Reconstructing the life course: health during early old age in a follow-up study based on the Boyd Orr cohort

A method is described for investigating life course influences on health in early old age. The lives of some 300 individuals at present aged 65-75 y have been reconstructed from the archived records of a pre-WWII survey, in which they took part as children, and from lifegrid interviews with the same individuals 60 y later. Despite loss to study at several points those interviewed are shown to be representative of the British population socio-demographically, in comparison with the 1931 and 1991 decennial censuses, and physically, in comparison with the Health Survey for England. Bias is conservative because the most disadvantaged were disproportionately affected by loss to follow-up through death and because non-responders to interview were more disadvantaged as children than the interviewees. Representativeness and conservative bias, it is argued, justify the use of these data for investigating life course influences on health in early old age.     

Sleep, age, and shiftwork experience

The effects of age and shiftwork experience (never, past, present) on sleep were studied in a sample of 3236 wage earners and retired workers by means of a questionnaire. The sample was composed of 32-, 42-, 52-, and 62-year-old subjects, and included both sexes and various occupational statuses. Age resulted in a continuously increasing frequency of sleep disturbances and hypnotic use, except for difficulty getting back to sleep and early awakening, which peaked at 52 years and then decreased at 62 years, thus suggesting a 'retirement effect'. Current and past shiftworkers reported more problems with falling asleep and early awakening than subjects who had never worked on shifts. This is a likely explanation of why the effect of age was massive in the latter group and much less pronounced in the former groups. There were no clear effects of the length or recency of shiftwork experience. This finding does not support the hypothesized permanent effect of shiftwork experience on subsequent sleep. Females had higher complaint rates at every age. There was little interaction between age and sex, but women were affected more by shiftwork as they got older, particularly as to hypnotic consumption. Some of the results support the hypothesis that a selection process excludes workers who are no longer able to cope with the demands of shiftwork.     

健康人心率变异性分析

心率变异性（ＨＲＶ）分析是一种无创性检测心脏自主神经张力的方法,对指导疾病的治疗及某些疾病的预后判断有重要价值,它受多种因素的影响。ＨＲＶ测定由于操作方法、仪器、指标不尽相同,缺乏可比性,目前国内尚缺乏统一的正常值,为此,中华心血管病杂志编委会ＨＲＶ专题对策组于１９９７ 年参考了欧美两会拟定的标准化方案［１］ 制定了全国ＨＲＶ分析研究协作组研究方案,并几经修改完善［２］ 。作为该协作成员之一,该研究进行了健康人的ＨＲＶ时域和频域指标的测定。初步探讨了性别、年龄、昼夜等因素对健康人ＨＲＶ的影响。     

我院5年住院死亡病人统计分析

为了了解住院死亡病例的主要死因、年龄构成比、性别和季节性差异等。本文就1994～1998年间我院1918例住院死亡病例进行了统计分析。结果显示,主要死因依次为肿瘤、循环系统疾病和外伤,死亡病例中男性比例高于女性（2.34：1）,50岁以上年龄段最高（64．76％）,第1和第4季度的死亡病例比例相对偏高。结论为提高肿瘤,循环系统疾病和外伤及老年患者的诊治水平是降低住院病人死亡率的关键。     

OCT imaging of choroidal neovascularisation and its role in the determination of patients'' eligibility for surgery

AIM: To evaluate the optical coherence tomographic characteristics of choroidal neovascularisation (CNV) in age related macular degeneration (AMD) and in idiopathic and inflammatory CNV. The use of this technique in the selection of patients for surgery is discussed. METHODS: Ocular coherence tomography (OCT), fluorescein, and indocyanine green angiography were performed in 23 patients affected by AMD complicated by well defined CNV and in 10 patients affected by inflammatory or idiopathic CNV. The neovascular membrane was surgically removed in five age related CNVs, two inflammatory choroidopathies, and two idiopathic CNVs. RESULTS: In inflammatory and idiopathic CNV, the OCT displayed a neovascularisation on the retinal pigment epithelium (RPE). In three cases the CNV was excised with an improvement of visual acuity equal to or greater than two Snellen lines; in a fourth case, the visual acuity after surgery was unchanged. In the cases of AMD the OCT fell into three different patterns: (A) CNV above the RPE (five cases); (B) focal, irregular thickening of the retinal pigment epithelial band (12 cases); (C) CNV above and below the RPE (six cases). The five pattern A CNV patients underwent the surgical excision of the neovascularisation. In four cases the visual acuity improved by two or more Snellen lines; in the fifth case the visual acuity remained unchanged. CONCLUSIONS: The authors suggest that the surgical removal of early age related CNV could be performed in those cases where the OCT shows a neovascular membrane on the RPE, as in idiopathic and inflammatory CNVs.     

Indocyanine green guided laser photocoagulation in patients with occult choroidal neovascularisation

AIMS: To determine whether indocyanine green (ICG) guided laser photocoagulation of occult choroidal neovascularisations (OCNV) is beneficial for patients with occult choroidal neovascularisation secondary to age related macular degeneration (AMD). METHODS: A prospective pilot study was performed in 21 eyes with OCNV secondary to AMD that could be identified extrafoveolarly or juxtafoveolarly in an early ICG angiographic study. Laser photocoagulation was applied to the neovascular membrane identified in the early ICG angiographic study. RESULTS: Visual acuity ranged from 20/400 to 20/20 (logMAR 0.54 (SD 0.29) before and hand movements and 20/30 (logMAR 0.81 (0.69)) at the last follow up after laser photocoagulation. During the follow up (30 (13) months) vision improved in four eyes (two lines), in seven eyes the initial visual acuity could be stabilised (two lines), in five eyes vision dropped moderately (three to five lines), and in five eyes vision decreased severely (six or more lines). Recurrences (seven patients) or persistent CNV (six patients) was observed in 13 patients. CONCLUSION: This preliminary study of ICG guided laser photocoagulation of occult extrafoveal and juxtafoveal choroidal neovascularisations suggests that this technique may improve the visual prognosis of these patients. Further prospective controlled studies are necessary to confirm these data.     

高龄老年白内障透明角膜切口超声乳化术临床探讨

目的 探讨避免高龄老年白内障手术风险的办法。方法 对高龄老年白内障３６眼采用透明角膜切口和机械碎核协助进行超声乳化手术。结果 术中血压平稳,眼心反射不明显,安全手术。术后１月视力〉０．５占８６．１１％。结论采用透明角膜切口避免球后麻醉和压迫眼球并缩短术程,能减少风险;机械碎核可降低超声能量,减少角膜并发症,提高疗效。     

Age and sex differences in the management of ischaemic heart disease

Objective

To investigate age and sex differences in the utilisation of hospital services for ischaemic heart disease.

Design

Analysis of routine mortality data and hospital activity data.

Setting

South West Thames Regional Health Authority.

Subjects

Residents of the South West Thames Regional Health Authority who in 1991 either died from ischaemic heart disease or were admitted to an NHS hospital in England and Wales with a main diagnosis of ischaemic heart disease.

Main outcome measures

Ratio of consultant episodes to deaths from ischaemic heart disease (as a proxymeasure of the utilisation of hospital care), and the percentages of consultant episodes in which further investigation (angiography or catheterisation) or revascularisation treatment (coronary artery bypass grafting or angioplasty) were carried out.

Results

The ratio of episodes to deaths was similar in men and women (odds ratio for men vs. women 0.96, 95% confidence intervals 0.90 to 1.03). The percentage of episodes in which further investigation was carried out was higher in men than women (odds ratio for men vs. women 1.46, 95% confidence intervals 1.25 to 1.70) as was the percentage of episodes in which revascularisation treatment was carried out (odds ratio for men vs. women 1.46, 95% confidence intervals 1.20 to 1.77). The ratio of episodes to deaths, the percentage of episodes in which further investigation was carried out, and the percentage of episodes in which revascularisation treatment was carried out all declined with age (all p values <0.001).

Conclusions

Women with ischaemic heart disease are as likely as men to be admitted to hospital, but afteradmission are less likely to undergo further investigation and revascularisation treatment. Elderly patients with ischaemic heart disease are less likely than younger patients to be admitted to hospital; after admission, they are also less likely to undergo further investigation and revascularisation treatment. Further research is needed to determine whether these age and sex differences in the use of hospital services are clinically justified.     

Morphometrical analysis of hemosiderin deposits in relation to wound age

A morphometrical analysis of the extent of hemosiderin deposits in 71 human skin wounds with post-infliction intervals between 2 days and 7 months was performed. Earliest positive findings were detectable in a lesion aged 3 days, and with increasing wound age an increase in the amount of hemosiderin occurred. A value of more than 20% of the microscopic field with hemosiderin deposits was found earliest 8 days after wounding and therefore the detection of considerable amounts of hemosiderin (arbitrarily defined as 20% or more of the evaluated area) indicates a minimum wound age of approximately 1 week. Since the extent of hemosiderin formation depends upon the extent of the initial hemorrhage and a physiological reduction in the amount of this pigment with advanced wound age, slight or absent hemosiderin deposits cannot provide information on the post-infliction interval.