Impact of psychosocial working conditions on health in older age

Work takes up a large proportion of time in our adult lives, thus possibly making it an important determinant of health. This doctoral thesis aimed to investigate the impact of psychosocial working conditions on health in older age, including metabolic and cognitive health, and disability. Psychosocial working conditions were defined in accordance with the job demand-control model and classified into four scenarios: high strain (high demands, low control), low strain (low demands, high control), passive job (low demands, low control), and active job (high demands, high control). The four studies in this thesis were based on data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Study I. This study used six-year follow-up data and examined the association between work-related stress, characterized by high strain, and the risk of diabetes. High strain was related to an increased risk of diabetes among people aged 60 years at baseline, especially in women, but not in men. Having more than 14 years of work experience in high strain increased the risk of diabetes among women aged 60 years. Study II. The association between demand-control status and cognitive decline over the nine-year follow-up period was examined. Compared to active jobs, low strain, high strain, and passive jobs were all associated with faster cognitive decline. Longer duration of work in low strain, high strain, or passive jobs was associated with an accelerated rate of cognitive decline, whereas longer duration of active jobs was related to slower cognitive decline. Study III. This study examined the association of demand-control combinations with dementia using 12-year follow-up data. Passive jobs were associated with a higher risk of dementia among the younger-old individuals (aged ≤72 years), but not among the older-old (aged ≥78 years). Long work duration of more than ten years in passive jobs increased the risk of dementia among the younger-old. Study IV. The relationship between demand-control categories and disability trajectories over 12 years of follow-up was investigated. Compared to active jobs, low strain, high strain, and passive jobs were all related to a faster rate of disability progression. These associations were mediated 38% by cognitive decline and 18% by chronic disease accumulation. Conclusion. The findings from this thesis underscore the importance of psychosocial working conditions for health in older age. High strain increases the risk of diabetes among women in their early 60s; passive jobs increase the risk of dementia among the younger-old individuals. Having non-active jobs, including high strain, low strain, and passive jobs, accelerates the speed of cognitive decline and disability progression in later life. In addition, duration of work plays a role in the associations between psychosocial working conditions and health outcomes. Both cognitive decline and chronic disease accumulation can partially mediate the association between psychosocial working conditions and disability progression

Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study

INTRODUCTION: Tracheostomy is frequently performed in critically ill patients for prolonged intubation. However, the optimal timing of tracheostomy, and its impact on weaning from mechanical ventilation and outcomes in critically ill patients who require mechanical ventilation remain controversial. METHODS: The medical records of patients who underwent tracheostomy in the medical intensive care unit (ICU) of a tertiary medical centre from July 1998 to June 2001 were reviewed. Clinical characteristics, length of stay in the ICU, rates of post-tracheostomy pneumonia, weaning from mechanical ventilation and mortality rates were analyzed. RESULTS: A total of 163 patients (93 men and 70 women) were included; their mean age was 70 years. Patients were classified into two groups: successful weaning (n = 78) and failure to wean (n = 85). Shorter intubation periods (P = 0.02), length of ICU stay (P = 0.001) and post-tracheostomy ICU stay (P = 0.005) were noted in patients in the successful weaning group. Patients who underwent tracheostomy more than 3 weeks after intubation had higher ICU mortality rates and rates of weaning failure. The length of intubation correlated with the length of ICU stay in the successful weaning group (r = 0.70; P < 0.001). Multivariate analysis revealed that tracheostomy after 3 weeks of intubation, poor oxygenation before tracheostomy (arterial oxygen tension/fractional inspired oxygen ratio <250) and occurrence of nosocomial pneumonia after tracheostomy were independent predictors of weaning failure. CONCLUSION: The study suggests that tracheostomy after 21 days of intubation is associated with a higher rate of failure to wean from mechanical ventilation, longer ICU stay and higher ICU mortality

Association Between Speed of Multimorbidity Accumulation in Old Age and Life Experiences: A Cohort Study

Abstract Rapidly accumulating multiple chronic conditions (multimorbidity) during aging are associated with many adverse outcomes. We explored the association between 4 experiences throughout life—childhood socioeconomic circumstances, early-adulthood education, midlife occupational stress, and late-life social network—and the speed of chronic disease accumulation. We followed 2,589 individuals aged ≥60 years from the Swedish National Study on Aging and Care in Kungsholmen for 9 years (2001–2013). Information on life experiences was collected from detailed life-history interviews. Speed of disease accumulation was operationalized as the change in the count of chronic conditions obtained from clinical examinations, medical histories, laboratory data, drug use, and register linkages over 9 years. Linear mixed models were used to analyze the data. Speed of disease accumulation was lower in individuals with more than elementary education (for secondary, β × time = −0.065, 95% CI: −0.126, −0.004; for university, β × time = −0.118, 95% CI: −0.185, −0.050); for active occupations compared with high-strain jobs (β × time = −0.078, 95% CI: −0.138, −0.017); and for richer social networks (for moderate tertile, β × time = −0.102, 95% CI: −0.149, −0.055; for highest tertile, β × time = −0.135, 95% CI: −0.182, −0.088). The association between childhood circumstances and speed of disease accumulation was attenuated by later-life experiences. Diverse experiences throughout life might decelerate chronic disease accumulation during aging

Outcome and prognostic factors in critically ill patients with systemic lupus erythematosus: a retrospective study

INTRODUCTION: Systemic lupus erythematosus (SLE) is an archetypal autoimmune disease, involving multiple organ systems with varying course and prognosis. However, there is a paucity of clinical data regarding prognostic factors in SLE patients admitted to the intensive care unit (ICU). METHODS: From January 1992 to December 2000, all patients admitted to the ICU with a diagnosis of SLE were included. Patients were excluded if the diagnosis of SLE was established at or after ICU admission. A multivariate logistic regression model was applied using Acute Physiology and Chronic Health Evaluation II scores and variables that were at least moderately associated (P < 0.2) with survival in the univariate analysis. RESULTS: A total of 51 patients meeting the criteria were included. The mortality rate was 47%. The most common cause of admission was pneumonia with acute respiratory distress syndrome. Multivariate logistic regression analysis showed that intracranial haemorrhage occurring while the patient was in the ICU (relative risk = 18.68), complicating gastrointestinal bleeding (relative risk = 6.97) and concurrent septic shock (relative risk = 77.06) were associated with greater risk of dying, whereas causes of ICU admission and Acute Physiology and Chronic Health Evaluation II score were not significantly associated with death. CONCLUSION: The mortality rate in critically ill SLE patients was high. Gastrointestinal bleeding, intracranial haemorrhage and septic shock were significant prognostic factors in SLE patients admitted to the ICU

The role of education in the association between self-rated health and levels of C-reactive protein: a cross-sectional study in rural areas of China

Objectives This study aims to examine the association between self-rated health (SRH) and levels of C-reactive protein (CRP) among adults aged 45 to 101 years old in rural areas of China, and to explore the role of education in the association. Design Cross-sectional study. Setting The study population was derived from two databases in China: Nanping project (NP) and the China Health and Retirement Longitudinal Study (CHARLS). Participants There were 646 participants from a rural area of Nanping (NP) and 8555 rural participants from a national representative sample of China (CHARLS). Methods CRP was measured using a high sensitivity sandwich enzyme immunoassay in the NP and immunoturbidimetric assay in the CHARLS. SRH was assessed by SRH questionnaires and categorised into good and poor. Education was measured by the maximum years of schooling and dichotomised into illiterate and literate. Multivariate linear regression models were used to study the associations. Results Compared to people with good SRH, those with poor SRH had higher levels of CRP in NP (β=0.16, 95% CI -0.02 to 0.34) and in CHARLS (β=0.07, 95% CI 0.02 to 0.11) after adjusting for potential confounders. Similar findings were observed in the pooled population (β=0.08, 95% CI 0.03 to 0.12), especially in men (β=0.13, 95% CI 0.06 to 0.20) and in literate people (β=0.12, 95% CI 0.06 to 0.18). Conclusion Poor SRH may be a predicator of elevated levels of CRP among middle-aged and older people in rural areas, especially in men and literate people

Hypoalbuminemia in peritoneal dialysis patients

This study aimed to determine the factors that were associated with hypoalbuminemia in peritoneal dialysis (PD) patients. End-stage renal disease patients who had received PD at the National Taiwan University Hospital for more than three months were included and divided into two groups. Patients who had mean serum albumin levels greater or equal to 3.5g/dL were allocated to Group 1, while those who had mean serum albumin levels less than 3.5g/dL were allocated to Group 2. Demographic characteristics, clinical parameters and laboratory data were then compared between the two groups. Logistic regression was also performed to identify the factors that were associated with hypoalbuminemia. There were 359 patients (mean age 54.3 years, male 46.5%) included. Group 2 patients (10.3%) were older (P=0.0536), had lower body mass index (P=0.0008), lower total Kt/V (P=0.0060), and lower levels of hemoglobin (P=0.0268), blood urea nitrogen (P=0.0501), creatinine (P<0.0001), triglyceride (P=0.0014), potassium (P=0.0028), phosphorus (P=0.0036), but higher levels of C-reactive protein (P=0.0194). More Group 2 patients had high or high-average peritoneal equilibration test (PET) (P=0.0199). Using logistic regression, factors that were found to be associated with hypoalbuminemia were total Kt/V (P=0.0015), hemoglobin (P=0.0019), creatinine (P<0.0001), triglyceride (P=0.0060), and potassium (P=0.0126). In conclusion, hypoalbuminemia in our PD patients was associated with total Kt/V as well as levels of hemoglobin, creatinine, triglyceride, and potassium

Pain sensitivities predict prophylactic treatment outcomes of flunarizine in chronic migraine patients: A prospective study

Abstract Background We aimed to assess the differences in quantitative sensory testing between chronic migraine and healthy controls and to explore the association between pain sensitivities and outcomes in chronic migraine following preventive treatment. Methods In this prospective open-label study, preventive-naïve chronic migraine and healthy controls were recruited, and cold, heat, mechanical punctate, and pressure pain thresholds over the dermatomes of first branch of trigeminal nerve and first thoracic nerve were measured by quantitative sensory testing at baseline. Chronic migraines were treated with flunarizine and treatment response was defined as ≥50% reduction in the number of monthly headache days over the 12-week treatment period. Results Eighty-four chronic migraines and fifty age-and-sex-matched healthy controls were included in the analysis. The chronic migraine had higher cold pain thresholds over the dermatomes of the first branch of trigeminal nerve and the first thoracic nerve (p  158 g (p = 0.020) or heat pain threshold over the dermatome of the first branch of the trigeminal nerve > 44.9°C (p = 0.002) were more likely to be responders. Conclusions Chronic migraine were generally more sensitive compared to healthy controls. Preventive treatment with flunarizine should be recommended particularly for chronic migraine who have relatively normal sensitivity to mechanical punctate or heat pain. Trial registration: This study was registered on ClinicalTrials.gov (Identifier: NCT02747940)

Mechanical punctate pain threshold is associated with headache frequency and phase in patients with migraine

Objective: Previous studies regarding the quantitative sensory testing are inconsistent in migraine. We hypothesized that the quantitative sensory testing results were influenced by headache frequency or migraine phase. Methods: This study recruited chronic and episodic migraine patients as well as healthy controls. Participants underwent quantitative sensory testing, including heat, cold, and mechanical punctate pain thresholds at the supraorbital area (V1 dermatome) and the forearm (T1 dermatome). Prospective headache diaries were used for headache frequency and migraine phase when quantitative sensory testing was performed. Results: Twenty-eight chronic migraine, 64 episodic migraine and 32 healthy controls completed the study. Significant higher mechanical punctate pain thresholds were found in episodic migraine but not chronic migraine when compared with healthy controls. The mechanical punctate pain thresholds decreased as headache frequency increased then nadired. In episodic migraine, mechanical punctate pain thresholds were highest (p<0.05) in those in the interictal phase and declined when approaching the ictal phase in both V1 and T1 dermatomes. Linear regression analyses showed that in those with episodic migraine, headache frequency and phase were independently associated with mechanical punctate pain thresholds and accounted for 29.7% and 38.9% of the variance in V1 (p¼0.003) and T1 (p<0.001) respectively. Of note, unlike mechanical punctate pain thresholds, our study did not demonstrate similar findings for heat pain thresholds and cold pain thresholds in migraine. Conclusion: Our study provides new insights into the dynamic changes of quantitative sensory testing, especially mechanical punctate pain thresholds in patients with migraine. Mechanical punctate pain thresholds vary depending on headache frequency and migraine phase, providing an explanation for the inconsistency across studies

The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders:a longitudinal study of three Dutch case-control cohorts

Background: The impact of the COVID-19 pandemic on mental health in people with pre-existing mental health disorders is unclear. In three psychiatry case-control cohorts, we compared the perceived mental health impact and coping and changes in depressive symptoms, anxiety, worry, and loneliness before and during the COVID-19 pandemic between people with and without lifetime depressive, anxiety, or obsessive-compulsive disorders. Methods: Between April 1 and May 13, 2020, online questionnaires were distributed among the Netherlands Study of Depression and Anxiety, Netherlands Study of Depression in Older Persons, and Netherlands Obsessive Compulsive Disorder Association cohorts, including people with (n=1181) and without (n=336) depressive, anxiety, or obsessive-compulsive disorders. The questionnaire contained questions on perceived mental health impact, fear of COVID-19, coping, and four validated scales assessing depressive symptoms, anxiety, worry, and loneliness used in previous waves during 2006–16. Number and chronicity of disorders were based on diagnoses in previous waves. Linear regression and mixed models were done. Findings: The number and chronicity of disorders showed a positive graded dose–response relation, with greater perceived impact on mental health, fear, and poorer coping. Although people with depressive, anxiety, or obsessive-compulsive disorders scored higher on all four symptom scales than did individuals without these mental health disorders, both before and during the COVID-19 pandemic, they did not report a greater increase in symptoms during the pandemic. In fact, people without depressive, anxiety, or obsessive-compulsive disorders showed a greater increase in symptoms during the COVID-19 pandemic, whereas individuals with the greatest burden on their mental health tended to show a slight symptom decrease. Interpretation: People with depressive, anxiety, or obsessive-compulsive disorders are experiencing a detrimental impact on their mental health from the COVID-19 pandemic, which requires close monitoring in clinical practice. Yet, the COVID-19 pandemic does not seem to have further increased symptom severity compared with their prepandemic levels. Funding: Dutch Research Council