Suchergebnisse

PUBLISHED ; Background: syncope is an important, but underestimated clinical problem in older persons. It is often overlooked in clinical practice or mistaken for falls. Atrial fibrillation (AF) is the most common cardiac arrhythmia, but little evidence exists regarding the association between AF, falls and syncope in the general population. Methods: cross-sectional analyses within a population sample of people aged 50+, taken from The Irish Longitudinal Study on Ageing. Ten-minute electrocardiogram recordings (n = 4,885) were analysed to detect AF. Syncope (self-reported faints or blackouts) and falls in the past year, co-morbidities, health measures and medications were gathered through computer-aided personal interviews. Multivariable logistic regression was performed to study associations between AF, falls and syncope. Results: mean age was 62 years (range: 50?91), 54% were female. Prevalence of AF was 3%, increasing to 8% in participants aged 75+. Of participants, 5% (n = 223) reported syncope and 20% (n = 972) reported falls. After adjustment for confounders, AF was significantly associated with faints and blackouts (odds ratio (OR) 2.0 [95% confidence interval (CI) 1.0?3.9]). After stratification by age category, we found that this association was strongest and only significant in participants aged 50?64 years (OR 4.4 [1.5?12.6]). Stratified for age group, AF was significantly associated with falls in participants aged 65?74 years (OR 2.0 [1.0?4.1]). Conclusions: adults aged 50+ with self-reported syncope and adults aged 65?74 years with falls are twice as likely to have AF at physical examination. These associations are independent of stroke, cardiovascular and psychotropic drugs and other confounders. Further longitudinal studies are needed to explore this association and potential causality further. ; Financial support was provided by Irish Life plc, the Irish Government and the Atlantic Philanthropies. The sponsors played no part in the design, methods, subject recruitment, data collection, analysis and preparation of this paper. There is no conflict of interest in this regard.

PUBLISHED ; Objectives This study aims to examine the extent to which statins are used by adults at high risk of cardiovascular disease (CVD) compared to European clinical guidelines. The high-risk groups examined are those with (1) known CVD, (2) known diabetes and (3) a high or very high risk (?5%) of CVD mortality based on Systematic COronary Risk Evaluation (SCORE). Design This study is cross-sectional in design using data from the first wave (2009?2011) of The Irish Longitudinal Study on Ageing (TILDA). Setting and participants The sample (n=3372) is representative of community living adults aged 50?64?years in Ireland. Results Statins were used by 68.6% (95% CI 61.5% to 75.8%) of those with known CVD, 57.4% (95% CI 49.1% to 65.7%) of those with known diabetes and by 19.7% (95% CI 13.0% to 26.3%) of adults with a SCORE risk ?5%. Over a third (38.5%, 95% CI 31.0% to 46.0%) of those with known CVD, 46.8% (95% CI 38.4% to 55.1%) of those with known diabetes and 85.2% (95% CI 79.3% to 91.1%) of those with a SCORE risk ?5% were at or above the low-density lipoprotein cholesterol (LDL-C) target of 2.5?mmol/L specified in the 2007 European guidelines. Conclusions Despite strong evidence and clinical guidelines recommending the use of statins for secondary prevention, a gap exists between guidelines and practice in this cohort. It is also of concern that a low proportion of adults with a SCORE risk ?5% were taking statins. A policy response that strengthens secondary prevention, and improves risk assessment and shared decision-making in the primary prevention of CVD is required. ; This work was supported by the Irish Health Research Board Interdisciplinary Capacity Enhancement Award [grant number: ICE/2012/7]. TILDA is funded by the Irish Government (Department of Health), Atlantic Philanthropies and Irish Life. The funders had no involvement in the analysis or preparation of this paper.

A sweeping history of nineteenth-century America, this book shows how slavery shaped immigration policy in the United States during the years when states controlled mobility within and across their borders. Only after the abolition of slavery did Congress begin to implement a national immigration policy, applying the policies of border control and deportation to different racial groups that continue to generate tensions between state and federal authority to the present day.