Walter Osika

Increasing Peripheral Artery Intima Thickness From Childhood to Seniority

Background—Using new, very high-resolution ultrasound biomicroscopy, we examined the thickness of artificial layers of silicone and intima thickness (IT) of radial and anterior tibial arteries in healthy subjects and in patients with vascular disease. Methods and Results—Silicone layers of varying thicknesses and mesenteric artery specimens obtained from 18 patients undergoing colectomy were measured by both ultrasound biomicroscopy (55 MHz) and morphometry. There was high correlation (r>0.9; P<0.0001) between IT and intima area versus ultrasound biomicroscopy. In 90 healthy subjects (aged between 10 and 90 years), radial and anterior tibial arterial IT and intima-media thickness were measured, as was carotid intima-media thickness in 56 of these subjects. Age was strongly related with both media thickness and IT of both peripheral arteries. Correlations were found between carotid intima-media thickness and both radial and anterior tibial IT/intima-media thickness (r=0.44 to 0.53; P<0.0001). The IT-to-lumen diameter ratio increased with age and was larger at all ages in the anterior tibial artery (0.067±0.034) versus the radial artery (0.036±0.012; P<0.0001). A thicker radial intimal layer was found in patients with peripheral artery disease. Conclusion—This study is the first to our knowledge in humans to show the feasibility of measuring IT of the radial and anterior tibial arteries using very high-resolution ultrasound. IT progresses with age, and the IT-to-lumen diameter ratio is largest in the arteries of the foot. Assessment of IT by ultrasound biomicroscopy may aid in detecting early peripheral vascular abnormalities.

Stress-related exhaustion disorder – clinical manifestation of burnout? A review of assessment methods, sleep impairments, cognitive disturbances, and neuro-biological and physiological changes in clinical burnout

The aim of this paper was to provide an overview of the literature on clinically significant burnout, focusing on its assessment, associations with sleep disturbances, cognitive impairments, as well as neurobiological and physiological correlates. Fifty-nine English language articles and six book chapters were included. The results indicate that exhaustion disorder (ED), as described in the Swedish version of the International Classification of Diseases, seems to be the most valid clinical equivalent of burnout. The data supports the notion that sleep impairments are causative and maintaining factors for this condition. Patients with clinical burnout/ED suffer from cognitive impairments in the areas of memory and executive functioning. The studies on neuro-biological mechanisms have reported functional uncoupling of networks relating the limbic system to the pre-frontal cortex, and decreased volumes of structures within the basal ganglia. Although there is a growing body of literature on the physiological correlates of clinical burnout/ED, there is to date no biomarker for this condition. More studies on the role of sleep disturbances, cognitive impairments, and neurobiological and physiological correlates in clinical burnout/ED are warranted.

The Symptom Checklist-core depression (SCL-CD6) scale: Psychometric properties of a brief six item scale for the assessment of depression:

Aims: Major depressive disorders are common, with substantial impact on individuals/society. Brief scales for depression severity, based on a small number of characteristics all of which are necessary for diagnosis, have been recommended in self-reported versions for clinical work or research when aiming to quickly and accurately measure depression. We have examined psychometric properties of a brief 6-item version of the Symptom Checklist (SCL), the Symptom Checklist core depression scale (SCL-CD6) and aimed to identify a cut-point for epidemiological research. Methods: The psychometric evaluation of the SCL-CD6 was mainly performed by a Mokken analysis of unidimensionality in a random sample of 1476 residents in the Stockholm County, aged 18–64 years. The standardization of SCL-CD6 was based on ROC analysis, using the Major Depression Inventory as index of validity. Predictive validity was subsequently assessed using register data on hospital admissions and purchases of prescribed medications linked to a sample of 5985 participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Results: The SCL-CD6 obtained a coefficient of homogeneity of 0.70 by Mokken analysis, which indicates high unidimensionality and a meaningful dimensional measure of depression severity. By ROC we identified a score of 17 or higher (total range 0–24) as the best cut-point for major depression (sensitivity 0.68, specificity 0.98) which predicted subsequent purchases of antidepressants as well as hospitalisations with a depressive episode. Conclusions: The SCL-CD6 was found a valid depression scale with higher unidimensionality than longer epidemiological instruments and thus particularly suitable for assessment in larger population surveys.

Reduced cardiac vagal activity in obese children and adolescents.

Objective:  Obese children present with various cardiovascular risk factors affecting their future health. In adults, cardiac autonomic function is a major risk factor, predicting cardiovascular morbidity and mortality. We hypothesized that obese children and adolescents had a lower cardiac vagal activity than lean subjects. We measured cardiac spontaneous baroreflex sensitivity (BRS), reflecting the dynamic regulation of cardiac vagal function, in large groups of obese and lean young individuals.

Self-perceived psychosomatic health in Swedish children, adolescents and young adults: an internet-based survey over time.

Objectives The authors investigated self-perceived psychosomatic health in young people (10–24 years of age) in Sweden and analysed different samples during the years 2005 and 2007–2010 via a community website. Design Repeated cross-sectional surveys: (1) single question on a single day in 2005. (2) One specific question delivered on each of eight separate days in 2005. (3) The same eight questions delivered to smaller groups on the same day in 2007 and then again to randomly selected subjects in 2010. Setting Validated questionnaires launched on the internet by a recognised Swedish community site. Study participants were invited to answer questions about their health with full anonymity as they logged into their personal area. Participants 10–24-year-old children, adolescents and young adults. Primary and secondary outcome measures Self-reported psychosomatic health in terms of sex and age over time. Results A large number of responses were obtained (up to 140 000). The response rate for the single item on stress was 41%. A high percentage of young subjects responded that they felt stressed very often/often; the numbers were higher for women (47%) than for men (29%). Older teenaged women had more psychosomatic complaints than did men of similar ages; in contrast, among 10–12-year-old children, the percentage of psychosomatic complaints was similar for men and women. When comparing results obtained in 2010 with those obtained in 2007, young people of both sexes had a slightly better self-perceived health status in 2007. Conclusions During the period 2005–2010 a high percentage of young people, particularly females, 16–18 years of age, had psychosomatic complaints and considered themselves as being often or very often stressed. These complaints were more pronounced in the older age groups. When directing questions to a large community, internet-based surveys appear to be valuable tools.

Mortality following unemployment during an economic downturn: Swedish register-based cohort study

Objective To investigate if unemployment during an economic downturn is associated with mortality, even among men with markers of better health (higher cognitive function scores and qualifications), and to assess whether the associations vary by age at unemployment. Design Longitudinal register-based cohort study. Setting Study entry was in 1990 and 2001 when Sweden was entering periods of significant economic contraction. Participants A representative sample of men from the general population (n=234 782) born between 1952 and 1956 who participated in military conscription examinations. Men in receipt of disability or sickness benefit at study entry were excluded. Main outcome measure All-cause mortality. Results Unemployment compared with employment in 1991 (ages 34–38 years) produced adjusted HRs (with 95% CIs) for all-cause mortality (3651 deaths) during follow-up to 2001 and after stratification by education of 2.35 (1.99 to 2.76) for compulsory education, 2.25 (1.97 to 2.58) for up to 3 years postcompulsory education and 1.90 (1.40 to 2.57) for more than 3 years postcompulsory education. When unemployment was compared with employment in 2001 (ages 45–49 years) with follow-up to 2010, the pattern of mortality risk (4271 deaths) stratified by education was reversed, producing adjusted HRs of 2.81 (2.47 to 3.21) for compulsory education, 2.87 (2.58 to 3.19) for up to 3 years postcompulsory education and 3.44 (2.78 to 4.25) for more than 3 years postcompulsory education. Interaction testing confirmed effect modification by age/period (p=0.003). The degree of gradient reversal was slightly less pronounced after stratification by cognitive function but produced a similar pattern of results (p=0.004). Conclusions Unemployment at older ages is associated with greater mortality risk than at younger ages, with the greatest relative increase in risk among men with markers of better health, suggesting the greater vulnerability of all older workers to unemployment-associated exposures.

24-h Systolic blood pressure and heart rate recordings in lean and obese adolescents

Objective  We assessed the hypothesis that differences in day and night‐time systolic blood pressure (SBP) and heart rate (HR) recordings were smaller in obese versus lean children and adolescents, and whether measurements obtained during a school week or during weekends or holidays influenced these nocturnal falls. We also wanted to determine whether the results were influenced by gender.

Increased intima thickness of the radial artery in individuals with prehypertension and hypertension

BACKGROUND We have used a novel ultra high-frequency (55MHz) ultrasound technique to non-invasively measure the radial arterial vessel wall and separate the intima-media (IMT) complex into measurements of intima and media thickness (IT and MT). Since no previous study has measured IT and MT separately in individuals with prehypertension and hypertension, the aim of the current study was to measure IT and MT thickness of the radial arteries among individuals with prehypertension, hypertension and healthy subjects. METHODS AND RESULTS Individuals with prehypertension (n=32), hypertension (n=34) and healthy subjects (n=29) underwent ultra high-resolution ultrasound of the radial artery. Individuals with prehypertension showed a 14% increase in IT compared to healthy subjects (0.083+/-0.020mm versus 0.073+/-0.015mm; p<0.05), whereas no difference was seen in MT. Individuals with hypertension showed a 12% increase of in IT compared to healthy subjects (0.082+/-0.018mm versus 0.073+/-0.015mm, p<0.05), whereas no differences were seen regarding MT. Prehypertensive and hypertensive individuals did not differ regarding IT and MT. CONCLUSION Both prehypertension and hypertension are associated with thickening of the intimal layer of the radial artery. The present data indicates that intima thickening appears early during the development of hypertension even when blood pressure is only slightly elevated.

Stress resilience in adolescence and subsequent antidepressant and anxiolytic medication in middle aged men : Swedish cohort study

It is unclear whether psychological resilience to stress in adolescence represents a persistent characteristic relevant to the subsequent risk for depression and anxiety in later adulthood. We aimed to test whether low psychological stress resilience assessed in adolescence is associated with an increased risk of receiving medication for depression and anxiety in middle age. We utilized Swedish register-based cohort study. Men born between 1952 and 1956 (n = 175,699), who underwent compulsory assessment for military conscription in late adolescence were followed to examine subsequent risk of pharmaceutically-treated depression and anxiety in middle age, from 2006 to 2009 corresponding to ages between 50 and 58 years, using Cox regression. The associations of stress resilience with prescription of antidepressant and anxiolytics medication through potential mediating factors cognitive and physical function and adult socioeconomic factors were calculated. Low stress resilience was associated with elevated risks for antidepressant (hazard ratio (HR):1.5 (95% CI 1.4 1.6)) and anxiolytics (HR:2.4 (CI 2.0 2.7)) medication. Adjustment for measures of childhood living circumstances attenuated the associations somewhat. Around a third of association with low stress resilience, and a half of that with moderate resilience, was mediated through cognitive and physical function in adolescence and adult socioeconomic factors. The magnitude of the inverse association of higher cognitive function with antidepressant medication was eliminated among those with low stress resilience. These results indicate that low stress resilience in adolescence is associated with an increased risk for antidepressant and anxiolytics medication over 30 years later, in part mediated through developmental factors in adolescence and socioeconomic circumstances in adulthood, and low stress resilience can diminish or eliminate the inverse association of higher cognitive function with antidepressant medication.

Laterality, hand control and scholastic performance: a British birth cohort study.

Objectives To use simple measures of laterality and hand control that can identify a greater risk of poorer scholastic ability, potentially signalling suboptimal hemispheric lateralisation. Design Analysis of material from a birth cohort study. Setting Members of the National Child Development Study, a British birth cohort study following people born in 1958. Participants 10 612 children who undertook tests at age 11 years. Primary outcome measures Teacher-administered tests of non-verbal general ability, verbal general ability, reading comprehension and mathematics. Results Linear regression produced associations (and 95% CIs) with tests of verbal general ability, non-verbal general ability, reading comprehension and mathematics scores for the lowest third (compared with highest) of a left-hand control test involving picking up matches of −1.21 (−1.73 to −0.68; p<0.001), −0.72 (−1.14 to −0.29; p=0.001), −0.70 (−1.06 to −0.35; p<0.001) and −1.32 (−1.90 to −0.73; p<0.001). Among those in the lowest third of the right-hand control test score, mixed-handedness compared with right-handedness was associated with poorer scholastic performance, with regression coefficients (and 95% CIs; p values) of 1.90 (−3.01 to −0.80; p=0.001), −1.25 (−2.15 to −0.35; p=0.007), −1.28 (2.04 to −0.53; p=0.001) and −1.33 (−2.53 to −0.13; p=0.030). The estimates are for a point change in the scholastic test scores, after adjustment for sex, left-hand motor function and social class. Statistically significant associations with mixed-handedness were only observed for the lowest third of right-hand motor function. Conclusions Measures involving poorer left-hand motor function may represent useful markers of reduced cognitive function possibly reflecting suboptimal hemispheric lateralisation. Crude measures of laterality such as reported non-right-handedness may be more useful for research when combined with measures of motor function.