The aim of this study was to compare the presence and severity of dementia in two large cross-sectional samples of nursing home residents from 2004/2005 and 2010/2011.Demographic information as well as data on the type of nursing home unit, length of stay before assessment, physical health, regularly used prescribed drugs and Clinical Dementia Rating scale scores were used in the analyses. Logistic and linear regression models for hierarchical data were estimated.The odds of the occurrence and of a greater severity of dementia were higher in 2010/2011 than in 2004/2005. Independent of the time of study, married men had more severe dementia than single men, and single women had more severe dementia than single men.The findings may reflect the increase in the need for more nursing home beds designed for people with dementia between 2004/2005 and 2010/2011.
The relationship between dust exposure and annual decline in lung function among employees in the smelting industry is unknown.The aim of the study was to investigate the relationship between annual change in lung function and occupational dust exposure among workers in 15 Norwegian smelters.All employees (n = 2,620) were examined annually for 5 years (11,335 health examinations). At each examination spirometry was performed and a respiratory questionnaire was completed. The smelters were grouped as follows: (1) ferrosilicon alloys (FeSi) and silicon metal (Si-metal); and (2) silicon manganese (SiMn), ferromanganese (FeMn), and ferrochromium (FeCr). A job exposure matrix was available on the basis of 2,619 personal dust exposure measurements. The association between lung function expressed as FEV(1) and FVC per squared height (height(2)) and dust exposure was investigated using multivariate linear mixed model analyses.The annual change in FEV(1)/height(2) (deltaFEV(1)) related to dust exposure in the FeSi/Si-metal and SiMn/FeMn/FeCr smelters was -0.42 (95% confidence interval, -0.95 to 0.11) and -1.1 (-2.1 to -0.12) (ml/m(2)) x (mg/m(3))(-1) x year(-1), respectively. The annual decline in FEV(1)/height(2) was 1.6 ml/m(2) (0.15 to 3.1) steeper in smokers than in nonsmokers. The median geometric mean of the time-weighted dust exposure concentration levels of the employees was 2.3 mg/m(3) in the FeSi/Si-metal smelters and 1.6 mg/m(3) in the SiMn/FeMn/FeCr smelters. Among nonsmokers, deltaFEV(1) was -0.86 (-1.6 to -0.10) and -1.1 (-2.5 to 0.25) (ml/m(2)) x (mg/m(3))(-1) x year(-1) in the FeSi/Si-metal and SiMn/FeMn/FeCr smelters, respectively. Thus, for a 1.80 m tall employee the annual decline in FEV(1) associated with average dust exposure was 5.7 ml/year in the SiMn/FeMn/FeCr smelters, and 6.4 ml/year for a nonsmoker in the FeSi/Si-metal smelters.In all smelters combined, the annual change in FEV(1) was negatively associated with increasing dust exposure. This association was also significant among workers in SiMn/FeMn/FeCr smelters and among nonsmokers in the FeSi/Si-metal smelters.
Previous reports indicate an association between Epstein-Barr virus (EBV) antibody levels and multiple sclerosis (MS) disease activity, but the results have been conflicting.The objective of this paper is to study if EBV antibody levels reflect MRI disease activity in MS and examine the potential for EBV antibody levels as biomarkers for treatment response.A total of 87 MS patients were followed for two years prior to and during interferon beta (IFNB) treatment, with MRI examinations and serum measurement of IgM and IgG antibodies to viral capsid antigen (VCA), EBV nuclear antigen 1 (EBNA-1) and early antigen (EA). Associations between EBV antibody levels and MRI activity were assessed by a logistic regression model.Higher anti-EBNA-1 IgG levels were associated with increased MRI activity, OR = 2.95 (95% CI 1.07-8.10; p = 0.036) for combined unique activity (CUA; the sum of T1Gd+ lesions and new or enlarging T2 lesions). Although most patients were anti-VCA IgM negative, there was an inverse association, OR = 0.32 (95% CI 0.12-0.84; p = 0.021) with CUA during IFNB treatment.This study supports an association between anti-EBNA-1 IgG levels and MS disease activity. We also found an inverse association with anti-VCA IgM levels during IFNB treatment not previously described, indicating anti-VCA IgM as a possible biomarker for IFNB treatment response.
We model spot prices in energy markets with exponential non-Gaussian Ornstein–Uhlenbeck processes. We generalize the classical geometric Brownian motion and Schwartz' mean-reversion model by introducing Lévy processes as the driving noise rather than Brownian motion. Instead of modelling the spot price dynamics as the solution of a stochastic differential equation with jumps, it is advantageous from a statistical point of view to model the price process directly. Imposing the normal inverse Gaussian distribution as the statistical model for the Lévy increments, we obtain a superior fit compared to the Gaussian model when applied to spot price data from the oil and gas markets. We also discuss the problem of pricing forwards and options and outline how to find the market price of risk in an incomplete market.
Abstract Aim Recognising changes in lung compliance can help clinicians to adjust initial inflations during resuscitation at birth. We examined whether physicians sensed low and normal compliance with a self‐inflating bag before and after an educational intervention that used a manikin connected to a newborn lung simulator. Methods We asked 43 physicians with neonatal duties to perform two low compliance ventilation attempts and two normal‐compliance ventilation attempts in a randomised order at baseline and after the educational intervention, with 34 taking part in a retest three months later. Results The physicians correctly recognised low and normal compliance in 71% and 66% of the ventilations at baseline, 80% and 66% of the ventilations after the intervention and 74% and 81% at retest. Correct recognition of normal compliance improved from baseline to retest (p = 0.04). Ventilations in low‐ vs normal‐compliance settings resulted in lower tidal volumes (4.4 vs 23.0 mL, p < 0.001), lower ventilation rates (42 vs 51, p < 0.001) and higher peak inflating pressure (35.2 vs 31.4 cmH 2 O, p < 0.001). Conclusion Around one in four physicians failed to recognise correct compliance levels when using a self‐inflating bag and showed limited improvement after an educational intervention. Ventilations in a low‐compliance setting resulted in suboptimal ventilation.
BackgroundHealth-related quality of life (HRQoL) is affected after out-of-hospital cardiac arrest (OHCA), but data several years after the arrest are lacking. We assessed long-term HRQoL in OHCA survivors and how known outcome predictors impact HRQoL.MethodsIn adult OHCA survivors, HRQoL was assessed five years post arrest using Short-form 36 (SF-36), EQ-5D-3 L (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) among others. Results were compared to the next of kins' estimates and to a Norwegian reference population.ResultsAltogether 96 survivors were included mean 5.3 (range 3.6–7.2) years after OHCA. HRQoL compared well to the reference population, except for lower score for general health with 67.2 (95%CI (62.1; 72.3) vs. 72.9 (71.9; 74.0)), p = 0.03. Younger (≤58 years) vs. older survivors scored lower for general health with mean (SD) of 62.1 (27.5) vs. 73.0 (19.5), p = 0.03, vitality (55.2 (20.5) vs. 64.6 (17.3), p = 0.02, social functioning (75.3 (28.7) vs. 94.1 (13.5), p < 0.001 and mental component summary (49.0 (9.9) vs. 55.8 (6.7), p < 0.001. They scored higher for HADS-anxiety (4.8 (3.6 vs. 2.7 (2.5), p = 0.001, and had lower EQ-5D index (0.72 (0.34) vs. 0.84 (0.19), p = 0.04. Early vs. late awakeners had higher EQ-5D index (0.82 (0.23) vs. 0.71 (0.35), p = 0.04 and lower HADS-depression scores (2.5 (2.9) vs. 3.8 (2.3), p = 0.04. Next of kin estimated HRQoL similar to the survivors' own estimates.ConclusionsHRQoL five years after OHCA was good and mainly comparable to a matched reference population. Stratified analyses revealed impaired HRQoL among younger survivors and those awakening late, mainly for mental domains.
Abstract The aim of the study was to describe the prevalence, incidence and persistence of depressive symptoms over a 36-month follow-up period among older people receiving in-home care, and to explore the association between cognitive function and the course of depressive symptoms. In all, 1001 older people (≥ 70 years) receiving in-home care were included in a longitudinal study over 36 months. Depressive symptoms, cognitive function, general medical health, activities of daily living, neuropsychiatric symptoms and use psychotropic drugs were assessed at three assessments. Dementia and mild cognitive impairment were diagnosed at all assessments. Baseline demographic characteristics and information on nursing home residency at follow-up were recorded. Linear mixed models were estimated. We found the prevalence and cumulative incidence of individual depressive symptoms to be higher in those with dementia at baseline than in those without. The persistence of depressive symptoms did not differ between those with or without dementia at baseline. The severity of cognitive decline and mean depressive symptom score assessed simultaneously were positively associated, but the strength of the association changed over time and was not significant at the last assessment. In conclusion: The differences in prevalence and cumulative incidence of depressive symptoms in those with and without dementia at baseline, and the association found between degree of cognitive decline and depressive symptoms over time shows that depression and dementia are interconnected. Nurses and clinicians should pay attention to cognitive status when observing or evaluating depression among older people receiving in-home care.
