Sense of coherence and disability pensions. A nationwide, register based prospective population study of 2196 adult Finns.

BACKGROUND: Strong sense of coherence (SOC) has been shown to be associated with good, perceived health both in cross sectional and longitudinal studies. STUDY OBJECTIVE: To find out if level of SOC was associated to incidence of disability pension. STUDY DESIGN: A prospective cohort study based on survey data on sense of coherence in 1989 or 1993 and data on disability pensions in 1990-1996 from national registers. PARTICIPANTS: 2196 identifiable subjects derived from a representative sample (n = 5000) in 1989 of male and female Finns between 15 and 64 years of age. Initial health was categorised on the basis of number of long term illnesses reported on entry into the study (no illnesses; one illness or several illnesses resulting in only mild or moderate functional limitation; one illness or several illnesses resulting in severe or very severe functional limitation). MAIN RESULTS: In an interindividual comparison a decrease in initial SOC score by one point was significantly (hazard ratio 1.56, 95% confidence intervals 1.15 to 2.12) associated with receipt of a disability pension by subjects who had been 50 years of age or less on entry into the study. Sex was not associated with outcome once initial level of health, level of occupational training, level of engagement in physical exercise, and alcohol consumption were taken into consideration. No similar significant association was seen in relation to people who had been more than 50 years of age on entry into the study. CONCLUSIONS: It seems probable that a weak SOC in people of 50 years or younger increases the likelihood of grant of a disability pension.

Effect of upper gastrointestinal endoscopy on cardiopulmonary changes in very old patients.

Although routine gastroscopy is regarded as a safe examination, it is sometimes associated, especially in elderly patients, with serious arrhythmias. We studied the influence of gastroscopy in very old patients on the occurrence and number of ECG changes and on oxygen saturation. Electrocardiographic (ECG) changes on a 24 h Holter recording and arterial oxygen saturation (SaO2) changes measured by pulse oximetry were observed in 37 hospitalized patients aged 80 years or more undergoing gastroscopy without premedication or conscious sedation and with supplementary oxygen (2 l/min). Gastroscopy did not induce significant arterial oxygen desaturation. ST changes were greatest or equal to that during gastroscopy in 16 (48%) patients. The number of VES increased during the 1-h period after gastroscopy, especially in those patients with an ST level change of over 1 mm h after gastroscopy (P=0.01) and in patients suffering from heart disease (P=0.007). In other arrhythmias no significant change was observed and no fatal complications occurred. Gastroscopy is a safe procedure also in very old patients. However, it induces increased number of VES after endoscopy in patients suffering from heart disease. In those patients a close follow-up of adverse symptoms is advisable, also for a short period after gastroscopy.