Physically demanding situations as predictors of disability pensioning with soft tissue rheumatism among persons 30-39 years old in Norway, 1981-90

OBJECTIVE: Physically demanding work is a predictor of disability pensioning with musculoskeletal diseases. Being a parent is probably also physically demanding. Having manual work and being a parent will be analyzed as possible predictors of becoming a disability pensioner with soft tissue rheumatism (DPSTR) after controlling for level of education, employment, number of hours worked, income, age, sex, and marital status. METHODS: In this prospective study based on census data of persons 30-39 years old in 1980, predictors of becoming DPSTR during the followup period 1981-90 were identified by logistic regression analysis. RESULTS: Manual work was a predictor for becoming DPSTR for both men and women, while being a parent was neither a risk factor nor a protective factor for becoming DPSTR. Being employed was a predictor of becoming DPSTR for married women, but a protective factor for unmarried women and all men. Low level of education and being married or divorced were predictors of becoming DPSTR for both men and women. Working part time and having low income were predictors of becoming DPSTR among men. CONCLUSION: Physically demanding employment, but not a physically demanding private life, predicts becoming DPSTR. This may reflect that factors concerning a patient's private life are not taken into account when evaluating whether or not a disability pension should be granted, at least not for patients with uncertain medical conditions.     

Association between etanercept use and employment outcomes among patients with rheumatoid arthritis

OBJECTIVE: To assess the association between use of etanercept and employment outcomes among patients with rheumatoid arthritis (RA). METHODS: In 1999, 497 RA patients of working ages (18-64 years) reported their employment status in the year of diagnosis and as of the study year, in structured telephone interviews. Of these, 238 had been in clinical trials of etanercept and were currently taking that medication, while 259 were members of an observational study and were not taking etanercept. We used regression techniques to estimate whether employment outcomes in 1999 (employed versus not and, among the employed, hours of work per week, weeks of work per year, and hours of work per year) among the 379 of the 497 patients who were employed at the time of diagnosis were associated with etanercept use, with and without adjustment for demographic characteristics, RA status, overall health status, and the nature of the job held at the time of diagnosis. RESULTS: At the time of diagnosis, 75% of RA patients from the observational study who did not take etanercept and 77% of those who did take the medication were employed. By 1999, among those employed at diagnosis, 55% of the former group and 71% of the latter were employed (difference 16 percentage points). After adjustment for demographics, overall health status, duration of RA, RA status, and occupation and industry, the difference widened to 20 percentage points. Among all who were employed at the time of diagnosis, those from the etanercept clinical trials worked an average of 5.4 more hours per week in 1999; after adjustment, the etanercept group worked 7.4 more hours per week. CONCLUSION: Among all persons who were employed at the time of RA diagnosis, having been in the etanercept clinical trials was associated with higher employment rates in 1999 and a greater number of hours per week of work in that year, suggesting that a randomized trial to establish the relationship between treatment and employment outcomes is now warranted.     

Participation in paid and unpaid work by adults with rheumatoid arthritis

OBJECTIVE: To define determinants of participation in paid and unpaid work by adults with rheumatoid arthritis (RA). METHODS: A survey was designed in consultation with working age (< 65 yrs) adults with RA and sent to 269 patients recruited through 5 rheumatology practices. Hours worked "last week" was the measure of participation in employment and unpaid work (household, home maintenance, caregiving, studying, and volunteering). Potential determinants, conceptually organized as attributes of the person, environment, or occupation, were ascertained. RESULTS: Recruitment response rate was 40% of patients invited, and 89% of those recruited submitted complete surveys. The 239 respondents were mostly women (81%), with mean age 50 years and duration of RA 13 years. Respondents reported an average of 47 hours of work: 19 paid and 28 unpaid hours. Regression analyses indicated more hours of paid work were associated with psychologically demanding work, higher social function, less pain, being male, managerial job type, and lower ratings of occupational balance. More hours of unpaid work were associated with more children in the household, greater perceived physical and psychological demand of the work, social support from family, and having a post-secondary education. Work limitations, reported by 73 respondents, were associated with lower functional status, more pain, and less psychologically demanding work. CONCLUSION: Factors associated with greater participation in paid work differed from those associated with unpaid work. Work limitation affects both paid and unpaid workers. Work-related rehabilitation and education programs may be enhanced by addressing factors identified by this sample of paid and unpaid workers.     

Effect of sex, age, and race on the clinical presentation of tuberculosis: a 15-year population-based study

Extrapulmonary tuberculosis (EPTB) is an important health problem that may cause serious morbidity and diagnostic challenges. We conducted a case-control study involving 5,684, approximately 99% of bacteriologically confirmed TB patients (including 1,925 EPTB cases) diagnosed in Denmark and Greenland during 1992-2007 to gain insight to the role of host factors in EPTB pathogenesis. Among patients from Somalia and Asia, persons 25-44 and 45-64 years of age were more likely to have EPTB than persons 15-24 years of age. In contrast, among persons from Greenland, the two oldest age groups were significantly less likely to have EPTB than the youngest age group. For all the age groups, the odds for having EPTB was significantly higher among patients from Somalia and Asia and significantly lower among the patients from Greenland than among patients from Denmark. Furthermore, the occurrence of specific types of EPTB significantly varied among different age groups or origins.     

Age-related differences in knee muscle strength in normal women

This study provides normal baselines of knee muscle strength for women up to 86 years of age. Knee muscle strength (torque) was measured during maximum isometric and dynamic (isokinetic) contractions in 72 normal healthy women in three age groups between 20 and 86 years. Strength of the oldest group ranged from 56 to 78% of that in the youngest group, depending on knee joint position. Strength values were greater for isometric contractions than for isokinetic contractions (performed at 36 degrees per second) and were approximately twice as great for the extensor as for the flexor muscles. For both muscle groups, the torque generated with the knee in 30 degrees of flexion was usually lower than that generated with the knee at the 45- or 60-degree position. Despite the significant deficit found in the strength of the oldest group, it is likely that this relative weakness would not be detected on routine clinical examination using manual muscle testing.     

Return to work after coronary artery bypass surgery in a population of long-term survivors

BACKGROUND: Return to paid employment may be facilitated by coronary artery bypass graft (CABG) surgery. We assessed work status in a population-based study of long-term outcomes of CABG. AIM: To determine the association between returning to work after CABG and clinical and socio-demographic factors. METHODS: A postal survey of 2,500 randomly selected patients 6-20 years post-CABG. The outcomes assessed were work status in the year before and after CABG and health-related quality of life (HRQOL) measured with SF-36. RESULTS: Response was 82% (n = 2,061). Employment fell from 56% in the year prior to CABG to 42% in the year after. Workers in 'blue-collar' occupations were more likely to reduce their work status than those in 'white collar' occupations (46% versus 29%, p < 0.001). Independent predictors of reducing employment were increasing age (9% per year, 99% CI: 1.06-1.11, p < 0.001), 'blue-collar' versus 'white collar' occupation (OR: 2.1, 99% CI: 1.4-3.1) and female sex (OR: 2.1, 99% CI: 1.1-3.6). HRQOL among participants under 60 years of age at follow-up was better for those who returned to work after CABG surgery. CONCLUSION: CABG surgery is followed by a net loss to paid employment of working age patients which increases with age, and is more likely for those in blue-collar occupations and women.     

Age, education and occupation as determinants of trends in body mass index in Finland from 1982 to 1997

OBJECTIVE: To investigate trends in body mass index (BMI) and prevalence of obesity among adults in Finland from 1982 to 1997, and to identify population groups with increasing obesity. SUBJECTS: Random samples from the national population register including men and women aged 25-64 y (n = 24604, total). DESIGN: Four cross-sectional surveys carried out in three areas in Finland every fifth year since 1982. MEASUREMENTS: Weight and height were measured, and data on occupation and education level were collected by a self-administered questionnaire. RESULTS: The mean BMI increased in both genders. In men, the upward trend was greatest (the increase of 1.3 kg/m2 in 15 y) in the oldest age group (55-64 y), and was found also (the increase of 0.6 kg/m2) in the youngest age group (25-34 y), whereas in women, the upward trend was most prominent (the increase of 0.9 kg/m2) in the youngest age group. BMI increased in all educational groups in men, but in women the upward trend seemed to be greatest in the lowest educational group. The upward trends were most prominent among retired and unemployed men, while in women changes in BMI were similar in all occupational groups. CONCLUSION: The strongest upward trend in BMI was found in the oldest men, in the youngest age group in both genders and, in particular, among men who were outside the labor force. Education is still a strong determinant of obesity, especially in women, although the social gradient in BMI has not widened in the 1990s.     

Body weight and coronary heart disease mortality: an analysis in relation to age and smoking habit. 15 years follow-up data from the Whitehall Study.

18,403 male civil servants aged 40-64 years were examined in London between 1968 and 1970. Mortality from all causes and specifically from coronary heart disease (CHD) over 15 years of follow-up was initially analysed in relation to deciles of body mass index (BMI = weight/height2) at entry into the study. In older men all causes mortality tended to be higher in those with a low BMI, but this was not so for CHD mortality. The latter was further studied after dividing the population into sub-groups according to age and cigarette smoking. With BMI distribution divided into fifths and five year age groups there were significant positive trends of CHD mortality across the BMI distribution in all age groups except the youngest (40-44 years) and oldest (60-64 years). For analysis by smoking category--never, ex- and current cigarette smoker--three age-specific groups were used: 40-49, 50-59 and 60-64 years. In men aged less than 60 years there were significant positive trends of CHD mortality and BMI in five of the six age and smoking categories, the exception being ex-smokers aged 40-49 years. Associations were strongest in the current smokers. By contrast in men aged 60-64 years there was a significant association between BMI and CHD mortality only in ex-smokers and this was of low order (P = 0.04). The data are compatible with some reports of a lesser association of obesity with mortality risk in older persons and in this data set the observation is not confounded by smoking habit.     

Disability and handicap in rheumatoid arthritis and ankylosing spondylitis--results from the German rheumatological database. German Collaborative Arthritis Centers

OBJECTIVE: To describe indicators of disability and handicap in the 2 major inflammatory rheumatic diseases rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and to estimate the burden of illness in terms of functional status, pain, and global well being, as well as with regard to unemployment and early retirement. METHODS: Data from the German rheumatological database on 52,444 patients with RA and 8,776 patients with AS seen at 21 collaborative arthritis centers in Germany between 1993 and 1997 were analyzed. To estimate the burden of the 2 diseases at different biographical phases, age and sex matched groups of patients were compared for functional disability, pain, global assessment of health status, education level, and employment status. RESULTS: For comparable ages, disability in female patients with AS or RA was rated similarly by the physicians (e.g., 61-70 years: 42% severe disability in RA and 44% in AS), whereas men with AS were rated more disabled than men with RA (61-70 years: 35% in RA and 48% in AS). Patients' self-ratings of disability were generally worse for women than for men (age 61-70: women 37% severe disability in RA and 35% in AS, men: 24% in RA and 19% in AS). Pain intensity was rated similarly by women and men with RA and AS at ages < 51 years (33% severe pain at ages 41-50 in men and 34% in women in both diseases). It increased with age in women (> 70 years: 41% severe pain in RA and 44% in AS) and remained stable in men (27% RA and 29% AS > 70 years). At 71.3% the employment rate in AS was clearly higher than in RA (49.5%). There was significant influence of the education level (men 51-60 years with AS: low education 56% employment rate, high education 79%) and the labor market (men 51-55 years with AS: 80% employment rate under good, 59% under bad overall labor market conditions). CONCLUSION: Age and sex matched groups of patients with RA and AS in tertiary rheumatological care show similar amounts of disability, pain, and reduction in well being. Therefore, the offer of comprehensive care and pain management to both groups should be comparable.     

Age, risk-benefit trade-offs, and the projected effects of evidence-based therapies

BACKGROUND: Physicians underutilize evidence-based therapies in the elderly, perhaps because of concerns about the generalizability of clinical trial results in elderly patients given that the relative efficacy of therapies may vary with age. We compared the estimated effects of age and efficacy of treatment on survival among patients with acute coronary syndromes. METHODS: Baseline risk, defined as mortality in the year after hospitalization for acute coronary syndromes, was determined for different age strata among 81,584 patients who had been discharged between April 1, 1997, and March 31, 2000, in Ontario, Canada. We calculated the relative efficacy (relative risk reduction) needed to achieve a clinically meaningful absolute survival benefit, using a number needed to treat of 50 patients for the different age strata. We also evaluated risk-benefit trade-offs in the elderly versus the young by modeling different levels of the relative efficacy and rates of fatal complication by age. RESULTS: Baseline risk (1-year all-cause mortality) was 12-fold lower in the youngest patients (age <50 years) than in oldest patients (age > or = 75 years). Given this gradient, a therapy would have to have a relative efficacy of 88% (i.e., a relative risk of 0.12) in the youngest age group, and 7% (a relative risk of 0.93) in the oldest age group, to generate a number needed to treat 50 patients. For a therapy whose relative efficacy was 25%, the fatal complication rate would have to be sevenfold greater in the oldest compared with the youngest age group to outweigh the survival benefits associated with treatment. CONCLUSION: For acute coronary syndromes, baseline mortality is so much higher for elderly patients that neither sharp reductions in the relative efficacy of therapies nor increases in the rates of serious complications are likely to negate the benefits of therapy. More attention should be paid to overall trial results and less to age-specific subgroup data, unless the latter provide very clear evidence for substantial reductions in absolute efficacy or net harm.     

Difficulties in performing leisure activities among persons with newly diagnosed rheumatoid arthritis: A prospective, controlled study

OBJECTIVE: To compare leisure activities and associated factors in a group with recent onset RA and matched community derived controls, to examine whether leisure activities are altered during the early years of disease and to seek predictors. METHODS: One hundred and forty-seven consecutive persons with early RA were followed for 0.9-5.9 yr. One hundred and forty-four RA patients were compared cross-sectionally at baseline with community-derived controls matched for age, gender and residential area. Leisure activities were evaluated with an interest checklist (20 domains). Socio-demographic variables, disease activity (DAS) and disability (HAQ) were evaluated as possible predictors for loss of participation in leisure activities at baseline and longitudinally (using area under the curve analyses). RESULTS: At baseline (mean disease duration 7 months) RA patients performed less (8.2 vs 9.9 domains, P < 0.001) but did not have significantly less interest (10.9 vs 11.4 domains, P = 0.15) in leisure activities compared with controls. Decrease in performed leisure activities was only significant in those with a low level of education. At baseline, in RA patients, low education (P = 0.035), age (P = 0.019) and HAQ (P < 0.001) significantly predicted performed leisure activity. No loss in performed leisure activities was seen during follow-up and no significant predictors were found for individual change. CONCLUSION: Loss of performed leisure activities occurs early in RA and chiefly in those with low formal education. Disability was associated with early loss, but not with change during follow-up. Other factors, possibly related to individual personality and resources, may be more important for predicting changes in leisure activities.     

Perceived influence of health status on sexual activity in RA patients: associations with demographic and disease-related variables

OBJECTIVE: To examine the prevalence of self-reported problems with sexual activity in patients with rheumatoid arthritis (RA), and associations with demographic and disease-related variables. METHODS: Perceived levels of problems with sexual activity were addressed through question 15 of the Health-Related Quality of Life (HRQoL) instrument 15D. Disease-related variables were determined with the Visual Analogue Scale (VAS), the Arthritis Impact Measurement Scale (AIMS2), the Health Assessment Questionnaire (HAQ), and the Arthritis Specific Self-Efficacy (ASES) questionnaire. RESULTS: Data were available from 830 patients with RA 74% female, mean (SD) age 58.5 (14.2) years, disease duration 13.4 (10.3) years, HAQ score 0.98 (0.72). No impact on sexual activity was reported by 31%, little by 38%, considerable by 21%, 3% reported sexual activity as almost impossible, and 7% reported sexual activity as impossible. When dichotomized, the 'large impact' group had worse health status across all dimensions compared to the group with 'no/little impact' (p<0.001). In the multiple logistic regression analyses, perceived impact on sexual activity was associated with male vs. female gender [odds ratio (OR) 3.18, 95% confidence interval (CI) 2.05-4.94], age (youngest vs. oldest group) (OR 3.56, 95% CI 1.78-7.09), increased levels of fatigue (OR 1.01, 95% CI 1.0-1.02) and mental distress (OR 1.21, 95% CI 1.06-1.38), HAQ score (OR 2.46, 95% CI 1.78-3.39), and low self-efficacy regarding symptoms (OR 0.97, 95% CI 0.96-0.98). CONCLUSION: One-third of the RA patients reported that their health status considerably influenced their sexual activity. Higher levels of fatigue, mental distress, functional limitations, lower levels of self-efficacy, and male gender were independently associated with perceived problems with sexual activity.     

Work disability and its economic effect on 55-64-year-old adults with rheumatoid arthritis

OBJECTIVE: To examine the extent and financial impact of work disability among older workers with rheumatoid arthritis (RA). METHODS: Year 2002 data from 5,419 subjects with RA < 65 years of age in the National Data Bank for Rheumatic Diseases were used, along with US population data. Measures of work disability were employment status, part-time work, sick day use, and limitation in work demands; the latter was assessed by the Work Limitations Questionnaire (WLQ). Measures of financial status were median household income and poverty level income. Statistical procedures included logistic and linear regression, Wilcoxon's rank sum test, and chi-square test. RESULTS: Despite being better educated, subjects with RA ages 55-64 years had lower employment rates than individuals of the same age in the US (women 40% versus 53% and men 54% versus 66%). These older subjects with RA had stopped working more often than younger subjects with RA, and more worked part time (40% versus 34%; P < 0.01). However, the older subjects used sick time less often than younger subjects (35% versus 41%; P < 0.01) and were similarly limited in job demands, e.g., physical demands (mean WLQ subscale score 27.0 versus 26.6; P = 0.65). Median household income of older employed subjects was 20,000 dollars greater than that of retired subjects; 56% of retired subjects had incomes lower than US median income versus 32% of employed subjects, and 11% had income below the poverty level. CONCLUSION: Premature work cessation in persons with RA ages 55-64 years is a serious problem that needs to be addressed.     

Plasmalogen phospholipids - facts and theses to their antioxidative qualities

Fatty aldehyde dimethyl acetals (DMA) derived from plasma and erythrocyte membrane plasmalogen phospholipids of 109 donors, aged 25-91 years, were measured as weight percent of total phospholipid fatty acids and DMA. The age range from 70 to 90 years (n = 82) was divided into age groups of five years each. Cumulative distributions of the DMA values of these age groups, when compared with those of 17 younger persons (aged 25-41 years), revealed a tendency to higher DMA values in the youngest age group, and to lower values in the oldest one. Linear regressions were computed between age and hexadecanaldimethylacetal (16:0 DMA) or octadecanaldimethylactal (18:0 DMA) of erythrocyte membrane and plasma phospholipids. Statistically significant negative correlations with age were obtained. Because of their sensitivity to oxidation reactions, a role of plasmalogens as a natural antioxidant in oxidative defense mechanisms appears to be convincing. However, it will possibly be difficult to separate the effects of normal aging on the decline of plasmalogen phospholipid levels in some tissues from those of certain pathological conditions - including hyperlipidemia and atherosclerosis.     

Delay in consultation with specialists for persons with suspected new-onset rheumatoid arthritis: a population-based study

OBJECTIVE: Care in rheumatoid arthritis (RA) is optimized by involvement of rheumatologists. We wished to determine whether patients suspected of having new-onset RA in Québec consulted with a rheumatologist, to document any delay in these consultations, and to determine factors associated with prompt consultation. METHODS: Physician reimbursement administrative data were obtained for all adults in Québec. Suspected new-onset cases of RA in the year 2000 were defined operationally as a physician visit for RA (based on the International Classification of Diseases, Ninth Revision diagnostic codes), where there had been no prior visit code to any physician for RA in the preceding 3 years. For those patients who were first diagnosed by a nonrheumatologist, Cox regression modeling was used to identify patient and physician characteristics associated with time to consultation with a rheumatologist. RESULTS: Of the 10,001 persons coded as incident RA by a nonrheumatologist, only 27.3% consulted a rheumatologist within the next 2.5-3.5 years. Of those who consulted, the median time from initial visit to a physician for RA to consultation with a rheumatologist was 79 days. The strongest predictors of shorter time to consultation were female sex, younger age, being in a higher socioeconomic class, and having greater comorbidity. CONCLUSION: Our data suggest that the vast majority of patients suspected of having new-onset RA do not receive rheumatology care. Further action should focus on this issue so that outcomes in RA may be optimized.     

Health effects of air pollution exposure on children and adolescents in São Paulo, Brazil

Children and adolescents have been considered more susceptible to the effects of air pollution than adults. In order to investigate the responses of children of different ages to air pollution exposure, daily records of hospital admissions for children in five age groups (equal or less than 2 years of age, 3-5, 6-13, 14-19, and all ages together, i.e., from 0-19 years of age) were obtained from January 1993 to November 1997 in S?o Paulo, Brazil, and were compared to daily records of PM10, O3, SO2, CO and NO2 concentrations in ambient air. For each age group a generalized additive Poisson regression was fitted controlling for smooth functions of time, temperature, humidity, and days of the week, with an additional indicator for holidays. Polynomial distributed lag models were used to estimate the 7-day cumulative effect of each pollutant. Children 2 years or less were the most susceptible to the effects of all five pollutants with an increase of 9.4% (95% CI: 7.9,10.9) in respiratory admissions associated with each interquartile range increase in PM10. The oldest group was the second most susceptible to air pollutants, with each interquartile range increase in PM10 associated with a 5.1% (95% CI: 0.3,9.8) increase in respiratory admissions. An interquartile range increase in CO was associated with an 11.3% (95% CI: 5.9,16.8) increase in respiratory hospitalizations. When a multipollutant model was used, the effect of PM10 on respiratory admissions for all ages together was unchanged, while the SO2 and the other pollutants effect was substantially reduced. This study showed that daily respiratory hospital admissions for children and adolescents in S?o Paulo increased with air pollution, and that the largest effects were found for the youngest (2 years or less) and oldest (14-19 years) age groups.     

Antibody response to Pseudomonas aeruginosa in cystic fibrosis patients: A marker of therapeutic success?—A 30‐year Cohort study of survival in Danish CF patients after onset of chronic P. aeruginosa lung infection

We studied the effects of increasingly intensive treatment regimens on anti-pseudomonal antibody response and survival in five successive cohorts of a total of 157 Danish cystic fibrosis patients after they had acquired chronic P. aeruginosa lung infection. The time periods were 1971-1975 (N = 21), 1976-1980 (N = 64), 1981-1986 (N = 27), 1987-1993 (N = 26), and 1994-2000 (N = 19). During this 30-year period, we introduced elective 2-week courses of chemotherapy every third month in all chronically infected patients, early aggressive treatment with inhalation of colistin and oral ciprofloxacin for 3 months whenever P. aeruginosa was cultured in sputum from noncolonized patients, and inhalation of recombinant human dornase alfa. There was a significant correlation between the calendar year when chronic P. aeruginosa infection was acquired and the subsequent increase in the level of precipitins (P < 0.00001). The median number of precipitins increased by 5 per year in the oldest calendar year cohort, and 1 per year in the youngest. The median age of onset of chronic P. aeruginosa increased from 9.3 years from 1981-1986 to 13.8 years from 1987-2000. Survival after acquisition of chronic P. aeruginosa lung infection improved with time (P = 0.008). Our study shows that CF patients who are treated intensively have lower antibody responses and longer survival after acquisition of chronic P. aeruginosa lung infection.     

Is the risk of occupational tuberculosis higher for young health care workers?

SETTING: Health care workers in Finland. OBJECTIVE: Occupational tuberculosis (TB) was studied separately in nurses, assistant nurses, physicians, psychiatric nurses, medical laboratory workers and radiographers during the period 1971-1995. DESIGN: All 447 notified cases between 20 and 59 years of age were included. Incidence ratios by age and occupation were compared to the corresponding general population. RESULTS: A common profile, with a higher rate of TB towards older age, was seen in the general population but not among health care workers. Among nurses, assistant nurses and physicians, the incidence ratio was higher among those aged 20-39 than among those aged 40-59 years. Compared to the controls, the risk of TB was significantly smaller in the older group of nurses during 1971-1990 and in assistant nurses during 1971-1995. The risk among the older group of physicians was significantly lower during 1971-1980, and among the younger group it was significantly higher during 1976-1990. CONCLUSIONS: We speculate that in certain fields of health care, young workers are at the greatest risk of TB.     

The Effect of Age on the Association Between Blood Pressure and Cognitive Function Later in Life

OBJECTIVES: To determine the prospective relationship between blood pressure (BP) and cognitive function across a wide age range.
DESIGN: Prospective population-based cohort study.
SETTING: The Rotterdam Study and the Leiden 85-plus Study.
PARTICIPANTS: Three thousand seventy-eight men and women, initial age 55 to 84 from the Rotterdam Study and 276 men and women, initial age 85, from the Leiden 85-plus Study.
MEASUREMENTS: Systolic BP (SBP) and diastolic BP (DBP) were measured at baseline, cognitive function was assessed at the end of follow-up using a dedicated neuropsychological test battery. The association between baseline BP levels and cognitive function later in life was assessed in 10-year age groups in the Rotterdam Study and in 85-year-olds of the Leiden 85-plus Study.
RESULTS: In the youngest participants (<65), SBP and DBP were not associated with cognitive function 11 years later. For persons aged 65 to 74, higher baseline SBP and DBP were related to worse cognitive function 11 years later. In contrast, in older age (≥75), higher SBP and DBP seemed to be related to better cognitive function at the end of follow-up. This effect appeared strongest in the highest age group (aged 85).
CONCLUSION: High BP was associated with greater risk of cognitive impairment in persons younger than 75 but with better cognitive function in older persons. Age-specific guidelines for BP management are needed, because the current directive that "lower is better" may not apply to BP levels in the very old.     

The impact of rheumatoid arthritis on employment status in the early years of disease: a UK community-based study

OBJECTIVE: To establish the prevalence of work disability and predictors of change in employment status in patients with early rheumatoid arthritis (RA). SETTING: The Norfolk Arthritis Register (NOAR), a primary-care based inception cohort of patients with recent-onset inflammatory arthritis. METHODS: Two cohorts of patients notified to NOAR, who satisfied the 1987 ACR criteria for RA at the time of notification (baseline) and who were economically active at the time of RA symptom onset, were identified. Cohort 1 consisted of 160 patients with an onset of RA between 1989 and 1992, and was followed for a mean of 8.6 yr from symptom onset. For 110 of these cases, a control group, matched for age, gender and employment status at baseline, was identified from the local population. Their employment histories were compared in 1995. Cohort 2 consisted of 134 patients with an onset of RA between 1994 and 1997, and was followed for a mean of 4.1 yr from symptom onset. RESULTS: One-third of RA cohort 1 had stopped working on the grounds of ill health by 1995. The baseline health assessment questionnaire (HAQ) score was the most important predictor of work disability. These patients were 32 times more likely to stop work on health grounds than the matched controls. The rates for work disability for the RA cases 1, 2, 5 and 10 yr after symptom onset were 14, 26, 33 and 39% respectively. For cohort 2, the rates for work disability 1 and 2 yr from onset were 23 and 33% respectively. CONCLUSION: Work disability is an important outcome in RA patients of working age. Many people stop working very early in the disease process, often before they are referred to hospital or started on disease-modifying anti-rheumatic drugs. Although the peak rates for work disability are in the early years, people with RA continue to leave the work force several years after onset. Thus, the recent move to earlier, more aggressive treatment has had no effect on the rates of work disability.