Are Physicians Healthy When They Are Aged and Retired? A Survey of the Ankara Chamber of Medicine and the Turkish Geriatrics Society.

In literature, there is a lack of knowledge about clinical and lifestyle characteristics of retired physicians. Aim of the study is to describe the health profile of older physicians registered to the Ankara Chamber of Medicine (Ankara, Turkey). Two hundred and seventy four registered physicians agreed to participate to a survery. Most of them (76.6%) were men. Mean age was 74.9 (standard deviation 6.3) years. More than 85% of the participants presented at least one chronic disease. High scores were reported for the role-physical component of the SF-36, differently from the general health section of it scoring low. The results of the present survey pose the basis for collaborative efforts from the Ankara Chamber of Medicine and the Turkish Geriatrics Society collaboratively to improve the design and development of services for local older physicians.

No alteration in bone mineral density in patients with periodontitis.

Alveolar bone destruction can be magnified in the presence of generalized skeletal disorders. We questioned whether severe generalized periodontitis patients display signs of bone metabolism disturbances. Our objective was to assess skeletal bone mineral density (BMD) and biochemical bone parameters in premenopausal women with periodontitis. Forty-five patients and 40 control individuals were included in the study. We measured BMD by dual-energy x-ray absorptiometry. The results showed no difference in BMD values between the periodontitis and control groups (p > 0.05). A positive relationship between the clinical attachment level and Body Mass Index (BMI) scores was observed (p = 0.03). Increased serum creatinine levels were noted in the periodontitis group (p = 0.04). Analysis of the data suggests that there is no evidence for an association between skeletal BMD and severe periodontitis in premenopausal women. There may be a link between elevated creatinine levels and periodontitis. The persons with high BMI scores seemed to be at risk for periodontitis.

Retired physicians: a survey study by the Turkish Medical Association.

BACKGROUND: The aim of this study was to assess the quality of life of retired Turkish physicians. The focus was on their working conditions, their health status, and the impact of their disabilities on activities of daily life. METHODS: The survey was conducted using a 35 item questionnaire, which was distributed to the local medical chambers allied with the Turkish Medical Association and thereafter was mailed to retirees aged 65 years and older. RESULTS: Out of 680 physicians, 391 (57.5%) responded, and percentages are expressed according to the number of physicians answering each question. The ages of the physicians ranged between 65 years and 91 years with a mean of 72.57+/-5.22 years. Overall, 236 physicians (60.8%) were still actively carrying on their profession, and 152 (39.2%) were not. Of the physicians who were working, 0.8% classified their working conditions as very bad, 9.7% as unsatisfactory, 37.7% as satisfactory, 33.6% as good, and 18.2% as excellent. The number of physicians with a disability was 42 (11.8%). The number of days on which physicians were hindered in their daily tasks ranged between 0 and 30 days with a mean (SD) of 1.55 (4.88) days, and the amount of sick leave ranged between 0 and 365 days with a mean of 2.25 (21.08) days. CONCLUSION: It is believed that planning for retirement in all its aspects should be a legitimate concern of all physicians. Recommendations for future retirees or the construction of guidelines for making this time of life enriching and a period of intellectual growth are awaited.

QT dispersion and cardiac involvement in patients with rheumatoid arthritis.

OBJECTIVE: To investigate the dispersion of repolarization variables in patients with rheumatoid arthritis (RA). METHODS: Electrocardiography (ECG) and Doppler echocardiography were performed on 40 patients with RA, which were divided into two groups according to the duration of disease and in 48 healthy controls. RESULTS: All patients had significantly longer QT dispersion (QTd) and corrected QT dispersion (QTc-d) values (p<0.05). The mean values of diastolic function variables were significantly different in all patients compared to healthy controls (p<0.05). There were no statistically significant differences between patient groups in terms of diastolic function variables except IVRT. However, QTd and QTc-d were significantly longer in patients with disease duration over 5 years (p<0.05). CONCLUSION: We conclude that repolarization heterogeneity and diastolic dysfunction are commonly seen in RA, and QTd is significantly longer in those patients with a disease duration over 5 years compared to those with new onset RA.

Predictors of bone mineral density in healthy males.

Osteoporosis (OP) is a growing health problem not only in women but also in men. It is well known that men lose bone during aging and are at risk for OP, but the risk factors for OP in men remain controversial. To assess determinants of bone mineral density (BMD) in the spine and femoral neck, 37 healthy men aged 43-73 years were measured using dual photon absorptiometry. Predictors of lumbar spine and femoral neck BMD were determined using multiple linear regression analysis. Backward elimination procedure was used to identify variables significantly related to BMD. The independent variables entered the regression model included age; body mass index (BMI); smoking history; alcohol intake; urinary calcium and hydroxyproline; and serum concentrations of osteocalcin, parathyroid hormone, testosterone, growth hormone, and cortisol. Backward regression analysis indicated that testosterone, cortisol, and BMI were significant predictors of BMD in the lumbar spine while testosterone, hydroxyproline, and osteocalcin were significant predictors of BMD in the femoral neck. Testosterone, cortisol, and BMI accounted for 44% of the total variance in lumbar spine BMD, and testosterone, hydroxyproline, and osteocalcin accounted for 20% of the total variance in femoral neck BMD. These observations suggest that testosterone, cortisol and BMI are determinants of lumbar spine BMD, while testosterone, urinary hydroxyproline, and osteocalcin are determinants of femoral BMD in healthy men.

Psychological disturbance in fibromyalgia: relation to pain severity.

Fibromyalgia is a form of nonarticular rheumatism characterized by musculoskeletal aching and tenderness on palpation. The role of psychological factors in fibromyalgia has been controversial. The aim of this study was to evaluate the relationship of fibromyalgia to the intensity of anxiety and depression and to determine the correlation between psychological disturbances with disease duration and pain severity. Thirty-nine patients with fibromyalgia and 36 healthy controls were included in this study. Beck depression inventory, State and trait anxiety inventory and Beck hopelessness scale were used to evaluate psychological disturbances. Visual analog scale was used to determine pain intensity. We found a significant difference in the psychological status between patients with fibromyalgia and control subjects as measured by Beck depression inventory and trait anxiety inventory; 35.9% of the patients scored higher than the cut-off score on the Beck depression rating scale. Pain severity was found to be correlated with trait anxiety inventory scores. These results suggest that somatic expression of depression is an important difference between fibromyalgia and control groups. The difference between state and trait anxiety inventory reflects that current anxiety is not secondary to pain but trait anxiety is possibly causally related to pain.

Bone mineral density in ankylosing spondylitis.

Vertebral osteoporosis is a well-recognized feature of ankylosing spondylitis (AS) and also the vertebral compression fractures due to osteoporosis are a common but frequently unrecognized complication of AS. Both may contribute to the pathogenesis of spinal deformity and back pain. The aim of this study was to measure vertebral and femoral neck bone mass in patients with AS by dual photon absorptiometry, to determine the prevalence of compression fractures and to examine the relationship between bone density and disease severity. We found that the bone mass was diminished in the lumbar spine in moderate AS versus mild forms but the patients with advanced disease had the highest BMD values. Examination of spinal radiographs revealed compression and biconcave fractures in 9 (40.9%) cases. Neither the duration of the disease and the degree of sacroiliitis, nor the disease activity assessed by laboratory and clinical parameters was found to significantly affect the results.

Osteoporosis in rheumatoid arthritis: effect of disease activity.

In addition to juxtaarticular osteoporosis, which appears to reflect predominantly local disease mechanisms, more generalized bone loss can occur in rheumatoid arthritis (RA). The aim of this study was to compare bone mineral density (BMD) of the lumbar spine and proximal femur in RA patients versus controls and evaluate the influence of disease related determinants. Twenty-seven patients with RA and twenty healthy subjects were included in this study. BMD was significantly reduced in RA patients compared with the control group. BMD was correlated with duration of disease, health assessment questionnaire scores, hand grip strength and erythrocyte sedimentation rate. These results support the hypothesis that BMD may be affected by RA related determinants.

Temporomandibular joint involvement in rheumatoid arthritis. Relationship with disease activity.

Involvement of temporomandibular joint (TMJ) in rheumatoid arthritis (RA) patients is described, but the incidence varies greatly. In this study our aim was to determine the frequency and character of TMJ involvement in RA patients asymptomatic for this joint, to investigate the relationship with disease activity, and to evaluate the early diagnostic value of imaging techniques. Twenty patients were included in this study, ten were evaluated with computed tomography (CT) and ten with magnetic resonance imaging (MRI). Among the 20 patients 45% had TMJ involvement detected by imaging techniques. The most frequent pathological signs were osteophyte formation, erosion of the mandibular condyle and decreased joint space (40%). Age, duration of disease, number of swollen joints. CRP and RF levels were found to be correlated with TMJ involvement. It is concluded that TMJ involvement may be detected even in asymptomatic patients with RA and there is a positive correlation between the severity of disease and involvement of TMJ.

Neuroelectrophysiological evaluation of untreated hyperthyroid patients.

Hyperthyroidism is a common endocrinologic disorder affecting many organ systems. Musculoskeletal and neurological involvement present themselves as fatigue, muscle weakness and paralysis. Electromyography (EMG) is essential for differential diagnosis of muscle weakness. Well defined neuropathy and myopathy have been described in these patients. In the present study 17 hyperthyroid patients were evaluated with electrophysiological tests in addition to physical and neurological examinations and biochemical laboratory studies. Needle EMG, motor and sensory conduction velocities, median and tibial somatosensory evoked potentials (SEP) were studied. For assessment of the activity of disease clinical status, neurological symptom and disability scores and serum T3, T4 and TSH levels were examined. Statistical analysis of neuroelectrophysiological findings of the patient and the control groups yielded meaningful difference in the needle EMG, sensory conduction velocity and evoked potential findings. Abnormalities were observed in 80% of the proximal muscles besides polyphasic potentials that were seen in 20% of the extensor digitorum brevis muscle. Median, ulnar and sural nerve sensory action potential amplitudes were found to be lower than that of the control group. Sural sensory nerve conduction velocity of patients was decreased in 35.5%, prolongation of median SEP latencies and increase in the amplitudes were not however statistically significant. Prolongation of Tibial SEP N1, P2 latencies were seen in 47%, amplitudes of N1 were increased in 88.2%, P2 in 58.8%, N2 in 47%. The thyroid clinical status score was correlated with Tibial SEPs amplitude. These findings suggest the presence of an initial axonal type of mild polyneuropathy. As a conclusion electrophysiological studies can be useful in the diagnosis of asymptomatic polyneuropathy in hyperthyroid patients.

Radial ray defect with vascular and vertebral anomalies.

A new case with combined intercalary radial ray defect, high origin of the radial and ulnar arteries, and anomalies of the thoracic vertebrae is presented. The diagnosis was based on roentgenography, arteriography, and electroneuromyography. The case was regarded as a thoracic outlet syndrome due to the first rib abnormality and was treated surgically.

Energy cost of walking with flat feet.

A comparative study has been conducted to assess the effects of arch support on oxygen consumption in 20 subjects with flat feet who were generally complaining about fatigue, and also to explore whether their feeling of weariness was objective or not. The resting, walking and final recovery heart rates, blood pressures, and walking oxygen consumption values of the patients with flat feet were measured and calculated and compared to a control group using treadmill and oxygen consumption devices. In stage one the patients did not wear any arch support. Then suitable arch supports were prepared for each patient and in stage two they wore these arch supports. The results did not show any significant difference between the resting heart rates, blood pressure and oxygen consumptions. However, differences in walking heart rate, systolic blood pressure, final recovery heart rate, oxygen consumption, and energy cost values were found to be significant between stage one and two of the test in the patient group. The difference in walking diastolic blood pressure values without and with arch support were found to be insignificant. It may therefore be deduced that oxygen consumption during walking is decreased when a suitable arch support is applied to patients with flat feet.