Experiences and perspectives of peer support among young adults with epilepsy.

Young adulthood is a critical developmental period which having epilepsy tends to complicate, suggesting support could be useful. This study aimed to examine the experiences and perspectives of peer support among young adults with epilepsy (YAWE). An online survey was completed by 144 YAWE. Most YAWE reported not having access to peer support but perceived several potential benefits which could support their mental health including mutual understanding, fostering friendships and reducing loneliness, and promoting self-management and coping strategies. Reported barriers to accessing peer support included practical barriers such as travel and time constraints, emotional barriers (e.g., anxiety), and peers not feeling confident or skilled enough to support others. The need for epilepsy peer support groups specifically designed for young adults, university students, and individuals with co-occurring conditions such as autism and attention deficit hyperactivity disorder were also recognised as well as online delivery to address some of the identified barriers. Appropriate training for facilitators and group moderation were noted as important. Overall, these preliminary findings support the acceptability of peer support among YAWE, indicating peer support could be a worthy focus of policy and care pathway development. However, future research is needed to evaluate the effectiveness of peer support for epilepsy populations.

Design of an individualised questionnaire to measure the impact of cancer on quality of life: The cancer dependent quality of life (CancerDQoL) questionnaire.

AIM: To design an individualised questionnaire to measure the impact of cancer and its treatments on quality of life (QoL). MATERIALS & METHODS: Design of the Cancer-Dependent Quality of Life (CancerDQoL) questionnaire was based on the Audit of Diabetes Dependent QoL (ADDQoL) questionnaire and related -DQoLs for other conditions. Item selection, face validity and content validity were established through clinician and patient ratings of the importance and relevance of 60 domains from the -DQoL Item Library, and semi-structured interviews with 25 English-speaking participants with a range of cancers attending a cancer centre in Zimbabwe (age range: 25-78 years; 16 women, 9 men). Ten interviews were subsequently conducted with UK English-speaking participants with a range of cancers attending Maggie's Centres in London and Dundee (age range: 40-76; 5 women, 5 men) to adapt the CancerDQoL for UK use. RESULTS: The first draft of the CancerDQoL contained 25 domain-specific items from the -DQoL Item Library plus four overview items. Zimbabwean participants indicated that cancer negatively impacted on all life domains included, except 'having children'. Weighted impact (impact ratings multiplied by importance) was most negative for 'sex life', 'depend on others' and 'physical capability'. The least negative weighted impact was found for 'having children', 'spiritual/religious life' and 'past medical/self-care'. UK interviews confirmed no new items were required. CONCLUSIONS: Face and content validity of the CancerDQoL is established for an adult sample of English-speaking cancer patients in Zimbabwe and confirmed in an adaptation following UK interviews.

Young adults with epilepsy: Relationships between psychosocial variables and anxiety, depression, and suicidality.

BACKGROUND: People with epilepsy (PWE) are at an increased risk of anxiety, depression, and suicidality. Young adulthood is a critical developmental period which can be complicated by the unique challenges of having epilepsy. The risk factors of mental health difficulties in young adults with epilepsy (YAWE) have not been investigated. AIMS: To examine the relationships between psychosocial variables (coping strategies and sources of social support) and mental health outcomes in YAWE, and determine whether these psychosocial variables independently predict mental health outcomes after controlling for sociodemographic and epilepsy-related factors. METHOD: An online survey was completed by 144 YAWE (18-25-year-olds), which measured sociodemographic and epilepsy-related factors, coping strategies, sources of social support, and current mental health symptoms (anxiety, depression, and suicidality). RESULTS: Avoidant-focused coping was positively correlated, and problem-focused coping and meaning-focused coping were negatively correlated, with symptoms of anxiety, depression, and suicidality. Social support from family, friends, and a special person all negatively correlated with mental health outcomes. Using multiple regression analyses, greater use of avoidant-focused coping strategies independently predicted higher symptoms of anxiety, depression, and suicidality. Greater support from friends independently predicted significantly lower anxiety and depression, whereas greater support from family independently predicted significantly lower suicidality. CLINICAL IMPLICATIONS: These findings have implications for clinical practice in YAWE and suggest that screening for mental health symptoms and psychosocial variables to identify those at risk would be beneficial. Access to tailored psychological support is also needed.

Design and development of the Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ).

AIMS: To evaluate the Hypoglycaemia Symptom Rating Questionnaire (HypoSRQ©) and relationships between self-reported hypoglycaemia and hypoglycaemia measured using blinded continuous glucose monitoring (CGM). METHODS: Diabetes outpatients (n = 113) recruited from Ashford and St. Peter's Hospital completed the HypoSRQ (recent weeks version) and provided clinical information. Thirty participants used blinded CGM for six days and completed the HypoSRQ (24-hour version) for seven days, at the end of each week (7-day version), and after four weeks (recent weeks version). RESULTS: The HypoSRQ had a single-factor structure and excellent internal consistency (α = 0.90). There was high correspondence in recalled symptoms, bother ratings and hypoglycaemic episodes across one week and four weeks (r = 0.84-0.98, p < 0.001). HypoSRQ-reported hypoglycaemia correlated significantly with CGM-measured hypoglycaemia (interstitial glucose ≤ 3.9 mmol/l) frequency (r = 0.72, p < 0.001) across six days. The magnitude of the correlation increased when the person's own threshold for detecting hypoglycaemia was used (r = 0.78, p < 0.001). The number of days (out of six) a person reported symptoms of hypoglycaemia was associated with the number of days CGM detected hypoglycaemia (interstitial glucose ≤ 3.9 mmol/l) (r = 0.83, p < 0.001) and remained significant after controlling for covariates. CONCLUSIONS: Psychometric properties of the HypoSRQ make it attractive for use in people with insulin-treated diabetes. The HypoSRQ may be a less-invasive and more-economical alternative to CGM.

Cross-modal personality attributions in synaesthetes and non-synaesthetes.

Those variants of synaesthesia that trigger colour are well studied, although comparatively less is known about variants that involve cognitive constructs such as personality types. Here we investigate sequence-personality synaesthesia (also known as ordinal linguistic personification, OLP) in which sequenced units (e.g., letters) become associated to personalities or genders. We present the first group study of this variant, showing similarities and differences between synaesthetes and non-synaesthetes. In Experiment 1, we show that synaesthetes differ from the general population in the phenomenology of their reports, the depth of their personality associations, and the consistency of those associations over time. In Experiment 2, we show that synaesthetes are similar to the general population in the underlying rules that link their personalities to letters. Specifically, we show that these mappings are not random, but are based on a shared rule system linking linguistic qualities of letters with quantitative dimensions of personality (based on Goldberg's Big Five personality traits; Goldberg, 1990, 1992). Synaesthetes tend to associate high-frequency letters with high agreeable and low neurotic personalities, and non-synaesthetes share these tendencies at an implicit level. Together, these data show that synaesthetes differ from the general population in phenomenological ways, but that their underlying mechanisms may be common to all people.

Five Factor Model personality traits and all-cause mortality in the Edinburgh Artery Study cohort.

OBJECTIVE: To examine whether personality traits are related to all-cause mortality in a general adult population in Scotland. METHODS: The Edinburgh Artery Study began in 1987 to 1988 by recruiting 1592 men and women aged 55 to 74 years to be followed-up for atherosclerotic diseases. The NEO Five-Factor Inventory (NEO-FFI) was completed by 1035 surviving participants in 1995 to 1996. Deaths from all causes were examined in relation to personality traits and social and physical risk factors for mortality. RESULTS: During follow-up, 242 (37.1%) men and 165 (24.6%) women died. For the whole sample, there was a 28% lower rate of all-cause mortality for each 1 SD increase in NEO-FFI openness (95% CI, 0.61-0.84) and a 18% lower rate of all-cause mortality for each 1 SD increase in NEO-FFI conscientiousness (95% CI, 0.70-0.97). In men, the risk of all-cause mortality was 0.63 (95% CI, 0.5-10.78) for a 1 SD increase in openness and 0.75 (95% CI, 0.61-0.91) for a 1 SD increase in conscientiousness. In women, none of the personality domains were significantly associated with all-cause mortality. Well fitting structural equation models in men (n = 652) showed that the relationships between conscientiousness and openness and all-cause mortality were not substantially explained by smoking, or other variables in the models. CONCLUSION: High conscientiousness and openness may be protective against all-cause mortality in men. Further investigations are needed on the mechanisms of these associations, and the influence of personality traits on specific causes of death.

Apolipoprotein E is not related to memory abilities at 70 years of age.

APOE e4-related memory deficits were reported in a normal population aged between 50 and 60 when controlling for general cognitive ability in early adulthood. This extended findings of APOE e4 effects on cognitive ability in 60-80-year-olds to a younger group and confirmed that this effect relates to changes in memory ability with age. The present study tests the association of APOE e4 variation with verbal and spatial memory in a sample of 70-year-olds both adjusted and non-adjusted for childhood and adult general cognitive ability. The 1,013 participants comprise surviving members of the 1947 Scottish Mental Survey resident in the Lothian area of Scotland. They were tested on general cognitive ability at age 11 years and followed up at about age 70 with tests of verbal (immediate and delayed) and spatial memory. General linear models were used to test the association between variation in the APOE polymorphism (e4 presence vs. absence) and memory measures. Of the eight measures tested, Spatial span forward was significantly associated with APOE e4 variation (P = 0.04) when adjusting for IQ, whereas Logical memory immediate was associated with APOE e4 variation (P = 0.04) in the analysis not controlling for IQ. Neither of these tests was significant when a correction for multiple testing was applied. APOE e4 does not influence memory abilities in a normal population of 70-year-olds.

An observational study of surgery-related activities between nurses and surgeons during laparoscopic surgery.

BACKGROUND: In the operating room (OR), nurse-surgeon coordination is essential to the success of a surgery. METHODS: This observational field study was conducted in the OR for selected laparoscopic surgeries to record surgery-related activities (SRAs) performed by the scrub nurses with different levels of OR experience. Those SRAs performed without instruction were defined as anticipatory movements. RESULTS: The scrub nurse spent 74% of OR time watching surgery and 35% of OR time performing SRAs. The intermediate skill nurses watch surgeon on 76% of the OR time and they performed 16 counts of anticipatory movements per procedure. Experienced nurses spent shorter amount of OR time (72%) watching surgery but they performed more anticipatory movements (20 counts) than the intermediate skill nurses. With basic cases, experienced and intermediate-skill nurses performed equal amounts of anticipatory movements; however, when assisting in complex cases, the experienced nurses performed significantly more anticipatory movements (24 counts) than the intermediate-skill nurses (16 counts). CONCLUSIONS: Experienced nurses develop sophisticated cognition during their careers in the OR, which allows them to maintain their involvement with the surgical team consistently. The anticipatory movement and the eye gaze are 2 valuable behavioral markers for assessing team performance.

Cognition and mortality from the major causes of death: the Health and Lifestyle Survey.

OBJECTIVE: To investigate the influence of reaction time and cognition on the risk of death from cause-specific mortality and to examine whether any association found remains after adjustment for available socioeconomic, lifestyle, and health factors. METHODS: Participants were from the UK Health and Lifestyle Survey. The sample consisted of 6424 community dwelling individuals aged between 18 and 97 years at baseline (1984/1985). Sociodemographic, lifestyle, health, and physiological information was collected alongside cognitive testing which included simple (SRT) and choice (CRT) reaction time, a short-term memory test, and a test of visual-spatial reasoning. Participants have been followed for 21 years for cause-specific mortality. RESULTS: Slower and more variable reaction times and poorer cognitive performance were associated with a higher risk of death from cardiovascular disease, stroke, and respiratory disease after controlling for age and sex. Slight attenuation was noted after adjustments for all covariates. However, only CRT mean remained significantly associated with death from respiratory disease. No associations were found for coronary heart disease, lung cancer, and all nonlung cancers. Significant cognition-mortality associations were mostly obtained in those aged over 60 years. The possibility of reverse causality was partly excluded by reanalysing the data after omitting individuals who died within 5 years of cognitive testing. CONCLUSIONS: Slower and more variable reaction times and poorer cognitive performance were related to an increased risk of mortality from cardiovascular disease, stroke, and respiratory disease. The possibility of reverse causality requires further testing.

The Lothian Birth Cohort 1936: a study to examine influences on cognitive ageing from age 11 to age 70 and beyond.

BACKGROUND: Cognitive ageing is a major burden for society and a major influence in lowering people's independence and quality of life. It is the most feared aspect of ageing. There are large individual differences in age-related cognitive changes. Seeking the determinants of cognitive ageing is a research priority. A limitation of many studies is the lack of a sufficiently long period between cognitive assessments to examine determinants. Here, the aim is to examine influences on cognitive ageing between childhood and old age. METHODS/DESIGN: The study is designed as a follow-up cohort study. The participants comprise surviving members of the Scottish Mental Survey of 1947 (SMS1947; N = 70,805) who reside in the Edinburgh area (Lothian) of Scotland. The SMS1947 applied a valid test of general intelligence to all children born in 1936 and attending Scottish schools in June 1947. A total of 1091 participants make up the Lothian Birth Cohort 1936. They undertook: a medical interview and examination; physical fitness testing; extensive cognitive testing (reasoning, memory, speed of information processing, and executive function); personality, quality of life and other psycho-social questionnaires; and a food frequency questionnaire. They have taken the same mental ability test (the Moray House Test No. 12) at age 11 and age 70. They provided blood samples for DNA extraction and testing and other biomarker analyses. Here we describe the background and aims of the study, the recruitment procedures and details of numbers tested, and the details of all examinations. DISCUSSION: The principal strength of this cohort is the rarely captured phenotype of lifetime cognitive change. There is additional rich information to examine the determinants of individual differences in this lifetime cognitive change. This protocol report is important in alerting other researchers to the data available in the cohort.

Neuroticism, extraversion, and mortality in the UK Health and Lifestyle Survey: a 21-year prospective cohort study.

OBJECTIVE: To examine the influence of neuroticism and extraversion on all-cause and cause-specific mortality over 21 years after controlling for risk factors. METHODS: Participants were members of the Health and Lifestyle Survey, a British nationwide sample survey of 9003 adults. At baseline (1984 to 1985), individuals completed a sociodemographic and health questionnaire, underwent physical health examination, and completed the Eysenck Personality Inventory. Mortality was assessed for 21 years after baseline. A total of 5424 individuals had complete data. RESULTS: After controlling for age and gender, 1-standard deviation (SD) increase in neuroticism was related to 9% (hazard ratio (HR) = 1.09; 95% Confidence Interval (CI) = 1.03-1.16) increased risk of mortality from all causes. The association was nonsignificant (HR = 1.05; 95% CI = 0.99-1.11) after additionally controlling for occupational social class, education, smoking, alcohol consumption, physical activity, and health. There was 12% (HR = 1.12; 95% CI = 1.03-1.21) increased risk of death from cardiovascular disease associated with 1-SD increase in neuroticism. This was still significant after adjustment. When the sample was divided into 40- to 59-year-olds and those >or=60 years, neuroticism remained a significant risk for all-cause mortality and cardiovascular disease mortality; associations were nonsignificant after controlling for all covariates. Neuroticism was not associated with deaths from stroke, respiratory disease, lung cancer, or other cancers. Extraversion was protective of death from respiratory disease (HR = 0.84; 95% CI = 0.70- 1.00). CONCLUSIONS: After controlling for several risk factors, high neuroticism was significantly related to risk of death from cardiovascular disease. The effects of neuroticism on death from cardiovascular disease may be mediated by sociodemographic, health behavior, and physiological factors.

Association between mortality and cognitive change over 7 years in a large representative sample of UK residents.

OBJECTIVE: To examine the association between change in reaction time and cognitive performance over 7 years and the risk of death from all causes and some specific causes after controlling for known risk factors. METHODS: The sample comprised members of the Health and Lifestyle Survey (HALS) of community-dwelling adults in England, Scotland, and Wales. Baseline testing (HALS1), involving 9003 people, took place in 1985 and 1986. Sociodemographic, lifestyle, health, and physiological information was collected. Cognitive functioning was measured using tests of simple and choice reaction time, a short memory test, and a test of visual-spatial reasoning. Follow-up testing (HALS2) took place in 1991 and 1992, when 5352 members of the study were administered the same questionnaires, physiological examinations, and cognitive tests. The sample has been followed for mortality up to June 2005. RESULTS: After controlling for age, gender, and the relevant baseline cognitive test scores, greater declines between HALS1 and HALS2 on simple reaction time mean and variability, choice reaction time mean and variability, memory and visual-spatial reasoning were associated with significantly increased risks of death from all causes, all cardiovascular diseases (CVDs), coronary heart disease (CHD), stroke, and respiratory disease. These associations were only slightly attenuated after adjusting for occupational social class, educational, smoking, alcohol consumption, physical activity, body mass index, blood pressure, and lung function. CONCLUSIONS: Decline in performance of reaction times and simple cognitive tasks across a 7-year period was associated with an increased risk of death from all causes, all CVDs, CHD, stroke, and respiratory disease up to 13 years later, even after adjustment for known risk factors.

Laparoscopic management of ventriculoperitoneal and lumboperitoneal shunt complications.

BACKGROUND AND OBJECTIVES: Minimally invasive approaches for the initial placement of ventriculoperitoneal (VP) and lumboperitoneal (LP) shunts have been well described. A laparoscopic approach has multiple advantages over open techniques, including decreased morbidity, more rapid recovery, and ability to visually assess catheter function. However, few series have addressed the role of laparoscopy in the management of VP and LP shunt complications. METHODS: We present here the largest published series of laparoscopic treatment of VP and LP shunt complications in adults, by retrospectively reviewing all cases performed in a 1-year interval by a single surgeon. RESULTS: Ten patients presented with complications of previous shunting; all were managed laparoscopically. Eighty percent of these patients had a successful single laparoscopic intervention. One patient developed a cerebrospinal fluid leak from the lumbar wound, and 2 patients required additional laparoscopic shunt revisions. CONCLUSIONS: We conclude that laparoscopy has great utility in the assessment of shunt function. Laparoscopic techniques should be considered not only for placement of peritoneal catheters, but also for the management of distal shunt malfunction and diagnosis of abdominal pain in these patients.

Cognition and all-cause mortality across the entire adult age range: health and lifestyle survey.

OBJECTIVE: To investigate the association of reaction time and brief measures of memory and spatial ability with all-cause mortality. METHODS: Participants were from the UK Health and Lifestyle Survey (HALS), a national sample survey of adults in England, Scotland, and Wales. In 1984/1985, data on lifestyle factors, socioeconomic status, and health were collected for 9,003 people. Cognitive data were collected for 7,414 individuals. All-cause mortality was investigated over 19 years of follow-up in relation to simple and choice reaction time, performance on a short-term verbal declarative memory test, and on a test of visual-spatial reasoning. RESULTS: Slower and more variable simple and choice reaction times were significantly related to increased risk of all-cause mortality over 19 years of follow-up. The increased risk of all-cause mortality was partly attenuated after adjustments for socioeconomic status, health behaviors, and health status. A novel finding was the existence of an effect of reaction time on all-cause mortality in young adults. Poorer verbal memory ability was also significantly related to an increased risk of dying in young adults independently of reaction time score. CONCLUSION: Slower and more variable reaction time was related to higher mortality risk in younger as well as older participants. Among younger adults, higher memory ability was also associated with lower risk of dying. The cognition-mortality relationship may be explained in part by the brain's efficiency of information processing and memory performance.

Childhood IQ and social factors on smoking behaviour, lung function and smoking-related outcomes in adulthood: linking the Scottish Mental Survey 1932 and the Midspan studies.

OBJECTIVE: To investigate the associations of childhood IQ and adult social factors, and smoking behaviour, lung function (forced expiratory volume in one second; FEV(1)), and smoking-related outcomes in adulthood. DESIGN: Retrospective cohort study. METHOD: Participants were from the Midspan prospective studies conducted on Scottish adults in the 1970s. The sample consisted of 938 Midspan participants born in 1921 who were successfully matched with their cognitive ability test results on the Scottish Mental Survey 1932. RESULTS: Structural equation modelling showed that age 11 IQ was not directly associated with smoking consumption, but that IQ and adult social class had indirect effects on smoking consumption via deprivation category. The influence of IQ on FEV(1) was partly indirect via social class. Gender influenced smoking consumption and also IQ and social class. There was a 21% higher risk of having a smoking-related hospital admission, cancer, or death during 25 years of follow-up for each standard deviation disadvantage in IQ. Adjustment for adult social class, deprivation category, and smoking reduced the association to 10%. CONCLUSION: Childhood IQ was associated with social factors which influenced lung function in adulthood, but was not associated directly with smoking consumption. In future studies, it is important to consider other pathways which may account for variance in the link between childhood IQ and health in later life.

Methicillin-resistant Staphylococcus aureus infections in vascular surgery: increasing prevalence.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism that causes substantial infection-related morbidity and mortality in hospitalized patients. For example, MRSA infection of prosthetic vascular grafts can be limb- and life-threatening in surgical patients. We investigated the incidence of MRSA infection in vascular surgical patients who developed postoperative infectious complications. METHODS: Prospective data (including procedure, nature of complication, and outcome) were collected on all vascular surgery patients (n = 772) over a two-year period from January, 2000, to December, 2001. The study cohort included all patients who developed postoperative complications (n = 119, 15.4%), including infection, unplanned or prolonged intubation, metabolic abnormalities, and myocardial ischemia. Bacteriologic data of all clinical cultures were reviewed and infection-related outcomes were examined. RESULTS: Hospital-acquired infection occurred in 79 (66.4%) of 119 patients who developed postoperative complications. Review of microbiology data (total, 197 bacterial isolates) confirmed that gram-positive organisms were the leading cause of infections, with 120 gram-positive isolates (60.9%). Of the gram-positive isolates, S. aureus was the most common pathogen, isolated in 73 (60.8%) cultures. The single most prevalent organism was MRSA, identified in 42 of 73 (57.5%) of cultures. The site of MRSA infection was confirmed to be the surgical site (54.8%), sputum (17.0%), blood (14.3%), urine (9.5%), peritoneal fluid (2.4%), or catheter insertion site (2.4%). Only four patients had prior MRSA infection or colonization. Prosthetic vascular grafts were placed in 51 (42.9%) of the 119 vascular patients, and 26 patients (51.6%) acquired MRSA infection. Graft removal was required in three patients due to infection (MRSA infection in two patients, Pseudomonas aeruginosa in one patient). Forty percent of patients with MRSA infection required an amputation as their surgical procedure. No patient died of MRSA bacteremia during the study period. Mean hospital length of stay (LOS) was longer in patients with MRSA infection (29.6 d vs. 22.7 days, range 2-174 days, p < 0.05) compared to the total study cohort of vascular patients with postoperative infections. CONCLUSIONS: Methicillin-resistant S. aureus has emerged as the leading cause of postoperative infection in vascular surgery patients, and is associated with substantial morbidity, increased hospital LOS, and higher incidences of amputation and graft removal. Greater emphasis on preoperative screening protocols for MRSA colonization is warranted, in conjunction with aggressive infection control measures, alteration of preoperative prophylactic antimicrobial use in MRSA-colonized patients, and meticulous postoperative surveillance for MRSA infection. Furthermore, antimicrobial treatment of postoperative infectious complications in vascular surgery patients should include empiric coverage for MRSA in institutions where MRSA is endemic.

Childhood mental ability and blood pressure at midlife: linking the Scottish Mental Survey 1932 and the Midspan studies.

OBJECTIVES: To establish the relationship between childhood mental ability and adult hypertension. DESIGN: Retrospective cohort study. SETTING: Community. PARTICIPANTS: Non-clinical sample of people born in 1921 who participated in both the Scottish Mental Survey 1932 and the Midspan studies. Nine hundred and thirty-eight people were participants in both studies. MAIN OUTCOME MEASURES: Mid-life systolic and diastolic blood pressure, intelligence quotient (IQ) at age 11 years, sex, social class, height and weight. RESULTS: After adjustment for age, sex, social class, body mass index, height, cholesterol level and smoking, there remained a 3.15 mmHg decrease in systolic blood pressure and a 1.5 mmHg decrease in diastolic blood pressure for each standard deviation increase in childhood IQ. CONCLUSIONS: The association between hypertension and lower cognitive function in adulthood is partly accounted for by individual differences in childhood IQ.

Childhood IQ, social class, deprivation, and their relationships with mortality and morbidity risk in later life: prospective observational study linking the Scottish Mental Survey 1932 and the Midspan studies.

OBJECTIVE: To investigate how childhood mental ability (IQ) is related to mortality and morbidity risk, when socioeconomic factors are also considered. METHODS: Participants were from the Midspan studies conducted on adults in the 1970s; 938 Midspan participants were successfully matched with the Scottish Mental Survey 1932 in which children born in 1921 and attending Scottish schools on June 1, 1932, took a cognitive ability test. Mortality, hospital admissions, and cancer incidence in the 25 years after the Midspan screening were investigated in relation to childhood IQ, social class, and deprivation. RESULTS: The risk of dying in 25 years was 17% higher for each standard deviation disadvantage in childhood IQ. Adjustment for social class and deprivation category accounted for some, but not all, of this higher risk, reducing it to 12%. Analysis by IQ quartile showed a substantial increased risk of death for the lowest-scoring quarter only. Structural equation modeling indicated that the effect of childhood IQ on mortality was partly indirectly influenced by social factors. Cause-specific mortality or hospital admission showed that lower IQ was associated with higher risks for all cardiovascular disease and coronary heart disease. Cause-specific mortality or cancer incidence risk was higher with decreasing IQ for lung cancer. CONCLUSIONS: Lower childhood IQ was related to higher mortality risk and some specific causes of death or morbidity. Childhood IQ may be considered as a marker for risk of death or illness in later life in similar and complementary ways to social class or deprivation category.

Trauma in the elderly: intensive care unit resource use and outcome.

BACKGROUND: As the population ages, the elderly will constitute a prominent proportion of trauma patients. The elderly suffer more severe consequences from traumatic injuries compared with the young, presumably resulting in increased resource use. In this study, we sought to examine ICU resource use in trauma on the basis of age and injury severity. METHODS: This study was a retrospective review of trauma registry data prospectively collected on 26,237 blunt trauma patients admitted to all trauma centers (n = 26) in one state over 24 months (January 1996-December 1997). Age-dependent and injury severity-dependent differences in mortality, ICU length of stay (LOS), and hospital LOS were evaluated by logistic regression analysis. RESULTS: Elderly (age > or = 65 years, n = 7,117) patients had significantly higher mortality rates than younger (age < 65 years) trauma patients after stratification by Injury Severity Score (ISS), Revised Trauma Score, and other preexisting comorbidities. Age > 65 years was associated with a two- to threefold increased mortality risk in mild (ISS < 15, 3.2% vs. 0.4%; < 0.001), moderate (ISS 15-29, 19.7% vs. 5.4%; < 0.001), and severe traumatic injury (ISS > or = 30, 47.8% vs. 21.7%; < 0.001) compared with patients aged < 65 years. Logistic regression analysis confirmed that elderly patients had a nearly twofold increased mortality risk (odds ratio, 1.87; confidence interval, 1.60-2.18; < 0.001). Elderly patients also had significantly longer hospital LOS after stratifying for severity of injury by ISS (1.9 fewer days in the age 18-45 group, 0.89 fewer days in the age 46-64 group compared with the age > or = 65 group). Mortality rates were higher for men than for women only in the ISS < 15 (4.4% vs. 2.6%, < 0.001) and ISS 15 to 29 (21.7% vs. 17.6%, = 0.031) groups. ICU LOS was significantly decreased in elderly patients with ISS > or = 30. CONCLUSION: Age is confirmed as an independent predictor of outcome (mortality) in trauma after stratification for injury severity in this largest study of elderly trauma patients to date. Elderly patients with severe injury (ISS > 30) have decreased ICU resource use secondary to associated increased mortality rates.