Jacqueline Agnew

Age‐specific norms for the Mini‐Mental State Exam

Article abstract—We administered the Mini-Mental State Exam (MMSE) to 194 healthy men and women, ages 40 to 89 years. Total score was significantly associated with age (p < 0.0001), but not vocabulary, education, Becks Depression Inventory Score, or sex. The lowest quartile cutoff scores for the MMSE by decade were 40s −29; 50s −28; 60s −28; 70s −28; and 80s −26. When screening for progressive decline in cognitive performance, the use of age-specific norms may provide greater sensitivity than the present recommended cutoff score of less than 24.

Age-related sex differences in verbal memory

Verbal learning and memory were studied in 196 healthy men and women aged 40 to 89. The Rey Auditory Verbal Learning Task (RAVLT), a 15-word list, was presented over five trials followed by free recall after each trial. A recognition trial of 50 words subsequently was administered. A stepwise regression that examined the contributions of age, sex, and vocabulary on the five trials of the RAVLT showed that age and sex accounted for a significant portion of the variance on each trial. Vocabulary accounted for a significant portion of the variance only on trials 4 and 5. The recognition trial was not affected by age, sex, or vocabulary. Men had lower scores overall as compared to women. In the older age group (ages 66-89), this difference was significant on trials two through five. Possible mechanisms that may underlie these age-related sex differences in learning curves are discussed.

Interventions for the primary prevention of work-related carpal tunnel syndrome

OBJECTIVE To evaluate interventions for the primary prevention of work-related carpal tunnel syndrome (CTS). SELECTION CRITERIA Studies had to include an engineering, administrative, personal, or multiple component intervention applied to a working or working-age population. All study designs that included comparison data were considered. Outcome measures included the incidence, symptoms, or risk factors for CTS, or a work-related musculoskeletal disorder of the upper extremity that included CTS in the definition. RESULTS Twenty-four studies met our inclusion criteria. Engineering interventions included alternative keyboards, computer mouse designs and wrist supports, keyboard support systems, and tool redesign. Personal interventions included ergonomics training, splint wearing, electromyographic biofeedback, and on-the-job exercise programs. Multiple component interventions (e.g., ergonomic programs) included workstation redesign, establishment of an ergonomics task force, job rotation, ergonomics training, and restricted duty provisions. Multiple component programs were associated with reduced incidence rates of CTS, but the results are inconclusive because they did not adequately control for potential confounders. Several engineering interventions positively influenced risk factors associated with CTS, but the evaluations did not measure disease incidence. None of the personal interventions alone was associated with significant changes in symptoms or risk factors. All of the studies had important methodologic limitations that may affect the validity of the results. CONCLUSIONS While results from several studies suggest that multiple component ergonomics programs, alternative keyboard supports, and mouse and tool redesign may be beneficial, none of the studies conclusively demonstrates that the interventions would result in the primary prevention of carpal tunnel syndrome in a working population. Given the societal impact of CTS, the growing number of commercial remedies, and their lack of demonstrated effec- tiveness, the need for more rigorous and long-term evaluation of interventions is clear. Fund- ing for intervention research should prioritize randomized controlled trials that include: (1) adequate sample size, (2) adjustment for relevant confounding variables, (3) isolation of speci- fic program elements, and (4) measurement of long-term primary outcomes such as the inci- dence of CTS, and secondary outcomes such as employment status and cost.

Age and fatal work-related falls.

In the work environment, an increased risk of fatal injury from falls is seen at ages not normally considered to be old. This study examined fatality data from a National Institute for Occupational Safety and Health death certificate database and from Occupational Safety and Health Administration (OSHA) investigations to analyze the relationship of age to fatal work-related falls. For 1980 to 1986, death certificates reported 43 505 fatal work injuries in men, 4179 of which were from falls. Fatality rates from falls showed an increase for older workers beginning with the age group of 45-54, whereas fatal injury rates for other work-related causes did not increase until the age group of 55-64. OSHA investigations of 996 fatal work related falls in 1984-1986 reported that falls from ladders accounted for 20% of fatal falls in workers aged 55 and over, significantly more than the average of 9% of all falls for workers of all ages. OSHA data also showed that fatal falls among older workers were associated with lower energy of impact, which means that the height of fatal falls tends to decrease with increasing age.

Workplace violence: prevalence and risk factors in the safe at work study.

Objective: Nurses face one of the highest rates of reported workplace violence (WPV). This research examined the prevalence of WPV and demographic, work-related, and adult and childhood abuse histories as risk factors for WPV among 2166 nurses/nursing personnel across four health care institutions in one US metropolitan area. Methods: Using data from an online cross-sectional survey, multivariate logistic regression was utilized to determine risk factors for physical and psychological WPV. Results: Almost one-third (30%) of nurses/nursing personnel experienced WPV (19.4% physical, 19.9% psychological). Risk factors included being a nurse, white, male, working in the emergency department, older age, longer employment, childhood abuse, and intimate partner violence. Conclusions: Adult and childhood abuse histories have not been considered in previous large-scale investigations, but were significant risk factors along with other previously identified risk factors for WPV.

Involuntary Tobacco Smoke Exposure and Urinary Levels of Polycyclic Aromatic Hydrocarbons in the United States, 1999 to 2002

Evidence supports active smoking as a major source of exposure to polycyclic aromatic hydrocarbons (PAH), compounds that are mutagenic and carcinogenic in humans. The influence of involuntary exposure to tobacco smoke on PAH exposure levels among nonsmokers, however, is unknown. This study evaluated the association between both active and involuntary tobacco smoke and biomarkers of PAH exposure in the general U.S. population. A cross-sectional analysis of 5,060 participants ≥6 years of age was done using data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES). PAH exposure was measured by urinary concentrations of 23 monohydroxylated metabolites of nine PAH compounds. Tobacco smoke exposure was defined as no exposure, involuntary exposure, and active exposure by combining serum cotinine levels, smoking status, and presence of household smokers. PAH metabolite levels ranged from 33.9 ng/L for 9-hydroxyphenanthrene to 2,465.4 ng/L for 2-hydroxynaphthalene. After adjustment for age, sex, race/ethnicity, education, household income, and broiled/grilled food consumption, participants involuntarily and actively exposed to tobacco smoke had urinary metabolite concentrations that were increased by a factor of 1.1 to 1.4 and 1.5 to 6.9, respectively, compared with unexposed participants. Associations for involuntary smoking were stronger and statistically significant for 1-hydroxypyrene, 2-hydroxyfluorene, 3-hydroxyfluorene, 9-hydroxyfluorene, 1-hydroxyphenanthrene, 2-hydroxyphenanthrene, and 3-hydroxyphenanthrene compared with other metabolites. Involuntary exposure to tobacco smoke was associated with elevated urinary concentrations of most PAH metabolites in a representative sample of the U.S. population. Policy and educational efforts must continue to minimize PAH exposure through active and involuntary tobacco smoke exposure. (Cancer Epidemiol Biomarkers Prev 2009;18(3):884–93)

Attributions, Stress, and Work-Related Low Back Pain

Occupational low back pain (LBP) is a major cause of morbidity and cost. Efforts to control LBP are largely unsuccessful, and better understanding of risks is needed, especially psychological factors. The purpose of this research was to assess the association between worker attributions and LBP. Attributing LBP to internal causes may increase the workers perceived control, whereas external attribution may cause distress. A new model was developed to explore these associations. A cross-sectional design was used in this study of 278 garment workers. Data were gathered by a self-administered questionnaire and through direct observation. Responses to questions on worker attributions of LBP cause and knowledge of back safety were subjected to factor analysis and other psychometric evaluation to develop scales. Six hypotheses were tested using multivariate logistic regression. Workers who scored high in internal attribution were more likely to be knowledgeable of back safety (OR = 3.7, 95% CI = 2.0-6.7). Workers reporting high demand were more likely to report LBP (OR = 2.3, 95% CI = 1.2-4.4). Workers attributing LBP to job tasks were more likely to report LBP (OR = 3.2, 95% CI = 1.5-6.9), and those reporting high supervisor support were less likely to report LBP (OR = 0.23, 95% CI = 0.08-0.66). Workers with annual incomes above 15,000 dollars were more likely to report LBP in the test of both the Demand-Control-Support and Attribution models (OR = 2.8, 95% CI = 1.2-6.9 and OR = 4.1, 95% CI = 1.5-11.1, respectively). While both models appeared to be useful for the study of low back pain, the R(2)(L) of the Demand-Control-Support model equaled only 11.9 percent, whereas the Attribution model equaled 26.2 percent. This study provides evidence that attribution theory is useful in the study of LBP, including in future interventions in the prevention of LBP.

Purdue pegboard age and sex norms for people 40 years old and older

A group of 212 healthy 40‐ to 85‐year‐olds were administered the Purdue Pegboard test of manual dexterity. The four subtests included dominant hand, nondominant hand, and bimanual performance as well as a more complex bimanual task, assembly. Differences between scores of each hand were calculated to evaluate lateralization. Performance on all subtests slowed significantly with increasing age. Women were significantly faster than men on all tasks, but the rate of age‐related decline in performance did not differ between sexes. Lateralization, which was significantly greater in women (p < .01), tended to increase with age, but this trend was not statistically significant. This study provides age‐ and sex‐specific normative values for Purdue Pegboard performance in individuals over age 40 and specifically emphasizes the need to consider sex when evaluating manual dexterity.

Simple visual reaction time: Sex and age differences

Although motor slowing is considered to reflect age‐related changes in the central nervous system, simple visual reaction time (SVRT) is considered a weak indicator of aging. A group of 176 healthy men and women, 40 to 90 years old, performed 44 trials on an SVRT task in which the stimulus occurred at random intervals of 1 to 10 sec. Sex and age accounted for a significant proportion of the variance of minimum (best motor performance) and truncated mean reaction times of the 44 responses. Men were consistently faster than women over all decades. Depression, personality traits, mental status, practice, or fatigue did not account for the difference in performance. SVRT is sensitive to sex differences and to aging of the nervous system.

Associations of multiple metals with kidney outcomes in lead workers

Objectives Environmental exposure to multiple metals is common. A number of metals cause nephrotoxicity with acute and/or chronic exposure. However, few epidemiologic studies have examined the impact of metal coexposure on kidney function. Therefore, the authors evaluated associations of antimony and thallium with kidney outcomes and assessed the impact of cadmium exposure on those associations in lead workers. Methods Multiple linear regression was used to examine associations between ln-urine thallium, antimony and cadmium levels with serum creatinine- and cystatin-C-based glomerular filtration measures and ln-urine N-acetyl-β-D-glucosaminidase (NAG). Results In 684 participants, median urine thallium and antimony were 0.39 and 0.36 μg/g creatinine, respectively. After adjustment for lead dose, urine creatinine and kidney risk factors, higher ln-urine thallium was associated with higher serum creatinine- and cystatin-C-based estimates of glomerular filtration rate; associations remained significant after adjustment for antimony and cadmium (regression coefficient for serum creatinine-based estimates of glomerular filtration rate =5.2 ml/min/1.73 m2; 95% CI =2.4 to 8.0). Antimony associations with kidney outcomes were attenuated by thallium and cadmium adjustment; thallium and antimony associations with NAG were attenuated by cadmium. Conclusions Urine thallium levels were significantly associated with both serum creatinine- and cystatin-C-based glomerular filtration measures in a direction opposite that expected with nephrotoxicity. Given similarities to associations recently observed with cadmium, these results suggest that interpretation of urine metal values, at exposure levels currently present in the environment, may be more complex than previously appreciated. These results also support multiple metal analysis approaches to decrease the potential for inaccurate risk conclusions.