Detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III)

Recent scientific work has established both a theoretical basis and strong empirical evidence for a causal impact of social relationships on health. Prospective studies, which control for baseline health status, consistently show increased risk of death among persons with a low quantity, and sometimes low quality, of social relationships. Experimental and quasi-experimental studies of humans and animals also suggest that social isolation is a major risk factor for mortality from widely varying causes. The mechanisms through which social relationships affect health and the factors that promote or inhibit the development and maintenance of social relationships remain to be explored.

https://science.sciencemag.org/content/sci/241/4865/540.full.pdf

Social relationships and health.

To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.

https://www.nejm.org/doi/pdf/10.1056/NEJM198812293192604

Risk factors for falls among elderly persons living in the community.

Numerous studies show that happy individuals are successful across multiple life domains, including marriage, friendship, income, work performance, and health. The authors suggest a conceptual model to account for these findings, arguing that the happiness-success link exists not only because success makes people happy, but also because positive affect engenders success. Three classes of evidence--crosssectional, longitudinal, and experimental--are documented to test their model. Relevant studies are described and their effect sizes combined meta-analytically. The results reveal that happiness is associated with and precedes numerous successful outcomes, as well as behaviors paralleling success. Furthermore, the evidence suggests that positive affect--the hallmark of well-being--may be the cause of many of the desirable characteristics, resources, and successes correlated with happiness. Limitations, empirical issues, and important future research questions are discussed.

/pdf/the-benefits-of-frequent-positive-affect-does-happiness-lead-4k0h6bmoho.pdf

The Benefits of Frequent Positive Affect: Does Happiness Lead to Success?

Background 
The quality and quantity of individuals' social relationships has been linked not only to mental health but also to both morbidity and mortality.
Objectives 
This meta-analytic review was conducted to determine the extent to which social relationships influence risk for mortality, which aspects of social relationships are most highly predictive, and which factors may moderate the risk.
Data Extraction 
Data were extracted on several participant characteristics, including cause of mortality, initial health status, and pre-existing health conditions, as well as on study characteristics, including length of follow-up and type of assessment of social relationships.
Results 
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships. This finding remained consistent across age, sex, initial health status, cause of death, and follow-up period. Significant differences were found across the type of social measurement evaluated (p<0.001); the association was strongest for complex measures of social integration (OR = 1.91; 95% CI 1.63 to 2.23) and lowest for binary indicators of residential status (living alone versus with others) (OR = 1.19; 95% CI 0.99 to 1.44).
Conclusions 
The influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality.

Please see later in the article for the Editors' Summary

/pdf/social-relationships-and-mortality-risk-a-meta-analytic-2ghmxi4ksm.pdf

Social Relationships and Mortality Risk: A Meta-analytic Review

A mortality study of 76,160 men who served on US nuclear submarines is reported. Indirect standardization was used to compare mortality rates to those of the US male population. Multiplicative models were developed to explore patterns of mortality within the cohort. Mortality rates for leukemia, acute myocardial infarction, and for motor vehicle accidents were equivalent to those of US males; rates for other causes were lower, generally consistent with the "healthy worker effect." Motor vehicle accident mortality dropped during the study period, perhaps reflecting efforts to control the problem. Suicide rates were depressed during the period of active duty. There was a suggestion that cancer mortality was associated with submarine type; however, the age distribution casts doubt that the excess was occupationally induced.

The mortality of US nuclear submariners, 1969-1982

There are a number of ongoing large complex sample surveys focused on health data being undertaken at present. Because of time and cost constraints, these surveys are usually highly stratified multistage cluster samples. The complexity of this design has made the usual simple random sampling assumptions untenable and therefore analyses are rarely more than descriptive in nature with some pairwise comparison using t-tests. Generalized regression procedures using weighted least squares are now available for solving this difficulty by incorporating the sample design into the data analysis through the variances and covariances of the sample estimates. These procedures are extended to the analysis of data from complex surveys conducted at two or more different points in time (successive surveys). The method is illustrated with an example taken from published data of hypertension prevalence estimates from the Health Examination Survey-Cycle I (1960-1962) and the Health and Nutrition Examination Survey (1971-1975).

Analysis of data from successive complex sample surveys, with an example of hypertension prevalence from the United States Health Examination Survey.

The Ad Hoc Committee on Headache Classification.

The clinical management of grief involves issues that demonstrate the integration of psychosocial risk factors into clinical practice. Recommendations for the clinical management of grief are based on a review of the pattern of morbidity and mortality of bereavement, of the emotional response to conjugal loss, and of several postulated pathogenetic mechanisms.

Adrian M. Ostfeld

Papers

The mortality of US nuclear submariners, 1969-1982

Analysis of data from successive complex sample surveys, with an example of hypertension prevalence from the United States Health Examination Survey.

The Ad Hoc Committee on Headache Classification.

The Clinical Management of Grief

Nutritional aspects of stroke, particularly in the elderly