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Objective To describe new onset and persistence of self reported post-traumatic stress disorder symptoms in a large population based military cohort, many of whom were deployed in support of the wars in Iraq and Afghanistan.

OBJECTIVE -To determine the prospective association between endogenous sex hormones and the development of type 2 diabetes in older men and women.RESEARCH DESIGN AND METHODS -A standardized medical history was obtained, an oral glucose tolerance test was performed, and plasma samples for sex hormones and covariates were collected from ambulatory, community-dwelling men and women at baseline from 1984 to 1987 . Approximately 8 years later (1992, another medical history was obtained, an oral glucose tolerance test was performed, fasting and 2-h insulin levels were measured, and the homeostasis model assessment for insulin resistance (HOMA-IR) was evaluated. This report is based on the 294 men and 233 women, aged 55-89 years, who completed both visits and who did not have diabetes as determined by history or glucose tolerance test at baseline, as well as women who were postmenopausal and not taking replacement estrogen.RESULTS -In age-adjusted correlation analyses, total testosterone was inversely and significantly related to subsequent levels of fasting and postchallenge glucose and insulin in men, whereas bioavailable testosterone and bioavailable estradiol were positively and significantly related to fasting and postchallenge glucose and insulin in women (all P Ͻ0.05). There was similar significant association with insulin resistance (HOMA-IR) in unadjusted and multiply adjusted analyses (P Ͻ0.05). There were 26 men and 17 women with new (incident) diabetes. The odds for new diabetes were 2.7 (95% CI 1.1-6.6) for men in the lowest quartile of total testosterone and 2.9 (1.1-8.4) for women in the highest quartile of bioavailable testosterone.CONCLUSIONS -Low testosterone levels in men and high testosterone levels in women predict insulin resistance and incident type 2 diabetes in older adults. Diabetes Care 25:55-60, 2002B oth human (1-9) and animal studies (10,11) show differences by sex in the effects of endogenous sex hormones on insulin resistance. In men, low plasma testosterone is associated with obesity, upper body fat distribution, and increased levels of glucose and insulin (1-3), whereas hyperandrogenicity is associated with an increased risk for type 2 diabetes and cardiovascular disease in women (3-9). Most of these studies were cross-sectional.Sex hormone-binding globulin (SHBG) is an indirect measure of androgenicity, because its concentration is mainly determined by free estrogen and testosterone (4,7-9,12,13). Several prospective studies show that low levels of testosterone and SHBG predict the development of type 2 diabetes in middle-aged (14,15) and elderly (16) men. One crosssectional study shows that women with type 2 diabetes have high levels of free testosterone and low levels of SHBG (17). Low levels of SHBG alone did not significantly predict incident type 2 diabetes in middle-aged men (18); in contrast, low levels of SHBG alone predicted the development of type 2 diabetes in women (18,19). To our knowledge, there are no large prospective, population-based studies of total and bioavailabl...

Key models relating personality and health predict that personality in childhood is indicative of later health and longevity. Longevity predictions are tested using data derived from the 7-decade longitudinal study initiated by L. M. Terman in 1921(L. M. Terman & M. H. Oden, 1947. Variables representing major dimensions of personality are used in statistical survival analyses of longevity in 1,178 males and females. Conscientiousness in childhood was clearly related to survival in middle to old age. This finding (a) establishes that childhood personality is related to survival decades into the future, (b) confirms the validity of the conscientiousness dimension in conceptualizing personality, and (c) points to likely and unlikely pathways linking personality to health. Contrary to expectation, cheerfulness (optimism and sense of humor) was inversely related to longevity, suggesting a possible need for reconceptualization of its health relevance.A central question about human nature concerns the extent to which personality is meaningful over time. For example, does knowing that a child is highly sociable tell us something important about that person's outcomes much later in life? Aside from the many methodological obstacles, this question is especially difficult to address because predisposing tendencies could be realized in so many different ways. However, perhaps such an effect of personality would be revealed if a significant outcome were selected, one that involved a host of converging factors.A second major question involves the nature of the relations between personality factors and physical health. For example, there is ample evidence that chronic hostility is related to cardiovascular disease (Barefoot, 1992;Matthews, 1988), at least over several years. Although there is reason to believe that personality is signifi-

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OBJECTIVE -Accumulating research suggests low-circulating vitamin D concentrations, i.e., 25-hydroxyvitamin-D [25(OH)D], may be associated with an increased prevalence of metabolic syndrome; however, previous studies have not accounted for parathyroid hormone (PTH) levels. We examined the association of 25(OH)D and PTH with the prevalence of metabolic syndrome in a community-based cohort of older adults. RESULTS -In men, there was a significant trend (P ϭ 0.03) of increasing adjusted odds for metabolic syndrome with increasing PTH concentrations, primarily due to an odds ratio of 2.02 (95% CI 0.96 -4.24) in men in the top quintile (Ն63 ng/l) of PTH concentration. This association remained unchanged after taking into account 25(OH)D levels and excluding men with diabetes or impaired renal function; it was attenuated after adjustment for the homeostasis model assessment of insulin resistance. Neither PTH in women nor 25(OH)D levels in either sex was related to the metabolic syndrome. RESEARCH DESIGN AND METHODSCONCLUSIONS -These findings suggest an increased risk of metabolic syndrome with elevated PTH levels in older men and no effect of 25(OH)D concentrations in either sex. The reason for the sex difference in the PTH-metabolic syndrome association is unknown. Prospective studies are necessary to better determine the roles of 25(OH)D and PTH in the etiology of metabolic syndrome. Diabetes Care 30:1549-1555, 2007D ecreased vitamin D and elevated parathyroid hormone (PTH) levels may play a role in the etiology of metabolic syndrome, either through an association with individual components of metabolic syndrome or via insulin resistance (1,2). Vitamin D levels have been shown to be inversely related both with fasting glucose concentrations (3-5) and adiposity (6 -10) and have been suspected to be involved in the regulation of blood pressure, based on blood pressure reduction with vitamin D 3 supplementation in patients with essential hypertension (11,12). Other evidence suggests a role for vitamin D in maintaining normal insulin synthesis and secretion (13,14). Vitamin D and PTH are both responsible for maintaining extracellular calcium homeostasis (19). Vitamin D increases the efficiency of intestinal calcium absorption, and PTH is secreted in response to low-circulating calcium concentrations. Elevated PTH secondary to low vitamin D increases calcium resorption from the skeleton at the expense of an increased risk of fracture (20). Secondary hyperparathyroidism may also increase the risk of developing components of metabolic syndrome, including hypertension (21-26), obesity (6,9,10,27-29), and diabetes (30 -32). However, we are unaware of previous research investigating whether PTH levels are also associated with the metabolic syndrome.Previous studies linking low 25(OH)D with an increased prevalence of metabolic syndrome (1,18) were limited by their inability to simultaneously account for PTH, since both vitamin D and PTH operate within a tightly controlled feedback system to maintain extracellular calcium conce...

Objective Case series suggest that Nonalcoholic Fatty Liver Disease (NAFLD) is associated with increased all-cause and cardiovascular mortality. The current study compared the survival of subjects with and without suspected NAFLD in a population-based cohort, and placed the finding in the context of previously published case series. Methods Primary analysis assessed mortality for NHANES-III participants with and without suspected NAFLD using the National Death Index. Suspected NAFLD was based upon unexplained ALT elevation. The Olmsted County and Cleveland Clinic case series were also used for comparison. Survivals were compared using Proportional Hazards Model and direct age standardization. Results The NHANES cohort included 980 with and 6594 subjects without suspected NAFLD. Over a mean of 8.7 years, suspected NAFLD had a hazards ratio of 1.37 (95%CI 0.98–1.91) for all-cause mortality. In the 45–54 age group, suspected NAFLD had significantly higher all-cause (4.40 95%CI 1.27–13.23) and cardiovascular mortality (8.15 , 95%CI 2.00–33.20) after adjusting for conventional cardiovascular risk factors. The age-standardized rate per 10,000 per year was 129 (95%CI 118–140) for the NHANES non-NAFLD cohort, 154 (95%CI 116–198) for the NHANES suspected NAFLD cohort, 214 (95%CI 157–279) for the Olmsted County series, and 426 (95%CI 298–573) for the Cleveland Clinic series. Conclusion The magnitude of mortality risk in NAFLD depends on the setting and method of ascertainment. Suspected NAFLD in the 45–54 age group is a strong independent risk factor for cardiovascular death and warrants further cardiovascular risk management guidelines.

Previous research showed that conscientiousness (social dependability) in childhood predicted longevity in an archival prospective cohort study of bright children first studied by Terman in the 1920s (H. S. Friedman et al., 1993). Possible behavioral mechanisms for this robust association are now examined by gathering cause of death information and by considering the possible mediating influences of drinking alcohol, smoking, and overeating. Survival analyses (N = 1,215) suggest that the protective effect of conscientiousness is not primarily due to accident avoidance and cannot be mostly explained by abstinence from unhealthy substance intake. Conscientiousness may have more wide-ranging effects on health-relevant activities.