The Association Between Midlife Leisure-Time Physical Activity and Hearing Loss in Late Life in the Atherosclerosis Risk in Communities Study

BACKGROUND

Hearing loss is highly prevalent in older ages and has several health consequences. Some cardiovascular risk factors are associated with worse hearing at older ages. Still, the role of midlife leisure-time physical activity (PA) as a risk factor for hearing loss is yet to be investigated.

METHODS

Among 3 198 participants of the Atherosclerosis Risk in Communities study, we investigated the associations of midlife and change from mid- to late-life PA (assessed via modified Baecke questionnaire) with hearing loss (audiometric battery [worse-ear pure-tone average, and speech-in-noise test]) at older ages. We used regression analyses, adjusted for demographics, medical conditions, and noise exposure, to estimate differences in hearing between those who met and did not meet PA recommendations at midlife and at late life.

RESULTS

A total of 1 386 (43.3%) participants met PA recommendations at midlife. These participants, compared to those who did not meet recommendations, had lower (better) pure-tone average by 1.51 (0.46, 2.55) decibels, identified 0.37 (0.01, 0.74) more words (better score) in the speech-in-noise test, and had a lower relative risk of having hearing loss at older ages (eg, relative risk ratio for severe hearing loss vs normal hearing = 0.70 [0.52, 0.95]). Similarly, those who persistently met PA recommendations from mid- to late life had, compared with those who did not, a better hearing at older ages.

CONCLUSIONS

Meeting PA public health recommendations in midlife and mid- to late life was associated with better hearing at older ages and reduced risk of hearing loss. Promoting adequate levels of PA may be an essential component of hearing care.

Prison suicide--politics and prevention: a view from Ireland

The pattern of suicide in Ireland broadly matches that in various neighbouring countries, with the prevalence among males being significantly greater than among women. Over recent years there has been a significant increase in suicide among young men. Similarly, prison suicide patterns mirror those in neighbouring jurisdictions, with a marked increase in prison suicides occurring over the last 10 years. Media interest in prison suicide is grossly disproportionate to its frequency. Existing prevention policies based on the identification of individuals at risk would appear to have failed, and it is argued that it would be more productive--albeit with significant difficulty--to re-orient prevention strategies towards identifying and remedying risk factors in the overall prison environment as opposed to identifying particular individuals.

The psychological effects of disaster at sea

BACKGROUND

In March 1987, the P&O car ferry Herald of Free Enterprise capsized killing 193 passengers. Seventy-five survivors and relatives were referred by their solicitors to the authors for assessment of psychological injury.

METHOD

Information was gathered retrospectively and systematically from clinical notes and legal reports.

RESULTS

The commonest symptoms suffered were sleep disturbance, loss of concentration and increased anger. The commonest diagnoses were post-traumatic stress disorder, other anxiety states and depression. Depressive symptoms were commoner in those who had been bereaved, anxiety symptoms were commoner in those who had not. Reluctance to discuss symptoms and to attend a psychiatric clinic was a common feature.

CONCLUSIONS

As expected, bereavement led to grief and depressive symptoms, whilst passengers who were not bereaved were more likely to suffer anxiety symptoms. Contrary to expectations, the degree of immersion during the accident did not influence the type or degree of symptoms. Those with worse symptoms were more likely to attend the clinic. Women showed more affective symptoms and men more substance abuse.

The impact of HIV disease on an Irish prison population

Between January 1987 and January 1991, 168 known HIV-infected prisoners have been incarcerated in Dublin's Mountjoy prison. This figure constitutes 16.6% of the total HIV-infected population in the Republic of Ireland over the same period. One hundred and forty-one (84%) of these prisoners have attended the Department of Genitourinary Medicine, St James's Hospital, Dublin. This group displayed considerable morbidity from HIV-related disease. Respiratory tract infection was the most frequent complication seen. Much additional morbidity was directly attributable to intravenous drug use. A survey of a representative group of inmates revealed that 64.7% were diagnosed HIV-positive in prison. The mean length of time spent incarcerated since the diagnosis of HIV infection was 38.9 months. Twenty-nine of 34 individuals who answered a questionnaire were imprisoned for drug-related crimes and 32 of 34 prisoners admitted to parenteral drug use within the prison. As the HIV epidemic unfolds in Dublin, increasing numbers of prisoners with symptomatic HIV disease will spend time incarcerated in Mountjoy prison. This will pose a considerable burden on prison and hospital medical services alike.

Prison suicide in England and Wales, 1972-87

The case notes of 295 suicides (98.3% of the total) in prisons in England and Wales between 1972 and 1987 were studied. This period has witnessed an increase in the suicide rate far in excess of the rate of rise in the prison population. The most common method of suicide was by hanging, usually at night. There was a frequent past history of psychiatric treatment and self-injury. People charged or convicted of violent or sexual offences were over-represented, as were those serving life sentences. There was an association between suicide and both guilt for the offence and being charged or convicted of a homicide offence. Some suicides occurred many years after reception into prison. Routine enquiry about previous suicide attempts must be implemented, along with better, ongoing, active communication between staff and inmates.