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Alcohol habits in Swedish women: observations from the population study of women in Gothenburg, Sweden 1968-1993.

In a prospective population study of women in Gothenburg, Sweden, three examinations were conducted with 12-year intervals between 1968-1969 and 1992-1993. There were 1462 participants aged 38-60 years in the baseline study in 1968-1969, with a participation rate of 90.1%. This paper describes longitudinal changes and secular trends with respect to women's alcohol habits. An alcohol frequency questionnaire was validated at baseline and was re-administered at all examinations. Between 1968-1969 and 1980-1981, the proportion of alcohol abstainers decreased significantly both in 38-year-old and 50-year-old women. Women reporting alcohol intake at least once per week had higher socio-economic status and higher education than other women. Serum gamma-glutamyl transpepsidase concentration was higher in women with the heavier alcohol intake, while a number of potential cardiovascular risk indicators were higher in women with the lower intake. Daily intake of wine and spirits was about as common at all three examinations, whereas moderate intake of wine and spirits was more common in 1980-1981 and 1992-1993 than in 1968-1969. There seemed to be an increase in overall consumption of alcohol, mainly due to the increase in moderate drinking, but there was no indication of a large increase in heavy consumption of alcohol.

Adult↗

Ultrasonographic bone velocity in pregnancy: a longitudinal study.

OBJECTIVE: Longitudinal changes in bone mass were evaluated with use of ultrasonography and bone remodeling markers in 40 normal pregnant women in relation to their calcium intake. STUDY DESIGN: The study took place at the University of Alcalá Hospital in Madrid. Biochemical markers of bone remodeling and ultrasonographic bone propagation velocity in the proximal phalanxes of fingers 2 to 5 were measured in all three trimesters of pregnancy. Wilcoxon, unpaired and paired t tests, and analysis of variance were used. RESULTS: Ultrasonographic bone propagation velocity (meters per second) was lower in the second and third trimesters of pregnancy (p < 0.0001) compared with the respective preceding trimesters and in the third trimester in the overall group of pregnant women. Tartrate-resistant acid phosphatase and alkaline phosphatase levels increased significantly (p < 0.0001) in parallel with the ultrasonographic bone propagation velocity decrease. CONCLUSIONS: Gestation was accompanied by a reduction in ultrasonographic bone propagation velocity that was greater in women with low calcium intake.

Acid Phosphatase↗

Factors causing hearing impairment: some perspectives from Europe.

This review concentrates on factors causing permanent hearing impairment in childhood, described in some European studies. The emphasis is on comparative studies, based on strict criteria and terminology upon which longitudinal changes in the pattern of factors causing hearing impairment can be demonstrated in well-defined cohorts of children. The high proportion of 20-39 percent of unknown causes of permanent hearing impairment in childhood reflects a general lack of knowledge about causative factors and systematic etiologic evaluation within pediatric audiology. Future surveillance programs, including examination procedures directed towards causative factors, may see a reduction of the "unknown" category and ultimately may result in prevention of permanent hearing impairment in childhood. Some factors causing hearing impairment in adults are mentioned, including recent studies that show organic toxic solvents as a factor. As well, some controversial findings concerning the relationship between hearing impairment and endocrine disorders such as hypothyroidism and diabetes mellitus are briefly reported. It is concluded that future developments and research in the etiologic field within pediatric and adult audiology may contribute to the delineation of yet unknown damaging factors or reduction of the effect of factors causing hearing impairment--a disorder that ultimately results in adverse effects on the quality of life in all age groups.

Adult↗

Rehabilitation of hearing-impaired children: intervention and outcome.

A cohort of 72 hearing-impaired children of a median age of 9.7 years, range 4.3-13.9, born during 1980-1990 and living in the health district of Copenhagen City was examined cross-sectionally in order to evaluate the interval from identification to the initial fitting of hearing aids (HAs) and children's use of HAs. As measures of outcome, the use of HAs at 1, 6, 12 months after fitting, and at the time of data collection was assessed along with the primary language of each child. One month after the fitting, 53% of the total sample used the HAs > 8 h/day, and no significant longitudinal changes in the proportion of time-related use were found. 56% of the children stayed in the same user category during the years, while the rest either increased (25%) or decreased (19%) the use of amplification from 1 month after fitting to the time of data collection. Children with better ear hearing level (BEHL) 0.5-4 kHz between 60 and 89 dB used the HAs significantly more than those with mild or profound hearing impairments, whereas age at onset (congenital, acquired, age at onset unknown) and age at intervention were unrelated to use of amplification. 72% of the children were oral, while 25% were manual (unknown 3%), and no differences in the use of HAs were found between these two groups. A subdivision of congenitally hearing-impaired children according to BEHL 0.5-4 kHz below/above 75 dB demonstrated a significantly larger proportion of manual children in the poorer hearing group despite a significantly younger amplification age. It is concluded that age at intervention is unrelated to primary language, although the number of children precludes dependable conclusions.

Adolescent↗

A 2 yr longitudinal radiographic study examining the effect of a bisphosphonate (risedronate) upon subchondral bone loss in osteoarthritic knee patients.

OBJECTIVES: To determine whether risedronate (RIS) slows down trabecular bone loss in the medial compartment of the proximal tibia, a characteristic of patients with progressive knee osteoarthritis (OA). METHODS: Initially, 100 patients were randomly selected from each treatment group (each N approximately 300) comprising placebo and RIS 5 mg/day, 15 mg/day and 50 mg/week from a double blind, multi-centre, placebo-controlled, 2 yr investigation of OA knee patients in North America. Using fluoroscopic semi-flexed standard radiography, baseline and exit knee radiographs were digitized by laser scanner. Following computerized measurement of minimum medial compartment joint space width, each group was subdivided into joint space narrowing (JSN) non-progressor or JSN-progressor (JSN >or=0.6 mm measured at any point post-baseline). Computerized method of fractal signature analysis (FSA) quantified longitudinal changes separately in horizontal and vertical trabeculae in region of interest (three-fourth width of tibial compartment x 6 mm height) in the medial compartment. Following the initial study, all JSN-progressor knees within the entire patient cohort (N = 1232) were similarly analysed. RESULTS: OA knees in JSN non-progressor group had a slight decrease in FSA for vertical and horizontal trabeculae and showed no drug effect. In JSN-progressor knees, bone loss was greater in both placebo and RIS 5 mg/day groups compared with those in RIS 15 mg/day group in which trabeculae were retained, and in the RIS 50 mg/week group in which the vertical trabecular number increased significantly (P < 0.05). CONCLUSION: This preliminary study showed that patients with marked cartilage loss (JSN>or=0.6 mm) receiving RIS 15 mg/day retained vertical trabecular structure, and those receiving RIS 50 mg/week increased vertical trabecular number, thereby preserving the structural integrity of subchondral bone in knee OA.

Adult↗

Correlates of movement initiation and velocity in Parkinson's disease: A longitudinal PET study.

Limited data exist concerning the mechanisms that underlie the different motor features of Parkinson's disease (PD) and their course over time. Our aims were (1) to identify longitudinal changes in PD patients and (2) to determine the neural correlates of the changes in movement initiation and velocity that occur in the course the disease. Thirteen early stage PD patients were scanned twice off antiparkinsonian medication with H(2)15O PET. Imaging was performed at baseline and again after 2 years while the subjects performed a motor task that was kinematically controlled across time. Paced reaching movements were made towards targets that were presented in a predictable order. Measures of movement onset time (OT) and mean velocity (MV) were recorded during PET. OT and MV decreased significantly from baseline to follow-up. With advancing disease, increasing subcortical activation was detected in the pallidum bilaterally and in the left putamen. In the cortex, motor-related activation increased in the right pre-SMA, anterior cingulate cortex and the left postcentral gyrus. Progressive delays in movement initiation (OT) correlated with increases in the right dorsal premotor cortex (dPMC). Slowing of movement (MV) was associated with declining activation in the left dorsolateral prefrontal cortex and dPMC. Our data suggest that with advancing PD, motor performance is associated with the recruitment of brain regions normally involved in the execution of more complex tasks.

Adult↗

Psychological adjustment to IDDM: 10-year follow-up of an onset cohort of child and adolescent patients.

OBJECTIVE: To evaluate the psychological adjustment of young adults with IDDM in comparison with similarly aged individuals without chronic illness. RESEARCH DESIGN AND METHODS: An onset cohort of young adults (n = 57), ages 19-26 years, who have been followed over a 10-year period since diagnosis, was compared with a similarly aged group of young adults identified at the time of a moderately severe, acute illness (n = 54) and followed over the same 10-year period. The groups were assessed at 10-year follow-up in terms of 1) sociodemographic indices (e.g., schooling, employment, delinquent activities, drug use), 2) psychiatric symptoms, and 3) perceived competence. In addition, IDDM patients were examined for longitudinal change in adjustment to diabetes. RESULTS: The groups differed only minimally in terms of sociodemographic indices, with similar rates of high school graduation, post-high school education, employment, and drug use. The IDDM group reported fewer criminal convictions and fewer non-diabetes-related illness episodes than the comparison group. There were no differences in psychiatric symptoms. However, IDDM patients reported lower perceived competence, with specific differences found on the global self-worth, sociability, physical appearance, being an adequate provider, and humor subscales. The IDDM patients reported improving adjustment to their diabetes over the course of the 10-year follow-up. CONCLUSIONS: Overall, the young adults with IDDM appeared to be as psychologically well adjusted as the young adults without a chronic illness. There were, however, indications of lower self-esteem in the IDDM patients that could either portend or predispose them to risk for future depression or other difficulties in adaptation.

Acute Disease↗

Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women.

BACKGROUND: Osteoporosis and related fractures will be growing public health problems as the population ages. It is therefore of great importance to identify modifiable risk factors. OBJECTIVE: We investigated associations between dietary components contributing to an alkaline environment (dietary potassium, magnesium, and fruit and vegetables) and bone mineral density (BMD) in elderly subjects. DESIGN: Dietary intake measures were associated with both cross-sectional (baseline) and 4-y longitudinal change in BMD among surviving members of the original cohort of the Framingham Heart Study. Dietary and supplement intakes were assessed by food-frequency questionnaire, and BMD was measured at 3 hip sites and 1 forearm site. RESULTS: Greater potassium intake was significantly associated with greater BMD at all 4 sites for men and at 3 sites for women (P < 0.05). Magnesium intake was associated with greater BMD at one hip site for both men and women and in the forearm for men. Fruit and vegetable intake was associated with BMD at 3 sites for men and 2 for women. Greater intakes of potassium and magnesium were also each associated with less decline in BMD at 2 hip sites, and greater fruit and vegetable intake was associated with less decline at 1 hip site, in men. There were no significant associations between baseline diet and subsequent bone loss in women. CONCLUSION: These results support the hypothesis that alkaline-producing dietary components, specifically, potassium, magnesium, and fruit and vegetables, contribute to maintenance of BMD.

Aged↗

Subgingival microbiota in adult Chinese: prevalence and relation to periodontal disease progression.

The "checkerboard" Dna-Dna hybridization technology was used to study the epidemiology of 18 microbial species associated with various states of periodontal health and disease, in a sample of 148 Chinese subjects never exposed to systematic dental therapeutic intervention, aged 30 to 39 and 50 to 59 years. Our aims were to: 1) describe the prevalence of these microorganisms; 2) correlate the microbiological and clinical profiles of the subjects; and 3) examine the association between the microbiological variables and the longitudinal changes of periodontal status that occurred over a preceding 10-year period. A maximum of 14 subgingival samples were obtained from each subject-1,864 in all. The frequency of occurrence of the 18 species examined was high in this Chinese population, on both the subject and the tooth site level. However, all species were not found equally capable of reaching high numbers in the subgingival samples and, as a rule, colonized heavily only limited proportions of tooth sites within each mouth. There was a profound increase of certain species such as Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus in deep pockets or progressing sites. Multivariate techniques using the subgingival profile could effectively discriminate between deep/shallow pockets and progressing/ stable tooth sites. The microbiological variables showed an enhanced discriminating potential when classifications were performed on the individual subject level. Colonization by P. gingivalis, B. forsythus, Campylobacter rectus, and T. denticola at levels exceeding certain thresholds entailed a significantly increased probability (odds ratios > 4) for an individual subject to harbor deep pockets or progressing tooth sites.

Adult↗

Longitudinal evaluation of the association between pulmonary function and total serum IgE.

The role of immunoglobulin E (IgE) in the development and course of impaired ventilatory function and chronic obstructive pulmonary disease (COPD) required further study. This role has been examined in the longitudinal Tucson Epidemiological Study of Airways Obstructive Disease, which started in 1972. The association between IgE and longitudinal changes in pulmonary function measures was examined in subjects in the community population sample in Tucson who had an initial age of 35 or more. There were a total of 1,533 such subjects with lung function tests over the 20 yr period who also had IgE determinations. A significant inverse association was found between total serum IgE and FEV1/FVC that was independent of smoking and asthma status. The finding was statistically separate from the relation with age in all but elderly current smokers (age > 55). The magnitude of this effect in nonasthmatic subjects was relatively small. For asthmatic subjects, however, the inverse association was larger in both current and never smokers. Subjects excluded from the current analysis either did not have an IgE measurement and/or had no pulmonary function values after 35 yr of age. These findings suggest that higher IgE levels may indicate the presence of a disease process that may involve inflammation and/or other mechanisms related to IgE production, which impair lung function over time. However, in this study we were not able to account for possible parental or inheritance contributions to increases in total IgE, which have been shown to be important.

Adult↗

Maleness as risk factor for slowly progressive IDDM.

The effect of sex on longitudinal changes in serum C-peptide immunoreactivity (CPR) response to the oral glucose tolerance test (OGTT) was examined up to 48 mo in 30 islet cell antibody-positive (ICA+), non-insulin-dependent diabetes mellitus (NIDDM) subjects (15 men, 15 women) who were matched for age, duration of diabetes, and mode of treatment. The subjects were recruited from 2858 NIDDM patients screened for ICA between 1980 and 1984. In male NIDDM subjects, CPR levels to OGTT decreased insidiously, and 8 of 15 men developed the insulin-dependent state with abolished CPR. Only 2 female NIDDM subjects progressed to the insulin-dependent state (P less than .05, women vs. men). Thus, CPR in female subjects tended to decrease less than in male subjects. There were no significant differences between the two groups in human leukocyte antigens (HLA) or titer of ICA during the follow-up period. These results suggest that maleness is a major risk factor for slowly progressive beta-cell dysfunction in adult-onset insulin-dependent diabetes mellitus (IDDM).

Adult↗

Complex partial and secondarily generalized seizure patients: cognitive functioning prior to treatment with antiepileptic medication. VA Epilepsy Cooperative Study 264 Group.

This investigation of cognitive functioning in patients with symptomatic localization-related (partial) epilepsy prior to administration of antiepileptic medication is part of a nationwide prospective, double-blind study of drug efficacy and longitudinal changes in cognition associated with seizure disorders. Recently-diagnosed patients with complex partial or secondarily generalized tonic clonic seizures, equated for age, education and IQ, were compared with normal controls on a battery of neuropsychological tests: verbal and figural memory measures (Rey auditory verbal learning test, Rey Osterrieth complex figure), and a brief behavioral toxicity battery comprising measures of motor function, concentration and mental flexibility (Lafayette grooved pegboard, controlled word association test, Stroop, paced auditory serial addition test [PASAT]). Control subjects perform significantly better than both groups of seizure patients on several measures of motor speed/integration and memory, specifically the pegboard and the RAVLT learning (3-5) and recall trials. Secondarily generalized seizure patients show greatest impairment. They perform significantly worse than patients with complex partial seizures and control subjects on the controlled word association test and the most demanding Stroop color word trial, both measures of concentration and mental flexibility. These findings document deficits in memory as well as concentration and motor function in complex partial and in secondarily generalized seizure patients prior to treatment with antiepileptic medication.

Adult↗

A longitudinal analysis of efficacy expectations and exercise in older adults.

The purpose of this study was to consider the longitudinal changes in self-efficacy and outcome expectations for exercise and the impact of these variables on maintaining regular exercise over a 4-year period in a group of older adults living in a continuing care retirement community. There were 78 individuals who completed all four surveys. The participants had at least a high school education, and the majority were Caucasian (99%), female (83%) and either widowed or never married (80%). The mean age of the participants was 84.4+/-5.1 years. Based on repeated measure analysis of covariance, controlling for mental and physical health, there was not a statistically significant difference in self-efficacy expectations (F = 2.0, p > .05) or outcome expectations (F = 2.2, p > .05) over time. There was a statistically significant decrease in exercise over time (F = 9.9, p < .05). Using path analysis it was demonstrated that self-efficacy expectations, outcome expectations, and physical health directly and indirectly influenced maintenance of regular exercise. Age, gender, and mental health had a limited and inconsistent influence on maintenance of exercise. Future research and clinical work should focus on developing and testing interventions that strengthen both self-efficacy and positive outcome expectations in older adults to facilitate maintenance of exercise behavior over time.

Aged↗

Longitudinal assessment of glycosylated blood protein concentrations in normal pregnancy and gestational diabetes.

Longitudinal changes in glycosylated hemoglobin concentration (GlyHb) and glycosylated serum protein concentration (GSP) in both normal pregnancy and pregnancy complicated by gestational diabetes were determined using affinity chromatography, a method in which nonenzymatically glycosylated proteins are specifically measured. At 7-10 wk gestation, GlyHb in women who developed diabetes (N = 21) was higher than GlyHb in normal women (N = 49) (6.7 +/- 0.2% versus 5.7 +/- 0.2%, respectively, P less than 0.001) and remained elevated throughout gestation. In normal pregnancy, GlyHb decreased to a nadir at 23-26 wk and returned to baseline concentration by 31-34 wk. In gestational diabetes, there was an initial increase in GlyHb to 7.1 +/- 0.5% at 11-14 wk followed by a steady decrease. At 7-10 wk, GSP in women who developed diabetes was not elevated compared with normal concentration, although at 11-14 wk there was significant difference between the two groups (P less than 0.02). In normal women, GSP remained constant throughout gestation. In gestational diabetes, GSP decreased to early pregnancy values (P less than 0.02). Glycosylated blood proteins were elevated in early gestation in women who developed gestational diabetes and may have predictive value in identifying women who will develop diabetes in pregnancy.

Adolescent↗

Longitudinal study of dental caries, tooth mortality and interproximal bone loss in adults with intellectual disability.

The investigation focused on longitudinal changes of oral health in a group of adults with intellectual disability. A number of 124 individuals, aged 21-40 yr in 1990, were followed during 8.5 yr. The incidence and prevalence of caries, incidence of tooth mortality, and interproximal bone loss were registered from clinical examinations and bite-wing radiographs. The subjects visited the dental clinic for preventive dental care on average every third month during the period. The caries incidence was low, on average 0.51 new lesions per yr. Persons with mild intellectual disability experienced more caries than other subjects. During the 8.5 yr, the subjects had lost on average 1.82 teeth, with periodontitis dominating as the reason for tooth mortality. Individuals who cooperated poorly with dental treatment had lost the most teeth. The average annual bone loss in all subjects was 0.03 mm. Subjects with Down syndrome had a higher bone loss compared to those with other diagnoses of intellectual disability. Thus, the major part of the persons with intellectual disability showed satisfactory oral health. However, subjects with poor ability to cooperate with dental treatment and subjects with Down syndrome showed an increased risk for impaired oral health.

Adult↗

Longitudinal analysis of clock drawing in Alzheimer's disease patients.

Longitudinal changes in the role of conceptual, spatial, and graphic processes in the drawing deficits of patients with Alzheimer's disease (AD) were assessed over a 2-year period. Both the drawing-to-command and copy conditions of the Clock Drawing Test were administered to 33 AD patients as part of three consecutive annual examinations. The drawings from each administration were evaluated for overall accuracy and the types of errors manifested. Although the patients showed a gradual decline in overall accuracy on both command and copy conditions over the three test sessions, they performed more poorly and evidenced a steeper decline on the command condition. Conceptual errors in the command condition were noted in the early stages of AD and increased over the three administrations. Stimulus-bound errors were usually associated with conceptual errors in the same or in a contiguous year. When the patients' performances on the first test session were correlated with their yearly scores on Mattis' Dementia Rating Scale, the presence of conceptual errors was associated with a steep decline on this measure of mental status. These results suggest that drawing deficiencies in AD often reflect impairments in conceptualization and semantic knowledge and that such losses may prove useful in predicting the disease's rate of progression.

Aged↗

A 9-year longitudinal study of reported oral problems and dental and periodontal status in 70- and 79-year-old city cohorts in northern Sweden.

Before 1981 no representative studies of oral health in an elderly population in northern Sweden had been presented, and longitudinal studies of oral health in the aging person were in general rare. Thus the aim of this study was to investigate longitudinal changes in oral health in a representative sample of an elderly city population in northern Sweden. Reported oral problems and treatment needs were noted, and dental and periodontal status was registered in clinical examinations. The frequency of reported annual dental visits and of being called by the dentist increased in the younger but not in the older cohort during the 9-year period. In 1990 all the 79- and 88-year-olds with annual visits reported that they were recalled by the dentist. The clinical investigation showed an increasing amount of tooth loss, root caries, and periodontal disease with increasing age. Among dentulous persons 1.7 teeth per subject were lost from 1981 to 1990 in the younger cohort, compared with 2.6 teeth per subject in the older cohort. The number of sound teeth decreased very little in the younger cohort (from 3.44 to 3.34) but more evidently in the older cohort (from 3.47 to 2.65) during the 9-year period. The frequency of surfaces with attachment level > 3 mm increased statistically significantly from 1981 to 1990 in the older cohort. Subjects with annual visits had in general fewer oral problems.

Aged↗

Effects of CAG repeat length, HTT protein length and protein context on cerebral metabolism measured using magnetic resonance spectroscopy in transgenic mouse models of Huntington's disease.

Huntington's disease is a neurodegenerative illness caused by expansion of CAG repeats at the N-terminal end of the protein huntingtin. We examined longitudinal changes in brain metabolite levels using in vivo magnetic resonance spectroscopy in five different mouse models. There was a large (>50%) exponential decrease in N-acetyl aspartate (NAA) with time in both striatum and cortex in mice with 150 CAG repeats (R6/2 strain). There was a linear decrease restricted to striatum in N171-82Q mice with 82 CAG repeats. Both the exponential and linear decreases of NAA were paralleled in time by decreases in neuronal area measured histologically. Yeast artificial chromosome transgenic mice with 72 CAG repeats, but low expression levels, had less striatal NAA loss than the N171-82Q mice (15% vs. 43%). We evaluated the effect of gene context in mice with an approximate 146 CAG repeat on the hypoxanthine phosphoribosyltransferase gene (HPRT). HPRT mice developed an obese phenotype in contrast to weight loss in the R6/2 and N171-82Q mice. These mice showed a small striatal NAA loss (21%), and a possible increase in brain lipids detectable by magnetic resonance (MR) spectroscopy and decreased brain water T1. Our results indicate profound metabolic defects that are strongly affected by CAG repeat length, as well as gene expression levels and protein context.

Animals↗