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PubMedDate not supplied

Mental status and functional abilities: change in institutionalized elderly women.

A study of 40 institutionalized elderly women was undertaken to determine if changes occurred in mental status and functional abilities over the course of 1 year. Although a number of studies examine factors that impact on successful adaptation in persons admitted to long-term care facilities, the longitudinal changes on functional abilities and mental status have not been addressed. These variables were examined in relation to the concept of self-care, which has been applied to the elderly only recently. Findings indicate a decline in mental status and an increase in functional dependency. Nursing implications and questions that merit further study in the area of self-care are presented.

Activities of Daily Living↗

PubMed1999

Length measurements of the aorta after endovascular abdominal aortic aneurysm repair.

BACKGROUND: successful endovascular repair of abdominal aortic aneurysms (AAA) generally leads to a decrease in aneurysm size. Theoretically, this may lead to foreshortening of the excluded segment. If so, vertically rigid endografts may dislocate over time and cover renal or hypogastric arteries. AIM: to assess length changes of the infrarenal aorta after endovascular AAA exclusion. PATIENTS AND METHODS: forty-four consecutive patients were scheduled for the EndoVascular Technologies endograft, a vertically non-rigid prosthesis which would potentially accommodate longitudinal changes. Twenty-four patients had completed at least 6 months of follow-up. In 18/24 patients a decrease in size was established by aneurysm volume measurements at 6 months' follow-up. Helical computer tomography (CT) angiograms were processed on a workstation. Aortic lengths were measured along the central lumen line from the lower renal artery orifice to the native aortic bifurcation. The computer tomography angiogram (CTA) reconstruction thickness of 2 mm yields at least a 4-mm error for each length measurement. RESULTS: in the shrinking aneurysm group, the median length change was 0 mm (range -9 mm to +4 mm) at 6 months' follow-up (n =18) and also 0 mm (range -7 mm to +4 mm) at 12 months' follow-up ( n =10). In 16/18 patients, length changes remained within the measurement error range of 4 mm. CONCLUSION: in this group of shrinking aneurysms after endovascular AAA repair, foreshortening of the excluded aortic segment appears not to be a clinically significant problem.

Aged↗

PubMed2000

Multifrequency bioelectrical impedance analysis in women with a normal and hypertensive pregnancy.

BACKGROUND: An increase in total body water is common in normal pregnancy. It is thought to be an important mechanism of maternal adaptation to pregnancy. OBJECTIVE: The aim of the present study was to assess longitudinal changes in body water compartments in pregnant women and to correlate these measurements with the course of pregnancy. DESIGN: One hundred seventy-three pregnant women with apparently normal, single pregnancies participated in this longitudinal study. Anthropometric measurements and multifrequency bioelectrical impedance were performed during the first, second, and third trimesters of pregnancy. RESULTS: One hundred three of the women completed all of the measurements; 50 of the women had a normal pregnancy and 13 had gestational hypertension. Total body water, extracellular water, and intracellular water values in normal pregnancies showed a significant, progressive increase throughout pregnancy. In women with gestational hypertension, total body water, extracellular water, and intracellular water values showed an opposite trend, suggesting a lack of plasma volume expansion through fluid-retention mechanisms. CONCLUSIONS: Our results show that multifrequency bioelectrical impedance analysis can be used to monitor variations in body water compartments in normal pregnancy and detect gestational hypertension.

Adult↗

PubMed2005

Cerebral structural changes in severe obstructive sleep apnea.

Obstructive sleep apnea is associated with abnormalities in neuropsychologic function, and defects in respiratory control may contribute to pathogenesis. Abnormalities may be reflected in structural brain changes. Twenty-seven male untreated patients with severe sleep apnea without comorbidities, and 24 age-matched control subjects, had T1-weighted brain imaging in a high-resolution magnetic resonance scanner. Twenty-three patients with sleep apnea had repeat imaging after 6 months of continuous positive airways pressure treatment. No areas of gray matter volume change were found in patients using an optimized voxel-based morphometry technique, at p < 0.05 adjusted for multiple comparisons (despite the method being sensitive to changes in gray matter fraction of 0.17 or less in all voxels). Furthermore, no differences were seen in bilateral hippocampal, temporal lobe, or whole brain volumes, assessed by manual tracing of anatomical borders. No longitudinal changes were seen in gray matter density or regional volumes after treatment, but whole brain volume decreased slightly. We have found no gray matter volume deficits nor focal structural changes in severe obstructive sleep apnea. Whole brain volume decreases without focal changes after 6 months of continuous positive airways pressure treatment.

Adult↗

PubMed2025

A randomized controlled trial to unveil the influence of an exercise intervention on brain integrity and gut microbiome structure in individuals with HIV.

OBJECTIVE: Exercise intervention programs enhance physical fitness, cognition, neuroimaging measures, and alter the structure of the gut microbiome in individuals without HIV. However, interventional studies exploring the effects of exercise in persons with HIV (PWH) have not included neuroimaging or gut microbiome analyses. DESIGN: A randomized controlled trial conducted at Washington University in St. Louis, MO, USA. METHODS: 65 PWH (aged ≥40 years, self-reported sedentary lifestyle) were randomly assigned to a 6-month cardiorespiratory and resistance training (EXS) or stretching control (SIS) intervention in a 2 : 1 ratio. Longitudinal change in cognition, cerebral blood flow (CBF), physical and cardiorespiratory fitness, and gut microbiome diversity and composition were examined among participants ( n  = 62) who completed any portion of the intervention (ClinicalTrials.gov: NCT02663934). RESULTS: Better fitness and better cognitive performance were associated with greater phylogenetic diversity in gut microbiome composition at baseline. Longitudinal findings indicated slight but significant improvements in psychomotor speed and executive function, reductions in body mass index, improvements in physical fitness, and increased gut microbiome diversity. These changes were observed regardless of assigned intervention group. There were no observed changes in CBF for either group. CONCLUSIONS: These findings highlight physical fitness as a modifiable factor in PWH that may improve cognitive performance and change gut microbiome composition. Both interventions were beneficial, suggesting light stretching exercise or study participation alone could have been sufficient to introduce positive cognitive shifts in previously sedentary PWH. Longer interventions with more participants are needed to identify changes in neuroimaging metrics related to brain integrity.

Humans↗

PubMed1988

A longitudinal study of pre- and postmenopausal changes in calcium metabolism.

Longitudinal changes in the serum concentration of calcium, phosphate, alkaline phosphatase, PTH, calcitonin and the renal handling of calcium and phosphate were studied in 19 normal women of the same age before and after the menopause. Significant increase in serum calcium, phosphate and calcitonin and urine calcium/creatinine and TmPO4/GF were shown to precede the premenopause. After cessation of the menstruation, no statistically significant further changes were observed in these variables. Changes in PTH were not observed neither during the premenopausal nor the post-menopausal period. Alkaline phosphatase increased in the postmenopausal period suggesting an increase in bone turn-over.

Calcium↗

PubMed1997

Access to health care: bridging the gap between policy and research.

Access to care has long been studied by researchers, but emphasis has shifted recently from measuring whether access is worse for the poor and uninsured to monitoring how access is changing over time. Only a limited number of measures have been used consistently to monitor changes longitudinally, and these suggest that access by the uninsured is declining. There are potentially more valuable measures to track access, but data that are consistent over time have not been available. This Issue Brief, which is based on a seminar held by the Center for Studying Health System Change, discusses current research efforts to measure access to care.

Data Collection↗

PubMed2000

Lipoprotein lipase (C/G)447 polymorphism and blood pressure in the Stanislas Cohort.

OBJECTIVE: Association between blood pressure and triglyceride levels, and between lipoprotein lipase (LPL) (C/G)447 polymorphism and triglyceride levels has been described. We investigated whether the LPL (C/G)447 polymorphism was associated with blood pressure (BP) levels and longitudinal changes. DESIGN AND PARTICIPANTS: For cross-sectional analysis, 767 men and 816 women (29-55 years) were selected from the Stanislas Cohort, a cohort of volunteers for a free health check-up. Only subjects without anti-hypertensive or lipid-lowering medication were included in the study. A subset of this sample population, 359 men and 337 women, had been followed during the 11 years prior to recruitment in the Stanislas Cohort and was used for longitudinal analysis. RESULTS: The cross-sectional study showed that serum triglyceride levels differed significantly according to LPL genotypes in both genders, the G447 allele being associated with the lowest triglyceride levels (P < or = 0.01). Univariate and multivariate analysis found that LPL polymorphism was not related to BP levels in men. In contrast, women with the LPL-G447 allele had lower systolic (SBP) and pulse (PP) pressure levels than those with the LPL-CC genotype (P < or = 0.01 and P < or = 0.05, respectively); this association being independent of triglyceride level. The longitudinal study showed LPL genotype was an independent predictor of PP and SBP follow-up levels in women; changes over 11 years being lower for LPL-G447 allele carriers (P < or = 0.05). These associations were independent of triglyceride level. CONCLUSION: The LPL-G447 allele was found associated with lower PP and SBP independently of triglyceride level in women. This result suggests that the LPL gene may influence blood pressure.

Adult↗

PubMed1995

Blue-collar normative spirometric values for Caucasian and African-American men and women aged 18 to 65.

Normative spirometric values were derived from 5,042 white (of mainly European ancestry) and black (of mainly African ancestry) men and women paper plant workers who are never-smokers, with no respiratory symptoms or diagnoses and no history of occupational exposure to fibrogenic dusts or irritant chemicals. This cohort was selected from a much larger population under long-term respiratory surveillance (n > 50,000 at 50 plants). Standardized equipment, procedures, and data reduction methods complied with ATS recommendations. Data were collected by the medical departments of the participating companies as part of their routine health surveillance, and the graphic and numeric test results were transmitted to the Tulane University Section of Environmental Medicine for centralized quality assurance, interpretation, and archiving. The large numbers allow derivation of gender- and race-specific reference values. Lower limits of normal were derived and depend upon residual variation and any changes in variation with age. The results indicate that polynomial regression equations provide a significantly better fit than linear regressions with breakpoints. In addition to being more biologically plausible, the polynomial model more closely matches observed longitudinal changes in lung function with age. The age range of the cohort, 18 to 65, provides a regression that more closely matches the observed values in this range, because it does not include "supernormal" elderly survivors, which can lessen the slope of the regression and artifactually increase the predicted values of 50 to 65 yr olds. The regression equations derived for black men and women do not support the use of a single race adjustment (0.85 or 0.88) for all age, sex, height, and spirometric test parameter combinations. These race- and gender-specific regression equations, with their respective lower limits of normal, should improve the detection and quantification of adverse health effects in working individuals and populations.

Adolescent↗

PubMedDate not supplied

Longitudinal evaluation of prostate-specific antigen levels in men with and without prostate disease.

OBJECTIVE: To evaluate longitudinal changes in prostate-specific antigen (PSA) levels in men with and without prostate disease. DESIGN: Case-control study of men with and without prostate disease who were participants in a prospective aging study. SETTING: Gerontology Research Center of the National Institute on Aging; the Baltimore (Md) Longitudinal Study of Aging. PATIENTS: Sixteen men with no prostate disease (control group), 20 men with a histologic diagnosis of benign prostatic hyperplasia (BPH), and 18 men with a histologic diagnosis of prostate cancer. OUTCOME MEASURES: Multiple PSA and androgen determinations on serum samples obtained from 7 to 25 years prior to histologic diagnosis or exclusion of prostate disease. RESULTS: Changes in androgen levels with age did not differ between groups. Control subjects did not show a significant change in PSA levels with age. There was a significant difference in the age-adjusted rate of change in PSA levels between groups (prostate cancer greater than BPH greater than control; P less than .01). At 5 years before diagnosis when PSA levels did not differ between subjects with BPH and prostate cancer, rate of change in PSA levels (0.75 micrograms/L per year) was significantly greater in subjects with prostate cancer compared with control subjects and subjects with BPH. Also, rate of change in PSA levels distinguished subjects with prostate cancer from subjects with BPH and control subjects with a specificity of 90% and 100%, respectively. CONCLUSIONS: The most significant factor affecting serum PSA levels with age is the development of prostate disease. Rate of change in PSA levels may be a sensitive and specific early clinical marker for the development of prostate cancer.

Aged↗

PubMed2002

Changes in the concentration of plasma matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases-1 (TIMP-1) after total joint replacement in patients with arthritis.

Matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) have been reported to be associated with arthritis. Total joint replacement results in total resection of cartilage and synovium at the joint. We investigated longitudinal changes in plasma MMP and TIMP after total joint replacement. Eight patients with osteoarthritis (OA) and 15 patients with rheumatoid arthritis (RA) had total knee or total hip replacements. Plasma was collected from all patients before surgery and at 1 week and 6 weeks after surgery. In RA patients the plasma MMP-3 and the MMP-3/TIMP-1 ratio decreased after total joint replacement, whereas CRP and ESR did not change. Therefore, CRP and ESR reflect systemic inflammation; however, plasma MMP-3 and the MMP-3/TIMP-1 ratio may reflect inflammation and/or degeneration of the affected joint.

Aged↗

PubMed2006

A comparison of glycaemic and metabolic control over time among South Asian and European patients with Type 2 diabetes: results from follow-up in a routine diabetes clinic.

AIMS: Although South Asians have a higher prevalence of diabetes which develops at a younger age, data on change in metabolic parameters post-diagnosis are relatively sparse. We therefore wished to determine whether South Asians with diabetes had similar or greater year-on-year deterioration in metabolic parameters compared with Europeans. METHODS: We analysed longitudinal change in metabolic parameters [glycated haemoglobin (HbA(1c)), blood pressure, body mass index (BMI), lipids] among South Asian (n = 210) and European (n = 1557) patients consecutively attending the same diabetes clinic over a mean period of 5.3 years. RESULTS: South Asians were younger than Europeans at first recorded diagnosis of diabetes (mean age 45.9 vs. 57.3 years, P < 0.001) and had significantly lower ( approximately 1.2 units) BMI and blood pressure. Mean HbA(1c) was not different across ethnic groups at first visit, but with time glycaemic control was worse in South Asians than Europeans, with average deterioration 1.31% (= 0.23%/year) in Asians vs. 0.82% (0.16%/year) in Europeans, P = 0.003. This ethnic difference in mean change in HbA(1c) persisted after adjustment for age, sex, baseline HbA(1c), and weight change in linear regression analysis (beta = 0.46, 95% CI 0.24-0.69, P < 0.001), and with additional adjustment for time to referral and duration of diabetes (P = 0.01). Moreover, South Asians had significantly smaller improvements in blood pressure (P < 0.001) and cholesterol (P = 0.044) over the follow-up period in keeping with fewer prescriptions of anti-hypertensive agents and lipid-lowering agents. CONCLUSIONS: These data suggest the need to be more aggressive in the management of diabetes and related risk factors in South Asians.

Age Distribution↗

PubMedDate not supplied

Creatine kinase and creatine kinase isoenzymes as a marker of uterine activity.

Creatine kinase (CK) and CK isoenzymes are known to fluctuate in labor. Reliable information about the longitudinal changes of CK and CK isoenzymes during labor is sparse. Nevertheless, they have been used to direct care in women with cardiopulmonary disease and preterm labor requiring tocolysis. This study evaluated fluctuations of CK and its isoenzymes longitudinally across labor in 49 women. Blood samples were obtained at 33 to 34 weeks' estimated gestational age, on admission in labor at 3 cm or less dilation, 8 cm to complete dilation, and postpartum in the recovery room. Specimens were analyzed for total CK, CK-MM, CK-MB, and CK-BB activity. CK levels increased for all peripartum patients (p < 0.001). CK activity at 3 cm was greater than at 34 weeks (p < 0.01). Furthermore, the early rise in CK activity was greater in those in active labor compared with those who required oxytocin stimulation (p < 0.001). CK values at 8 cm and postdelivery (mean IU/liter) were often above nonpregnant norms. The early rise of CK in spontaneously laboring patients versus those requiring oxytocin augmentation may represent a difference in uterine activity. Nonpregnant normative data for CK is not appropriate when assessing cardiovascular side effects of betamimetic therapy.

Biomarkers↗

PubMed1996

Natural history of infantile anisometropia.

AIMS/BACKGROUND: In a previous study longitudinal changes of anisometropia were investigated. It was shown that anisometropia arises and vanishes during the emmetropisation process and that the associated risk for amblyopia is low. The aim of this study was to follow acuity and refraction longitudinally in children with marked anisometropia at 1 year of age. METHODS: Refractive errors and visual acuity were estimated every sixth month for a selected group of 20 children with marked anisometropia > or = 3.0 D (spherical equivalent) at 1 year of age from approximately 3 to 10 years of age. RESULTS: The children could be classified into three groups. In six subjects the anisometropia increased (mean 1.4 D) and they all developed amblyopia. The remaining children could be classified into two groups of equal size. One group developed no amblyopia and the anisometropia decreased with a mean of 3.0 D. The seven remaining children developed amblyopia and/or strabismus; the mean anisometropia decrease was 1.2 D. CONCLUSION: Anisometropia at 1 year of age that is larger or equal to 3.0 D will in 90% of the cases still be there at 10 years of age. There is a substantial risk of this group developing amblyopia (60%).

Amblyopia↗

PubMed2006

Using consecutive Rapid Participatory Appraisal studies to assess, facilitate and evaluate health and social change in community settings.

BACKGROUND: To investigate how a relatively socio-economically deprived community's needs have changed over time, assess which recommendations from an earlier assessment were implemented and sustained, and consider whether serial Rapid Participatory Appraisal is an effective health research tool that can promote community development and has utility in assessing longitudinal change. METHODS: Rapid Participatory Appraisal involves communities in identifying and challenging their own health-related needs. Information on ten health and social aspects was collated from existing documentation, neighbourhood observations, and interviews with a range of residents and key informants, providing a composite picture of the community's structure, needs and services. RESULTS: The perceived needs after 10 years encompassed a wide construct of health, principally the living environment, housing, and lack of finance. Most identified upstream determinants of health rather than specific medical conditions as primary concerns. After the initial Rapid Participatory Appraisal many interviewees took the recommendations forward, working to promote a healthier environment and advocate for local resources. Interventions requiring support from outwith the community were largely not sustained. CONCLUSION: Rapid Participatory Appraisal proved valuable in assessing long-term change. The community's continuing needs were identified, but they could not facilitate and sustain change without the strategic support of key regional and national agencies. Many repeatedly voiced concerns lay outwith local control: local needs assessment must be supported at higher levels to be effective.

Adult↗

PubMed2026

Pilot study identifying distinct circulating proteomic profiles associated with longitudinal CT-defined fibrotic and inflammatory sarcoidosis.

INTRODUCTION: Pulmonary sarcoidosis exhibits heterogeneous clinical trajectories ranging from self-limited disease resolution to chronic progressive fibrosis, yet reliable biomarkers capable of distinguishing these disease patterns remain lacking. Whether longitudinal CT-defined sarcoidosis phenotypes are associated with distinct circulating molecular signatures remains unknown. METHODS: We performed high-throughput plasma proteomics (SomaScan 11K) in participants with pulmonary sarcoidosis classified into longitudinal chest CT-defined progressive fibrosis, progressive nodular inflammatory disease, or resolving disease trajectories, along with healthy controls. CT phenotypes were assigned based on predefined longitudinal changes in reticulation, traction bronchiectasis, nodular involvement, and mediastinal lymphadenopathy across serial CT scans. One plasma sample per participant was selected from the study visit corresponding to the CT time point at which criteria for the assigned longitudinal phenotype were met. Principal component analysis, hierarchical clustering, pathway enrichment, and correlation-based analyses linking protein expression to quantitative CT features were used to evaluate whether distinct longitudinal CT phenotypes were associated with divergent proteomic signatures. RESULTS: Principal component analysis and hierarchical clustering suggested partial segregation by CT-defined phenotype. Longitudinal CT phenotypes were associated with distinct pathway-level proteomic signatures, with progressive fibrosis enriched for epithelial-mesenchymal transition signaling, and progressive nodular inflammatory disease enriched for mTORC1, MYC, oxidative phosphorylation, adipogenesis, and fatty acid metabolism pathways. Correlation analyses showed coordinated protein-expression patterns associated with fibrotic CT features and mediastinal lymph node enlargement. DISCUSSION: These findings suggest that longitudinal CT-defined fibrotic and inflammatory sarcoidosis phenotypes are associated with distinct pathway-level proteomic signatures. This pilot study provides preliminary proof-of-concept evidence that integrating longitudinal CT imaging phenotypes with plasma proteomics may serve as a framework for future mechanistic studies and biomarker discovery in pulmonary sarcoidosis.

Humans↗

PubMed2005

The changes in running performance and maximal oxygen uptake after long-term training in elite athletes.

AIM: The relationship between VO2max (mL x kg(-1) x min(-1)) and running performance has been assessed in cross-sectional studies. Follow-up studies of the long-term effects of running training on the changes in performance and VO2max have not been undertaken. METHODS: Twenty-five male endurance-trained (MET) and 8 female endurance-trained (FET) athletes were tracked over 4 years. In each event the athletes were divided into Class A, including half the number of athletes with the best performances, and Class B. VO2max, examined at the end of the competitive season, and the best performance was chosen each year. RESULTS: After 3 years of training, in MET and FET athletes the performance improved by 1.77% and 0.69% (P<0.01 and P=0.579), respectively. In Class A runners, training resulted in non-significant increase in performance (-0.04%) (P=0.982) and in Class B runners, performance increased by 3.16% (P=0.001). In all groups VO(2max) remained essentially unchanged. Longitudinal changes in the VO2max were not related with the changes in running performance in any group. CONCLUSIONS: This study show than in older runners with more years of training, heavy training does not produce improvements in running performance neither changes in the VO2max. It is possible that these elite athletes have reached the plateau in their performance; although unlikely, some improvement in training techniques may happen and break the present limit. In younger runners with less years of training, heavy training produce improvements in running performance without changes in the VO2max. These athletes that had not attained his biological limits at the beginning of study improved the performance in competition and it is quite probable that this improvement be due to training. The changes in performance were not related to changes in VO2max. Consequently, another physiological or psychological variables must be studied by longitudinal form to explain the variability of performance in competition.

Adaptation, Physiological↗

PubMed2000

Coronary artery blood flow visualization signifies hemodynamic deterioration in growth-restricted fetuses.

OBJECTIVE: To determine the relationship between fetal coronary blood flow (CBF) visualization in intrauterine growth restriction (IUGR), longitudinal changes in arterial and venous flow velocity waveforms and perinatal outcome. METHODS: A total of 48 IUGR fetuses (abdominal circumference below the 5th percentile for gestational age) with absent or reversed umbilical artery (UA) end-diastolic velocity (AREDV) were examined longitudinally by echocardiography attempting CBF visualization at each examination. Doppler evaluation of the middle cerebral artery, inferior vena cava (IVC), ductus venosus (DV) and umbilical vein (UV) was performed at each examination. Doppler measurements were correct for gestational age by conversion into Z-scores (delta-indices). Doppler results and outcome from fetuses in which CBF was visualized (group 1, n = 20) and those in which CBF was never visualized (group 2, n = 28) were compared. Outcome parameters analyzed included Apgar scores, cord arterial blood gases, perinatal mortality, respiratory distress, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis and postpartum circulatory failure requiring pressor support. RESULTS: There was no difference in Doppler indices between groups at study entry. CBF visualization coincides with a significant increase of UA-, IVC- and DV delta-indices. The greatest rate of change was observed for indices in the ductus venosus which occurred in the 24 h preceding CBF visualization. Group 1 fetuses required earlier delivery (median 27 + 4, vs. median 30 + 0), had lower birthweight (682 +/- 305 g vs. 936 +/- 416 g), lower cord pH (7.21 +/- 0.1 vs. 7.27 +/- 0.06) and cord pO2 (13 +/- 4.5 vs. 24.1 +/- 13.5 mmHg) compared to group 2 (all values P < 0.05). Mortality was similar (group 1 = 6/20, 30%; group 2 = 6/28, 21.4%). CONCLUSIONS: In IUGR, fetuses with AREDV and centralization are at high risk for hypoxemia, acidemia and adverse outcome. CBF visualization coincides with deteriorating venous flows. Operator dependence of CBF visualization and the strong association with abnormal venous flow stresses the importance of venous Doppler surveillance in these fetuses.

Blood Flow Velocity↗