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Changes in disease specific and generic quality of life related to changes in lower urinary tract symptoms: the Krimpen study.

PURPOSE: We determined if and to what extent longitudinal changes in lower urinary tract symptoms are related to disease specific and generic quality of life in men. MATERIAL AND METHODS: A longitudinal, population based study with a followup of 4.2 years was done in 1,688 who were 50 to 79 years old. Data were collected through self-administered questionnaires, including the Sickness Impact Profile (3 domains), Inventory of Subjective Health, International Prostate Symptom Score (I-PSS) and Benign Prostatic Hyperplasia Impact Index. Moreover, they completed various physical and urological measurements. Mean I-PSS and quality of life scores at baseline and followup were analyzed for certain subgroups. Multiple linear regression was used to determine the change in quality of life in relation to baseline I-PSS, I-PSS changes between baseline and followup, and age. RESULTS: Although mean I-PSS increased with time, the average generic quality of life improved and almost a third of the men reported better disease specific quality of life. Multiple linear regression revealed that disease specific quality of life was associated with I-PSS at baseline, changes in I-PSS between baseline and followup, and age. However, generic quality of life scores were not associated with these parameters. CONCLUSIONS: Changes in lower urinary tract symptoms severity had little impact on disease specific quality of life in 50 to 79-year-old men or on generic quality of life during the 4.2-year followup.

Activities of Daily Living↗

Divorce, family conflict, and adolescents' well-being.

The relative effects of family conflict and divorce on the well-being of adolescents were examined in a longitudinal study of a heterogeneous community sample. Higher levels of family conflict were associated with increases in adolescents' depressed mood, anxiety, and physical symptoms over time. In contrast, neither recent divorce nor earlier divorce was associated with longitudinal changes in any health outcomes. Also, adolescents living in intact families with high conflict had significantly poorer well-being than those living in families of divorce with low conflict. Finally, the longitudinal effects of divorce and family conflict did not differ by age and sex, but Hispanic adolescents experienced more negative effects of family conflict than non-Hispanic whites, and the well-being of Asian adolescents was influenced more strongly by recent divorce.

Adolescent↗

Long-term stability of dental arch form in normal occlusion from 13 to 31 years of age.

Based on observations of longitudinal changes in dental arch dimensions, it has been stated that an individuality of arch form and an integrity of this form exists. However, longitudinal studies evaluating arch form changes have rarely been reported in the literature. The purpose of this investigation was to use a computer-assisted method for the description and analysis of maxillary and mandibular arch form in a sample of normal occlusion subjects, and to evaluate the long-term stability in dental arch form from the age of 13-31 years. The study was carried out on 30 subjects of Scandinavian origin with normal occlusion, recorded at a mean age of 13.6 years and at follow-up at 31.1 years. Arch form analysis was based on a standardized photographic procedure, digitization of morphological landmarks, and a computerized form analysis in which arch form was described using eccentricity values of conics. No specific arch form could be found to represent the sample. Age changes occurred in arch form, although with large individual variations. For the mandible, a significant change to a more rounded arch form with age was found, which in males was accompanied by a significant increase in inter-molar distance and reduction in arch depth. There was also a significant correlation between change in mandibular arch form and increased irregularity of the lower incisors. These findings of lack of stability in arch form in normal occlusion subjects, when passing from adolescence into adulthood, further question the possibility of achieving stability post-orthodontically.

Adolescent↗

Mood change and empathy decline persist during three years of internal medicine training.

PURPOSE: To examine longitudinal changes in mood and empathy over the course of the internal medicine residency. METHOD: The authors conducted a cohort study of 61 residents who completed the Profile of Mood States (POMS) and the Interpersonal Reactivity Index (IRI) at six time points during their internal medicine residency at a university-based program. (POMS was administered five times, and IRI was administered six times.) The main outcomes measured were trends in mood disturbances and multiple domains of empathy over the three-year residency, and comparisons to norms. RESULTS: Response rates varied from Time 1 to Time 6 (98%, 72%, 79%, 79%, 94%, and 95%, respectively). Interns had better scores on four POMS subscales: Depression-Dejection (p = .0031), Anger-Hostility (p < .0001), Fatigue-Inertia (p < .0001), and Vigor-Activity (p < .0001) compared with later administrations, especially midinternship. By the end of residency all POMS scores were returning towards baseline (effects sizes in the .20 s), but only depression was no longer significantly different. IRI scores showed the decline in Empathic Concern remained over residency whereas Personal Distress peaked midinternship year but approached baseline at the end of residency. Compared with the general population, the graduating residents were less tense, depressed, and confused. Personal Distress was significantly lower than the norm group. CONCLUSIONS: Internal medicine residency presents challenges resulting in common mood disturbances. Although graduating residents appear to be better off than the population norms, some domains of their mood disturbances and empathy never fully recover from their internship year.

Affect↗

Long-term changes in corneal surface configuration after penetrating keratoplasty.

PURPOSE: To examine the long-term longitudinal changes in corneal surface configuration as determined by Fourier series harmonic analysis of videokeratography data and of visual acuity and refraction after penetrating keratoplasty (PK). DESIGN: Interventional case series. METHODS: One hundred thirty eyes of 130 consecutive patients who were scheduled for PK using 16 interrupted 10-0 nylon sutures were recruited. Spherical equivalent power, regular astigmatism component, irregular astigmatism (asymmetry and higher-order irregularity) component of the central cornea as determined by Fourier analysis of videokeragraphic data, spectacle-corrected visual acuity, and spherical equivalent were examined at 1 week, and at 1, 3, 6, 9, 12, 18, and 24 months after PK. RESULTS: Spherical equivalent power increased considerably for up to 1 month after PK, but thereafter showed no further appreciable change up to the final follow-up at 24 months. The regular astigmatism component decreased markedly for up to 6 months after PK, while the total irregular astigmatism (sum of the asymmetry and higher-order irregularity) component decreased considerably up to approximately 3 months, and then these showed no further relevant change for up to 24 months. Spectacle-corrected visual acuity also improved markedly until approximately 3 months after PK, after which it was virtually stable. Furthermore, important correlations were found between regular and irregular astigmatism and the spectacle-corrected visual acuity. CONCLUSIONS: Corneal surface configuration after PK appears to be stable by approximately 6 months after PK, concurrent with postkeratoplasty stabilization of visual acuity.

Adult↗

Changes in physical strain and physical capacity in men with spinal cord injuries.

To determine longitudinal changes in physical capacity and physical strain during activities of daily living (ADL), 37 men with spinal cord injuries (C4/5-L5) performed an exercise test and various ADL on two occasions (T1 and T2; interval 34.5 +/- 1.5 months). Parameters of physical capacity were aerobic power (VO(2peak)) and maximal power output (PO(max)). Physical strain was estimated by the heart rate response relative to the heart rate reserve. VO(2peak) at T2 (1.75 +/- 0.55 1*min(1)) did not significantly differ from that at T1 (1.67 + 0.47 1*min(-1)). Absolute PO max improved (P < 0.05) from 64.9 +/- 25.9 (T1) to 71.7 +/- 27.2 W (T2), whereas relative PO(max) did not change. Activity level, time since injury, change in body mass, and occurrence of rehospitalization were the most important predictors of changes in physical capacity. Changes in relative VO(2peak) were related (P < 0.05) to changes in strain during transfers to the shower wheelchair (r = -0.39) and shower seat (r = -0.46), and during the curb ascent (r = -0.47). In conclusion, the hypothesized decline in physical capacity did not occur over the 3-yr period. Maintenance of physical capacity, which may in part be achieved through sport participation and improved medical care, together with avoidance of excessive body mass, may be useful to prevent high levels of strain during ADL.

Activities of Daily Living↗

Mapping hippocampal and ventricular change in Alzheimer disease.

We developed an anatomical mapping technique to detect hippocampal and ventricular changes in Alzheimer disease (AD). The resulting maps are sensitive to longitudinal changes in brain structure as the disease progresses. An anatomical surface modeling approach was combined with surface-based statistics to visualize the region and rate of atrophy in serial MRI scans and isolate where these changes link with cognitive decline. Sixty-two [corrected] high-resolution MRI scans were acquired from 12 AD patients (mean [corrected] age +/- SE at first scan: 68.7 +/- 1.7 [corrected] years) and 14 matched controls (age: 71.4 +/- 0.9 years) [corrected] each scanned twice (1.9 +/- 0.2 [corrected] years apart, when all subjects are pooled [corrected] 3D parametric mesh models of the hippocampus and temporal horns were created in sequential scans and averaged across subjects to identify systematic patterns of atrophy. As an index of radial atrophy, 3D distance fields were generated relating each anatomical surface point to a medial curve threading down the medial axis of each structure. Hippocampal atrophic rates and ventricular expansion were assessed statistically using surface-based permutation testing and were faster in AD than in controls. Using color-coded maps and video sequences, these changes were visualized as they progressed anatomically over time. Additional maps localized regions where atrophic changes linked with cognitive decline. Temporal horn expansion maps were more sensitive to AD progression than maps of hippocampal atrophy, but both maps correlated with clinical deterioration. These quantitative, dynamic visualizations of hippocampal atrophy and ventricular expansion rates in aging and AD may provide a promising measure to track AD progression in drug trials.

Aged↗

A longitudinal and retrospective study of PTSD among older prisoners of war.

OBJECTIVE: The authors examined the longitudinal changes in posttraumatic stress disorder (PTSD) symptom levels and prevalence rates over a 4-year time period among American former prisoners of war (POWs) from World War II and the Korean War. Retrospective symptom reports by World War II POWs dating back to shortly after repatriation were examined for 1) additional evidence of changing PTSD symptom levels and 2) evidence of PTSD cases with a long-delayed onset. METHOD: PTSD prevalence rates and symptom levels were measured by the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder. For the longitudinal portion of the study, participants were 177 community-dwelling World War II and Korean POWs. For the retrospective portion, participants were 244 community-dwelling World War II POWs. RESULTS: PTSD prevalence rates and symptom levels increased significantly over the 4-year measurement interval. Retrospective symptom reports indicated that symptoms were highest shortly after the war, declined for several decades, and increased within the past two decades. Long-delayed onset of PTSD symptoms was rare. Demographic and psychosocial variables were used to characterize participants whose symptoms increased over 4 years and differentiate participants who reported a long-delayed symptom onset. CONCLUSIONS: Both longitudinal and retrospective data support a PTSD symptom pattern of immediate onset and gradual decline, followed by increasing PTSD symptom levels among older survivors of remote trauma.

Age Factors↗

Food purchased away from home as a predictor of change in BMI z-score among girls.

OBJECTIVES: To assess the relationship between eating food purchased away from home (FAH) and longitudinal change in body mass index (BMI) z-score among girls, and to assess the longitudinal tracking of eating FAH from childhood through adolescence. DESIGN: Participants kept 7-day dietary records at two points in time. The records included the place and time for all foods consumed. We recorded how often participants ate FAH, calculated the percent of total energy derived from FAH, and classified foods as quick-service food, coffee-shop food, or restaurant food. PARTICIPANTS: Healthy girls (n=101) between the ages of 8 and 12 y at baseline and 11 and 19 y at follow-up participated in a longitudinal study of growth and development at the Massachusetts Institute of Technology. STATISTICAL ANALYSES: Analysis of variance was used to assess the relationship between change in BMI z-score and both the frequency of eating FAH and energy derived from eating FAH. The participants' baseline BMI z-score was a significant covariate and was controlled for in both models. We used the kappa coefficient to assess FAH tracking from childhood through adolescence. RESULTS: The frequency of eating quick-service food at baseline was positively associated with change in BMI z-score (F=6.49, P<0.01). Participants who ate quick-service food twice a week or more at baseline had the greatest mean increase in BMI z-score compared to those who ate quick-service food once a week or not at all. Quick-service food eating tracked slightly from childhood through adolescence (k=0.17, P<0.05). DISCUSSION: Adolescent girls who eat quick-service food twice a week or more are likely to increase their relative BMI over time.

Adolescent↗

Changes in quality of life among elderly patients with hip fracture in Taiwan.

To examine the longitudinal change in health related quality of life (HRQoL) during 1 year following hospital discharge in elderly subjects, 110 hip fractured subjects (age, mean+/-SD: 79.3+/-7.4 years) were enrolled in a prospective study. Face-to-face interviews with the patients were conducted, using Short Form 36 (SF-36) at 1, 3, 6, and 12 months after they were discharged from the hospital. The GEE approach was employed to evaluate changes in the variables of interest among different time points. Subjects in this study appeared to have lower scores in most dimensions of SF-36, with physical function and role limitation being the lowest due to physical problems (mean+/-SD=10.97+/-16.19; 6.32+/-20.60) during the 1st month after hospital discharge, compared to community dwelling subjects (mean+/-SD=77.5+/-20.5; 63.8+/-45.30). Most of the dimensions of SF-36, except general health (6th month versus 3rd month=57.56+/-21.90 versus 61.75+/-23.46, P>0.05) improved significantly from the 1st month to the 3rd month (range of means of improved scores from 12.81 to 30.76, P<0.01). After the 3rd month after discharge, physical functions kept improving significantly until 6 months after hospital discharge (3rd month versus 6th month=25.18+/-23.66 versus 40.30+/-25.94, P<0.05). Role limitation due to physical problems reached a plateau between the 3rd and 6th month, and then again improved significantly during the 6th month and the 1st year after hospital discharge (6th month versus 1st year=17.69+/-31.78 versus 32.22+/-44.47, P<0.05). The rest of the dimensions of SF-36 remained stable from the 3rd month to 1 year after discharge. These results indicated that different aspects of SF-36 recovered differently for the hip fractured patients in Taiwan. Similar studies may be helpful for health-care providers in other countries with Chinese populations to develop specific intervention programs.

Aged↗

Incidence and progression of nuclear opacities in the Longitudinal Study of Cataract.

PURPOSE: To estimate incidence and progression rates of nuclear opacities in the Longitudinal Study of Cataract, an epidemiologic study of the natural history of all types of lens opacities. METHODS: The Lens Opacities Classification System III was used to assess longitudinal changes between baseline and follow-up lens photographs for the 764 Longitudinal Study of Cataract participants. Baseline data, collected until December 1988 as part of a case-control study, included color slit, retroillumination, and Scheimpflug photographs. The same data were collected by the longitudinal Study of Cataract at four subsequent visits at yearly intervals. RESULTS: Among patients free of nuclear opacities at baseline, the incidence of new opacities was 6% after 2 years and 8% after 5 years of follow-up. The progression of pre-existing nuclear opacities was much higher. After 2 years, nuclear opacities had progressed in more than one third of the patients with pre-existing opacities; after 5 years, almost half had progressed. Older age was significantly related to higher incidence of new nuclear opacities, but not to progression of pre-existing opacities. Patients with other opacity types had higher nuclear incidence and progression rates. CONCLUSIONS: In this clinic-based, older-patient population, new nuclear opacities developed in less than one tenth of the patients after 5 years of follow-up. In contrast, almost one half of the patients with pre-existing opacities had worsened after 5 years. These estimated rates can be used to plan intervention or other studies of nuclear changes in similar populations.

Aged↗

Changes in ponderosity and blood pressure in childhood: the Muscatine Study.

This paper describes the association between longitudinal changes in blood pressure and changes in measures of ponderosity. Between 1971 and 1981, 2,925 Muscatine, Iowa schoolchildren were measured at least once between ages 6 and 15 years and again between ages 15 and 18. The study shows that change in ponderosity is associated with change in blood pressures; children whose ponderosity decreases relative to their peers usually exhibit a similar drop in their systolic and diastolic blood pressures, while children who gain in ponderosity show a similar gain in their blood pressures. The magnitude of change in blood pressure is related to amount of ponderosity gain or loss and does not depend on initial blood pressure. These data suggest that for obese children weight loss might be an effective method for reducing their blood pressure.

Adolescent↗

Cochlear whole mount in situ hybridization: identification of longitudinal and radial gradients.

The morphology of the organ of Corti has a radial asymmetry and also changes longitudinally from base to apex. Cellular localization of transcripts within the inner ear has relied primarily on the use of sectioned tissue with in situ hybridization. However, radial and longitudinal gradients of expression are not readily recognized using sectioned tissue owing to problems in visualization of signals with varying intensities. Herein, we describe the use of whole mount in situ hybridization for identification of cochlear longitudinal and radial expression gradients in the neurosensory epithelium, hair cells. Not only can these hair cell gradients be shown in adult tissues, but also the developmental up-regulation and down-regulation of genes and their associated spatio-temporal expression patterns can be demonstrated.

Aging↗

Changes in maternal distress and child-rearing strategies across treatment for pediatric cancer.

OBJECTIVES: To examine longitudinal changes in perceived stress, affective distress, and self-reported parenting strategies among mothers of children with cancer over the initial 6 months of diagnosis and treatment, and to examine relationships between changes in distress and subsequent parenting strategies. METHOD: Questionnaire data were gathered regarding parental perceived stress, caregiver burden, affective distress, and parenting strategies from 65 mothers of children (mean age = 8.3 years) with cancer at 2-5, 12-14, and 22-24 weeks postdiagnosis. RESULTS: Consistent with other studies in the literature, maternal affective distress decreased over the time course of the study. Perceived stress also decreased, while caregiver burden remained relatively stable. Parental consistency fluctuated over the study period, while other parenting strategies (i.e., control, nurturance, and responsiveness) remained stable. CONCLUSIONS: Although maternal affective distress decreased following the initial diagnosis of cancer, sources of stress (e.g., caregiver burden) may remain stable, indicating the need for interventions to bolster parental coping resources.

Child↗

Lifestyle influences on 9-year changes in BMD in young women.

UNLABELLED: The effects of dietary calcium intake and physical activity on longitudinal changes in BMD over a mean of 9.4 years were examined in 62 healthy young women. Proximal femur BMD declined, lumbar spine BMD increased, and physical activity was associated with BMD change at intertrochanter and total hip sites. INTRODUCTION: Maximizing premenopausal BMD is an important strategy for the prevention of osteoporosis and resultant fractures later in life. MATERIALS AND METHODS: Young women who previously participated in a placebo-controlled 2-year calcium intervention study at a mean age of 18.5 +/- 0.3 years were remeasured at 27.8 +/- 1.0 years of age. DXA (Hologic QDR 1000W) was used to measure changes in BMD, and lifestyle factors were ascertained by questionnaire. RESULTS AND CONCLUSIONS: Early decline in BMD at the neck of femur (-3.3%/decade) and the converse gain in BMD at the lumbar spine (+4.3%/decade) and intertrochanter (+1.9%/decade) suggest site-specific changes in BMD in young premenopausal women. No effect of previous calcium supplementation was seen on current BMD or changes in BMD (p > 0.10). Lifestyle predictors of change in BMD were determined using hierarchical regression analysis after forced correction for the covariates baseline BMD and previous calcium supplementation. Physical activity was positively associated with change in BMD at total hip and intertrochanter sites (beta-coefficients, beta = 0.26 and 0.26 respectively; p < 0.05). Calcium intake was negatively associated with change in BMD at the lumbar spine (beta = -0.27, p < 0.05). Parity was negatively associated with change in BMD at all sites (beta = -0.40 to -0.26, p < 0.05). These data show that BMD is already declining at the proximal femur in these healthy young women. Physical activity assists in maintenance of BMD at some sites and thus may contribute to lifelong fracture prevention. There was no positive association between calcium intake and change in BMD.

Adult↗

A longitudinal study of change in domain-specific self-efficacy among older adults.

Predictors of change in domain-specific self-efficacy were examined in a sample of community-residing men and women aged 62 and older. Self-efficacy perceptions were assessed for eight domains of living: productivity, health, transportation, family relationships, relationships with friends, finances, safety, and living arrangements. Using pooled logistic regression models, both baseline and time-varying predictors of decline and improvement in self-efficacy were examined. The results indicated that while demographic and health factors were predictive of decline in self-efficacy for some domains of living, the most consistent predictors of decline were psychosocial characteristics. Specifically, prior levels of depression were associated with decline in the transportation, family relationships, relationships with friends, financial, safety, and living arrangements domains of living. The presence of a domain-specific hassle was associated with a decline in self-efficacy for the transportation, family relationships, finances, and living arrangements domains. In addition, lower levels of social network contact were predictive of decline in the health and safety domains, and the absence of instrumental support was also associated with decline in the productivity, health, and transportation domains of living. Improvements in self-efficacy perceptions were associated with fewer of the health and psychosocial characteristics and were primarily influenced by the availability of financial and emotional support resources.

Activities of Daily Living↗

Assessment of bias in the SENECA study.

OBJECTIVE: To assess manifest bias in ageing effects, i.e. longitudinal changes due to unintended time effects or to selection. DESIGN: Mixed-longitudinal study in birth cohorts 1913-1918, with baseline measurements taken in 1988/1989 and repeated in 1993, including a short questionnaire in non-responders. SETTING: Full baseline and follow-up data were collected in nine towns in eight European countries including Belgium, Denmark, France, Italy, The Netherlands, Portugal, Spain and Switzerland. Incomplete data were available from towns in Portugal, Poland, Northern Ireland and Connecticut, USA. SUBJECTS: Using standardized methodologies data were collected from a random age-stratified sample of elderly men and women, including a total of 1221 re-invited subjects from nine towns and 210 newly-invited subjects from three towns in 1993. RESULTS: An overall retrieval of 50-74% of the former participants could be reached in towns that had previously participated (apart from one exception of 41%), where estimates of mortality varied from 10% to 18%. There was a tendency for healthy and active persons to have a higher participation rate than others, as was the case for high educated newly-invited subjects compared to lower educational classes. For most of the variables used in the analysis of period effects, no evidence of any undesirable period effect was found. In those instances that period effects showed up to be statistically significant, coinciding implausible cohort effects gave the impression that these were due to instability of the estimation procedure. CONCLUSIONS: Non-participants may be less healthy and active than the participants. Only very limited unconvincing evidence to suggest unintended time effects was observed. This confirms the high standards of the methodology and of measurements.

Aged↗

Changes and tracking of physical activity across seven years in Mexican-American and European-American mothers.

Longitudinal changes in physical activity among 129 Mexican-American (mean age 30.8; SD = 5.6) and 97 European-American (mean age 31.2; SD = 5.4) women were studied. Two physical activity recall interviews were administered at baseline and 7 years later. At baseline, European-American women reported more vigorous leisure activity (p < .005) than Mexican-Americans, and Mexican-Americans reported more moderate work activity (p < .02) than European-Americans. Virtually all components of physical activity increased significantly over the 7 years. Pearson tracking correlations for total energy expenditure were about r = 0.30. The finding that both groups increased physical activity overtime was unexpected and was unrelated to a reduction in the number of preschool children in the homes over time.

Adult↗