In apparently healthy middle-aged subjects, physical HRQoL decreases with increasing level of BMI and more so in women than in men. Mental components of HRQoL do not differ between the categories of BMI in either gender.

Impaired HRQoL in hypertensive patients might be secondary to the awareness of hypertension, adverse drug effects, newly diagnosed type 2 diabetes or obesity, not high blood pressure per se.

Background: According to several studies the QRS amplitude of the ECG increases during hemodialysis. The detailed background to this phenomenon has not been defined. Two main mechanisms have been suggested: myocardial ischemia and volume changes. New noninvasive technologies make possible a comparison of QRS complex changes synchronously with myocardial ischemia and extracellular water (ECW)/blood volume (BV) changes during hemodialysis. Methods: In this study hemodialysis-related changes in body weight, biochemical blood variables, BV, ECW, ST segment and QRS complex were analyzed in 15 patients (age 36–76, time on dialysis 0–6 years) undergoing chronic hemodialysis treatment. QRS complex and ST segment changes were measured using a dynamic vectorcardiographic monitoring system. The ECG parameters measured were QRS vector difference (QRS-VD) and ST vector magnitude (ST-VM6). Bioimpedance analysis was used to detect changes in the ECW. Continuous measurement of BV changes was implemented using an on-line optical reflection method based on the reflection of infrared light by erythrocyte membranes. Blood hemoglobin (B-Hb), hematocrit (B-Hcr), plasma sodium (P-Na), chloride (P-Cl), magnesium (P-Mg), potassium (P-K), ionized calcium (P-iCa), phosphate (P-Pi), creatinine (P-Crea) and urea (S-Urea) were monitored. Results: The mean QRS-VD increase during the dialysis session was almost fourfold (372 ± 300%) from 4.16 ± 2.40 to 15.60 ± 7.0 μVs (p < 0.001). This change was due to a change in amplitude, since the duration of the QRS complex did not alter significantly. The correlation between the changes in QRS-VD and body weight from the start to the end of the dialysis session was moderate and statistically significant (r = –0.55, p < 0.05). The correlation between the changes in QRS-VD and ECW varied from r = –0.67 to –0.97, being statistically significant in all patients (p < 0.001). The correlation between BV and QRS-VD was assessed at one minute intervals during the dialysis and varied from r = –0.22 to –0.98, being significant in 14 of the 15 patients (p < 0.001). Significant ST segments alterations (ST-VM6 elevation > 100 μV) did not occur during dialysis. Laboratory parameters reflecting volume and osmotic changes during hemodialysis correlated with QRS-VD change: B-Hcr (r = 0.56, p < 0.05), B-Hb (r = 0.63, p < 0.05), P-Na (r = 0.62, p < 0.05) and S-Urea (r = –0.62, p < 0.05). Conclusions: The increase in QRS complex amplitude during hemodialysis is correlated to reduced ECW. The mechanism involved is most probably augmentation of electrical resistance of the tissues around the heart caused by loss of interstitial fluid.

Background There is a lack of agreement about applicable instrument to screen frailty in clinical settings. Aims To analyze the association between frailty and mortality in Finnish community-dwelling older people. Methods This was a prospective study with 10-and 18-year follow-ups. Frailty was assessed using FRAIL scale (FS) (n = 1152), Rockwood's frailty index (FI) (n = 1126), and PRISMA-7 (n = 1124). To analyze the association between frailty and mortality, Cox regression model was used. Results Prevalence of frailty varied from 2 to 24% based on the index used. In unadjusted models, frailty was associated with higher mortality according to FS (hazard ratio 7.96 [95% confidence interval 5.10-12.41] in 10-year follow-up, and 6.32 [4.17-9.57] in 18-year follow-up) and , and 3.95 [3.16-4.94], respectively) in both follow-ups. Also being pre-frail was associated with higher mortality according to both indexes in both follow-ups (FS 2.19 [1.78-2.69], and 1.69 [1.46-1.96]; FI 1.81[1.25-2.62], and 1.31 [1.07-1.61], respectively). Associations persisted even after adjustments. Also according to PRISMA-7, a binary index (robust or frail), frailty was associated with higher mortality in 10-(4.41 [3.55-5.34]) and 18-year follow-ups (3.78 [3.19-4.49]). Discussion Frailty was associated with higher mortality risk according to all three frailty screening instrument used. Simple and fast frailty indexes, FS and PRISMA-7, seemed to be comparable with a multidimensional time-consuming FI in predicting mortality among community-dwelling Finnish older people. Conclusions FS and PRISMA-7 are applicable frailty screening instruments in clinical setting among community-dwelling Finnish older people.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Introduction:The diagnosis of peripheral arterial disease (PAD) can be made by measuring the ankle–brachial index (ABI). Traditionally ABI values > 1.00–1.40 have been considered normal and ABI ≤ 0.90 defines PAD. Recent studies, however, have shown that individuals with ABI values between 0.90–1.00 are also at risk of cardiovascular events. We studied this cardiovascular risk population subgroup in order to determine their endothelial function using peripheral arterial tonometry (PAT).Methods:We selected 66 individuals with cardiovascular risk and borderline ABI. They all had hypertension, newly diagnosed glucose disorder, metabolic syndrome, obesity, or a ten year risk of cardiovascular disease death of 5% or more according to the Systematic Coronary Risk Evaluation System (SCORE). Subjects with previously diagnosed diabetes or cardiovascular disease were excluded. Endothelial function was assessed by measuring the reactive hyperemia index (RHI) from fingertips using an Endo-PAT device.Results:The mean ABI was 0.95 and mean RHI 2.11. Endothelial dysfunction, defined as RHI < 1.67, was detected in 15/66 (23%) of the subjects. There were no statistically significant differences in RHI values between subjects with different cardiovascular risk factors. The only exception was that subjects with impaired fasting glucose (IFG) had slightly lower RHI values (mean RHI 1.91) than subjects without IFG (mean RHI 2.24) (P = 0.02).Conclusions:In a cardiovascular risk population with borderline ABI nearly every fourth subject had endothelial dysfunction, indicating an elevated risk of cardiovascular events. This might point out a subgroup of individuals in need of more aggressive treatment for their risk factors.

Abstract-The objective of this study was to estimate the prevalence of undiagnosed impaired glucose homeostasis in hypertensive subjects in the general population. The most reasonable screening strategy for glucose disorders was also assessed. We carried out an oral glucose tolerance test for 1106 hypertensive subjects aged 45 to 70 years without previously diagnosed diabetes or cardiovascular disease. Blood pressure, waist circumference, body mass index, and plasma lipids were also measured. Type 2 diabetes was found in 66 (6%) of the subjects, impaired glucose tolerance in 220 (20%), and impaired fasting glucose in 167 (15% Key Words: hypertension Ⅲ oral glucose tolerance test Ⅲ impaired fasting glucose Ⅲ impaired glucose tolerance Ⅲ type 2 diabetes Ⅲ metabolic syndrome C oncomitant hypertension and diabetes increase the risk of end organ damage, incidence of cardiovascular disease (CVD), and mortality. 1,2 Also, the prediabetic condition, impaired glucose tolerance (IGT), is an independent risk predictor for incident CVD, as well as premature all-cause and cardiovascular mortality. 3 Oral glucose tolerance test (OGTT) is the "gold standard" for diagnosing impaired glucose homeostasis. If fasting glucose is used alone as a screening tool, a third of diabetic subjects will not be diagnosed. 4 Moreover, it is impossible to diagnose IGT without an OGTT.The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology and of the European Association for the Study of Diabetes recently presented a recommendation that an OGTT should be carried out in all high-risk patients, such as patients with CVD. 5 The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and of the European Society of Cardiology recommended in the 2007 Guidelines for the Management of Arterial Hypertension 6 that an OGTT should be carried out in all hypertensive patients whose fasting plasma glucose is Ն5.6 mmol/L.Hypertension, per se, is associated with a double risk of developing type 2 diabetes (T2D). 7 In this study we tried to assess whether all hypertensive subjects should be screened for glucose disorders with OGTT or whether fasting plasma glucose is sufficient to find the subjects for OGTT on the basis of experiences from the Harmonica Project, a population survey in southwestern Finland. Methods SubjectsThe study sample of hypertensive subjects was drawn from the participants of a population survey, the Harmonica Project, which was carried out in the rural towns of Harjavalta and Kokemäki in southwestern Finland from autumn 2005 to autumn 2007. A risk factor survey, tape for the measurement of waist circumference (WC), and T2D risk assessment form (Finnish Diabetes Risk Score, 8 available at http://www.diabetes.fi/english) were mailed to all of the inhabitants aged 45 to 70 years (nϭ6013). In the risk factor survey, subjects were asked for WC measured at the level of the navel, latest blood pressure, use of antihypertensive medication, gestational diabetes or hypertens...

AbstractBackground and aimsMusculoskeletal pain is a common symptom and many people even with chronic pain continue to work. The aim of our study is to analyze how musculoskeletal pain affects work wellbeing by comparing work engagement in employees with or without pain, and how pain-related risk of disability is associated with work engagement. In a separate analysis, we also studied, how psychosocial factors are related to work engagement.MethodsThis is a cross-sectional study of Finnish female employees of the city of Pori, Finland (PORi To Aid Against Threats (PORTAAT) study). Data was collected by trained study nurses and self-administrated questionnaires. Work well-being was measured by work engagement using Utrecht Work Engagement Scale (UWES-9) questionnaire and the burden of pain was measured by using the short version of Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ). Study population was divided into four groups: those without pain and the groups with low (I), medium (II) or high (III) ÖMPSQ score, reflecting increasing risk of long term disability due to musculoskeletal pain. The study nurse assessed psychosocial risk factors using defined core questions.ResultsWe evaluated 702 female employees, 601 (86%) had suffered from musculoskeletal pain over the past 12 months, whereas 101 (14%) reported no pain at all. Pain was chronic (duration at least 3 months) in 465/601 (77%) subjects. Subjects with musculoskeletal pain were older, had higher BMI and were on sick leave more often than subjects without pain. Of the psychosocial risk factors, depression, type D personality, anxiety and hostility were significantly more common among subjects with musculoskeletal pain. Hypertension and the use of non-steroidal anti-inflammatory drugs were significantly more frequent in the musculoskeletal pain group. Quality of sleep and working capability were significantly better among persons without pain. Average weekly working hours were slightly higher among those with musculoskeletal pain.In crude analysis, work engagement (UWES-9) was similar in women without pain and those with musculoskeletal pain (4.96 vs. 4.79; p = 0.091). After adjustment for age, education years, BMI, working hours and financial satisfaction, the difference between the groups became statistically significant (p = 0.036). Still, there was no difference between the groups of no-pain and low burden of pain (p = 0.21, after adjustment). Work engagement was significantly lower in the groups of medium (p = 0.024, after adjusted) and high (p < 0.001, after adjustment) burden of pain. Linearity across the Linton tertiles was significant (p < 0.001). In univariate and multivariate ordered logistic regression analyses relating study variables to the work engagement musculoskeletal pain per se did not enter in the model to explain work engagement. Work and family stress, type D personality and duration of sick leave due to pain reduced work engagement, whereas financial satisfaction, moderate and high leisure time physical activity and higher BMI improved it.ConclusionsAmong women with musculoskeletal pain psychosocial and lifestyle factors significantly correlate with work engagement, while the pain itself does not.ImplicationsSpecial attention should be paid to the psychosocial aspects in female employees with musculoskeletal pain to improve work well-being and maintain work ability.

Health-related quality of life of individuals with asymptomatic or atypical PAD or borderline PAD is worse than that of individuals with normal ABI. The level of ABI is independently related to physical functioning.