Hospital readmissions among older people with intellectual disability in comparison with the general population

BACKGROUND

Older people with intellectual disability have high multimorbidity and poor physical and mental health compared with the general population. Consequently, they have a greater need for health care. Hospital readmissions may be an indicator of the quality of health care. However, so far, only a few studies have investigated this outcome in populations of people with intellectual disability. None has focused on older people.

METHOD

We identified a cohort of people with intellectual disability aged 55+ years and alive at the end of 2012 (n = 7936). Moreover, we established a reference cohort from the general population, one-to-one matched by sex and year of birth. Data on hospital visits during the period 2002-2012 were collected from the Swedish National Patient Register. Readmissions were defined as unplanned visits with the same diagnosis occurring within 30 days of discharge and with no planned visit for the same diagnosis during this time.

RESULTS

Compared with the general population, people with intellectual disability had increased risk of readmissions for diseases of the nervous system [relative risk (RR) 2.62], respiratory system (RR 1.48), digestive system (RR 1.40) and musculoskeletal system and connective tissue (RR 2.10). Within these diagnostic groups, increased risks were found for arthropathies (RR 3.73), disorders of gallbladder, biliary tract and pancreas (RR 1.78), other diseases of intestines (RR 1.30), and other forms of heart disease (RR 1.23). Decreased risk of readmissions was found for mental and behavioural disorders (RR 0.78) and diseases of the circulatory system (RR 0.64).

CONCLUSIONS

The increased risk for readmissions related to diseases of the nervous and musculoskeletal systems has a clear relation to the prevalence of comorbidities in these areas. People with intellectual disability often also have inborn limitations and damages in these systems which with time lead to complications and risk for diseases, which can be difficult to discover. The increased risk for readmissions for disease of the respiratory system, together with the already known increased prevalence of such diagnoses and their occurrence as a cause for death, warrants further investigations and considerations of potential preventive measures. The pattern of readmissions among older people with intellectual disability cannot be explained solely by a higher prevalence of disorders in this group. Our finding of increased risks for readmissions for diseases in the digestive system could be interpreted as communication problems, which sometimes result in too rapid discharges and their consequential early readmissions.

Sarcopenia Indicators as Predictors of Functional Decline and Need for Care among Older People

OBJECTIVES

Sarcopenia is associated with poor health outcomes. We examined the relative roles of muscle mass, strength, physical performance and obesity as health predictors among older sarcopenic people.

DESIGN AND PARTICIPANTS

This prospective study examined community-dwelling people aged 75+ (N=262).

SETTING

Porvoo Sarcopenia and Nutrition Trial.

MEASUREMENTS

We collected demographic data and medical history by postal questionnaire including RAND-36 at baseline and at four years and measured BMI, Short Physical Performace Battery (SPPB), hand-grip strength, cognition and two surrogate measures of muscle mass; the Single Frequency Skeletal Muscle Index (SF-SMI) and the Calf Intracellular Resistance Skeletal Muscle Index (CRi-SMI).

RESULTS

Adjusted for age and gender, independent outdoors mobility was predicted positively by baseline physical functioning scores in RAND-36 (p<0.001), the SPPB (p<0.001), the two-minute step test (p<0.001), and grip strength (p=0.023), as well as CRi-SMI (p<0.001). However, the prediction was negative in BMI (p<0.001) and the Charlson co-morbidity Index (p= 0.004). Similar associations were found when the physical component RAND-36 was used as an outcome measure. The use of home care was predicted by high co-morbidity (p=0.057) and low scores in RAND-36 (p<0.001), SPPB (p<0.001) and the two-minute step test (p<0.001), and low CRi-SMI (p<0.001). CRi-SF was a more consistent predictor than SF-SMI, which was partly masked by BMI. Controlled for age, gender and comorbidity, a 10% difference in CRi-SMI was associated with a 4% higher probability (p=0.019) of independently living at home, whereas the respective figures for SF-SMI and BMI were -18% (p=0.098) and -14% (p=0.088).

CONCLUSIONS

In contrast to SF-SMI, high CRi-SMI appeared to indicate good prognosis and less need of care, independently of BMI.

Perspectives on recycling centres and future developments

The overall aim of this paper is to draw combined, all-embracing conclusions based on a long-term multidisciplinary research programme on recycling centres in Sweden, focussing on working conditions, environment and system performance. A second aim is to give recommendations for their development of new and existing recycling centres and to discuss implications for the future design and organisation. Several opportunities for improvement of recycling centres were identified, such as design, layout, ease with which users could sort their waste, the work environment, conflicting needs and goals within the industry, and industrialisation. Combining all results from the research, which consisted of different disciplinary aspects, made it possible to analyse and elucidate their interrelations. Waste sorting quality was recognized as the most prominent improvement field in the recycling centre system. The research identified the importance of involving stakeholders with different perspectives when planning a recycling centre in order to get functionality and high performance. Practical proposals of how to plan and build recycling centres are given in a detailed checklist.

Systematic knockdown of epigenetic enzymes identifies a novel histone demethylase PHF8 overexpressed in prostate cancer with an impact on cell proliferation, migration and invasion

Our understanding of key epigenetic regulators involved in specific biological processes and cancers is still incomplete, despite great progress in genome-wide studies of the epigenome. Here, we carried out a systematic, genome-wide analysis of the functional significance of 615 epigenetic proteins in prostate cancer (PrCa) cells. We used the high-content cell-spot microarray technology and siRNA silencing of PrCa cell lines for functional screening of cell proliferation, survival, androgen receptor (AR) expression, histone methylation and acetylation. Our study highlights subsets of epigenetic enzymes influencing different cancer cell phenotypes. Plant homeo domain (PHD) finger proteins have a key role in cell survival and histone methylation, whereas histone deacetylases were primarily involved in regulating AR expression. In contrast, JumonjiC-domain (JmjC) containing histone lysine demethylases (KDMs) mainly had an impact on cell proliferation. Our results show that the KDMs JARID1B, PHF8, KDM3A, KDM3B and KDM4A were highly expressed in clinical PrCa samples. The PHD-finger protein 8 (PHF8), a transcriptional coactivator with both PHD- and JmjC-domains, was moderately to strongly expressed in 80% of clinical PrCa samples, whereas 76% of normal and benign samples were negative or only showed weak PHF8 expression. Strong PHF8 expression correlated significantly with high Gleason grade and was borderline significant for poor prognosis. The results of functional PHF8 knockdown implicate a role in cell migration and invasion, as shown by cell motility and 3-D invasion assays. Our study suggests that various cellular phenotypes are regulated by distinct subsets of epigenetic enzymes. Proteins interpreting and modifying histone methylation, such as JmjC-domain and particularly PHD-finger proteins like PHF8, are activated in subsets of PrCa's and promote cancer relevant phenotypes.

Joint investigation of working conditions, environmental and system performance at recycling centres--development of instruments and their usage

Recycling is a new and developing industry, which has only been researched to a limited extent. This article describes the development and use of instruments for data collection within a multidisciplinary research programme "Recycling centres in Sweden - working conditions, environmental and system performance". The overall purpose of the programme was to form a basis for improving the function of recycling centres with respect to these three perspectives and the disciplines of: ergonomics, safety, external environment, and production systems. A total of 10 instruments were developed for collecting data from employees, managers and visitors at recycling centres, including one instrument for observing visitors. Validation tests were performed in several steps. This, along with the quality of the collected data, and experience from the data collection, showed that the instruments and methodology used were valid and suitable for their purpose.

Hemodynamic and hormonal changes induced by noise

Eighteen healthy male volunteers with normal hearing were exposed to industrial noise at different sound levels (75, 85 and 95 dB A) in a noise laboratory. Blood pressure, heart rate, stroke volume and cardiac output were recorded with noninvasive techniques. Adrenaline and noradrenaline concentration in venous plasma were analyzed before and during noise exposure. The mean resting blood pressure of the whole group was 120/70 mm Hg. During noise stimulation diastolic blood pressure increased (12.2%, p less than 0.001) as did mean arterial pressure (6.6%, p less than 0.001) and total peripheral resistance (12.7%, p less than 0.001). Stroke volume (7.3%, p less than 0.001) and cardiac output (5.0%, p less than 0.01) were both reduced at 95 dB A. Heart rate and systolic blood pressure did not change significantly. At 75 and 85 dB A there were similar but smaller changes in the hemodynamic parameters. There were no changes in adrenaline and noradrenaline in plasma during maximal noise exposure. The noise induced hemodynamic changes remained 5 minutes after the noise stimulation was stopped but had disappeared after 10 minutes of rest.

Noise as a contributory factor in the development of elevated arterial pressure. A study of the mechanisms by which noise may raise blood pressure in man

Arterial pressure and other hemodynamic variables (stroke volume (SV), cardiac output and total peripheral resistance) were studied in 18 healthy males before and during exposure to recorded industrial noise. All measurements took place under strictly standardized conditions in a noise laboratory. the frequency distribution and level of noise used for stimulation were continuously monitored and kept constant within close limits throughout the experiments. SV was measured with impedance cardiography. Indirect blood pressure (BP) in the brachial artery was measured with an automatic device and the derived parameters, cardiac output and total peripheral resistance, were calculated from these measurements. Compared with resting conditions at 40 dBA, stimulation with industrial noise at 95 dBA caused significant increases in diastolic BP, mean arterial pressure and total peripheral resistance. Minor but statistically significant reductions of SV and cardiac output were seen. Heart rate and systolic BP did not change. These alterations of the hemodynamic variables persisted throughout 20 min of noise stimulation and were maintained for 5 min following cessation of noise stimulation. All variables had returned to their initial levels 10 min after discontinuation of noise stimulation. This study suggests that exposure to industrial noise at levels prevailing during several industrial processes may cause acute elevations of arterial BP and peripheral vascular resistance. In animal studies, repeated elevations of BP due to exposure to noise have been shown to cause a permanent elevation of BP. Therefore, we suggest that noise may be one of several external stimuli contributing to the development of arterial hypertension in man.

A descriptive cross-sectional study of annoyance from low frequency noise installations in an urban environment

In order to improve the living conditions for respondents highly exposed to traffic noise, it has been recommended that one side of the building should face a "quiet side". Quiet may, however, be spoilt by noise from installations such as ventilation and air-conditioning systems. The noises generated by installations of this kind often have a dominant portion of low frequencies (20-200 Hz) and may be a source of great annoyance and sleep disturbance. This paper describes the cross-sectional part of an intended intervention study among residents exposed to traffic noise on one side of the building and to low frequency noise from installations on the other side of the building. A questionnaire masked as a general living environment study was delivered to a randomly selected person in each household. In total 41 respondents answered the questionnaire (71% response rate). Noise from installations was measured indoors in a bedroom facing the courtyard in a selection of apartments and outdoors in the yard. 24h traffic noise outdoor and indoor levels were calculated. The noise levels from installations were slightly above or at the Swedish recommendations for low frequency noise indoors with the window closed and exceeded the recommendations by about 10 dB SPL when the window was slightly opened. The proportion of persons who reported that they were very or extremely annoyed indoors from noise from installations was more than twice as high as for traffic noise. Installation noise also affected respondents' willingness to have their windows open and to sleep with an open window. The high disturbance of installation noises found in this study indicates the importance of also regulating the noise exposure on the "quiet side" of buildings. Further studies will give a better base for the extent of annoyance and acceptable levels of installation noises.

Compounds labelled with short-lived beta(+)-emitting radionuclides and some applications in life sciences. The importance of time as a parameter

Some examples of recent development of the synthesis of compounds labelled with short-lived beta(+)-emitting radionuclides will be discussed with an emphasis on the importance of time in selecting a synthetic strategy. Furthermore the use of such labelled compounds to monitor certain processes in areas within the field of analytical chemistry and in various applications in drug development will be presented.

A novel subtype of prostacyclin receptor in the central nervous system

Recently, in the course of our search for the prostacyclin receptor in the brain, we found a novel subtype, designated as IP2, which was finely discriminated by use of the specific ligand (15R)-16-m-tolyl-17,18,19,20-tetranorisocarbacyclin (15R-TIC) and specifically localized in the rostral part of the brain. In the present study, the tritiated compound 15R-[15-(3)H]TIC was synthesized and utilized for more specific research on IP2. The specificity of binding to rat brain regions was confirmed by use of several prostacyclin derivatives including 15S-TIC. Mapping of 15R- and 15S-[3H]TIC binding in adjacent pairs of frozen sections of rat brain demonstrated a quite similar pattern of distribution in almost all rostral brain regions, indicating that the regions may contain only the IP2 subtype. On the other hand, 15R-[3H]TIC binding was very faint as compared with 15S-[3H]TIC binding in the caudal medullary region. High densities of 15R-[3H]TIC binding sites were shown in the dorsal part of the lateral septal nucleus, thalamic nuclei, limbic structures, and some of the cortical regions. Scatchard plot analysis showed two components of high-affinity 15R-[3H]TIC binding in the rostral regions, one with a K(D) value at approximately 1 nM and the other with approximately 30 nM. These results strengthen our previous finding that a different subtype of prostacyclin receptor is expressed in the CNS, and the map with 15R-[3H]TIC obtained here could guide further studies on the molecular and functional properties of the IP2.

Synthesis of 11C/13C-labelled prostacyclins

A one-pot synthesis of (15R)-16-(3-[11C]methylphenyl)-17,18,19, 20-tetranoriso-carbacyclin methyl ester was performed using a palladium-promoted reaction of [11C]methyl iodide with (15R)-16-(3-tri-n-butylstannylphenyl)-17,18,19, 20-tetranorisocarbacyclin methyl ester. The C-15 epimer (15S)-16-(3-[11C]methylphenyl)-17,18,19,20-tetranorisocarbacyclin methyl ester was synthesised in the same way starting from (15S)-16-(3-tributylstannylphenyl)-17,18,19,20-tetranorisocarba cyclin methyl ester. The decay-corrected radiochemical yields were 33-45% based on [11C]methyl iodide produced, and the radiochemical purity of the product was > 95%. The total synthesis time was 35 min, counted from end of radionuclide production to product ready for administration. The 11C-labelled prostacyclin methyl esters were easily hydrolysed using sodium hydroxide affording the 11C-labelled prostacyclin acids in quantitative yields. The stereoisomers (15R)-16-(3-methylphenyl)-17,18,19,20-tetranorisocarbacyclin [11C]methyl ester and (15S)-16-(3-methylphenyl)-17,18,19,20-tetranorisocarbacyclin [11C]methyl ester were synthesised by esterification using [11C]methyl iodide and the tetrabutylammonium salts of (15R)-16-(3-methylphenyl)-17,18,19,20-tetranorisocarbacyclin acid and (15S)-16-(3-methylphenyl)-17,18,19,20-tetranorisocarbacyclin acid, respectively. The decay-corrected radiochemical yields were in the range of 55% counting from [11C]methyl iodide produced, and the radiochemical purity of the product was > 95%. The total synthesis time was 35 min, counting from end of radionuclide production to product ready for administration. Both of these labelling methods can be used for labelling with 13C when (13C)methyl iodide is used. The methods described herein have already proved important since they enable the in vivo use of PET to study the action of prostacyclins in the brain.

Realism of confidence in sensory discrimination: the underconfidence phenomenon

This paper documents a very pervasive underconfidence bias in the area of sensory discrimination. In order to account for this phenomenon, a subjective distance theory of confidence in sensory discrimination is proposed. This theory, based on the law of comparative judgment and the assumption of confidence as an increasing function of the perceived distance between stimuli, predicts underconfidence--that is, that people should perform better than they express in their confidence assessments. Due to the fixed sensitivity of the sensory system, this underconfidence bias is practically impossible to avoid. The results of Experiment 1 confirmed the prediction of underconfidence with the help of present-day calibration methods and indicated a good quantitative fit of the theory. The results of Experiment 2 showed that prolonged experience of outcome feedback (160 trials) had no effect on underconfidence. It is concluded that the subjective distance theory provides a better explanation of the underconfidence phenomenon than do previous accounts in terms of subconscious processes.

Aircraft noise annoyance and average versus maximum noise levels

A questionnaire study was performed in seven areas located around the airports of Landvetter and Save, Gothenburg, in an attempt to elucidate the extent of annoyance in populations exposed to aircraft noise. Noise exposure was estimated as the energy equivalent level (Aircraft Noise Level--FBN) or as the number of aircraft with levels that exceeded 70 dBA, combined with the maximum noise level. The results were compared with data obtained from the earlier Scandinavian Aircraft Noise Investigation. The results supported the conclusion that the annoyance reaction is better related to the number of aircraft and the maximum noise level than to energy equivalent levels for noise exposure.

Noise annoyance with regard to neurophysiological sensitivity, subjective noise sensitivity and personality variables

To evaluate the relation between annoyance to environmental noise, general neurophysiological sensitivity, subjective noise sensitivity and other individual characteristics, experiments were undertaken in which 93 subjects assessed their subjective annoyance after exposure to noise under laboratory conditions. Evaluations were made of the discomfort threshold for pulsating sound, the light discomfort, and heat and cold discomfort. The heart rate and discomfort after exposure to a series of impulse noises was also determined. Subjective noise sensitivity, attitudes to noise, mood and personality characteristics of the subjects were evaluated using questionnaires. The results show that the annoyance after exposure to noise was not closely related to the general neurophysiological sensitivity, measured as discomfort threshold for noise, heat, cold and light; or to the heart rate reaction or discomfort after exposure to impulse noise. The annoyance was highly correlated with subjectively reported noise sensitivity and with the attitude to noise. There was also a relationship with neuroticism, measured with the EPI scale. It is suggested that the subjective noise sensitivity, attitude and neuroticism for the definition of noise sensitivity be defined in future studies of long term effects of noise exposure.

Dose-response relationships for traffic noise and annoyance

The annoyance due to road traffic noise was studied in 18 areas in five countries. A total of 1379 interviews was performed and noise measurements were made in each area. The relation between Leq and the extent of the population expressing that they were "very annoyed" was poor (rxy = 0.03). An augmentation of the number of heavy vehicles from 1000/24 hr up to greater than 3000/24 hr did not increase the extent of annoyance. The highest correlation was obtained for the maximum noise level. The dose-response relationship implies that the number of events above a certain limit will not increase the extent of annoyance: it is determined by the highest noise level from single vehicles. It is suggested that this model for the human reaction to environmental noise, which has now been demonstrated for aircraft, train, and traffic noise, should be considered for the establishment of standards.

Sleep disturbance before and after traffic noise attenuation in an apartment building

A study on traffic noise sleep disturbance was made in an apartment building before and after the installation of noise insulating windows. Three tenants completed a questionnaire each morning one week before and one week after the insulation of windows, and body movements during sleep were recorded during these periods. All persons demonstrated a decrease in the number of body movements after the windows had been insulated and two reported improved sleep quality. The results suggest that subjectively judged sleep quality as well as recordings of bed movements are useful tools for evaluating actions to reduce noise.

Effect of noise on blood pressure and 'stress' hormones

1. Noise stimulation (95 dBA) for 20 min caused a significant increase in diastolic (12%, P less than 0.001) and mean arterial pressure (7%, P less than 0.001) in 15 healthy normotensive male subjects. 2. There was no significant change in systolic blood pressure or heart rate during exposure to noise. 3. Adrenaline, noradrenaline, prolactin, cortisol and growth hormone concentration in venous plasma were not affected during noise stimulation.

Haemodynamic effects of noise exposure before and after beta 1-selective and non-selective beta-adrenoceptor blockade in patients with essential hypertension

1. Noise stimulation (100 dBA) for 10 min caused a significant increase in diastolic (7.0%, P less than 0.001) and mean arterial blood pressure (4.3%, P less than 0.01) in patients with essential hypertension. 2. The blood pressure response to noise was due to an increase in total peripheral resistance (4.8%, P less than 0.02); heart rate, stroke volume and cardiac output were unchanged. 3. beta 1-selective adrenoceptor blockade (metoprolol) did not change the haemodynamic reaction pattern induced by noise. 4. Noise exposure during non-selective beta-adrenoceptor blockade (propranolol) caused an accentuated blood pressure response with increments of both systolic and diastolic blood pressure as well as a more pronounced rise in total peripheral resistance. 5. The haemodynamic changes induced by noise stimulation at 100 dBA totally disappeared after 5 min of quiet rest at 40 dBA.

[Traffic noise: estimation of discomfort in Geneva and in Scandinavian countries]

Annoyance among persons exposed to traffic noise has been studied using an interview technique. Results show a better correlation between annoyance and the number of heavy vehicles between 5-10 p.m. than the LEq values. The same reactions were measured in Geneva and Scandinavia.