69; p [SSBI] = 3.2 x 10 -24), and MRI-defined white matter hyperintensity burden (p [BI]=1.43 x 10-157; p [SSBI] = 3.16 x 10-106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p <= 0.0022), without indication of directional pleiotropy. Conclusion In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significa

Background: Aneurysmal subarachnoid hemorrhage (aSAH) disproportionally affects women. The etiology of this is unclear, and the contribution of sex differences in aSAH risk factors is unknown. We aimed to identify sex differences in aSAH risk factors in a systematic review and meta-analysis. Method(s): A systematic search was conducted using the Pubmed, Scopus, Embase, and Medline databases from inception to November 2017 to identify studies that included aSAH risk factors stratified by sex. aSAH risk factors were assessed using meta-analysis with pooled odds ratios (OR) calculated for risk factors with at least 2 studies. Result(s): There were 34 eligible case-control studies; however, 15 did not report sex specific findings with 19 were included. Hypertension (men pooled ORadjusted 3.13 [95% CI 2.26-4.34]; women pooled ORadjusted 3.65 [95% CI 2.87-4.63], p=0.18), smoking (men pooled ORadjusted 2.96 [95% CI 1.68-5.21]; women pooled ORadjusted 3.11 [95% CI 1.21-7.97], p=0.95),family history of aSAH, increased systolic blood pressure, age, angiotensin-converting enzyme gene polymorphism and variation in a protease gene had the same odds for aSAH in both sexes. Alcohol intake (men pooled ORadjusted 1.50 [95% CI 1.04-2.17], women pooled ORadjusted 0.83 [95% CI 0.48-1.45], p=0.003), high alanine aminotransferase levels, and endothelial nitric oxide synthase gene variant were associated with higher odds of aSAH in men than women. Cold temperature, polymorphisms in factor XIII gene and genetic variation on chromosome 9p21 increased the odds of aSAH in women but not men. High aspartate aminotransferase levels were associated with a reduced risk in men while diabetes mellitus decreased the risk in women (men pooled ORadjusted 0.57 [95% CI 0.32- 1.01], women pooled ORadjusted 0.24 [95% CI 0.13-0.43], p=0.017). Conclusion(s): Except for alcohol intake and diabetes mellitus, the magnitude of aSAH risk associated with most common risk factors were similar for both sexes. We adv

Background: Aneurysmal subarachnoid hemorrhage (aSAH) affects women more than men, unlike other stroke types. We completed a systematic review and meta-analysis of risk factors associated with the occurrence of aSAH in women. Method(s): A systematic search was conducted using the Pubmed, Scopus, Embase, and Medline databases from inception to November 2017 to identify studies that included aSAH risk factors among women only or mentioned female sex as a risk factor. The risk factors were assessed using meta-analysis if reported by at least two studies. Result(s): Fourteen studies (10 case-control; 4 cohort) were included. Female sex was associated with higher odds or risk of aSAH in pooled estimates of cohort studies (HRadjusted 1.90, 95% CI 1.47-2.46) but not in case-control studies (ORadjusted 1.44, 95% CI 0.83-2.52). Menarche at an early age (age <12 years HRcrude 1.15 [95% CI 0.52-2.55], age <13 years ORadjusted 3.24 [95% CI 1.25-4.03]), pregnancy at >=26 years (ORadjusted 1.78 [95% CI 1.13-2.80]), use of contraceptive pills (RRcrude range, 5.3-6.5), nulligravidity (ORadjusted 4.23 [95% CI 1.05-7.56]), aSAH predilection area (RRcrude 1.81) and being divorced (RRcrude 1.89) increased the risk for aSAH in women. Parity moderately decreased the risk for aSAH (parity >3 HRcrude 1.21 [95% CI 0.68-2.14], parity=2 ORadjusted 0.87 [95% CI 0.64-1.19], parity >=5, ORadjusted 0.25 [95% CI 0.03-1.89]). Conclusion(s): A number of risk factors, primarily related to reproductive hormones, for aSAH were identified in women. These could be potential causes of higher incidence of aSAH in women compared to men. There is a need for further research focused on aSAH in order to explore the association of these risk factors with aSAH in women.

OBJECTIVE: To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. METHODS: We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n = 20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. RESULTS: The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10-8; and LINC00539/ZDHHC20, p = 5.82 × 10-9. Both have been associated with blood pressure (BP)-related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p [BI] = 9.38 × 10-25; p [SSBI] = 5.23 × 10-14 for hypertension), smoking (p [BI] = 4.4 × 10-10; p [SSBI] = 1.2 × 10-4), diabetes (p [BI] = 1.7 × 10-8; p [SSBI] = 2.8 × 10-3), previous cardiovascular disease (p [BI] = 1.0 × 10-18; p [SSBI] = 2.3 × 10-7), stroke (p [BI] = 3.9 × 10-69; p [SSBI] = 3.2 × 10-24), and MRI-defined white matter hyperintensity burden (p [BI] = 1.43 × 10-157; p [SSBI] = 3.16 × 10-106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p ≤ 0.0022), without indication of directional pleiotropy. CONCLUSION: In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most si

Objective To explore genetic and lifestyle risk factors of MRI-defined brain infarcts (BI) in large population-based cohorts. Methods We performed meta-analyses of genome-wide association studies (GWAS) and examined associations of vascular risk factors and their genetic risk scores (GRS) with MRI-defined BI and a subset of BI, namely, small subcortical BI (SSBI), in 18 population-based cohorts (n = 20,949) from 5 ethnicities (3,726 with BI, 2,021 with SSBI). Top loci were followed up in 7 population-based cohorts (n = 6,862; 1,483 with BI, 630 with SBBI), and we tested associations with related phenotypes including ischemic stroke and pathologically defined BI. Results The mean prevalence was 17.7% for BI and 10.5% for SSBI, steeply rising after age 65. Two loci showed genome-wide significant association with BI: FBN2, p = 1.77 × 10−8; and LINC00539/ZDHHC20, p = 5.82 × 10−9. Both have been associated with blood pressure (BP)–related phenotypes, but did not replicate in the smaller follow-up sample or show associations with related phenotypes. Age- and sex-adjusted associations with BI and SSBI were observed for BP traits (p value for BI, p[BI] = 9.38 × 10−25; p[SSBI] = 5.23 × 10−14 for hypertension), smoking (p[BI] = 4.4 × 10−10; p[SSBI] = 1.2 × 10−4), diabetes (p[BI] = 1.7 × 10−8; p[SSBI] = 2.8 × 10−3), previous cardiovascular disease (p[BI] = 1.0 × 10−18; p[SSBI] = 2.3 × 10−7), stroke (p[BI] = 3.9 × 10−69; p[SSBI] = 3.2 × 10−24), and MRI-defined white matter hyperintensity burden (p[BI] = 1.43 × 10−157; p[SSBI] = 3.16 × 10−106), but not with body mass index or cholesterol. GRS of BP traits were associated with BI and SSBI (p ≤ 0.0022), without indication of directional pleiotropy. Conclusion In this multiethnic GWAS meta-analysis, including over 20,000 population-based participants, we identified genetic risk loci for BI requiring validation once additional large datasets become available. High BP, including genetically determined, was the most significant modifi

Aims: To describe the longitudinal associations between physiological falls risk, and between-person and within-person effects of 25-hydroxyvitamin D (25OHD), physical activity (PA), knee pain and dysfunction in community-dwelling older people. Method(s): Data for 1053 participants (51% women; mean age 63 +/- 7.4 years) studied at baseline, 2.5, 5, and 10 years were analysed. Falls risk (Z-score) was measured using the Physiological Profile Assessment. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Moderate-to-vigorous PA (MVPA) was measured using accelerometer. Linear mixed-effect regression models, with adjustment for confounders, were used to estimate the association between physiological falls risk and between-person and within-person effects of PA, 25OHD and WOMAC score. Result(s): Between-person effects showed that 10-year average physiological falls risk was lower in participants who had a higher 10-year average 25OHD (beta = -0.005 per nmol/l, 95% CI: -0.008, -0.002), log-MVPA (beta = -0.16 per minute, 95% CI: -0.22, -0.10) and lower mean WOMAC score (beta = 0.005 per-unit score, 95% CI: 0.003, 0.01). Within-person effects showed that a higher physiological falls risk at any time-point was associated with higher than average WOMAC score (beta = 0.002 per-unit score, 95% CI: 0.0003, 0.004) and lower than average log-MVPA (beta = -0.15 per minute, 95% CI: -0.24, -0.06), but not 25OHD, at the same time-point. Conclusion(s): Having higher WOMAC global score above an individual's average increases the risk of falling, whereas, increasing one's own MVPA level further reduces their risk of falling. The presence of between-person but not within-person associations for 25OHD suggests the former may be confounded by other factors.Copyright © 2018 Elsevier Inc.

Aims: To describe the longitudinal associations between physiological falls risk, and between-person and within-person effects of 25-hydroxyvitamin D (25OHD), physical activity (PA), knee pain and dysfunction in community-dwelling older people. Method(s): Data for 1053 participants (51% women; mean age 63 +/- 7.4 years) studied at baseline, 2.5, 5, and 10 years were analysed. Falls risk (Z-score) was measured using the Physiological Profile Assessment. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Moderate-to-vigorous PA (MVPA) was measured using accelerometer. Linear mixed-effect regression models, with adjustment for confounders, were used to estimate the association between physiological falls risk and between-person and within-person effects of PA, 25OHD and WOMAC score. Result(s): Between-person effects showed that 10-year average physiological falls risk was lower in participants who had a higher 10-year average 25OHD (beta = -0.005 per nmol/l, 95% CI: -0.008, -0.002), log-MVPA (beta = -0.16 per minute, 95% CI: -0.22, -0.10) and lower mean WOMAC score (beta = 0.005 per-unit score, 95% CI: 0.003, 0.01). Within-person effects showed that a higher physiological falls risk at any time-point was associated with higher than average WOMAC score (beta = 0.002 per-unit score, 95% CI: 0.0003, 0.004) and lower than average log-MVPA (beta = -0.15 per minute, 95% CI: -0.24, -0.06), but not 25OHD, at the same time-point. Conclusion(s): Having higher WOMAC global score above an individual's average increases the risk of falling, whereas, increasing one's own MVPA level further reduces their risk of falling. The presence of between-person but not within-person associations for 25OHD suggests the former may be confounded by other factors.Copyright © 2018 Elsevier Inc.

BACKGROUND: To estimate the prevalence of non-communicable disease (NCD) risk factors at a provincial level in Vietnam, and to assess whether the summary estimates allow reliable inferences to be drawn regarding regional differences in risk factors and associations between them. METHODS: Participants (n=14706, 53.5 % females) aged 25-64 years were selected by multi-stage stratified cluster sampling from eight provinces each representing one of the eight geographical regions of Vietnam. Measurements were made using the World Health Organization STEPS protocols. Data were analysed using complex survey methods. RESULTS: Differences by sex in mean years of schooling (males 8.26+/-0.20, females 7.00+/-0.18), proportions of current smokers (males 57.70 %, females 1.73 %), and binge-drinkers (males 25.11 %, females 0.63 %), and regional differences in diet, reflected the geographical and socio-cultural characteristics of the country. Provinces with a higher proportion of urban population had greater mean levels of BMI (r=0.82), and lesser proportions of active people (r=-0.89). The associations between the summary estimates were generally plausible (e.g. physical activity and BMI, r=-0.80) but overstated, and with some anomalous findings due to characterisation of smoking and hypertension by STEPS protocols. CONCLUSIONS: This report provides an extensive description of the sex-specific and regional distribution of NCD risk factors in Vietnam and an account of some health-related consequences of industrialisation in its early stages. The STEPS protocols can be utilized to provide aggregate data for valid between-population comparisons, but with important caveats identified.

Cognitive impairment and dementia are common contributors to institutionalization and loss of quality of life in older people. Both type 2 diabetes mellitus (T2DM) and physical inactivity are prevalent and important modifiable risk factors for developing dementia. Physical activity is recommended in the management of T2DM, and there is growing evidence that exercise, a subgroup of physical activity, is also beneficial for maintaining and improving brain structure and function. This paper reviews the evidence for a benefit of exercise on T2DM related cognitive impairment and dementia. In addition, the type (e.g., aerobic, resistance), intensity, duration, and frequency of exercise are discussed. This review shows that although exercise has known benefits on the mechanisms linking T2DM to dementia, there are very few randomized controlled trials examining whether this is the case. It is concluded that the uptake of exercise for the brain has great potential to improve quality of life and provide significant cost savings, but further research is warranted to clarify the effects of exercise on T2DM and those on dementia.Copyright © 2017-IOS Press and the authors. All rights reserved.

Objective: Traditionally, analysis has focused on examining how risk factors for falls differ between individuals (between-person comparison). Less well recognized is how variability in risk factors over time within the same individual (within-person comparison) is associated with falls risk. To describe the associations between falls risk, and between-person and within-person variability in 25-hydroxyvitamin D (25OHD), physical activity (PA), knee pain and dysfunction in community-dwelling older people. Material(s) and Method(s): Data for 1053 participants (51% women; mean age 63+/-7. 4 years) studied at baseline, 2. 5, 5, and 10 years were analysed. Falls risk (Z-score) was measured using the validated Physiological Profile Assessment. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Moderate and vigorous PA (MVPA) was measured using accelerometer. Linear mixed effect regression models, with adjustment for confounders, were used to estimate the association between falls risk and between-person and within-person variability in PA, 25OHD and WOMAC score. Result(s): Between-person effects showed that 10-year average falls risk was lower in participants who had a higher 10-year average 25OHD (beta=-0. 005 per nmol/l, 95% CI:-0. 008,-0. 002, P<0. 001), log-MVPA (beta=-0. 16 per minute, 95% CI:-0. 22,-0. 10, P<0. 001) and lower mean WOMAC score (beta=0. 005 per-unit score, 95% CI: 0. 003, 0. 01, P<0. 001). Within-person effects showed that a higher falls risk at any time-point was associated with higher than average WOMAC score (beta=0. 002 per-unit score, 95% CI: 0. 0003, 0. 004, P=0. 025) and lower than average log-MVPA (beta=-0. 15 per minute, 95% CI:-0. 24,-0. 06, P=0. 003), but not 25OHD, at the same time-point. Conclusion(s): Within-person analysis showed that at time-points when participants had higher pain and dysfunction and lower MVPA, they also had a higher falls risk. This sup-ports cli

Applying HaploReg v4.1 analysis to the 536 variants resulted in 9 categories (Supplementary Table 8): miscRNA (1 variant); snoRNA (2 variants); microRNA (4 variants); snRNA (9 variants); pseudogenes (14 variants); sequencing in progress (43 variants); LINC RNA (86 variants); and 372 variants within protein coding genes. In addition, some variants annotate to the same gene resulting in a total of 139 genes (protein-coding or non-coding). Of those genes, 6 are exceptionally long, containing over a million base-pairs, the longest of which is PTPRT coded by 1117219bp. The shortest genes are the ones coding for micro (MIR3143) or small nuclear (U7) RNAs at 63bp each. There is only partial information regarding the chromatin state of each variant. However, from the information gathered in the analysis we observed 14 transcription start sites and 245 enhancers (Supplementary Table 8).

BACKGROUND: To estimate the prevalence of non-communicable disease (NCD) risk factors at a provincial level in Vietnam, and to assess whether the summary estimates allow reliable inferences to be drawn regarding regional differences in risk factors and associations between them. METHODS: Participants (n=14706, 53.5 % females) aged 25-64 years were selected by multi-stage stratified cluster sampling from eight provinces each representing one of the eight geographical regions of Vietnam. Measurements were made using the World Health Organization STEPS protocols. Data were analysed using complex survey methods. RESULTS: Differences by sex in mean years of schooling (males 8.26+/-0.20, females 7.00+/-0.18), proportions of current smokers (males 57.70 %, females 1.73 %), and binge-drinkers (males 25.11 %, females 0.63 %), and regional differences in diet, reflected the geographical and socio-cultural characteristics of the country. Provinces with a higher proportion of urban population had greater mean levels of BMI (r=0.82), and lesser proportions of active people (r=-0.89). The associations between the summary estimates were generally plausible (e.g. physical activity and BMI, r=-0.80) but overstated, and with some anomalous findings due to characterisation of smoking and hypertension by STEPS protocols. CONCLUSIONS: This report provides an extensive description of the sex-specific and regional distribution of NCD risk factors in Vietnam and an account of some health-related consequences of industrialisation in its early stages. The STEPS protocols can be utilized to provide aggregate data for valid between-population comparisons, but with important caveats identified.

Cognitive impairment and dementia are common contributors to institutionalization and loss of quality of life in older people. Both type 2 diabetes mellitus (T2DM) and physical inactivity are prevalent and important modifiable risk factors for developing dementia. Physical activity is recommended in the management of T2DM, and there is growing evidence that exercise, a subgroup of physical activity, is also beneficial for maintaining and improving brain structure and function. This paper reviews the evidence for a benefit of exercise on T2DM related cognitive impairment and dementia. In addition, the type (e.g., aerobic, resistance), intensity, duration, and frequency of exercise are discussed. This review shows that although exercise has known benefits on the mechanisms linking T2DM to dementia, there are very few randomized controlled trials examining whether this is the case. It is concluded that the uptake of exercise for the brain has great potential to improve quality of life and provide significant cost savings, but further research is warranted to clarify the effects of exercise on T2DM and those on dementia.Copyright © 2017-IOS Press and the authors. All rights reserved.

Objective: Traditionally, analysis has focused on examining how risk factors for falls differ between individuals (between-person comparison). Less well recognized is how variability in risk factors over time within the same individual (within-person comparison) is associated with falls risk. To describe the associations between falls risk, and between-person and within-person variability in 25-hydroxyvitamin D (25OHD), physical activity (PA), knee pain and dysfunction in community-dwelling older people. Material(s) and Method(s): Data for 1053 participants (51% women; mean age 63+/-7. 4 years) studied at baseline, 2. 5, 5, and 10 years were analysed. Falls risk (Z-score) was measured using the validated Physiological Profile Assessment. Knee pain and dysfunction were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC). Moderate and vigorous PA (MVPA) was measured using accelerometer. Linear mixed effect regression models, with adjustment for confounders, were used to estimate the association between falls risk and between-person and within-person variability in PA, 25OHD and WOMAC score. Result(s): Between-person effects showed that 10-year average falls risk was lower in participants who had a higher 10-year average 25OHD (beta=-0. 005 per nmol/l, 95% CI:-0. 008,-0. 002, P<0. 001), log-MVPA (beta=-0. 16 per minute, 95% CI:-0. 22,-0. 10, P<0. 001) and lower mean WOMAC score (beta=0. 005 per-unit score, 95% CI: 0. 003, 0. 01, P<0. 001). Within-person effects showed that a higher falls risk at any time-point was associated with higher than average WOMAC score (beta=0. 002 per-unit score, 95% CI: 0. 0003, 0. 004, P=0. 025) and lower than average log-MVPA (beta=-0. 15 per minute, 95% CI:-0. 24,-0. 06, P=0. 003), but not 25OHD, at the same time-point. Conclusion(s): Within-person analysis showed that at time-points when participants had higher pain and dysfunction and lower MVPA, they also had a higher falls risk. This sup-ports cli

A roundtable discussion and debate will summarize the evidence in favor of and against considering “gait and cognition” as an emerging geriatric syndrome. Specifically, we will discuss whether there is sufficient evidence to support the idea that gait and cognitive impairments among older individuals in the absence of an overt neurological disease represent a distinct phenotype caused by shared mechanisms. Potential clinical applicability of the construct will be discussed.

Aims: To provide nationally representative data on alcohol consumption in Vietnam and to assess whether reported numbers of 'standard drinks' consumed have evidence of validity (particularly in rural areas where home-made alcohol is consumed from cups of varying size). Method(s): A nationally representative population-based survey of 14,706 participants (46.5% males, response proportion 64.1%) aged 25-64 years in Vietnam. Measurements were made in accordance with WHO STEPS protocols. Data were analysed using complex survey methods. Result(s): Among men, 80% reported drinking alcohol during the last year, and 40% were hazardous/harmful drinkers. Approximately 60% of men and <5% of women had consumed alcohol during the last week, with one-in-four of the men reporting having consumed at least five standard drinks on at least one occasion. Numbers of standard drinks reported by men were associated with blood pressure/hypertension, particularly in rural areas (P < 0.001 for trend). Most of the calibration and discrimination possible from self-reported information on alcohol consumption was provided by binary responses to questions on whether or not alcohol had been consumed during the reference period. Conclusion(s): Alcohol use and harmful consumption were common among Vietnamese men but less pronounced than in Western nations. Self-reports of quantity of alcohol consumed in terms of standard drinks had predictive validity for blood pressure and hypertension even in rural areas. However, using detailed measures of consumption resulted in only minor improvements in prediction compared to simple measures.Copyright © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

The aims of the present study were to provide nationally representative data on fruit and vegetable consumption in Vietnam, and to assess the accuracy of the reported numbers of 'standard servings' consumed. Data analysed were from a multi-stage stratified cluster survey of 14 706 participants (46.5 % males, response proportion 64.1 %) aged 25-64 years in Vietnam. Measurements were made in accordance with the WHO STEPwise approach to surveillance of non-communicable diseases (STEPS) protocols. Approximately 80 % of Vietnamese people reported having less than five servings of fruit and vegetables daily in a typical week. Fruit and vegetable intake reported in 'standard serving' sizes was positively correlated with levels of education completed and household income (P<0.001 for trend). The correlations between summary values for each province reflect some known demographic, geographical and climatic characteristics of the country. For example, provinces at higher latitude had higher mean servings of vegetables (r 0.90), and provinces with higher proportions of urban population had higher mean servings of fruit (r 0.40). In conclusion, about eight in ten Vietnamese people aged 25-64 years did not meet WHO recommendations for daily consumption of at least five servings of fruit and vegetables. On the basis of the consistency of the data collected with other estimates and with physical and demographic characteristics of the country, the WHO STEPS instrument has construct validity for measuring fruit and vegetable intake, but with two issues identified. The issues were seasonal variation in reporting and a limitation on the usefulness of the information for associative analyses.Copyright © The Authors 2016.

Aim: Type 2 diabetes mellitus (T2D) is associated with gray matter atrophy. Adiposity and physical inactivity are risk factors for T2D and brain atrophy. We studied whether the associations of T2D with total gray matter volume (GMV) and hippocampal volume (HV) are dependent on obesity and physical activity. Material(s) and Method(s): In this cross-sectional study, we measured waist-hip ratio (WHR), body mass index (BMI), mean steps/day and brain volumes in a community dwelling cohort of people with and without T2D. Using multivariable linear regression, we examined whether WHR, BMI and physical activity mediated or modified the association between T2D, GMV and HV. Result(s): There were 258 participants with (mean age 67+/-7 years) and 302 without (mean age 72+/-7 years) T2D. Adjusting for age, sex and intracranial volume, T2D was independently associated with lower total GMV (p = 0.001) and HV (p<0.001), greater WHR (p<0.001) and BMI (p<0.001), and lower mean steps/day (p = 0.002). After adjusting for covariates, the inclusion of BMI and mean steps/day did not significantly affect the T2D-GMV association, but WHR attenuated it by 32% while remaining independently associated with lower GMV (p<0.01). The T2D-HV association was minimally changed by the addition of BMI, steps/day or WHR in the model. No statistical interactions were observed between T2D and measures of obesity and physical activity in explaining brain volumes. Conclusion(s): Abdominal obesity or its downstream effects may partially mediate the adverse effect of T2D on brain atrophy. This requires confirmation in longitudinal studies.Copyright © 2015 Climie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Measurement reliability of the L4/5 lumbar multifidus (MF) muscles is high in older adults, but few studies have investigated measurement reliability of the abdominal and upper lumbar MF muscles in this age group. Objectives To determine measurement reliability of abdominal and lumbar MF muscles from a single ultrasound (US) image in older adults. Methods Resting thickness of rectus abdominis and obliquus externus, resting and contracted thickness of obliquus internus, transversus abdominis and lumbar MF, and resting cross-sectional area (CSA) of MF levels (L2-5) were obtained from US images of 92 community-dwelling older adults (aged 65-89 years). Measurements of images were undertaken by an experienced rater and repeated 7-10 days later for intra-rater, and by a second expert rater for inter-rater calculations. Intra-rater reliability was estimated for all muscles. Inter-rater reliability was estimated for all abdominal muscles and for L5 multifidus. Reliability was estimated by intraclass correlation coefficients (ICC). Results Intra-rater ICC(3,1) and inter-rater ICC(2,1) of resting thickness measures of all muscles and CSA of MF were >=0.86. The ICCs for percentage thickness change were >=0.76 for the abdominal muscles, and >=0.42 for MF. Conclusions Measurement reliability of US imaging for abdominal and MF muscle thickness and MF CSA was high, and consistent with previous findings for younger adults. Reliability of percentage thickness change was lower suggesting caution is needed when using this as an outcome measure or study factor among older adults.Copyright © 2016 Elsevier Ltd

Background: Exercise participation is recommended following stroke to reduce cardiovascular risk and improve psychological wellbeing, but little is known about how exercise participation changes over time after stroke. Method(s): Data were from a population-based stroke incidence study with follow-up to 10 years (excluding subarachnoid hemorrhage, first-ever strokes only). Questionnaires about exercise (defined as active exercise lasting >= 20 minutes that caused sweating or 'huffing and puffing') before and after stroke were collected five (2001-04) and ten (2006-09) years post stroke. We examined changes in exercise habits between 5 and 10 years, how this related to pre-stroke exercise habits and participant characteristics (age, sex, stroke severity, stroke type and disability at 5 years) with multinomial regression. Result(s): There were 248 (87% of those alive) people with complete exercise data at 5 and 10 years post stroke (mean [SD] age 69 [SD 14] years, 47% female). Only 16% (n = 41) reported exercising at 5 and 10-years, where 95% of these participants identified as exercising prior to stroke. There were 10% (n = 25) that reported commencing exercise between 5 and 10-years, with 36% (n = 9) of these participants reporting as exercising prior to stroke. Continual exercise was associated with younger age and less disability at 5 years, while commencing exercise was also associated with less disability at 5 years. Conclusion(s): Few people exercise following stroke. Exercise participation prior to stroke influences long term exercise. Commencement of exercise between 5 and 10-years post stroke suggests there may be opportunities for capturing 'new' exercisers.

Background: Exercise participation is recommended following stroke to reduce cardiovascular risk and improve psychological wellbeing, but little is known about how exercise participation changes over time after stroke. Method(s): Data were from a population-based stroke incidence study with follow-up to 10 years (excluding subarachnoid hemorrhage, first-ever strokes only). Questionnaires about exercise (defined as active exercise lasting >= 20 minutes that caused sweating or 'huffing and puffing') before and after stroke were collected five (2001-04) and ten (2006-09) years post stroke. We examined changes in exercise habits between 5 and 10 years, how this related to pre-stroke exercise habits and participant characteristics (age, sex, stroke severity, stroke type and disability at 5 years) with multinomial regression. Result(s): There were 248 (87% of those alive) people with complete exercise data at 5 and 10 years post stroke (mean [SD] age 69 [SD 14] years, 47% female). Only 16% (n = 41) reported exercising at 5 and 10-years, where 95% of these participants identified as exercising prior to stroke. There were 10% (n = 25) that reported commencing exercise between 5 and 10-years, with 36% (n = 9) of these participants reporting as exercising prior to stroke. Continual exercise was associated with younger age and less disability at 5 years, while commencing exercise was also associated with less disability at 5 years. Conclusion(s): Few people exercise following stroke. Exercise participation prior to stroke influences long term exercise. Commencement of exercise between 5 and 10-years post stroke suggests there may be opportunities for capturing 'new' exercisers.

Aims: To provide nationally representative data on alcohol consumption in Vietnam and to assess whether reported numbers of 'standard drinks' consumed have evidence of validity (particularly in rural areas where home-made alcohol is consumed from cups of varying size). Method(s): A nationally representative population-based survey of 14,706 participants (46.5% males, response proportion 64.1%) aged 25-64 years in Vietnam. Measurements were made in accordance with WHO STEPS protocols. Data were analysed using complex survey methods. Result(s): Among men, 80% reported drinking alcohol during the last year, and 40% were hazardous/harmful drinkers. Approximately 60% of men and <5% of women had consumed alcohol during the last week, with one-in-four of the men reporting having consumed at least five standard drinks on at least one occasion. Numbers of standard drinks reported by men were associated with blood pressure/hypertension, particularly in rural areas (P < 0.001 for trend). Most of the calibration and discrimination possible from self-reported information on alcohol consumption was provided by binary responses to questions on whether or not alcohol had been consumed during the reference period. Conclusion(s): Alcohol use and harmful consumption were common among Vietnamese men but less pronounced than in Western nations. Self-reports of quantity of alcohol consumed in terms of standard drinks had predictive validity for blood pressure and hypertension even in rural areas. However, using detailed measures of consumption resulted in only minor improvements in prediction compared to simple measures.Copyright © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

The aims of the present study were to provide nationally representative data on fruit and vegetable consumption in Vietnam, and to assess the accuracy of the reported numbers of 'standard servings' consumed. Data analysed were from a multi-stage stratified cluster survey of 14 706 participants (46.5 % males, response proportion 64.1 %) aged 25-64 years in Vietnam. Measurements were made in accordance with the WHO STEPwise approach to surveillance of non-communicable diseases (STEPS) protocols. Approximately 80 % of Vietnamese people reported having less than five servings of fruit and vegetables daily in a typical week. Fruit and vegetable intake reported in 'standard serving' sizes was positively correlated with levels of education completed and household income (P<0.001 for trend). The correlations between summary values for each province reflect some known demographic, geographical and climatic characteristics of the country. For example, provinces at higher latitude had higher mean servings of vegetables (r 0.90), and provinces with higher proportions of urban population had higher mean servings of fruit (r 0.40). In conclusion, about eight in ten Vietnamese people aged 25-64 years did not meet WHO recommendations for daily consumption of at least five servings of fruit and vegetables. On the basis of the consistency of the data collected with other estimates and with physical and demographic characteristics of the country, the WHO STEPS instrument has construct validity for measuring fruit and vegetable intake, but with two issues identified. The issues were seasonal variation in reporting and a limitation on the usefulness of the information for associative analyses.Copyright © The Authors 2016.

Aim: Type 2 diabetes mellitus (T2D) is associated with gray matter atrophy. Adiposity and physical inactivity are risk factors for T2D and brain atrophy. We studied whether the associations of T2D with total gray matter volume (GMV) and hippocampal volume (HV) are dependent on obesity and physical activity. Material(s) and Method(s): In this cross-sectional study, we measured waist-hip ratio (WHR), body mass index (BMI), mean steps/day and brain volumes in a community dwelling cohort of people with and without T2D. Using multivariable linear regression, we examined whether WHR, BMI and physical activity mediated or modified the association between T2D, GMV and HV. Result(s): There were 258 participants with (mean age 67+/-7 years) and 302 without (mean age 72+/-7 years) T2D. Adjusting for age, sex and intracranial volume, T2D was independently associated with lower total GMV (p = 0.001) and HV (p<0.001), greater WHR (p<0.001) and BMI (p<0.001), and lower mean steps/day (p = 0.002). After adjusting for covariates, the inclusion of BMI and mean steps/day did not significantly affect the T2D-GMV association, but WHR attenuated it by 32% while remaining independently associated with lower GMV (p<0.01). The T2D-HV association was minimally changed by the addition of BMI, steps/day or WHR in the model. No statistical interactions were observed between T2D and measures of obesity and physical activity in explaining brain volumes. Conclusion(s): Abdominal obesity or its downstream effects may partially mediate the adverse effect of T2D on brain atrophy. This requires confirmation in longitudinal studies.Copyright © 2015 Climie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Measurement reliability of the L4/5 lumbar multifidus (MF) muscles is high in older adults, but few studies have investigated measurement reliability of the abdominal and upper lumbar MF muscles in this age group. Objectives To determine measurement reliability of abdominal and lumbar MF muscles from a single ultrasound (US) image in older adults. Methods Resting thickness of rectus abdominis and obliquus externus, resting and contracted thickness of obliquus internus, transversus abdominis and lumbar MF, and resting cross-sectional area (CSA) of MF levels (L2-5) were obtained from US images of 92 community-dwelling older adults (aged 65-89 years). Measurements of images were undertaken by an experienced rater and repeated 7-10 days later for intra-rater, and by a second expert rater for inter-rater calculations. Intra-rater reliability was estimated for all muscles. Inter-rater reliability was estimated for all abdominal muscles and for L5 multifidus. Reliability was estimated by intraclass correlation coefficients (ICC). Results Intra-rater ICC(3,1) and inter-rater ICC(2,1) of resting thickness measures of all muscles and CSA of MF were >=0.86. The ICCs for percentage thickness change were >=0.76 for the abdominal muscles, and >=0.42 for MF. Conclusions Measurement reliability of US imaging for abdominal and MF muscle thickness and MF CSA was high, and consistent with previous findings for younger adults. Reliability of percentage thickness change was lower suggesting caution is needed when using this as an outcome measure or study factor among older adults.Copyright © 2016 Elsevier Ltd

Introduction: To supplement limited information on tobacco use in Vietnam, data from a nationally-representative population-based survey was used to estimate the prevalence of smoking among 25-64 year-olds. Method(s): This study included 14,706 participants (53.5% females, response proportion 64%) selected by multi-stage stratified cluster sampling. Information was collected using the World Health Organization STEPwise approach to surveillance of risk factors for non-communicable disease (STEPS) questionnaire. Smoking prevalence was estimated with stratification by age, calendar year, and birth year. Result(s): Prevalence of ever-smoking was 74.9% (men) and 2.6% (women). Male ever-smokers commenced smoking at median age of 19.0 (interquartile range [IQR]: 17.0, 21.0) years and smoked median quantities of 10.0 (IQR: 7.0, 20.0) cigarettes/day. Female ever-smokers commenced smoking at median age of 20.0 (IQR: 18.0, 26.0) years and smoked median quantities of 6.0 (IQR: 4.0, 10.0) cigarettes/day. Prevalence has decreased in recent cohorts of men (p = .001), and its inverse association with years of education (p < .001) has strengthened for those born after 1969 (interaction p < .001). At 60 years of age, 53.0% of men who had reached that age were current smokers and they had accumulated median exposures of 39.0 (IQR: 32.0, 42.0) years of smoking and 21.0 (IQR: 11.5, 36.0) pack-years of cigarettes. The proportion of ever-smokers has decreased consistently among successive cohorts of women (p < .001). Conclusion(s): Smoking prevalence is declining in recent cohorts of men, and continues to decline in successive cohorts of women, possibly in response to anti-tobacco initiatives commencing in the 1990s. Low proportions of quitters mean that Vietnamese smokers accumulate high exposures despite moderate quantities of cigarettes smoked per day.Copyright © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rig

Background and Purpose-White matter lesion (WML) progression on magnetic resonance imaging is related to cognitive decline and stroke, but its determinants besides baseline WML burden are largely unknown. Here, we estimated heritability of WML progression, and sought common genetic variants associated with WML progression in elderly participants from the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium. Methods-Heritability of WML progression was calculated in the Framingham Heart Study. The genome-wide association study included 7773 elderly participants from 10 cohorts. To assess the relative contribution of genetic factors to progression of WML, we compared in 7 cohorts risk models including demographics, vascular risk factors plus single-nucleotide polymorphisms that have been shown to be associated cross-sectionally with WML in the current and previous association studies. Results-A total of 1085 subjects showed WML progression. The heritability estimate for WML progression was low at 6.5%, and no single-nucleotide polymorphisms achieved genome-wide significance (P<5×10-8). Four loci were suggestive (P<1×10-5) of an association with WML progression: 10q24.32 (rs10883817, P=1.46×10-6); 12q13.13 (rs4

Introduction: Our aims were to provide the first national estimates of physical activity (PA) for Vietnam, and to investigate issues affecting their accuracy. Method(s): Measurements were made using the Global Physical Activity Questionnaire (GPAQ) on a nationally-representative sample of 14706 participants (46.5% males, response 64.1%) aged 25-64 years selected by multi-stage stratified cluster sampling. Result(s): Approximately 20% of Vietnamese people had no measureable PA during a typical week, but 72.9%(men) and 69.1% (women) met WHO recommendations for PA by adults for their age. On average, 52.0 (men) and 28.0 (women) Metabolic Equivalent Task (MET)-hours/week (largely from work activities) were reported. Work and total PA were higher in rural areas and varied by season. Less than 2% of respondents provided incomplete information, but an additional one-in-six provided unrealistically high values of PA. Those responsible for reporting errors included persons from rural areas and all those with unstable work patterns. Box-Cox transformation (with an appropriate constant added) was the most successful method of reducing the influence of large values, but energy-scaled values were most strongly associated with pathophysiological outcomes. Conclusion(s): Around seven-in-ten Vietnamese people aged 25-64 years met WHO recommendations for total PA, which was mainly from work activities and higher in rural areas. Nearly all respondents were able to report their activity using the GPAQ, but with some exaggerated values and seasonal variation in reporting. Data transformation provided plausible summary values, but energy-scaling fared best in association analyses. Copyright:Copyright © 2015 Bui et al.This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Introduction: To supplement limited information on tobacco use in Vietnam, data from a nationally-representative population-based survey was used to estimate the prevalence of smoking among 25-64 year-olds. Method(s): This study included 14,706 participants (53.5% females, response proportion 64%) selected by multi-stage stratified cluster sampling. Information was collected using the World Health Organization STEPwise approach to surveillance of risk factors for non-communicable disease (STEPS) questionnaire. Smoking prevalence was estimated with stratification by age, calendar year, and birth year. Result(s): Prevalence of ever-smoking was 74.9% (men) and 2.6% (women). Male ever-smokers commenced smoking at median age of 19.0 (interquartile range [IQR]: 17.0, 21.0) years and smoked median quantities of 10.0 (IQR: 7.0, 20.0) cigarettes/day. Female ever-smokers commenced smoking at median age of 20.0 (IQR: 18.0, 26.0) years and smoked median quantities of 6.0 (IQR: 4.0, 10.0) cigarettes/day. Prevalence has decreased in recent cohorts of men (p = .001), and its inverse association with years of education (p < .001) has strengthened for those born after 1969 (interaction p < .001). At 60 years of age, 53.0% of men who had reached that age were current smokers and they had accumulated median exposures of 39.0 (IQR: 32.0, 42.0) years of smoking and 21.0 (IQR: 11.5, 36.0) pack-years of cigarettes. The proportion of ever-smokers has decreased consistently among successive cohorts of women (p < .001). Conclusion(s): Smoking prevalence is declining in recent cohorts of men, and continues to decline in successive cohorts of women, possibly in response to anti-tobacco initiatives commencing in the 1990s. Low proportions of quitters mean that Vietnamese smokers accumulate high exposures despite moderate quantities of cigarettes smoked per day.Copyright © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rig

Background and Purpose-: Although cerebral white matter lesions (WMLs), silent infarcts (SIs), and microbleeds (MBs) are individually associated with poorer gait and balance, it is unknown if they interact. We studied the interactions of WML volume with SI and MB on gait and postural stability. Methods-: Participants in a population-based study aged 60 to 86 years underwent brain MRI, computerized gait measurement, and a physiological profile assessment of postural stability. Segmentation procedures and standard rating Methods were used to measure WML, SI, and MB. Linear regression was used to test interactions between lesions on gait and postural stability, adjusting for age, sex, and total intracranial volume. Results-: There were 395 participants (mean age, 72 years; SD, 7.0). SIs were predominantly located in subcortical frontal white matter and in deep gray structures, and MBs were largely lobar. Participants with SI or MB had higher WML volumes than those without (P<0.001 and P=0.05, respectively). The presence of SI (P for interaction=0.01) or MB (P for interaction <0.01) magnified the adverse association of WML volume with gait. SI (P for interaction=0.02), but not MB, magnified the adverse association of WML volume with postural stability. Conclusions-: Subclinical cerebrovascular lesions are adversely associated with gait and postural stability in older people in a cumulative fashion. © 2012 American Heart Association, Inc.

Background and Purpose-: Although cerebral white matter lesions (WMLs), silent infarcts (SIs), and microbleeds (MBs) are individually associated with poorer gait and balance, it is unknown if they interact. We studied the interactions of WML volume with SI and MB on gait and postural stability. Methods-: Participants in a population-based study aged 60 to 86 years underwent brain MRI, computerized gait measurement, and a physiological profile assessment of postural stability. Segmentation procedures and standard rating Methods were used to measure WML, SI, and MB. Linear regression was used to test interactions between lesions on gait and postural stability, adjusting for age, sex, and total intracranial volume. Results-: There were 395 participants (mean age, 72 years; SD, 7.0). SIs were predominantly located in subcortical frontal white matter and in deep gray structures, and MBs were largely lobar. Participants with SI or MB had higher WML volumes than those without (P<0.001 and P=0.05, respectively). The presence of SI (P for interaction=0.01) or MB (P for interaction <0.01) magnified the adverse association of WML volume with gait. SI (P for interaction=0.02), but not MB, magnified the adverse association of WML volume with postural stability. Conclusions-: Subclinical cerebrovascular lesions are adversely associated with gait and postural stability in older people in a cumulative fashion. © 2012 American Heart Association, Inc.

BACKGROUND AND PURPOSE: The association between cerebral white matter lesions (WMLs) and the risk of falls in older people is uncertain, with no supporting prospective evidence. We aimed to determine the risk of incident falls associated with WML volume, and the interactions between WML volume, gait, and other sensorimotor factors leading to falls. METHOD(S): We conducted a prospective, population-based study (n<=294, mean age 72.3 years, independently mobile). Volumetric MRI, computerized gait measures, and sensorimotor measures of falls risk were obtained at baseline. Incident falls were recorded prospectively over a 12-month period. Using regression modeling, we estimated the risk of incident falls associated with baseline WML volume. RESULT(S): Increasing baseline WML volume was independently associated with any incident fall (P<=0.01) and multiple incident falls (P<=0.02). The risk of incident falls was doubled in people with lesion volumes in the highest quintile of its distribution compared with the lowest (adjusted relative risk, 2.32; 95% CI, 1.284.14). Greater lesion volume was also associated with poorer gait and greater gait variability (both P<0.001). The effect of WML volume on the risk of falls was magnified in people with poorer quadriceps muscle strength (P<=0.03) and greater gait variability (P<=0.001). CONCLUSION(S): These data provide the first prospective evidence to our knowledge demonstrating that WMLs are strong risk factors for falls in the general older population. WMLs present potential therapeutic targets for interventional trials in falls prevention. Copyright © 2009 American Heart Association. All rights reserved.

BACKGROUND AND PURPOSE: The association between cerebral white matter lesions (WMLs) and the risk of falls in older people is uncertain, with no supporting prospective evidence. We aimed to determine the risk of incident falls associated with WML volume, and the interactions between WML volume, gait, and other sensorimotor factors leading to falls. METHOD(S): We conducted a prospective, population-based study (n<=294, mean age 72.3 years, independently mobile). Volumetric MRI, computerized gait measures, and sensorimotor measures of falls risk were obtained at baseline. Incident falls were recorded prospectively over a 12-month period. Using regression modeling, we estimated the risk of incident falls associated with baseline WML volume. RESULT(S): Increasing baseline WML volume was independently associated with any incident fall (P<=0.01) and multiple incident falls (P<=0.02). The risk of incident falls was doubled in people with lesion volumes in the highest quintile of its distribution compared with the lowest (adjusted relative risk, 2.32; 95% CI, 1.284.14). Greater lesion volume was also associated with poorer gait and greater gait variability (both P<0.001). The effect of WML volume on the risk of falls was magnified in people with poorer quadriceps muscle strength (P<=0.03) and greater gait variability (P<=0.001). CONCLUSION(S): These data provide the first prospective evidence to our knowledge demonstrating that WMLs are strong risk factors for falls in the general older population. WMLs present potential therapeutic targets for interventional trials in falls prevention. Copyright © 2009 American Heart Association. All rights reserved.