202 research outputs found
Incidence of dementia over a period of 20 years in a Norwegian population
INTRODUCTION: In Norway, the prevalence of dementia is higher than in demographically comparable, high income countries, but reliable incidence studies are lacking.
This study calculated the incidence of age-specific dementia from 2000 to 2019.
METHODS: Participants from The Tromsø Study (n = 44,214) were included. Participants with a dementia diagnosis (n = 2049 cases) were identified. Poisson regression
was used to calculate age-specific yearly and 5-year incidence rates from 2000 to 2019.
RESULTS: The incidence of dementia has decreased from 2000 to 2019. The trend was
highly significant for ages of 60–99 years, and was similar for both sexes.
DISCUSSION: The incidence of dementia in North Norway has decreased over the past
two decades similar to that in Western countries, indicating that the total prevalence
is increasing due to an aging population. This decrease of incidence could introduce a
reduction in future estimation of dementia prevalence
Global myocardial longitudinal strain in a general population—associations with blood pressure and subclinical heart failure: The Tromsø Study
This is a post-peer-review, pre-copyedit version of an article published in International Journal of Cardiovascular Imaging. The final authenticated version is available online at: https://doi.org/10.1007/s10554-019-01741-3.The early detection of subclinical myocardial dysfunction can contribute to the treatment and prevention of heart failure (HF). The aim of the study was to (i) describe myocardial global longitudinal strain (GLS) patterns in a large general population sample from Norway and their relation to established cardiovascular disease (CVD) risk factors; (ii) to determine its normal thresholds in healthy individuals and (iii) ascertain the relation of myocardial GLS to stage A subclinical heart failure (SAHF). Participants (n = 1855) of the 7th survey of the population-based Tromsø Study of Norway (2015–2016) with GLS measurements were studied. Linear and logistic regression models were used for assessment of the associations between CVD risk factors and GLS. Mean GLS (SD) in healthy participants was − 15.9 (2.7) % in men and − 17.8 (3.1) % in women. Among healthy subjects, defined as those without known cardiovascular diseases and comorbidities, GLS declined with age. An increase of systolic blood pressure (SBP) of 10 mm Hg was associated with a 0.2% GLS reduction. Myocardial GLS in individuals with SAHF was 1.2% lower than in participants without SAHF (p < 0.001). Mean myocardial GLS declines with age in both sexes, both in a general population and in the healthy subsample. SBP increase associated with GLS decline in women. Our findings indicate high sensitivity of GLS for early subclinical stages of HF
Agrárpiaci Jelentések Zöldség, gyümölcs és bor
Kiadványunk a következÅ‘ témákban ad információkat: gyümölcspiac, zöldségpiac, borpiac, értékesÃtési árak, termelÅ‘i árak, nagybani piac, kereslet-kÃnálat, fogyasztói piac, nemzetközi árinformációk
Self-reported health as a predictor of mortality: A cohort study of its relation to other health measurements and observation time.
Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s. We examined the association between SRH and mortality and how this is affected by time and health measurements in a prospective cohort study using repeated measurements and physical examinations of 11652 men and 12684 women in Tromsø, Norway. We used Cox proportional hazard regression to estimate hazard ratios (HRs) of death for SRH, controlling for pathology, biometrics, smoking, sex and age. SRH predicted mortality independently of other, more objective health measures. Higher SRH was strongly associated with lower mortality risk. Poor SRH had HR 2.51 (CI: 2.19, 2.88). SRH is affected by disease, mental health and other risk factors, but these factors had little impact on HRs (Poor SRH: HR 1.99; CI: 1.72, 2.31). SRH predicted mortality, but with a time-dependent effect. Time strongly affected the hazard ratio for mortality, especially after ten-year follow-up (Poor SRH HR 3.63 at 0-5 years decreased to HR 1.58 at 15-21 years). SRH has both methodological and clinical value. It should not be uncritically utilised as a replacement instrument when measures of physical illness and other objective health measures are lacking
Low-grade impairments in cognitive and kidney function in a healthy middle-aged general population: a cross-sectional study
Background: Although the relationship between manifest chronic kidney disease and reduced cognitive function is well established, limited data exists on GFR and cognitive function in the general population. Both the brain and kidneys have low-impedance vascular beds, rendering them susceptible to damage from pulsatile blood flow. An association between mildly reduced GFR and cognitive function in the healthy general population may reveal early disease mechanisms underlying low-grade impairment of both organs as well as the possibility for intervention. Our aim was to identify an early stage of low-grade impairments in both the brain and the kidneys in the general population.
Methods: This investigation was a population-based cross-sectional study that included 1627 participants aged 50-62 years who were representative of the general population in the municipality of Tromsø, Norway. The associations between GFR, measured as iohexol clearance, the urinary albumin-creatinine ratio and performance on five tests of cognitive function—the Digit Symbol Substitution Test, the finger tapping test, the Mini-Mental State Examination and the 12-word test parts 1 and 2 – were examined. The data were adjusted for factors known to be associated with both GFR and cognitive function, including cardiovascular risk factors, medications and education level.
Results: In multivariate adjusted linear regression analyses, we did not observe associations of the measured GFR or albumin-creatinine ratio with performance on any of the five cognitive tests. In an analysis without adjustment for the education level, an association of worse performance on the Digit Symbol Substitution Test with higher measured GFR (p = 0.03) was observed. An exploratory analysis revealed an inverse relationship between mGFR and a higher education level that remained significant after adjusting for factors known to influence mGFR.
Conclusions: We did not find evidence of an association between low-grade impairments in either the kidneys or the brain in the middle-aged general population. A possible association between a high GFR and reduced cognitive function should be investigated in future studies
Management of patients with acute ST-segment elevation myocardial infarction in Russian hospitals adheres to international guidelines
Objective - Russia has one of the highest cardiovascular mortality rates. Modernisation of the Russian health system has been accompanied by a substantial increase in uptake of percutaneous coronary intervention (PCI), which substantially reduces the risk of mortality in patients with acute ST-elevation myocardial infarction (STEMI). This paper aims to describe contemporary Hospital treatment of acute STEMI among patients in a range of hospitals in the Russian Federation.
Methods - This study used data from a prospective observational cohort of 1128 suspected patients with myocardial infarction recruited in both PCI and non-PCI hospitals across 13 regions and multiple levels of the health system in Russia. The primary objective was to examine the use of reperfusion strategies in patients with STEMI.
Results - Among patients reaching PCI centres within 12 hours of symptom onset, the vast majority received angiography and PCI, regardless of age, sex and comorbidity, in line with current European Society of Cardiology guidelines.
Conclusion- Patients reaching Russian hospitals are very likely to receive appropriate treatment, although performance varies. The best hospitals can serve as beacons of good practice as PCI facilities continue to expand across Russia where geography allows
Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review
Objective The objective of this study was to determine
the diagnostic accuracy in detecting valvular heart disease
(VHD) by heart auscultation, performed by medical doctors.
Design/methods A systematic literature search for
diagnostic studies comparing heart auscultation to
echocardiography or angiography, to evaluate VHD in
adults, was performed in MEDLINE (1947–November 2021)
and EMBASE (1947–November 2021). Two reviewers
screened all references by title and abstract, to select
studies to be included. Disagreements were resolved by
consensus meetings. Reference lists of included studies
were also screened. The results are presented as a
narrative synthesis, and risk of bias was assessed using
Quality Assessment of Diagnostic Accuracy Studies-2.
Main outcome measures Sensitivity, specificity and
likelihood ratios (LRs).
Results We found 23 articles meeting the inclusion
criteria. Auscultation was compared with full
echocardiography in 15 of the articles; pulsed Doppler was
used as reference standard in 2 articles, while aortography
and ventriculography was used in 5 articles. One article
used point-of-care ultrasound. The articles were published
from year 1967 to 2021. Sensitivity of auscultation
ranged from 30% to 100%, and specificity ranged from
28% to 100%. LRs ranged from 1.35 to 26. Most of the
included studies used cardiologists or internal medicine
residents or specialists as auscultators, whereas two used
general practitioners and two studied several different
auscultators.
Conclusion Sensitivity, specificity and LRs of auscultation
varied considerably across the different studies. There is a
sparsity of data from general practice, where auscultation
of the heart is usually one of the main methods for
detecting VHD. Based on this review, the diagnostic utility
of auscultation is unclear and medical doctors should not
rely too much on auscultation alone. More research is
needed on how auscultation, together with other clinical
findings and history, can be used to distinguish patients
with VHD
Interrater and intrarater agreement on heart murmurs
Objective: To investigate interrater and intrarater agreement between physicians and medical
students on heart sound classification from audio recordings, and factors predicting agreement
with a reference classification.
Design: Intra- and interrater agreement study.
Subjects: Seventeen GPs and eight cardiologists from Norway and the Netherlands, eight medical students from Norway.
Main outcome measures: Proportion of agreement and kappa coefficients for intrarater agreement and agreement with a reference classification.
Results: The proportion of intrarater agreement on the presence of any murmur was 83% on
average, with a median kappa of 0.64 (range k ¼ 0.09–0.86) for all raters, and 0.65, 0.69, and
0.61 for GPs, cardiologist, and medical students, respectively.
Results: The proportion of agreement with the reference on any murmur was 81% on average,
with a median kappa of 0.67 (range 0.29–0.90) for all raters, and 0.65, 0.69, and 0.51 for GPs, cardiologists, and medical students, respectively.
Results: Distinct murmur, more than five years of clinical practice, and cardiology specialty were
most strongly associated with the agreement, with ORs of 2.41 (95% CI 1.63–3.58), 2.19
(1.58–3.04), and 2.53 (1.46–4.41), respectively.
Conclusion: We observed fair but variable agreement with a reference on heart murmurs, and
physician experience and specialty, as well as murmur intensity, were the factors most strongly
associated with agreement
Algorithm for predicting valvular heart disease from heart sounds in an unselected cohort
ObjectiveThis study aims to assess the ability of state-of-the-art machine learning algorithms to detect valvular heart disease (VHD) from digital heart sound recordings in a general population that includes asymptomatic cases and intermediate stages of disease progression.MethodsWe trained a recurrent neural network to predict murmurs from heart sound audio using annotated recordings collected with digital stethoscopes from four auscultation positions in 2,124 participants from the Tromsø7 study. The predicted murmurs were used to predict VHD as determined by echocardiography.ResultsThe presence of aortic stenosis (AS) was detected with a sensitivity of 90.9%, a specificity of 94.5%, and an area under the curve (AUC) of 0.979 (CI: 0.963–0.995). At least moderate AS was detected with an AUC of 0.993 (CI: 0.989–0.997). Moderate or greater aortic and mitral regurgitation (AR and MR) were predicted with AUC values of 0.634 (CI: 0.565–703) and 0.549 (CI: 0.506–0.593), respectively, which increased to 0.766 and 0.677 when clinical variables were added as predictors. The AUC for predicting symptomatic cases was higher for AR and MR, 0.756 and 0.711, respectively. Screening jointly for symptomatic regurgitation or presence of stenosis resulted in an AUC of 0.86, with 97.7% of AS cases (n = 44) and all 12 MS cases detected.ConclusionsThe algorithm demonstrated excellent performance in detecting AS in a general cohort, surpassing observations from similar studies on selected cohorts. The detection of AR and MR based on HS audio was poor, but accuracy was considerably higher for symptomatic cases, and the inclusion of clinical variables improved the performance of the model significantly
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