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Purpose: This study identified modifiable risks associated with incident functional dependence, compared their effects, and estimated the percent risk attributable to each factor, by ethnicity. Design and Methods: The prospective study cohort comprised 751 rural Hispanic and non-Hispanic White elders from southern Colorado who reported no dependence in basic and instrumental activities of daily living (ADLs and IADLs) at baseline. Logistic regression modeled the effects of physical inactivity, nutritional risk, smoking, and falls on incident disability 22 months later, with and without adjustment for baseline ADL and IADL difficulty. Population attributable risk percentages assessed these modifiable risks by ethnicity. Results: Each risk factor multiplied the likelihood of incident dependence by 1.4 or more, adjusted for covariates. Attributable risk percentages ranged from 8% to 32% depending on risk factor, ethnicity, and baseline ADL and IADL difficulty status. Attributable risk was generally greater among Hispanic elders, the result of higher prevalence of most of the risk factors. Implications: Interventions targeted at inadequate nutrition, inactivity, smoking, and preventable falls offer opportunities to reduce incident functional disability, especially among Hispanic elders. Key Words: Cohort study, Ethnic disparities, Attributable Aging, Functional disability

Women whose own birth weight was much lower than normal are more likely to develop diabetes during pregnancy, according to a study of 23,395 women. Diabetes during pregnancy, also called gestational diabetes, is a risk factor for type 2, or adult-onset, diabetes., Context: Several studies have reported links between reduced fetal growth and subsequent risk for type 2 diabetes among older adults, but the association between indices of fetal growth and gestational diabetes mellitus (GDM), a major complication of pregnancy and a strong predictor of type 2 diabetes, remains little explored. Objective: To test the hypothesis that a woman's own fetal growth is inversely related to her later risk for GDM. Design and Setting: Case-control study of linked hospital discharge and vital record data from the New York State Department of Health. Population: Healthy women who completed their first pregnancies in New York State between 1994 and 1998 and who were also born in New York State. Records from each woman's first pregnancy were linked to those from her own birth (1970-1985). Cases were 440 women with a record of GDM. Controls were 22955 remaining women with no indication of GDM. Main Outcome Measure: A woman's own birth weight, alone and adjusted for gestational age. Results: Birth weight showed a U-shaped relationship to a woman's risk of GDM in her first pregnancy, with the highest risks associated with low and high birth weights. Odds ratios (ORs) adjusted for gestational age were 2.16 (95% confidence interval [CI], 1.04-4.50) for birth weight of less than 2000 g and 1.53 (95% CI, 1.03-2.27) for a birth weight of 4000 g or more. Adjustment for potential confounding factors, particularly prepregnancy body mass index and maternal diabetes, increased the OR for low birth weight to 4.23 (95% CI, 1.55-11.51), but reduced the OR for high birth weight to 0.92 (95% CI, 0.54-1.57), leaving a strong inverse dose-response relationship between birth weight and risk of GDM (adjusted P for trend Conclusions: In this large population-based study, a woman's own birth weight was strongly and inversely related to her risk of GDM, suggesting that early life factors may be important in the etiology of this disorder.

Many children with type 1, or juvenile-onset, diabetes develop ketoacidosis or low blood sugar. Ketoacidosis occurs when there is not enough insulin in the body and low blood sugar occurs when there is too much insulin. Children who are not insured and those with psychiatric disorders are most likely to develop these complications of type 1 diabetes., Context: Diabetic ketoacidosis and severe hypoglycemia are acute complications of type 1 diabetes that are related, respectively, to insufficient or excessive insulin treatment. However, little is known about additional modifiable risk factors. Objective: To examine the incidence of ketoacidosis and severe hypoglycemia in children with diabetes and to determine the factors that predict these complications. Design, Setting, and Participants: A cohort of 1243 children from infancy to age 19 years with type 1 diabetes who resided in the Denver, Colo, metropolitan area were followed up prospectively for 3994 person-years from January 1, 1996, through December 31, 2000. Main Outcome Measures: Incidence of ketoacidosis leading to hospital admission or emergency department visit and severe hypoglycemia (loss of consciousness, seizure, or hospital admission or emergency department visit). Results: The incidence of ketoacidosis was 8 per 100 person-years and increased with age in girls (4 per 100 person-years in Conclusions: Some children with diabetes remain at high risk for ketoacidosis and severe hypoglycemia. Age- and sex-specific incidence patterns suggest that ketoacidosis is a challenge in adolescent girls while severe hypoglycemia continues to affect disproportionally the youngest patients and boys of all ages. The pattern of modifiable risk factors indicates that underinsured children and those with psychiatric disorders or at the extremes of the [HbA.sub.1c] distribution should be targeted for specific interventions.

We conducted a cross-sectional study to determine the distribution of cognitive functioning as measured by the Mini-Mental State Examination (MMSE) among a sample of Hispanic and non-Hispanic White (NHW) residents from two counties in rural, southern Colorado. Residents aged 60 years and older (N=1,360) were administered the full MMSE, a sociodemographic and medical interview. Protocols were developed to administer the MMSE equitably in both ethnic groups. Younger Hispanics tended to be categorized as severely impaired more than similarly aged NHWs (OR at age 70 = 4.14), however, older Hispanics and NHWs performed similarly after adjusting for education and gender (OR at age 90 = 1.00). The use of a modified MMSE scale that removed the ethnic bias demonstrated that NHWs and Hispanics had similar levels of severe impairment after full adjustment (OR = 0.93). Given the widespread use of the MMSE, these findings indicate the need for further validation of this instrument.

Objective To describe the prevalence of nutritional risk factors among elderly residents in a rural Hispanic and non-Hispanic white population. Design A geographically based survey of community-dwelling elderly adults. Subjects/setting From July 1993 to July 1995, all Hispanic persons older than 65 years and an age-stratified, random sample of 69% of non-Hispanic white persons, from 2 Colorado counties, were invited to participate in a study of functional impairment and disability (81% responded). After exclusion of 184 respondents who required a surrogate respondent and 8 with missing diet data, the study consisted of 1,006 subjects. Interviews included questions similar to the Nutrition Screening Initiative checklist, a 21-item food frequency questionnaire, and anthropometric measures. Statistical analyses performed Gender- and ethnicity-specific, age-adjusted prevalence for each risk factor was estimated by use of logistic regression. Results Hispanic participants were more likely than non-Hispanic whites to report inadequate intake of vegetables, problems with teeth or dentures that limited the kinds and amounts of food eaten, difficulty preparing meals, and lack of money needed to buy food. Hispanic women reported nutritional risk factors more often than Hispanic men, although anthropometric markers indicated that Hispanic men may be at higher risk of nutritional deficiency. Applications/conclusions Hispanic men and women had a higher prevalence of nutritional risk factors than non-Hispanic whites. Intervention programs targeting rural, elderly Hispanics should aim to ensure that basic nutrition needs (access to food, help preparing meals, and adequate dental care) are being met. Community programs to increase activity levels and consumption of nutrient-dense foods are recommended., Many of the chronic medical conditions commonly seen in the elderly (eg, osteoporosis, osteoarthritis, diabetes, gastrointestinal conditions, and dementia) have nutritional causes as well as nutritional consequences, such as restricted [...]

Objectives. This study evaluated the association between quality of life and non-insulin-dependent diabetes mellitus (NIDDM) status, and whether this association differs between Hispanics and non-Hispanic Whites. Methods. Between 1986 and 1989. cross-sectional data on perceived quality of life (PQOL) were collected from 223 persons with NIDDM and 753 non-diabetic subjects. Results. After adjustments, persons with NIDDM rated their PQOL significantly lower than did control subjects. The relationship of diabetes and PQOL did not differ by ethnicity. The number of complications of diabetes was not associated with lower PQOL scores. Conclusions. Control and treatment strategies should reflect an understanding of the impact that diabetes has on social functioning, leisure activities, and physical and mental health. (Am J Public Health. 1998;88:1225-1229)

Clonal CD[8.sup.+] T-cell expansions have been identified in the peripheral blood of healthy adults and occasionally in children. These expansions are often large, yet their etiology is unknown. This study evaluated the relationship between age and the prevalence of these expansions in a healthy population (n = 147) aged 9 months to 85 years. Expansions were determined using immunofluorescence staining with monoclonal antibodies to different T-cell receptor (TCR)-variable regions. The overall prevalence was 13.6% and increased linearly with age as follows: 0% for 9-month-olds, 2.7% for 4- to 12-year-olds, 13.3% for 20- to 30-year-olds, 20.7% for 35- to 50-year-olds, and 33.4% for 65- to 85-year-olds. Multiple expansions were observed only in the oldest group. Certain TCR-variable regions appeared to be preferentially utilized by these expansions, which suggests a response to a particular antigenic stimulus. Childhood illness and vaccination histories did not provide insight into the etiology of these expansions. Age was the only measured factor that was associated with these expansions.