Life satisfaction and cardiovascular disease risk in Poland

Introduction

Cardiovascular disease is the most common cause of death. Life satisfaction is a predictor of morbidity and mortality, irrespectively of objective measures of health status. The aim of the study was to evaluate the relationship between life satisfaction (LS) and cardiovascular disease risk (CVD) assessed with the Framingham Risk Score (FRS) in Polish adults.

Material and methods

Past, present and projected LS were estimated. The FRS reflecting 10-year CVD risk was calculated from health indices and lifestyle parameters. Relationships between LS and FRS were tested by two-way analysis of variance in 489 men and 591 women, 40–50 years of age.

Results

Subjects with a reduction in LS over time had a higher FRS compared to peers with an improvement in LS. The relationship between current LS and FRS had a J-shape in men; FRS was lowest in men with an LS of 5–7 (average LS), slightly higher in men with an LS of 8–10 (highest LS), and highest in men with an LS of 1–4 (lowest LS). Among women, there was an inverse linear relationship between LS and FRS: the higher the LS, the lower FRS. There was a strong linear relationship between predicted LS and CVD risk. Highest risk was evident in subjects with low LS in whom low LS was predicted over the next five years.

Conclusions

Low LS (dissatisfaction) thus has a long-term negative effect on CVD risk in Polish adults of both sexes.     

Assessment of lifestyle effect on oxidative stress biomarkers in free‐living elderly in rural Japan

Background: Oxidative stress is believed to play a crucial role in aging and age‐related diseases, and is widely thought to increase morbidity and mortality in the elderly. Assessment of biomarkers of oxidative stress, such as 8‐isoprostane and 8‐hydroxy‐2‐deoxyguanosine, are considered to be useful in predicting disease risks at the population level. Objective: The aim of the present study was to assess the health status of the elderly by comparing their lifestyles and levels of oxidative stress biomarkers. Methods: We carried out a cross‐sectional study where urine samples from a total of 100 elderly men and women were assayed for 8‐isoprostane, 8‐hydroxy‐2‐deoxyguanosine, selenium, cadmium and creatinine. They were asked to answer a questionnaire that included questions about their lifestyle. Results: Most of the participants were prehypertensive, non‐alcohol users and on a rich plant‐based diet. There were no differences in any biomarkers of oxidative stress between men and women. 8‐Isoprostane was found to correlate positively with systolic blood pressure in women, but not in men. There was a slight increase of 8‐isoprostane in participants with a poor intake of vegetables, and a decrease of 8‐hydroxy‐2‐deoxyguanosine in participants who consumed fish. Multiple regression analysis showed that oxidative stress biomarkers were positively associated with cadmium, and negatively associated with selenium and fish intake in all participants, 89% of which were non‐smokers. Conclusion: Results from the present study show that fish intake has the potential of decreasing oxidative stress among elderly persons. Geriatr Gerontol Int 2012; 12: 547–554.     

The joint contribution of physical activity,insomnia symptoms,and smoking to the cost of short‐term sickness absence

Physical inactivity has been associated with both insomnia symptoms and smoking. Further, they are all independently associated with increased sickness absence (SA) from work. However, joint contribution of either physical activity (PA) with insomnia symptoms or with smoking to SA and, especially, their direct cost for the employer is poorly understood. Therefore, we aimed to examine these joint associations with short‐term (<15 days) SA cost. The Helsinki Health Study is a cohort of midlife employees of the City of Helsinki, Finland (baseline n = 8960, response rate 67%). During 2000‐2002, the participants were mailed a survey questionnaire that gathered information on health behavior and sociodemographic characteristics. SA, salary, and time of employment were followed up through the employer's personnel register between 2002 and 2016 for those with a written consent to the use of their register data (78% of the participants). Individual salary data were used to calculate the direct cost of short‐term SA. Data were analyzed with a two‐part model. Inactive participants with frequent insomnia symptoms had 2526€ (95% CI 1736€‐3915€) higher cost of short‐term SA than vigorously active participants without insomnia symptoms. Furthermore, inactive smokers had 4166€ (95% CI 2737€‐5595€) higher cost for the employer over the follow‐up than vigorously active non‐smokers. In conclusion, this study showed that PA and insomnia symptoms as well as PA and smoking are jointly associated with short‐term SA cost. The results emphasize encouraging employers to improve work environments so that they promote active lifestyle, good sleep, and non‐smoking in order to reduce the cost of SA.     

Pharmacotherapy for the treatment of depression in patients with alzheimer’s disease: a treatment-resistant depressive disorder

Introduction: Pharmacotherapy for the treatment of depressive disorders in Alzheimer’s Disease (AD) represents a clinical challenge. pharmacological options are often attempted after a period of watchful waiting (8–12 weeks). monoaminergic antidepressant drugs have shown only modest or null clinical benefits, maybe because the etiology of depressive symptoms in ad patients is fundamentally different from that of nondemented subjects.

Areas covered: The following article looks at the selective serotonin reuptake inhibitor sertraline, which is one of the most frequently studied antidepressant medications in randomized controlled trials (RCTs). It also discusses many other pharmacological approaches that have proven to be inadequate (antipsychotics, acetylcholinesterase inhibitors, anticonvulsants, hormone replacement therapy) and new drug classes (mainly affecting glutamate transmission) that are being studied for treating depression in AD. It also gives discussion to the phase II RCT on the alternative drug S47445 and the potential effect on cognition of the multimodal antidepressant vortioxetine in older depressed patients. Finally, it discusses the N-methyl-D-aspartate antagonist ketamine.

Expert opinion: The present RCT methodologies are too disparate to draw firm conclusions. Future studies are required to identify effective and multimodal pharmacological treatments that efficiently treat depression in AD. Genotyping may boost antidepressant treatment success.     

The Impact of an Immersive Elective on Learners’ Understanding of Lifestyle Medicine and Its Role in Patients’ Lives

Objective. To design an immersive, active learning, lifestyle medicine (LM) elective and evaluate its impact on a pharmacy learners’ ability to understand the challenges of implementing lifestyle changes.Design. A 3-credit elective was developed that incorporated goal setting and immersion into the realm of LM as experienced by both the patient and the practitioner. Learners were assessed via a survey instrument, formal assignments, reflections, and the Presidential Fitness Challenge.Assessment. Learners reported that their ability to initiate LM as a primary intervention within a care plan significantly increased after taking this course. They also improved their overall health.Conclusion. By identifying and implementing self-identified lifestyle modifications, learners increased confidence in their abilities to produce evidence-based outcomes for patients. Learners were able to understand the challenges of trying to change their daily habits as they undertook their own personal goals.     

A New Operational Definition of Frailty: The Frailty Trait Scale

ObjectivesTo provide a new instrument to diagnose frailty, the Frailty Trait Scale (FTS), that allows a more precise assessment and monitoring of individuals.DesignProspective population-based cohort study.SettingThe Toledo Study for Healthy Aging, Spain.ParticipantsA total of 1972 men and women aged 65 years or older.MeasurementsWe identified 7 frailty dimensions (energy balance–nutrition, physical activity, nervous system, vascular system, strength, endurance, and gait speed) represented by 12 items. Each item was pondered based on the quintiles of its distribution in the study population. Validity was evaluated by testing its association with factors related to frailty and its predictive value for adverse events. This predictive capacity was further compared with the capacity of 2 well-established frailty models (the frailty phenotype and the Frailty Index).ResultsFTS score was associated with several comorbidities and biomarkers classically associated with frailty. The FTS was associated with the incidence of hospitalization and mortality (hazard ratio associated with a score in the highest quartile [versus the first quartile] = 2.3, 95% confidence interval [CI] 1.6–3.4, and 2.5, 95% CI 1.8–3.6, respectively). Compared with Fried et al's definition, the FTS showed a better predictor for hospitalization in persons younger than 80 (area under the curve [AUC] = 0.65 vs 0.62, P = .01), and for mortality in the oldest group (AUC = 0.77 vs 0.72, P = .02). FTS showed similar predictive value to the Frailty Index.ConclusionFTS associates with many of the factors linked to frailty and has a similar predictive capacity to that provided by the classical instruments. Its characteristics offer some advantages over them, with potential utility in research and clinical practice.