Cardiovascular diseases, risk factors and cognitive decline in the general population

Cognitive function constitutes a critical dimension of the health status of elderly individuals. Age-associated decline in cognitive function may partly be attributed to the negative effects of systemic medical diseases and related factors, including cardiovascular diseases (CVDs) and vascular risk factors. Cognitive decline has been an understudied outcome in cardiovascular epidemiological research. Few reports have comprehensively examined cognitive function in relation to clinical manifestations of systemic atherosclerotic disease in different arterial beds. Inconsistent findings are common in the literature and these arc likely to reflect the vast differences between studies regarding the choice of population under study, the methods applied for measuring and defining CVD, the types and timing of administration of protocols used for assessing cognitive function, and the paths taken in the analysis of data.The principal aim of the present study was to examine the longitudinal change in cognitive test performance in relation to major clinical CVDs and vascular risk factors in a population-based sample of older people. The administration of a battery of neuropsychological tests on two separate occasions facilitated the study of actual change in both general cognition and across different cognitive abilities according to an objectively-determined CVD status. A valid estimation of peak prior cognitive ability allowed the exploration of the impact of CVD and risk factors on the imputed decline from best-ever level of cognitive function to that measured in old age.The analysis is based on a cohort of 809 men and 783 women aged 55-74 years which in 1987/8 was randomly selected from the general population of Edinburgh. A comprehensive assessment of the prevalence of major CVDs and vascular risk factors was held at baseline and during two follow-up examinations. Since baseline, the study sample has been followed up to determine the incidence of angina pectoris, peripheral arterial disease (PAD), myocardial infarction (MI), and stroke. Cognitive testing was first held in 1998/9 when the mean age of the surviving cohort (n=1209) was 73.1 years (SD=5.0) and subsequently about four years later using the same test protocol. The present investigation is based on the 452 study participants who attended follow-up cognitive testing in 2002/3.Both general cognition, as indexed by a general cognitive factor representing the variance common to all the cognitive tests used, and most individual cognitive measures were negatively affected in participants with CVD but no evidence of stroke relative to non-vascular controls. Of the specific CVD manifestations, stroke was significantly associated with a steeper four-year decline in both general cognitive function and verbal memory. When decline was estimated from peak, prior cognitive level, stroke was related to a greater decline in both general cognition and verbal fluency. In the absence of stroke, MI was associated with an accelerated fouryear decline in non-verbal reasoning ability but the presence of angina was not related to cognitive decline in this study. Symptomatic PAD also independently predicted faster decline in both general cognition and verbal memory over the fouryear follow-up. Several potentially modifiable vascular risk factors, including education, body mass index, smoking, diastolic blood pressure, inflammatory markers and blood viscosity were also related to decline in general and specific cognitive abilities, independently of age, sex, prior cognitive ability and vascular disease. The associations with decline in specific cognitive measures principally resulted from the impact of atherosclerotic disease and risk factors on general cognitive ability rather than the individual functions per se.The findings from the present study further add to those of previous investigations demonstrating a relationship between CVDs, vascular risk factors, and cognitive decline in older people. Specifically, they reveal that, even in the absence of overt stroke, clinical CVDs are associated with a greater cognitive decline in the elderly, independently of potential confounding by a wide range of vascular risk factors. Also, the relationships between several vascular risk factors and cognitive decline proved to be independent of overt co-existing vascular pathology. Based on these findings, further study is needed to determine the combined effects of CVDs and multiple risk factors on cognitive outcomes in samples of older people. In addition, what the likely pathological mechanisms are underlying cognitive decline associated with atherosclerotic disease and vascular risk factors needs to be addressed in future studies. From a perspective of preventing or delaying vascular based cognitive decline and impairment, more research is required to assess the effectiveness of both individual and population-based strategies targeting vascular disease and risk factors in older age groups. Finally, further investigation is needed to address the potential impact of subtle cognitive deficits on indicators of the quality of life and the capability of self-maintenance of elderly vascular patients, on adherence to medical treatment and rehabilitation, and further cognitive decrements and survival

Death within 8 days after discharge to home from the emergency department

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldBACKGROUND: Deaths within 8 days after discharge have, in previous studies, been evaluated retrospectively based on review of hospital records and the cause of death. The aim of the study was to evaluate the association of death within 8 days after discharge to home from the emergency department with a non-causative diagnosis in a prospective cohort study. METHODS: The records from the emergency department were filed by personal identification number and included information on gender, age, admission, discharge and diagnosis. The cause of death was obtained from a nation-wide registry by record linkage. Mortality per 100,000 within 8 days and the hazard ratio and 95% confidence intervals (CIs) were calculated for all causes of death in a time-dependent analysis. RESULTS: A non-causative diagnosis had been given to 11% of those who died within 8 days after discharge home. The mortality per 100,000 within 8 days was 208.5, within 15 days 347.4 and within 30 days 648.6. In the analysis of deaths within 8 days, the hazard ratio was higher for men than women and increasing age was significantly associated with high mortality. The hazard ratio for non-causative diagnosis was 0.44 (95% CI 0.20-0.96) as compared to causative diagnosis, adjusted for gender and age. CONCLUSION: The mortality rate within 8 days of discharge found in the present study is considerably higher than findings in previous studies. Death shortly after discharge of patients with non-causative diagnosis may indicate a misjudgement of the patients' condition at the time of discharge

Musculoskeletal symptoms among female workers in fish-fillet plant who ceased or continued working

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: An earlier study of workers in fish-filleting plants in Iceland showed high prevalence of musculoskeletal symptoms. The prevalence of symptoms of the upper limbs is higher after introduction of the flow-line since the women have a longer duration with repetitive tasks. The overall aim of this study was to compare the prevalence of musculoskeletal symptoms among women working at the flow-line with symptoms among those who had ceased to work there and to throw some light on the selection process of workers from this industry. Material and methods: The standardised Nordic Questionnaire was used. Lists of names and addresses of the plant workers were obtained from plant management. Questionnaires were mailed to the home addresses of the workers. The overall participation rate was 71%. Two hundred eighty two women aged 16-54 answered where 28 women had left the plants after answering the questionnaires and 254 were still working there. The Mantel-Haenszel test was used and stratified by age and odds ratio and 95% confidence intervals (CI) calculated. Results: The prevalence of musculoskeletal symptoms during the previous 12 months was higher among former than current workers. The Mantel-Haenszel odds ratio for symptoms of the fingers, ankles and wrists hindering normal work during the previous 12 months prior to the study was 7.1 (95% CI 2.8-18.0), 5.3 (95% CI 1.3-21.5) and 3.4 (95% CI 1.3-8.8) respectively. Conclusions: The selection process of workers from the fish-processing plants may be determined by the high prevalence of musculoskeletal symptoms, a healthy worker selection. There may be a causal relationship between musculoskeletal symptoms and ceasing to work at fish-processing plants.Inngangur: Fyrri rannsóknir hafa leitt í ljós að óþægindi frá hreyfi- og stoðkerfi meðal fiskvinnslukvenna eru tíð. Óþægindin frá efri útlimum hafa orðið tíðari með tilkomu flæðilína enda verja konurnar lengri tíma við einhæf störf eftir þessa tæknibreytingu. Tilgangur rannsóknarinnar var að kanna algengi óþæginda frá hreyfi- og stoðkerfi meðal kvenna sem hafa hætt að starfa í fiskvinnslu og bera saman við algengi óþæginda kvenna sem héldu áfram að vinna þar og varpa þannig nokkru ljósi á hugsanleg áhrif hraustra starfsmanna í þessari starfsgrein. Efniviður og aðferðir: Notaður var staðlaður norrænn spurningalisti um óþægindi frá hreyfi- og stoðkerfi. Nafnalisti og heimilisföng starfsmanna fengust hjá stjórnendum fiskvinnsluhúsanna og var listinn sendur heim til fólksins. Samtals svöruðu 282 konur á aldrinum 16-54 ára, sem er 71% svörun. Af þeim hættu 28 konur störfum stuttu eftir að þær svöruðu en 254 héldu áfram í starfi. Notuð var Mantel-Haenszel jafna þar sem efniviðnum var lagskipt eftir aldri til að reikna út hlutfallslega áhættu (odds ratio, OR) og 95% öryggismörk (confidence interval, CI). Niðurstöður: Algengi óþæginda frá hreyfi- og stoðkerfi síðastliðna 12 mánuði var hærra meðal fyrrverandi fiskvinnslukvenna en meðal þeirra sem voru áfram í starfi. Hlutfallstala vegna óþæginda frá fingrum, ökklum og úlnliðum sem hindruðu dagleg störf síðastliðna 12 mánuði var 7,1 (95% CI 2,8-18,0); 5,3 (95% CI 1,3-21,5) og 3,4 (95% CI 1,3-8,8). Ályktanir: Þær konur sem hættu að vinna í fiskvinnslunni höfðu almennt tíðari óþægindi en hinar sem héldu áfram að vinna. Hugsanlegt er að hér gæti áhrifa hraustra starfsmanna. Þær konur sem hafa mikil óþægindi frá hreyfi- og stoðkerfi hætta en hinar halda áfram að vinna

Increase in musculo-skeletal symptoms of upper limbs among women after the introduction of the flow-line in the fish-fillet plants

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjectives: An earlier study of workers in fish-fillet plants in Iceland showed higher prevalence of musculoskeletal symptoms as compared to a random sample of the Icelandic population. Since that study a new manufacturing process, the flow-line, has been introduced. The aim of this study was to evaluate whether this new work situation changed the prevalence of musculoskeletal symptoms among the workers of the fish-fillet plants. Material and methods: The same standardised Nordic Questionnaire was used in both surveys. Results: The monotony and the repetitiveness of the work increased with the new technique. The results showed that women had higher prevalence of symptoms of the upper limbs when working at the flow-line than before. The Mantel-Haenszel odds ratio for symptoms of elbows, fingers and wrists during the last seven days prior to the study was 2.1 (95% confidence interval (CI) 1.0-4.4), 1.9 (95% CI 1.1-3.2) and 1.7 (95% CI 1.0-2.7). The odds ratio for knees and ankles was less than one. Conclusions: The higher prevalence of symptoms of the upper limbs seems to be causally related to the increase of monotonous and repetitive work in the fish industry.Tilgangur: Fyrri rannsóknir á algengi óþæginda frá hreyfi- og stoðkerfi sýndu að fiskvinnslufólk hefur tíðari óþægindi frá hreyfi- og stoðkerfi en gerðist í samanburðarhópnum sem var úrtak íslensku þjóðarinnar. Eftir rannsóknina 1987 hófust tæknilegar breytingar í fiskvinnsluhúsum með tilkomu flæðilína. Megintilgangur þessarar rannsóknar er að kanna hvort ný tækni hafi breytt algengi óþæginda meðal fiskvinnslufólks. Efniviður og aðferðir: Staðlaður norrænn spurningalisti var notaður í báðum tilvikum. Niðurstöður: Einhæfni og síendurteknar hreyfingar hafa aukist með tilkomu flæðilína. Algengi óþæginda er hærra meðal kvenna sem vinna við flæðilínur en þeirra sem vinna í fiskvinnslu án flæðilína. Hlutfallstala (odds ratio, OR) óþæginda var reiknuð með aðferðum Mantel-Haenszels og var 2,1 (95% öryggismörk (confidence interval, CI) 1,0-4,4) frá olnbogum, 1,9 (95% CI 1,1-3,2) frá fingrum og 1,7 (95% CI 1,0-2,7) frá úlnliðum þegar spurt var um óþægindi síðastliðna sjö daga. Hlutfallstalan var minni en einn vegna óþæginda frá ökklum og hnjám. Ályktanir: Það má því álykta að ástæða hærra algengis óþæginda frá efri útlimum meðal kvenna í fiskvinnslu sé tilkoma flæðilína sem hafa aukið einhæfni og lengt viðveru kvenna við síendurteknar hreyfingar

Positive and negative well-being of older adults with symptomatic peripheral artery disease: A population-based investigation

Objective We investigated positive and negative subjective well-being in relation to lower-extremity peripheral artery disease (PAD) in a sample of older adults. Method 4760 participants in the English Longitudinal Study of Ageing (ELSA) provided baseline data on symptomatic PAD, sociodemographic characteristics, lifestyle risk factors, and co-morbid conditions. Baseline and two-year follow-up data were available for life satisfaction, quality of life, and depressive symptoms. Results Participants with PAD symptoms had lower baseline levels of life satisfaction (β = −0.03, p < .05) and quality of life (β = −0.04, p < .01), and more depressive symptoms (β = 0.03, p < .05). These associations remained statistically significant in multivariate analyses. Baseline PAD did not, however, influence well-being levels at two-year follow-up. Discussion Greater awareness of the potential for chronic vascular morbidity to disrupt the lives of older adults is needed to inform effective multidisciplinary support and interventions that help maintain the quality of life of those affected

Cancer Incidence among Female Manual Workers

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenWe investigated cancer incidence during the period 1970-1992 among unskilled Icelandic female workers who contributed to two pension funds for manual workers. We found an increase in the standardized rate ratios (SRRs) for all cancer with increasing time before the follow-up period began. We found no clear relation between cancer incidence and length of employment. The SRRs were higher for those who became members of the funds in 1977 or later than for those who started earlier: among these women we found SRRs for all cancers, 1.36; cancer of the stomach, 1.49; cancer of the lung, 1.48; cancer of the cervix, 3.19; and cancer of the bladder, 6.00.Markmið: Tilgangur rannsóknarinnar var að kanna nýgengi krabbameina meðal ófaglærðra íslenskra verkakvenna. Efniviður og aðferðir: Efniviðurinn í þessari afturskyggnu hóprannsókn voru 16.175 konur sem höfðu greitt í lífeyrissjóði verkakvenna í Reykjavík og Hafnarfirði á árabilinu 1970-1986. Fylgst var með krabbameinum í hópnum til 1. desember 1992. Reiknaðar voru staðlaðar hlutfallstölur (standardized rate ratios, SRRs) og 95% öryggisbil (95% confidence intervals). Niðurstöður: Staðlaðar hlutfallstölur krabbameina í heild hækkuðu eftir því sem biðtími var lengri, það er lengra leið frá því að konurnar hófu greiðslu í sjóðina þar til farið var að fylgjast með krabbameinstíðni í hópnum. Engin skýr tengsl sáust hins vegar á milli hækkaðs nýgengis og starfstíma en starfstími var skilgreindur sem tímabilið frá fyrstu greiðslu í sjóðina til þeirrar síðustu. Stöðluðu hlutfallstölurnar voru hærri meðal þeirra sem hófu greiðslu til sjóðanna 1977 eða síðar en meðal þeirra sem urðu sjóðfélagar fyrr, stöðluð hlutfallstala allra krabbameina 1,36 í stað 0,95, magakrabbameins 1,49 í stað 0,82, lungnakrabbameins 1,48 í stað 1,02, leghálskrabbameins 3,19 í stað 1,66 og þvagblöðrukrabbameins 6,00 í stað 0,82. Ályktanir: Niðurstöðurnar gáfu til kynna að bilið á milli verkakvenna og annarra kvenna fari breikkandi að því er varðar tíðni tiltekinna krabbameina, en skýringa verði að leita annars staðar en í vinnunni, þar eð ekki sáust tengsl milli hærri krabbameinstíðni og þess hve lengi konurnar höfðu greitt til lífeyrissjóða verkakvenna

Stiffness and Damping Parameters for Dynamic Analysis of Retaining Walls

The displacements of retaining walls developed during earthquakes have been recognized for many years. Mathematical models have been developed to simulate the behavior of retaining walls during earthquakes. The determination of the soil parameters needed for solution of the displacements has neither been adequately described nor used in a realistic analysis. In this paper theories describing spring and damping constants of rigid retaining walls, for both the base-soil and the back-fill, arc discussed along with the recommended solutions

On Seismic Design Displacements of Rigid Retaining Walls

Correlation of the dynamic displacement and significant factors are presented. Three computer programs (Rafnsson, 1991) have been modified to develop design charts. The wall dimension computed by static condition and related displacement under dynamic loading can be estimated from the computer programs. Twenty-one combinations of base soil and back fill, 5 different ground motions and 7 different heights of wall are used in the analyses to develop design charts. These will help the designer to predict the dynamic behavior of retaining walls and to optimize the design work. Furthermore, equations have been fitted to predict the displacement without using the computer program in several cases

Association between exposure to crystalline silica and risk of sarcoidosis.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVES: The possibility of an association between exposure to silica and autoimmune diseases has recently come under discussion. In the following case-referent study, a cohort exposed to diatomaceous earth and cristobalite provided an opportunity to evaluate such an exposure with reference to sarcoidosis. METHODS: The inhabitants of a district served by a single healthcare centre and a hospital formed the study base. A diatomaceous earth plant is located in this community and the medical institutions are responsible for primary and secondary health care of the population. Cases of sarcoidosis were identified from the hospital records according to certain clinical, radiological, and histological criteria. Referents were selected randomly from the population of the district. Information on exposure to crystalline silica, cristobalite, was obtained by record linkage of the cases and referents with a file which included all present and past workers at the diatomaceous earth plant and those who had worked at loading vessels with the product from the plant. RESULTS: Eight cases of sarcoidosis were found, six of which were in the exposed group. Of the 70 referents, 13 were exposed. The odds ratio (95% confidence interval) was 13.2 (2.0 to 140.9). CONCLUSION: The odds ratios were high and there were some indications of a dose-response relation which will hopefully encourage further studies. To our knowledge this is the first study to indicate a relation between sarcoidosis and exposure to the crystalline silica, cristobalite