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Epidemiological approach to the paleopathological diagnosis of leprosy.

In paleopathology it is usually assumed that modern diagnostic criteria can be applied to infectious diseases in the past. However, as both the human species and populations of pathogenic microorganisms undergo evolutionary changes, this assumption is not always well-founded. To get valid estimates of the frequency (the point prevalence at death) of leprosy in skeletal samples, sensitivity, specificity, and sample frequency must be estimated simultaneously. It is shown that more than three symptoms must be evaluated in at least three samples in order to reach estimates with well-described properties. The method is applied to three skeletal samples from Medieval Denmark; the samples were scored for the presence of seven osteological conditions indicating leprosy. For the osteological conditions, sensitivity varied from 0.36-0.80, and specificity from 0.58-0.98. The frequency of leprosy in the three samples was: Odense (a lepers' institution), 0.98, 95% CI 0.64-1.00; Malmö (urban cemetery), 0.02, 95% CI 0.00-0.07; and Tirup (rural cemetery), 0.36, 95% CI 0.23-0.46. It is concluded that it is indeed possible to estimate disease frequencies without reference to modern standards, and that leprosy occurred with widely differing frequencies in different segments of the Medieval population in southern Scandinavia.

Adult↗

Alzheimer's disease and other dementing illnesses in a defined United States population: incidence rates and clinical features.

In this study, for the first time to our knowledge all new cases of Alzheimer's disease and other dementing illnesses have been documented in a well-defined United States community. A total of 178 patients in an average annual at-risk population of 18,991 persons over age 29 developed dementia during 1960 through 1964 in Rochester, Minnesota, yielding an average annual incidence rate of 187.5 new cases/100,000/year. The corresponding rate for clinically and/or pathologically diagnosed Alzheimer's disease (the most common cause of dementia in this community) was 123.3 new cases/100,000/year, based on 117 cases. The incidence rates for both dementia in general and Alzheimer's disease in particular rise dramatically with age. All patients were followed to death or to 1982, and the median survival was 63 months. These data include only those in the community who came to medical attention, but they yield higher rates than studies in Scandinavia, indicating a relatively high level of case ascertainment.

Adult↗

The dissemination of multiple sclerosis: a Viking saga? A historical essay.

The highest prevalence rates for multiple sclerosis are found in Iceland, Scandinavia, the British Isles, and the countries settled by their inhabitants and their descendants, that is, the United States, Canada, Australia, and New Zealand. This suggests that the Vikings may have been instrumental in disseminating the genetic susceptibility to the disease in those areas as well as in other parts of the world. The Vikings raided in most European countries and settled in Normandy and in Sicily and southern Italy. They engaged in trade with the Arabs along the river routes to the Caucasus and to the Black and Caspian Seas and penetrated into Persia, India, and probably China. They also migrated to the East and established the Russian state. Under the name Varangians, they became part of the Byzantine army and were active in all of the military activities of the Byzantine Empire. They participated in the Crusades. Russians, many of Scandinavian origin, also constituted a regiment of the Mongol army and roamed throughout that empire as well. The custom of capturing and keeping or selling women and children, which was widespread in the early Middle Ages, as well as the flourishing slave trade in men, were important factors in this genetic dissemination.

Asia↗

Fine-needle aspiration cytology: its origin, development, and present status with special reference to a developing country, India.

Fine-needle aspiration cytology (FNAC) was performed on a large scale at Memorial Hospital, New York, during the 1930s, but during the ensuing years, it did not gain much encouragement in United States. The technique had a resurgence in Scandinavia during the 1950s and 1960s, where it flourished before spreading to other parts of the world. It had also a revival in the United States, which contributed enormously to this tool in each and every aspect. The status of FNA during 1966-2002 was assessed through review of MEDLINE search data on FNA and its correlation with World Bank website data on classification of countries. A total of 849 journals published 5,609 articles on FNA over a period of 37 years. Both the number of publishing journals and the number of published articles on FNA were low during the 1960s (3.5 +/- 0.58 and 4.0 +/- 0.82, respectively) and 1970s (20.3 +/- 14.72 and 25.0 +/- 20.54, respectively), but their number increased sharply from the 1980s onward (78.2 +/- 25.65 and 147.2 +/- 66.89, respectively, during the 1980s, 126.2 +/- 11.94 and 301.4 +/- 35.99, respectively, during the 1990s, and 113.3 +/- 36.46 and 287.3 +/- 85.93, respectively, during the 2000s). The difference between the decades of 1960s-2000s, with respect to the number of publishing journals and published articles, was highly significant (P < 0.0001). Only 90 (10.6%) of the journals were from the arena of pathology and its branches. The remaining journals belonged to various other disciplines of medicine; a small fraction were even from the veterinary sciences. Ten journals, including three in the field of cytopathology, published 2,448 (43.6%) of the total articles on FNA. During 1987-2002, 46 (29.7%) of the 155 developing nations published articles on FNA, whereas 28 (52.8%) of the developed (high-income economies) countries did so, the difference being highly significant (P = 0.0044). The total number of publications from high-income economies was 3,124 (195.3 per year), as opposed to 772 (48.3 per year) from the developing world. The number of articles published from the developing nations (16.8 +/- 52.21) was significantly lower as compared with that from the high-income economies (111.6 +/- 242.03) (P = 0.005). Except for infectious diseases, the high-income economies had a definite edge over the developing nations in the absolute number of publications from each and every site/organ. However, when the frequency of publications on various organs/sites was compared between the two groups, it was found that the number of articles from high-income economies was significantly higher with respect to breast diseases (P < 0.001) and pancreatic lesions (P = 0.0158), whereas the developing nations published more frequently on small round cell tumors (excluding exclusive reports on lymphoma) and infectious diseases (P < 0.001). In India, FNAC was first introduced during the early 1970s and spread to different parts through formal teaching under the postgraduate curriculum in pathology and by conducting workshops and continuing medical education program for pathologists, surgeons/physicians, and radiologists. FNAC is now practiced in all medical colleges, in big public sector hospitals, and even in private clinics and laboratories. The number of centers practicing FNAC increased sharply during 1980s, as evident from the response of 69 laboratories in various parts of India to a questionnaire. As of 1998, 55.9% of the laboratories performed >/=1,000 cases of FNA per year. In 46% of the centers, pathologists alone performed the FNAC, whereas in 51%, they performed it in collaboration with radiologists and surgeons. Disposable syringes and needles were used in all the centers, but syringe holders were used in only in 61% of centers. In 86% of laboratories, two or more routine stains were used, and one or more ancillary techniques on fine-needle aspirates were adopted in 72.5% centers. Of the 772 publications from the developing world during 1987-2002, India alone contributed to 374 (48.4%). During 1975-2002, 154 articles on FNA were published needles were used in all the centers, but syringe holders were used in only in 61% of centers. In 86% of laboratories, two or more routine stains were used, and one or more ancillary techniques on fine-needle aspirates were adopted in 72.5% centers. Of the 772 publications from the developing world during 1987-2002, India alone contributed to 374 (48.4%). During 1975-2002, 154 articles on FNA were published in 15 indexed Indian journals.

Biopsy, Needle↗

Insulin therapy in Europe.

The prevalence of type 1 diabetes is rising in all European countries, particularly in Scandinavia and the UK. Insulin therapy in Europe is strongly influenced by the results of the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), both of which showed the importance of tight metabolic control in patients with diabetes. The importance of tight glycemic control is also emphasized in the Saint Vincent Declaration, which established 5-year goals for antidiabetic therapy in Europe. Insulin therapy in Europe has been significantly improved over the past 10 years, owing to a number of developments. These include increased use of intensive insulin therapy in patients with type 1 diabetes; the development of new insulin analogs, including insulin glargine for injection therapy and short-acting agents that are particularly suitable for use in pumps and the establishment of comprehensive and standardized treatment goals and guidelines. Nevertheless, important obstacles must still be overcome to optimize therapy for patients with diabetes and reduce the long-term complications of this disease. These obstacles include low public awareness of diabetes and its symptoms, training of physicians as well as patients that is often insufficient to ensure adherence to professional guidelines for diabetes care, and limitations in communication among professional care providers.

Blood Glucose↗

Designing standardized clinical protocols: some organizational and behavioral issues.

In the present environment, the clinical ordering patterns of hospital-based physicians can be expected to come under increasing scrutiny. This paper considers three major aspects of the case for inpatient clinical ordering protocols. First, it reviews the argument that hospitals do not, at present, exercise adequate management over physician-triggered resource consumption. Subsequently, the paper examines existing but partial protocol models in the United States and Scandinavia that could provide a basis for an adequate physician management system. In its third section, the paper explores the fundamental characteristics of a full-fledged Standardized Clinical Protocol (SCP) system, developing two alternative 'ideal-type' models for further discussion. The paper concludes with the argument that physicians, rather than economists or politicians, should control the design of future protocol systems.

Behavior↗

Phenylketonuria mutations in Europe.

Phenylketonuria (PKU) is heterogeneous. More than 400 different mutations in the phenylalanine hydroxylase (PAH) gene have been identified. In a systematic review of the molecular genetics of PKU in Europe we identified 29 mutations that may be regarded as prevalent in European populations. Comprehensive regional data for these mutations were collated from all available studies. The spectrum of mutations found in individual regions results from a combination of factors including founder effect, range expansion and migration, genetic drift, and probably heterozygote advantage. Common mutations include R408W on a haplotype 2 background in Eastern Europe, IVS10-11G>A in the Mediterranean, IVS12+1G>A in Denmark and England, Y414C in Scandinavia, I65T in Western Europe, and R408W on haplotype 1 in the British Isles. Molecular data from mild hyperphenylalaninemia (MHP) patients are available from a number of countries, but it is currently not possible to calculate relative allele frequencies. The available data on PAH mutations are useful for the understanding of both the clinical features and the population genetics of PAH deficiency in Europe.

Europe↗

D90A-SOD1 mediated amyotrophic lateral sclerosis: a single founder for all cases with evidence for a Cis-acting disease modifier in the recessive haplotype.

More than 100 different heterozygous mutations in copper/zinc superoxide dismutase (SOD1) have been found in patients with amyotrophic lateral sclerosis (ALS), a fatal neurodegenerative disease. Uniquely, D90A-SOD1 has been identified in recessive, dominant and apparently sporadic pedigrees. The phenotype of homozygotes is stereotyped with an extended survival, whereas that of affected heterozygotes varies. The frequency of D90A-SOD1 is 50 times higher in Scandinavia (2.5%) than elsewhere, though ALS prevalence is not raised there. Our earlier study indicated separate founders for recessive and dominant/sporadic ALS and we proposed a disease-modifying factor linked to the recessive mutation. Here we have doubled our sample set and employed novel markers to characterise the mutation's origin and localise any modifying factor. Linkage disequilibrium analysis indicates that D90A homozygotes and heterozygotes share a rare haplotype and are all descended from a single ancient founder (alpha 0.974) c.895 generations ago. Homozygotes arose subsequently only c.63 generations ago (alpha 0.878). Recombination has reduced the region shared by recessive kindreds to 97-265 kb around SOD1, excluding all neighbouring genes. We propose that a cis-acting regulatory polymorphism has arisen close to D90A-SOD1 in the recessive founder, which decreases ALS susceptibility in heterozygotes and slows disease progression.

Amino Acid Substitution↗

Use of hormone therapy and risk of breast cancer detected at screening and between mammographic screens.

Postmenopausal hormone therapy (HT) is associated with increased risk of breast cancer, but in women undergoing breast cancer screening it is not clear whether use of HT is associated with increased risk of breast cancer detected at screening or between screens (interval cancer). Further, it is unclear whether the use of the HTs that have been common in Scandinavia is associated with higher risk of breast cancer than the HTs used in other countries. Our study was based on data from 296,651 women aged 50-69 years, who participated in the Norwegian Breast Cancer Screening Program during 1995-2004. After a mean enrollment time of 3.8 years, 1,512 women were diagnosed with invasive screen detected breast cancer, and 814 with invasive interval breast cancer. Cox regression models were used to estimate hazard ratios (HRs) of breast cancer associated with HT use, after adjusting for confounders. Ever users of HT had a 58% increased risk of breast cancer, compared to never users. The HRs associated with HT use were 1.45 (95% confidence interval (CI) = 1.29-1.63) for screen detected and 1.89 (95% CI = 1.61-2.23) for interval cancer. The difference between screen detected and interval cancer was statistically significant (p = 0.011). The HR of breast cancer increased with duration of HT use, but significantly more so for interval than for screen detected cancer (use of HT for 5 or more years compared to never use; HR = 2.91, 95% CI = 2.10-4.04 and HR = 1.94, 95% CI = 1.51-2.50, respectively; p = 0.002). The population attributable fraction of breast cancer due to HT use was 19.8% overall. Ever users of HT tended to develop a cancer of lower grade. No other differences in histological tumor characteristics were observed between ever and never users of HT among screen detected or interval cancers. The estimated risks of either breast cancer overall with HT use are higher in Norway than reported in similar studies from the U.S. HT-use is a stronger risk factor for interval cancer than for screen detected cancer. The increased risk of interval cancer, which may partly be due to decreased sensitivity of mammograms in HT users, remains a challenge in breast cancer screening programs.

Aged↗

Different types of postmenopausal hormone therapy and mammographic density in Norwegian women.

Postmenopausal hormone therapy (HT) is associated with increased risk of breast cancer. The HTs used in Scandinavia is associated with higher risk estimates than those used in most other countries. Mammographic density is one of the strongest risk factors for breast cancer, and possibly an intermediate marker for breast cancer. We decided to examine the relationship between use of different types of HT and mammographic density in Norwegian women. Altogether, 1,007 postmenopausal participants in the governmental mammographic screening program were asked about current and previous HT use. Mammograms were classified according to percent and absolute mammographic density. Overall, current users of HT had on average 3.6% higher mean percent mammographic density when compared with never users (p < 0.001). After adjustment for age at screening, number of children and BMI in a multivariate model, women using the continuous estradiol (E(2)) plus norethisterone acetate (NETA) combination had a mean percent mammographic density significantly higher than never users (6.1% absolute difference). Those using the continuous E(2) plus NETA combination had an 4.8% (absolute difference) higher mean percent mammographic density after <5 years of use when compared with never users, while the corresponding number for >or=5 years of use was 7% (p-trend < 0.001). We found similar associations when absolute mammographic density was used as the outcome variable. In summary, our study shows a statistical significant positive dose-response association between current use of the continuous E(2) plus NETA combination and both measures of mammographic density.

Aged↗

Childhood cancer incidence: geographical and temporal variations.

Data from the first four volumes of Cancer Incidence in Five Continents (CI-5) and from the first 5 years of the US Surveillance, Epidemiology and End Results (SEER) program were analyzed for evidence of geographical and temporal variations in the incidence of selected childhood tumors. Only lymphoid leukemia and glial neoplasms are common enough for the observed differences between US registries to be distinguished from sampling variation. Internationally, kidney and eye tumors and leukemia show less geographical variation than do lymphomas and brain tumors, but for none of the tumors examined is the incidence constant. Wilms' tumor rates among Japanese, Singapore Chinese and Indians (Bombay) are approximately 60% of the rates in North America and Britain, whereas in Scandinavia the rates are up to 30% higher. This lessens the status of Wilms' tumor as an "index tumor" of childhood. Areas or countries with especially high or low rates of other tumors are identified. Rates for glial neoplasms (SEER data) and Hodgkin's disease (CI-5) are increasing with time in the US, while brain tumors are being diagnosed more frequently worldwide. However, the results for brain tumors may largely reflect changes in pathology diagnosis or reporting practices, and those for Hodgkin's disease may reflect improvements in case ascertainment. Otherwise, there is a remarkable stability in the incidence of selected childhood cancers over time.

Adolescent↗

Enzyme-linked immunosorbent assay for detection of enteric adenovirus 41.

An enzyme-linked immunosorbent assay (ELISA) for direct detection of enteric adenovirus 41 (Ad41) in stool specimens was developed and compared with an Ad40-specific ELISA described previously [Johansson et al, 1980]. Rabbit antiserum to Ad41 was obtained by immunization with purified virions. To eliminate genus-specific reactivity the serum was passed through an immunosorbent column containing soluble adenovirus components of members of subgenera A to E. The anti-Ad41 serum still displayed high reactivity against Ad40 and had to be immunoabsorbed with soluble virus components of Ad40 to be rendered type-specific. The absorbed antiserum was used in an indirect ELISA and proved to be specific for Ad41. No heterotypic reactivity against Ad40 or Ad1 through Ad35 was found. The Ad41-specific ELISA proved to be of equal sensitivity to electron microscopy. The type-specific ELISAs for Ad40 and Ad41 were evaluated by testing 76 stool specimens containing enteric adenoviruses originating from England and Scandinavia. All specimens could be typed--41 (54%) as Ad40 and 35 (46%) as Ad41. These results were confirmed by DNA restriction site analysis. The type-specific ELISA proved to be a specific, sensitive, and a rapid technique for detection of Ad41 and allowed clear-cut discrimination from Ad40 in clinical specimens.

Adenoviruses, Human↗

Use of recombinant nucleocapsid proteins of the Hantaan and nephropathia epidemica serotypes of Hantaviruses as immunodiagnostic antigens.

Hantavirus nucleocapsid protein has previously been identified as the major antigen recognized by the humoral immune response in hemorrhagic fever with renal syndrome (HFRS). It was therefore considered to be a suitable antigen for the development of rapid and reliable immunodiagnostic assays. Genes encoding the nucleocapsid proteins of two Hantavirus strains, one of the Puumala serotype [nephropathia epidemica virus (NEV)] and the other of the Hantaan serotype were expressed in E. coli, and the expression products were used as diagnostic antigens in solid-phase enzyme immunoassays. The assays were used to detect IgG- and IgM-antibodies in sera of HFRS patients originating from different geographic regions (China, Germany, Greece, Yugoslavia, Scandinavia). ELISA was highly sensitive and proved to be superior to the indirect immunofluorescence assay. Both antigens were necessary to diagnose all HFRS cases originating from the different countries. Most of the sera revealed a predominant reactivity with either 1 of the 2 antigens, allowing the characterization of the etiologic virus as Hantaan-like or NEV-like. The results of the analysis of sera obtained from China and Greece suggested that the Hantaviruses prevalent in these countries are closely related to the Hantaan serotype. In contrast, an NEV-like reactivity was observed in Central and Northern European patients. In the sera of Yugoslav patients both reactivity patterns were found, suggesting that both virus types occur in the Balkan region.

Antibodies, Viral↗

Coffee consumption and human health--beneficial or detrimental?--Mechanisms for effects of coffee consumption on different risk factors for cardiovascular disease and type 2 diabetes mellitus.

Coffee is probably the most frequently ingested beverage worldwide. Especially Scandinavia has a high prevalence of coffee-drinkers, and they traditionally make their coffee by boiling ground coffee beans and water. Because of its consumption in most countries in the world, it is interesting, from both a public and a scientific perspective, to discuss its potential benefits or adverse aspects in relation to especially two main health problems, namely cardiovascular disease and type 2 diabetes mellitus. Epidemiological studies suggest that consumption of boiled coffee is associated with elevated risk for cardiovascular disease. This is mainly due to the two diterpenes identified in the lipid fraction of coffee grounds, cafestol and kahweol. These compounds promote increased plasma concentration of cholesterol in humans. Coffee is also a rich source of many other ingredients that may contribute to its biological activity, like heterocyclic compounds that exhibit strong antioxidant activity. Based on the literature reviewed, it is apparent that moderate daily filtered, coffee intake is not associated with any adverse effects on cardiovascular outcome. On the contrary, the data shows that coffee has a significant antioxidant activity, and may have an inverse association with the risk of type 2 diabetes mellitus.

Animals↗

Use of psychiatric drugs in Slovenia in comparison to Scandinavian countries.

PURPOSE: To find out the consumption of psychotropic drugs in Slovenia and the extent to which Slovenian consumption correlates to Scandinavian countries. METHODS: Data of ambulatory prescribing of psychiatric drugs in Slovenia for the years 1999 and 2000 and data for Norway, Sweden and Denmark are shown. All data are expressed in defined daily doses per thousand inhabitants per day (DDD's). RESULTS: The use of all neuroleptics in Slovenia is lower (5.3 vs 6.1-7.6 DDD's), however the share of atypicals (34%) is comparable to Scandinavian countries. Use of anticholinergics is up to five times greater (1.6 vs 0.3-0.5 DDD's). The use of lithium is five time lower (0.2 vs 1.1-1.4). Regarding the use of antidepressants, Slovenia is behind Scandinavia (12.2 vs 30-47 DDD's), whereas the share of SSRI's (73%) is at the same level. The use of anxiolytics is higher (25.4 vs 16-22.4 DDD's) and ratio with antidepressants is also unfavourable. The use of hypnotics and sedatives is favourably low (10.7 vs 31.8-44.6 DDD's). CONCLUSIONS: Low use of hypnotics and sedatives is favourable. The share of new neuroleptics and antidepressants is comparable. The use of antidepressants is probably too low. However, prescribing guidelines for anxiolytics, anticholinergics (too high use of both group) and lithium (too low use) should be introduced in Slovenia.

Alcoholism↗

Examination of movement in patients with long-lasting musculoskeletal pain: reliability and validity.

BACKGROUND AND PURPOSE: An examination method based on psychosomatic physiotherapy, with 24 standardized tests related to general aspects of mobility, flexibility and the ability to relax, is used in some pain and rehabilitation clinics in Scandinavia in order to document where--and to what degree--patients have aberrations within the domain 'movement'. The measurement properties of the movement tests have, however, not been investigated in patients with long-lasting musculoskeletal pain. The aims of the present study were, therefore, to investigate inter-tester reliability and validity (construct, discriminative and concurrent validity) related to movement. METHOD: The study design was cross-sectional. Reliability was examined by three physiotherapists examining 19 people. Construct validity was studied by means of structural equation modelling (SEM). Discriminative validity was examined by comparing movement data from 247 patients with long-lasting musculoskeletal pain, and 104 healthy subjects. The patient sample was categorized according to localized or widespread pain, and movement scores compared between the groups. Most patients filled in a psychological screening questionnaire (MMPI-2), plus information about pain intensity and function, and concurrent validity of the movement measures were examined by correlation. RESULTS: SEM results indicated a modified movement scale, consisting of 16 items in four subscales. Both the original and modified versions showed good reliability, and scores differed significantly between healthy subjects and patients, and between patients with localized versus widespread pain. A relationship was found between the movement tests and psychological characteristics, but mainly in patients with widespread pain. Significant relationships were found between the ability to relax and pain, and between all aspects of movement and function. CONCLUSIONS: Movement may be reliably and validly assessed with composite scores from 4 x 4 items. The method may be useful as a global screening instrument in order to examine where, and to what extent, patients with long-lasting pain problems have movement aberrations; findings to be addressed in treatment.

Adult↗

Confirmation of the prostate cancer susceptibility locus HPCX in a set of 104 German prostate cancer families.

BACKGROUND: Several prostate cancer (PCa) susceptibility loci have been reported, but attempts to confirm them in independent data sets have produced inconsistent results. It is not yet clear, how much of this variation is due to differences between different populations. HPCX was originally identified in a combined data set of PCa families from the USA and Scandinavia. Considerable differences in the frequency of linked families were observed in this heterogeneous family sample as well as in following studies. METHODS: In order to estimate the significance of HPCX in the German population, DNA samples from 104 PCa families were genotyped at six polymorphic markers spanning a region of approximately 14 cM on Xq27-28, which includes the proposed HPCX candidate locus. RESULTS: In the entire data set, a maximum NPL Z score of 1.20 (P = 0.11) at marker DXS984 was observed. Statistically significant evidence for linkage was obtained in the subset of 63 families with early-onset disease (i.e., < or = 65 years) with a maximum NPL Z score of 2.32 (P = 0.009) at the same location. CONCLUSION: Our results confirm the existence of a prostate cancer susceptibility gene on Xq27-28 also in the German population.

Age Factors↗

Modelling migration: the clock-and-compass model can explain the distribution of ringing recoveries.

The aim of the present study was to test whether the directional distributions found in ringing recoveries could be explained if night-migrating passerines use only a simple clock-and-compass strategy during autumn migration. I developed a mathematical model that predicts the expected directional distributions as a function of distance covered by birds using a clock-and-compass strategy. The predictions were compared with data from natural migration: all ringing recoveries of pied flycatchers, Ficedula hypoleuca, ringed in Scandinavia and recovered elsewhere in Europe and North Africa within the same autumn. The predictions of the model correlated strongly with the distribution of ringing recoveries. This suggests that at least young pied flycatchers, and perhaps night-migrating passerines in general, use a simple clock-and-compass strategy to reach their wintering area. If so, all the prerequisites (a compass and an internal clock) that they need to orient during migration seem to be known at present, at least at the behavioural level, and navigational abilities or any elusive map-sense are not needed for migration. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗