The effect of occupation on the incidence of vascular dementia: A 12-year follow-up cohort study.

INTRODUCTION: Vascular dementia (DV) is the second cause of dementia with 15.8-20% of cases. Previous studies of the effect of occupation in DV do not show conclusive results, therefore, the objective was to analyze if the type of occupation can vary the risk of developing DV in those older than 55 years. MATERIAL AND METHODS: In the ZARADEMP project, a community sample of 4,803 individuals were followed longitudinally in four waves. The occupation was classified following the National Classification of Occupations (CNO-11) and the International Standard Classification of Occupations (ISCO-08). Different standardized instruments were used: the medical and psychiatric histories (History and Aetiology Schedule) and other risk factors (Mini-Mental Status Examination, Geriatric Mental State-AGECAT). For this study, we calculated incidence rates, incidence rate ratios and hazard ratios in multivariate Cox regression models, stratified by gender. For this study, we included 3,883 participants. RESULTS: In women, the risk of DV was doubled in Blue-collar workers, with a moderate effect (Cohen's d=0.54) and multiplying by 2.7 in Homeworks respect to White Collar with a moderate effect (Cohen's d=0.77), although they did not reach statistical significance. We did not observe the effect of occupation on the risk of DV in men. CONCLUSIONS: We have found a moderate but non-significant effect between occupation and DV risk in women. We found no effect of occupation on the risk of VD in males while other clinical factors (age, diabetes or body mass index) presented a clearer effect than the occupation.

The effect of occupation on the incidence of vascular dementia: A 12-year follow-up cohort study. / El efecto de la ocupación laboral en la incidencia de demencia vascular: un estudio de cohortes de 12 años de seguimiento.

INTRODUCTION: Vascular dementia (DV) is the second cause of dementia with 15.8-20% of cases. Previous studies of the effect of occupation in DV do not show conclusive results, therefore, the objective was to analyze if the type of occupation can vary the risk of developing DV in those older than 55 years. MATERIAL AND METHODS: In the ZARADEMP project, a community sample of 4,803 individuals were followed longitudinally in 4 waves. The occupation was classified following the National Classification of Occupations of 2011 and the International Standard Classification of Occupations of 2008. Different standardized instruments were used: the medical and psychiatric histories (History and Aetiology Schedule) and other risk factors (Mini-Mental Status Examination, Geriatric Mental State-AGECAT). For this study, we calculated incidence rates, incidence rate ratios and hazard ratios in multivariate Cox regression models, stratified by gender. For this study, we included 3,883 participants. RESULTS: In women, the risk of DV was doubled in blue-collar workers, with a moderate effect (Cohen's d=0.54), and multiplying by 2.7 in homeworks respect to white-collar with a moderate effect (Cohen's d=0.77), although they did not reach statistical significance. We did not observe the effect of occupation on the risk of DV in men. CONCLUSIONS: We have found a moderate but non-significant effect between occupation and DV risk in women. We found no effect of occupation on the risk of VD in males while other clinical factors (age, diabetes or body mass index) presented a clearer effect than the occupation.

The effect of occupation type on risk of Alzheimer's disease in men and women.

OBJECTIVES: To examine the association between the principal lifetime occupation and the incidence of Alzheimer's disease (AD) in men and women in a southern European population aged 55 years or more. STUDY DESIGN: A community-dwelling sample of 3883 dementia-free individuals aged 55 years or over was classified according the Spanish National Classification of Occupations (CNO-11) and the International Standard Classification of Occupations (ISCO-08) in a four-wave epidemiological study. Medical and psychiatric histories were collected using standardized instruments, including the Mini-Mental Status Examination (MMSE), the History and Aetiology Schedule (HAS), the Geriatric Mental State-AGECAT, and a risk factor Questionnaire. Cases of AD were diagnosed according to DSM-IV criteria. Cox regression models were performed, stratified by sex. MAIN OUTCOME MEASURES: Cases of AD according to the main occupation and sex. RESULTS: In men, compared with the "white collar" category, the risk of AD in "farmers" was 66% times lower, after controlling for potential confounding factors (HR: 0.34; 95% CI: 0.08-1.33). It did not reach statistical significance but the magnitude was large (Cohen's d = 0.84). In women, "farmers" had almost 50% less risk of AD after controlling for all potential confounding factors (HR: 0.55; 95% CI: 0.17-1.78), compared with homemakers, but with a medium effect size (Cohen's d = 0.46). CONCLUSIONS: Men and women farmers had a lower risk of AD, reinforcing the importance of lifetime occupation in the risk of AD at older ages. These results could suggest some environmental hypotheses.

[Influence of occupation on cognitive impairment with no dementia in a sample population over 55 years from Zaragoza]. / Influencia de la ocupación en el deterioro cognitivo libre de demencia en una muestra de sujetos mayores de 55 años de Zaragoza.

INTRODUCTION: The prevalence of cognitive impairment with no dementia (CIND) varies between 5.1% and 35.9%, increasing between 65 and 85 years. The CIND increases the risk of dementia. Factors such as education, occupation, and social activities are associated with the risk of cognitive impairment. The main objective of this study was to analyse the association between the main occupation developed throughout life and CIND in a general population sample of over 55 years. METHODS: In wave I of the ZARADEMP Project, a sample (n=4803) of people over 55 years was interviewed. CIND measurement was obtained through the Mini Mental State Examination. Occupational activity data were recoded into white collar, blue collar, homemakers, and farmers. The association between the occupation variables and CIND was estimated using the odds ratio, and 95% confidence intervals using logistic regression equations. RESULTS: The prevalence of CIND in the sample was 28.2%. As regards white collar workers, the CIND diagnosis odds was 53% higher for blue collar workers, 77% higher for women who were homemakers and almost twice for farmers, after controlling for socio-demographic, behavioural and clinical variables. All results were statistically significant. CONCLUSIONS: CIND frequency is influenced by the previous occupation of the subjects. An occupation with higher intellectual requirements can help keep cognitive functions intact for longer.

A tool to assess sex-gender when selecting health research projects.

OBJECTIVE: To validate the questionnaire "Gender Perspective in Health Research" (GPIHR) to assess the inclusion of gender perspective in research projects. DESIGN: Validation study in two stages. Feasibility was analysed in the first, and reliability, internal consistence and validity in the second. WHERE: Aragón Institute of Health Science, Aragón, Spain. PARTICIPANTS: GPIHR was applied to 118 research projects funded in national and international competitive tenders from 2003 to 2012. MAIN MEASUREMENTS: Analysis of inter- and intra-observer reliability with Kappa index and internal consistency with Cronbach's alpha. Content validity analysed through literature review and construct validity with an exploratory factor analysis. RESULTS: Validated GPIHR has 10 questions: 3 in the introduction, 1 for objectives, 3 for methodology and 3 for research purpose. Average time of application was 13min Inter-observer reliability (Kappa) varied between 0.35 and 0.94 and intra-observer between 0.40 and 0.94. Theoretical construct is supported in the literature. Factor analysis identifies three levels of GP inclusion: "difference by sex", "gender sensitive" and "feminist research" with an internal consistency of 0.64, 0.87 and 0.81, respectively, which explain 74.78% of variance. CONCLUSIONS: GPIHR questionnaire is a valid tool to assess GP and useful for those researchers who would like to include GP in their projects.

The validity of the 12-item Bem Sex Role Inventory in older Spanish population: an examination of the androgyny model.

The Bem Sex Role Inventory (BSRI) is the most commonly used and validated gender role measurement tool across countries and age groups. However, it has been rarely validated in older adults and sporadically used in aging and health studies. Perceived gender role is a crucial part of a person's identity and an established determinant of health. Androgyny model suggests that those with high levels of both masculinity and femininity (androgynous) are more adaptive and hence have better health. Our objectives were to explore the validity of BSRI in an older Spanish population, to compare different standard methods of measuring gender roles, and to examine their impact on health indicators. The BSRI and health indicator questions were completed by 120 community-dwelling adults aged 65+ living in Aragon, Spain. Exploratory factor analysis was performed to examine psychometric properties of the BSRI. Androgyny was measured by three approaches: geometric mean, t-ratio, and traditional four-gender groups classification. Relationships between health indicators and gender roles were explored. Factor analysis resulted in two-factor solution consistent with the original masculine and feminine items with high loadings and good reliability. There were no associations between biological sex and gender roles. Different gender role measurement approaches classified participants differently into gender role groups. Overall, androgyny was associated with better mobility and physical and mental health. The traditional four groups approach showed higher compatibility with the androgyny model and was better able to disentangle the differential impact of gender roles on health.

[Can the gender perspective be assessed in research projects?]. / ¿Se puede evaluar la perspectiva de género en los proyectos de investigación?

OBJECTIVE: Gender perspective is a theoretical approach that developed from feminist theories and whose main focus is the analysis of gender inequalities. Integration of this perspective is central to promoting equity in health. The aim of our study was to devise a protocol/questionnaire to assess whether gender is present in research projects and thus help to fill the gap in assessment tools. METHODS: We used a qualitative design with two techniques: group discussion and expert group meetings. The discussion group conducted a dialectical analysis of the basic concepts in research and gender and integrated the results of the discourse produced in the expert group meeting. The drafting of the protocol was organized around the pertinent questions that should be asked at each stage of a research project. RESULTS: The protocol consists of 15 questions: four in the introduction section, two in goals and hypotheses, three in methodology, three in purpose of the study and three to be implemented throughout the research project. CONCLUSIONS: The protocol identifies projects that include a gender perspective. Use of this protocol will improve the quality of research and will help to reduce gender inequities.

Sedentary behaviours and socio-economic status in Spanish adolescents: the AVENA study.

BACKGROUND: This study aimed to describe the influence of socio-economic status (SES) on the prevalence sedentary behaviours among Spanish adolescents. METHODS: Cross-sectional data from Spanish adolescents from the Alimentación y Valoración del Estado Nutricional de los Adolescentes (AVENA) Study (2002). A national representative sample of 1776 adolescents aged 13-18.5 years provided information about time spent watching television (TV), playing with computer or videogames and studying. Parental education and occupation were assessed as SES. Participants were categorized by gender, age, parental education and occupation. Logistic regression models were used. RESULTS: No gender differences were found for TV viewing. For computer and videogames use (weekdays), more boys played >3 h/day (P < 0.001), whereas a higher percentage of girls reported studying >3 h/day (P < 0.001). Among boys, parental education and occupation were inversely associated with TV viewing, parental occupation directly associated with study and maternal education inversely with computer and videogames use during weekdays (all P < 0.05). For girls, parental occupation was inversely associated with TV viewing. CONCLUSION: Spanish adolescents presented different sedentary patterns according to age, gender and SES. Boys reported more time engaged in electronic games, whereas girls reported more time studying. Parental occupation had more influence than parental education on the time spent in sedentary behaviours.

Extra-curricular participation in sports and socio-demographic factors in Spanish adolescents: the AVENA study.

The aims of this study were to identify differences between the sexes in extra-curricular participation in sports and to determine its association with body fat and socio-demographic factors in Spanish adolescents. A total of 2165 adolescents (1124 males and 1041 females) aged 13.0-18.5 years from the AVENA Study participated. Participants filled in an ad hoc questionnaire for extra-curricular participation in sports, which was the dependent variable. Independent variables were: age, percent body fat, and father's and mother's educational level and occupation. Chi-square tests and logistic regression were applied. Bivariate analysis showed for male adolescents that age and father's occupation were related to extra-curricular participation in sports. In addition, body fat and mother's education and occupation (all P < 0.05) were related to extra-curricular participation of in sports for female adolescents. Logistic regression analysis showed that the likelihood of involvement in extra-curricular participation in sports was 5.3-fold (3.86-7.38) higher for males than females. Age and father's education in both males and females were independently associated with extra-curricular participation in sports. In summary, Spanish male adolescents were shown to engage in more extra-curricular sports than females. In addition, age and father's education (in both sexes) were associated with the participation of their offspring in extra-curricular sports during adolescence.

Assessment of the medial longitudinal arch in children and adolescents with obesity: footprints and radiographic study.

The purpose of this study was to evaluate foot arch types of obese children and adolescents aged 9-16.5 years using both indirect and direct measures. Fifty-eight obese children/adolescents attending the paediatric endocrinology unit of the University Hospital "Lozano Blesa" in Zaragoza were selected as experimental subjects. Fifty-eight gender and age matched, normal-weight children/adolescents were selected as control subjects. To assess the medial longitudinal arch (MLA) height, which is used as a main reference for the diagnosis of flatfoot, footprints from both feet were collected (in both groups) and lateral weight-bearing radiographs of both feet were taken (of 49 of the 58 obese children). Footprint angle (FA) and the Chippaux-Smirak index (CSI) were calculated from the footprints. Talus-first metatarsal (TFMA) and calcaneal inclination angles (CIA) were obtained from lateral feet radiographs. In the normal-weight group, mean values of FA and CSI indicated a normal MLA. In the obese group, morphological flatfoot was identified. Comparison between both groups, by side and gender, showed a decrease of FA (p<0.001) and an increase of CSI (p<0.001) in obese subjects. Mean values of TFMA and CIA in the obese group indicated a lowering of the MLA. Obese children/adolescents between 9 and 16.5 years of age had significantly lower values of FA and higher CSI, related to a lower MLA. Radiographic parameters supported these findings and mean values were associated with a fall of this arch.

Foot structure in overweight and obese children.

OBJECTIVE. To analyse the association between overweight and obesity and foot structure in children older than 9 years of age, whose longitudinal medial arch (MLA) should be practically established. DESIGN, SETTING AND SUBJECT. A cross-sectional study of 245 children (age: 13.22±1.8 years) from four randomly selected schools (Zaragoza, Spain). Body mass index (BMI) was calculated and normal-weight, overweight and obese groups were defined. Footprints for both feet were collected. MEASUREMENTS. Foot angle (FA) and Chippaux-Smirak index (CSI) were calculated from the footprints. Height and body mass were measured to calculate the BMI. RESULTS. Mean values of FA and CSI in the normal-weight group indicated the presence of a normal MLA; however, in the overweight they indicated an intermediary MLA and in the obese group, a low MLA. Comparison among the groups showed a decrease of FA (p<0.01) and an increase of CSI (p<0.01) with increasing weight associated with a lower MLA. A low but significant correlation (p<0.0001) was found between the z-score BMI and footprint parameters. CONCLUSIONS. In children aged 9 to 16.5 years, the increase of body mass is related to a lower MLA. The MLA is lower in these obese children than in the younger ones studied in previous works probably due to the continuous bearing of excessive mass from childhood. A lower MLA could cause health problems. An assessment of foot structure in these children is recommended as the classification of the foot arch type can help decide if treatment to avoid these problems is necessary.

Cross-cultural psychometric testing of the Care Dependency Scale with data.

BACKGROUND: The importance of the present study lies in addressing whether it is justified to compare the care dependency status of older patients from different settings and cultures using the same instrument. AIM: The aim of this international study was to compare the psychometric properties of the Care Dependency Scale (CDS) by analysing data gathered in Finland, Spain and the United Kingdom (UK). METHOD: The Finnish, Spanish and UK research instruments were translations of the original Dutch CDS. Psychometric evaluations of this were carried out for each country separately as well as for the three countries combined, based on a convenience sample of 378 older patients. RESULTS: High alpha coefficients between 0.94 and 0.97 were obtained. Subsequent test-retest and interrater reliability revealed moderate to almost perfect kappa values. CONCLUSION: One of the main outcomes of the international comparison was that the findings between the three countries showed more similarities than differences in psychometric assessment, indicating that the CDS can be used for care dependency assessment in different countries.