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PubMedDate not supplied

Longitudinal study of peritoneal membrane function in continuous ambulatory peritoneal dialysis: relationship with peritonitis and fibrosing factors.

BACKGROUND: The peritoneal equilibration test (PET) is a useful assessment of peritoneal function in continuous ambulatory peritoneal dialysis (CAPD) patients. However, the natural course of longitudinal change in peritoneal transport is not well defined. PATIENTS: We studied 105 unselected CAPD patients. Average age at enrollment was 50.7 +/- 11.3 years. METHODS: A PET was performed at enrollment. Peritoneal transport was expressed as dialysate-to-plasma creatinine ratio at 4 hours (DIP). Fibrosing factors and mesothelial cell markers, including TGFbeta, epidermal growth factor (EGF), platelet-derived growth factor (PDGF), hyaluronan, and cancer antigen 125 (CA125), were measured in overnight peritoneal dialysate effluent (PDE). Patients were followed for two years. Peritonitis episodes were recorded. Severe peritonitis was defined as an episode that required catheter removal or antibiotic therapy for more than 3 weeks. After two years, 75 patients were still alive and on CAPD. RESULTS: The PET was repeated in 64 patients, of whom 35 were male and 9 had diabetes. The change in D/P over two years was represented as AD/P. No significant change in peritoneal transport was seen after two years (D/P: 0.56 +/- 0.12 vs 0.55 +/- 0.13). A centripetal pattern of change in D/P was observed. The deltaD/P had normal distribution and was inversely correlated with D/P at baseline (r = -0.427, p < 0.005). Both results suggest a regression-to-mean phenomenon. The deltaD/P had no significant correlation with the total number of peritonitis episodes (Spearman r = 0.052, p = 0.74), but after severe peritonitis, affected patients had higher deltaD/P than patients who experienced no severe infection (0.040 +/- 0.136 vs -0.032 +/- 0.120, p < 0.05). For patients with no episodes of severe peritonitis (n = 47), deltaD/P was weakly correlated with baseline TGFbeta level (r = -0.506, p < 0.01). No correlation was seen between the levels of other fibrosing factors and change in peritoneal transport. CONCLUSIONS: Our findings suggest that the centripetal change of peritoneal transport probably reflects a regression-to-mean phenomenon. Peritoneal transport increases after severe peritonitis. The role of TGFbeta levels in PDE with regard to longitudinal change in peritoneal transport requires further study.

Adolescent↗
PubMed1996

Longitudinal decline in lung function in patients with occupational asthma due to western red cedar.

BACKGROUND: There are few reports about longitudinal changes in lung function in asthmatic patients. Patients with asthma had a greater loss of lung function than normal healthy adults. To date, there have been no studies about the longitudinal changes in lung function in patients with occupational asthma. METHODS: 280 male patients with red cedar asthma (RCA) who were followed up for at least one year were the study group. The exposed controls consisted of 399 male sawmill workers. Forced expiratory volume in one second (FEV1) was measured with a Collins water spirometer. Changes in FEV1 over time (FEV1 slope) were calculated by a two point method for each subject. Atopy was considered to be present if the subjects showed at least one positive response to three allergens by skin prick test. RESULTS: Multiple regression analysis was carried out to examine factors that might affect longitudinal decline in FEV1. Patients with RCA who were still exposed had a greater decline in FEV1 slope (-26 ml/y) than sawmill workers. Smokers also showed a greater rate of decline in FEV1 (-43 ml/y) than non-smokers. CONCLUSIONS: Patients with RCA who continued to be exposed had a greater rate of decline in FEV1 than sawmill workers. Early diagnosis of occupational asthma and removal of these patients from a specific sensitiser is important in the prevention of further deterioration of lung function and respiratory symptoms.

Adult↗
PubMed2000

Early changes in longitudinal performance predict future improvement in global left ventricular function during long term beta adrenergic blockade.

OBJECTIVE: Contraction of longitudinal and subendocardial myocardial muscle fibres is reflected in descent of the atrioventricular (AV) plane. The aim was therefore to determine whether beta blocker treatment with prolongation of diastole might result in improved function as reflected by AV plane movements in patients with chronic heart failure. DESIGN: Double blind, randomised, placebo controlled and open intervention study. SETTING: University hospital. PATIENTS: Patients with congestive heart failure: placebo controlled (n = 26) and an open protocol (n = 15). INTERVENTIONS: 12 months of metoprolol treatment. MAIN OUTCOME MEASURES: Short axis and long axis echocardiography, invasive haemodynamics, radionuclide angiography. RESULTS: Recovery of systolic and diastolic function during metoprolol treatment was reflected by early changes in mean (SD) AV plane amplitude, from 5.3 (2.0)% to 7.1 (3.2)% and 7.8 (3. 1)% (at 3 and 12 months, respectively; p < 0.05). In a multivariate analysis, only the change in AV plane amplitude by three months was independently associated with improvement in pulmonary capillary wedge pressure by six months (r = 0.80, p = 0.017). Change in AV plane amplitude by three months was also a better predictor of improvement in ejection fraction by 12 months (r = 0.78, p < 0.001) than changes in radionuclide ejection fraction by three months (r = 0.34, p = 0.049). CONCLUSIONS: Improvement in longitudinal contraction was closely associated with a decrease in left ventricular filling pressure during metoprolol treatment. This association was stronger than changes in short axis performance or radionuclide ejection fraction, emphasising the importance of AV plane motion for left ventricular filling and systolic performance in patients with heart failure.

Adrenergic beta-Antagonists↗
PubMed1999

Diurnal variation in lung function in subgroups from two Dutch populations: consequences for longitudinal analysis.

We studied circadian variation in FVC, FEV1, PEF, TLC, VC, and RV between 9:00 A.M. and 9:00 P.M. and analyzed how this variation affected estimated longitudinal change. Data from 876 adults were obtained in a longitudinal survey of samples from two Dutch areas. Subjects participated in four surveys held at 3-yr intervals between 1975 and 1985. FVC, FEV1, PEF, and VC increased from 9:00 A.M. until noon and decreased afterwards. TLC was constant over the day, whereas RV decreased from 9:00 A.M. to noon. Average variation in FVC, FEV1 and PEF, expressed as percentages of average level, was 4. 8% (200 ml), 2.8% (86 ml), and 3.1% (250 ml/s), respectively. These results are compatible with circadian changes in airway size. No differences in variability were found between men and women. Significantly larger changes between 9:00 A.M. and noon were found in young adults, smokers, and those with respiratory symptoms than in other subgroups. Adjustment for diurnal variation reduced, albeit slightly, residual standard deviations of estimated longitudinal declines. Average diurnal change was large relative to underlying longitudinal change. Its effect on longitudinal change within an individual can therefore be large depending on age, smoking habits, symptomatology, number of visits, time of measurement, and difference in time between measurements. However, when people are measured at random times during the day for at least three visits, or when measurements are made after 11:00 A.M., effects of diurnal variation in pulmonary function on estimated average longitudinal decline are minimal.

Adult↗
PubMed2003

Interrelations between subjective health and episodic memory change in Swedish and Canadian samples of older adults.

Recent research has documented associations between subjective health ratings and objective indicators of disease and death. Less is known about relations between subjective health ratings and level of cognitive performance in older adults. In this study, we explored whether subjective health ratings are related to episodic memory performance, both concurrently and across a three-year longitudinal interval. Persons aged 75-84 years, and participating in the Swedish Kungsholmen Project (n = 105) or the Canadian Victoria Longitudinal Study (n = 71), were examined. Results showed that in both samples, while the cross-sectional relationship was non-significant, longitudinal change in perceptions of subjective health were related to change in episodic memory performance. Next, the two samples were combined in additional analyses. Here, results further revealed that the associations between longitudinal change in subjective health and memory performance generalized across samples independently of demographic, changing physical health status, and subjective memory decline differences. Thus, the present findings suggest that subjective health may be added to the growing number of individual-difference variables that are predictive of episodic memory change in very old age.

Aged↗
PubMed1982

Patterns of adult weight and fat change in six Solomon Islands societies: a semi-longitudinal study.

Semi-longitudinal changes with aging in weight, height, arm circumference, and subscapular and triceps skinfold circumference are presented for adult males and females in 6 different populations in the Solomon Islands and Papua New Guinea, which have differed dramatically in their exposure to modern industrialized societies over the past decade. Those groups who remain less acculturated show little or no evidence of a secular trend in adult body size and women in these groups lose weight through their childbearing years and into old age. Men lose less. In the more acculturated groups, weight gain due to increases in fatness have already become the norm for all female cohorts, and most male cohorts. In most groups there are significant losses in muscle mass after age 40 in men, regardless of acculturation status, which were not detected in women. Because changes in diet have been more extreme for men than women in the more acculturated groups, and childbearing and nursing patterns have not changed, the more consistent and significant shift in female fat changes with age is most likely due to a sharp change in activity pattern, in addition to dietary change.

Adipose Tissue↗
PubMed2006

Changes in total alkaline phosphatase level after hip fracture: comparison between femoral neck and trochanter fractures.

BACKGROUND: Biochemical bone metabolic markers are affected by fractures, and total alkaline phosphatase (ALP) is considered one of the bone formation markers. Only a few reports have dealt with changes in bone formation markers during the healing process of bone fragility hip fractures. Despite the difference in the amount of callus formation and bone fusion rate, no significant differences in longitudinal change of total ALP between femoral neck and trochanter fracture have been reported. METHODS: A total of 69 osteoporotic patients with femoral neck or trochanter fracture whose serum concentrations of total ALP were examined at least four times at six periodic examination points (1, 2, 3, 4, 6, and 8 weeks after surgery) and whose state of bone union was obtained within 24 weeks after surgery were selected for this retrospective study. The characteristic longitudinal change of total ALP during the healing process was shown, and the possibility of total ALP as a predictive factor for the state of osteosynthesis of hip fractures is discussed. RESULTS: Changes in the total ALP level according to the healing process were similar for femoral neck and trochanter fractures. The concentration of total ALP rose to a maximum at 3 weeks after surgery and then gradually decreased for both fractures. However, the range of change was significantly greater for trochanter fractures than for femoral neck fractures. For trochanter fractures, total ALP decreased from 3 to 6 weeks after surgery in all but one patient. CONCLUSIONS: Increases in the concentration of total ALP after surgery and the subsequent decreases may reflect the normal healing process. A significant difference in the changes of total ALP after surgery between femoral trochanter and neck fractures was shown. Periodic measurement of total ALP might be useful for obtaining information on the osteosynthesis state.

Age Factors↗
PubMed1980

Quantitative computerized analysis of lower incisor changes: a longitudinal implant study in man.

Computer aided interpretation of longitudinal growth data has been presented in summary fashion for four or thirty-six young patients with maxillary and mandibular tantalum implants employing the U.C.S.F. computer program. Broad generalizations of changes in mandibular morphology cannot be made from the small sample. Caution is the watchword in employing so-called natural reference points for superpositioning over an extended period of growth. Identification of cephalometric point B is difficult on a long-term serial basis. The direction of eruption of the lower incisor tip can be followed rather easily and accurately in patients with mandibular implants but varies considerably from patient to patient. Discrepancies arising between customary anatomic tracing methods and implant references have been demonstrated.

Adolescent↗
PubMed2002

Effects of 5-year treatment with elcatonin and alfacalcidol on lumbar bone mineral density and the incidence of vertebral fractures in postmenopausal women with osteoporosis: a retrospective study.

The purpose of this retrospective study was to compare the effects of long-term treatment (5 years) with elcatonin and alfacalcidol on bone mineral density (BMD) and the incidence of vertebral fractures in postmenopausal women with osteoporosis. Fifty-six osteoporotic women, more than 5 years after menopause and 58-79 years of age, were enrolled in the study and allocated to an elcatonin treatment group (20 units IM, weekly; n = 30) or an alfacalcidol treatment group (1 micro g/day, daily; n = 26). BMD of the lumbar spine (L2-L4) was measured by dual energy X-ray absorptiometry at baseline and every year for 5 years. There were no significant differences in age, body mass index, years since menopause, BMD, or number of prevalent vertebral fractures at baseline between the two groups. One-way analysis of variance with repeated measurements showed no significant longitudinal changes in BMD in either group, suggesting that both treatments sustained the BMD over 5 years. Two-way analysis of variance with repeated measurements also showed no significant differences in longitudinal changes in BMD between the two groups, suggesting that the effects of the two treatments on BMD were similar. However, the number of incident vertebral fractures per patient was significantly lower in the alfacalcidol treatment group than in the elcatonin treatment group (0.80 +/- 1.19 and 2.08 +/- 2.73, respectively; P < 0.05). These findings indicate that both treatments appeared to sustain lumbar BMD similarly over a 5-year period in postmenopausal women with osteoporosis, but alfacalcidol treatment may be superior to elcatonin treatment regarding the incidence of vertebral fractures. Further study with prospective observations are needed to confirm the results of the present study.

Aged↗
PubMed1995

Menopause-related changes in bone mineral density in Japanese women: a longitudinal study on lumbar spine and proximal femur.

We investigated 2-year longitudinal changes of bone mineral density (BMD) in lumbar spine and proximal femur in 64 Japanese women aged 38-67. Forty subjects were premenopausal (mean age 44.9) and 24 postmenopausal (mean age 54.6) at enrollment of the study. Six subjects experienced menopause during the 2-year study period and were defined as the perimenopausal group. Measurements of BMD were performed using dual-energy X-ray absorptiometry at L2-4, femoral neck, greater trochanter, and Ward's triangle. Paired t test revealed no significant decrease in BMD at any site in the premenopausal group. Significant annual decrease in BMD was observed in the perimenopausal group at L2-4, femoral neck, and greater trochanter. A similar tendency was observed in Ward's triangle, but did not reach statistical significance. In the postmenopausal group, significant decrease in BMD was found at the proximal femur, but not at L2-4. Significant inverse correlation between age and change rate of BMD was found at L2-4, but not at the proximal femur, in premenopausal women. In postmenopausal women, there was a significant association between body weight (BW) change and change rate in BMD at L2-4, femoral neck, or greater trochanter. This association was not found in the premenopausal group. These results suggest that effect of menopause on BMD may be different in individuals and sites of the skeleton. BW change may affect change in BMD in postmenopausal women.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed2004

Evidence for an "epidemic" of myopia.

INTRODUCTION: It has been widely suggested that the prevalence of myopia is growing worldwide, and that the increases observed in East Asia, in particular, are sufficiently severe as to warrant the term "epidemic". Data in favour of a cohort effect in myopia prevalence are reviewed, with attention to significant shortcomings in the quality of available evidence. Additional factors contributing to myopia prevalence, including near work, genetics and socioeconomic status, are detailed. MATERIALS AND METHODS: Medline search of articles regarding myopia prevalence, trends and mechanisms. RESULTS: Age-related changes in myopia prevalence (increase during childhood, and regression in the fifth and sixth decades) are discussed as an alternative explanation for cross-sectional patterns in myopia prevalence. There have only been a handful of studies that have examined the relative contribution of longitudinal changes in refraction over life and birth cohort differences on age-specific myopia prevalence as measured in cross-sectional studies. Available data suggest that both longitudinal changes and cohort effects may be present, and that their relative contribution may differ in different racial groups. CONCLUSIONS: In view of the relatively weak evidence in favour of a large cohort effect for myopia in East Asia, and the even greater lack of evidence for increased prevalence of secondary ocular pathology, there appears to be inadequate support for large-scale interventions to prevent or delay myopia at the present time.

Asia, Eastern↗
PubMed1989

Longitudinal IQ changes in fragile X males.

Previous studies have reported a drop of IQ in males with Martin-Bell or fragile X syndrome during childhood and adolescence. It is uncertain when and why this drop occurs and whether it affects all fragile X males. We have analyzed longitudinal IQ data on all 24 fragile X males who have been followed for at least 2 years through the Child Development Unit in Denver and who have been evaluated with a Stanford-Binet Form L-M assessment. A significant drop in IQ occurred for the group as a whole, but an individual z analysis demonstrated that only 7 of 24 had a significant decline in IQ. Visual inspection demonstrates an initial decline in IQ beginning in middle childhood and continuing through adolescence. We postulate that this drop occurs because of relatively greater weaknesses with abstract reasoning and higher symbolic language skills that are stressed in the cognitive testing of later childhood and adolescence.

Adult↗
PubMed2005

Changing prevalence of gastroesophageal reflux with changing time: longitudinal study in an Asian population.

BACKGROUND: The purpose of the present paper was to study previously obtained population-based data on the prevalence of reflux symptoms in a random sample of community adults in Singapore. This sample was re-investigated 5 years later to determine changes in the prevalence of reflux symptoms. METHODS: In 1999, 237 (34%) of the original cohort of 696 persons who were interviewed in 1994, were re-interviewed using a validated Gastrointestinal Symptoms Questionnaire. The original cohort was a race-stratified random sample of residents in a Singaporean town. Reflux was defined as heartburn and/or acid regurgitation occurring at least once a month. RESULTS: Among the 237 respondents (aged 25-89 years; male : female, 49:51; Chinese n = 106, 45%; Malay n = 69, 29%; Indian n = 60, 25%), reflux was reported by 25 respondents, giving a prevalence of 10.5 +/- 2.0%. This compared with the prevalence of 5.5 +/- 1.5% (odds ratio [OR], 2.2; 95% confidence interval [CI]: 1.0-5.2; P = 0.05) among the same 237 respondents in the 1994 survey. Of the 25 subjects who reported reflux in the current survey, 22 (88.0%) did not complain of reflux symptoms in the 1994 survey. The ethnic-adjusted prevalence of reflux in 1999 was estimated to be 9.9 +/- 1.9%. This was an increase above the prevalence in 1994 of 1.6 +/- 1.0% (P = 0.051). The upward trend in the prevalence of reflux was not related to age, smoking, alcohol consumption, or increase in bodyweight. CONCLUSIONS: There is a rising trend of reflux symptoms frequency in the general population of Singapore over a 5-year period.

Adult↗
PubMed1999

Longitudinal phenotypic analysis of human immunodeficiency virus type 1-specific cytotoxic T lymphocytes: correlation with disease progression.

Few studies have examined longitudinal changes in human immunodeficiency virus type 1 (HIV)-specific cytotoxic T lymphocytes (CTL). To more closely define the natural history of HIV-specific CTL, we used HLA-peptide tetrameric complexes to study the longitudinal CD8(+) T-cell response evolution in 16 A*0201-positive untreated individuals followed clinically for up to 14 years. As early as 1 to 2 years after seroconversion, we found a significant association between high frequencies of A*0201-restricted p17(Gag/Pol) tetramer-binding cells and slower disease progression (P < 0.01). We observed that responses could remain stable over many months, but any longitudinal changes that occurred were typically accompanied by reciprocal changes in RNA viral load. Phenotypic analysis with markers CD45RO, CD45RA, and CD27 identified distinct subsets of antigen-specific cells and the preferential loss of CD27(+) CD45RO(+) cells during periods of rapid decline in the frequency of tetramer-binding cells. In addition we were unable to confirm previous studies showing a consistent selective loss of HIV-specific cells in the context of sustained Epstein-Barr virus-specific cell frequencies. Overall, these data support a role of HIV-specific CTL in the control of disease progression and suggest that the ultimate loss of such CTL may be preferentially from the CD27(+) CD45RO(+) subset.

Disease Progression↗
PubMed2004

In vivo application of 3D-line skeleton graph analysis (LSGA) technique with high-resolution magnetic resonance imaging of trabecular bone structure.

Over the last several years magnetic resonance (MR) imaging has emerged as a means of measuring in vivo 3D trabecular bone structure. In particular, MR based diagnosis could be used to complement standard bone mineral density (BMD) methods for assessing osteoporosis and evaluating longitudinal changes. The aim of this study was to demonstrate the feasibility of using the 3D-LSGA technique for the evaluation of trabecular bone structure of high-resolution MR images, particularly for assessing longitudinal changes, in vivo. First, the reproducibility of topological 3D-LSGA based measurements was evaluated in a set of seven volunteers, and coefficients of variations ranged from 3.5% to 6%. Second, high-resolution MR images of the radius in 30 postmenopausal women from a placebo controlled drug study (Idoxifene), divided into placebo ( n=9) and treated ( n=21) groups, were obtained at baseline (BL) and after 1 year of treatment (follow-up, FU). In addition, dual X-ray absorptiometry (DXA) measures of BMD were obtained in the distal radius. Standard morphological measurements based on the mean intercept length (MIL) technique as well as 3D-LSGA based measurements were applied to the 3D MR images. Significant changes from BL to FU were detected, in the treated group, using the topological 3D-LSGA based measurements, morphological measures of volume of connected trabeculae and App Tb.N from MIL analysis. The duration of the study was short, and the number of patients remaining in the study was small, hence these results cannot be interpreted with regard to a true therapeutic response. Furthermore, the site (wrist) and the drug (idoxifene) are not optimal for follow-up study. However, this paper demonstrated the feasibility of using 3D-LSGA based evaluation coupled with in vivo high-resolution MR imaging as a complementary approach for the monitoring of trabecular bone changes in individual subjects.

Adult↗
PubMed1995

Long-term follow-up of cross-arch fixed partial dentures in patients with advanced periodontal destruction. Evaluation of the supporting tissues.

The aim of the study was to evaluate the periodontal conditions in patients treated more than 10 years ago for advanced periodontal disease and rehabilitated with cross-arch fixed partial dentures (FPDs). Of 50 randomly selected patients, 34 subjects carrying 43 FPDs agreed to participate in a clinical and radiographic follow-up examination. The FPDs were divided into three groups on the basis of prosthesis design (end abutments, unilateral cantilever, and bilateral cantilevers) and amount of supporting tissues at the time of bridge installation. Seventy per cent of the FPDs were found to be unchanged, whereas the rest had been modified due to various complications leading to extraction of one or more of the abutment teeth. Six FPDs (14%) had been partially replaced by FPDs anchored to osseointegrated dental implants. A total of 21 (8%) of the original 274 abutment teeth had been extracted. Longitudinal changes in the amount of periodontal support were minimal over the average of 15 years of follow-up. FPD design or initial amount of supporting tissues was found not to have significant influence on longitudinal changes in periodontal conditions. It was concluded that combined periodontal and prosthodontic treatment of patients with advanced loss of periodontal support may provide a high rate of long-term successful outcome, provided proper adequate periodontal and prosthetic treatment and maintenance care are given.

Aged↗
PubMed2000

Rate of caudate atrophy in presymptomatic and symptomatic stages of Huntington's disease.

Previous research by our group demonstrated a longitudinal change in caudate volume for symptomatic subjects with Huntington's disease (HD), and suggested that volume of the caudate may be a useful outcome measure for therapeutic studies in symptomatic patients. The current study was designed to determine whether longitudinal change in caudate atrophy could be documented in presymptomatic carriers of the HD gene mutation, and to compare rate of change in these subjects with rate of change in mildly and moderately affected symptomatic patients. We measured caudate volumes on serial magnetic resonance image scans from 30 patients at three stages of HD: 10 presymptomatic; 10 with mild symptoms, as indicated by scores on the Quantified Neurological Exam (QNE) < or =35; and 10 with moderate symptoms (QNE >45). The mean interscan interval was 36 months. When analyzed separately, both symptomatic groups and the presymptomatic group demonstrated a significant change in caudate volume over time. Amount of change over time did not differ significantly among the three groups. We conclude that change in caudate volume may be a useful outcome measure for assessing treatment effectiveness in both presymptomatic and symptomatic subjects.

Adult↗
PubMed2002

Health behaviors in elderly people. A 5-year follow-up of 75-year-old people living in three Nordic localities. Smoking, physical activity, alcohol consumption, and healthy eating, and attitudes to their importance.

Few studies about health behavior among elderly persons in the Nordic countries are available, and our knowledge about longitudinal changes is especially limited. The purpose of this study was to assess the prevalence of selected health behaviors as reported at age 75 years in Finland, Sweden and Denmark together with answers regarding attitudes to such habits, and study longitudinal changes between 75 and 80 years. The study population included 499 men and 704 women born in 1914/15 and examined in 1989/90 in Jyväskylä (Finland), Göteborg (Sweden), and Glostrup (Denmark). Survivors were re-examined in 1994/95. A self-administered validated questionnaire developed from the Danish Nationwide Health Surveys was given to the participants during a home visit and checked when the subjects came to the laboratory examination. The Danes had the highest proportion of smokers and persons with daily alcoholic beverage consumption and the smallest proportion of healthy eaters, but the Swedes had the most sedentary life-style. Women had the healthiest life-style. Between ages 75 and 80 years, the proportion of participants who tried to improve their health decreased, but there was no change in believing the importance of one's own effort in maintaining health. The free-time physical activity decreased, but there was no change in the attitude towards physical activity. There were major cross-national differences among the three Nordic localities, but the health behaviors were rather stable, though the proportion of participants who tried to improve their health decreased. Not more than 60 to 70% of the subjects believed that their own efforts are important to health.

Aged↗