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Objective As 90% of fractures are caused by falls, and as fractures are more common in elderly women than in elderly men, a better understanding of potential sex differences in fall rates and underlying mechanisms is needed. The purpose of this study was to determine whether women are more prone than men to falling, and to evaluate whether the risk of falling is associated with variations in gait patterns. Design, setting, and participants The cohort for this prospective observational study consisted of 1390 community-dwelling men and women aged 70 years, examined in a health survey between July 2012 and November 2014. Measurements Gait patterns were measured using a computerized walkway system during normal-speed, fast-speed, and dual-task trials. Triaxial accelerometers were used to collect objective data on physical activity, and self-reported fall data were collected by telephone 6 and 12 months after examination. Incident low-energy falls were defined as unexpected events in which participants came to rest on the ground. Results During the follow-up period, 148 study participants (88 women, 60 men; P = .01) reported falls. After adjusting for multiple confounders, including objective measures of physical activity, socioeconomic factors, cardiovascular disease, and cognitive function, the odds ratio for falling in women was 1.49 (95% confidence interval [CI] 1.02–2.19). Variations in gait pattern were significantly (20%–40%) increased in fallers compared with nonfallers during the dual-task trial for step width, step length, stride length, step time, stance time, stride velocity, and single support time (all P < .05). Furthermore, women showed 15% to 35% increased variability in all of these gait parameters during the dual-task trial compared with men (all P < .01). Conclusion In the present cohort, 70-year-old women were at greater risk of falls compared with their male counterparts. This increased risk was associated with increased variation in gait pattern during dual-task activities, and may contribute to women's greater fracture risk compared with men. [ABSTRACT FROM AUTHOR]

As the world's population ages, the occurrence of osteoporosis-related fractures is projected to increase. Low areal bone mineral density (aBMD), a well-known risk factor for fractures, may be influenced by physical activity (PA). In this cross-sectional study, we aimed to investigate potential associations between objective measures of PA and bone properties, in a population-based cohort of 1228 70-year-old men and women. We measured volumetric BMD (vBMD, mg/cm 3 ) together with cross-sectional area (CSA, mm 2 ) by peripheral quantitative computed tomography at sites located 4% and 66% in the distal–proximal trajectory at the tibia and radius. We also measured aBMD (g/cm 2 ) by dual energy X-ray absorptiometry at the femoral neck, lumbar spine (L1–L4) and radius. Participants wore triaxial accelerometers for 7 consecutive days to obtain objective estimates of PA. The intensity of the objective PA was divided into light (100–1951 counts/min [CPM]), moderate (1952–5724 cpm) and vigorous (≥ 5725 cpm). Maximal accelerations for the anterior–posterior ( z ), medio-lateral ( x ), and vertical ( y ) axes were also separately assessed. Associations were investigated using bivariate correlations and multiple linear regression, adjusted for height, weight and sex. Vigorous PA showed the strongest association with femoral neck aBMD ( β = 0.09, p < 0.001), while both moderate and vigorous PAs were associated with cortical area and trabecular vBMD in the weight-bearing tibia (all p < 0.05). Peak vertical accelerations were associated significantly with cortical area ( β = 0.09, p < 0.001) and trabecular vBMD ( β = 0.09, p = 0.001) of the tibia, whereas peak anterior–posterior accelerations showed no correlation with these properties. No positive association was found between objectively measured PA and bone parameters of the radius. In conclusion, vertical accelerations and moderate to vigorous PA independently predict bone properties, especially in the weight-bearing tibia, in 70-year-old men and women. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hematocrit is an independent predictor of cardiovascular risk in middle and old age, but whether hematocrit is also a predictor at younger ages is presently not known. In this study, we examined whether hematocrit measured in adolescence was associated with the risk of myocardial infarction later in life. Methods: During Swedish national conscription tests conducted between 1969 and 1978, the hematocrit was measured in 417,099 young Swedish men. The cohort was followed for subsequent myocardial infarction events through December 2010. Associations between hematocrit and myocardial infarction were accessed using Cox regression models. Results: During a median follow-up period of 36years, 9322 first-time myocardial infarctions occurred within the study cohort. After adjusting for relevant confounders and potential risk factors for myocardial infarction, men with a hematocrit≥49% had a 1.4-fold increased risk of myocardial infarction compared with men with a hematocrit≤44%. This relationship was dose dependent (p <0.001 for trend) and remained consistent throughout the follow-up period. Conclusions: In this cohort of young Swedish men, hematocrit was associated with the risk of myocardial infarction later in life after controlling for other coronary risk factors. The study findings indicate that hematocrit may aid future risk assessments in young individuals. [Copyright &y& Elsevier]

Background: There is evidence that atherosclerosis begins in childhood. There is also evidence that inflammatory markers measured in middle and old age predict risks of cardiovascular disease. In this report, we test whether an inflammatory marker measured in young adult men is associated with risk of myocardial infarction in middle age. Methods: During Swedish national conscription tests from 1969 through 1978, the erythrocyte sedimentation rate, as a measure of inflammation, was measured in 433,577 young Swedish men. The cohort was observed for subsequent myocardial infarction events through December 2009. Results: During an average follow-up time of 35 years, a total of 8,081 first-time myocardial infarctions occurred within the cohort. After adjustments for potential confounders and known risk factors for myocardial infarction, men with an elevated erythrocyte sedimentation rate (≥15 mm/h) had a 1.7 times increased risk of myocardial infarction during follow-up (95% CI 1.4-2.1) compared with men with an erythrocyte sedimentation rate of 1 mm/h. This relationship was dose dependent for each unit increase in erythrocyte sedimentation rate (P for trend < .001). Conclusions: In this cohort of young Swedish men, the erythrocyte sedimentation rate was associated with risk of myocardial infarction 35 years later after control of the available data on other coronary risk factors. These data add important relevant information to the existing evidence that atherosclerosis begins in childhood. [ABSTRACT FROM AUTHOR]

Abstract: The influence of bone mass, bone size and previous low energy fractures upon prospective fractures has not been investigated in a referral osteoporotic population. We investigated the association between bone mass, bone size, previous fractures, body constitution, and prospective validated fractures in 5701 women and 1376 men, aged 30 years and older. Bone mass measurements of the femoral neck were collected at a single study center in Sweden. Most of the subjects were measured on suspicion of osteoporosis. Data on validated low energy retrospective and prospective fractures in the cohort were collected from the corresponding health care district. Bone mineral density (BMD, g/cm2) and estimated volumetric BMD (vBMD, g/cm3) were shown to be good independent predictors for fracture in both women and men (Hazard ratio per standard deviation decrease (HR)=1.27–1.52, p <0.05). Bone size did not predict prospective fractures in either sex (HR=0.91–0.99, p >0.05), and bone size completely explained the higher BMD in men than in women. In women, retrospective low energy fractures (HR=1.78, p <0.001) and height (HR=1.02, p =0.006) were additional independent predictors of osteoporotic fractures after adjusting for age and BMD. In conclusion, we show that in a large osteoporotic referral population, age, BMD and previous fractures are independent predictors of prospective low energy fractures. These results add additional strength to the recent change in focus towards a multivariate analysis when assessing the future risk of fracture. [Copyright &y& Elsevier]

Abstract: Two biomarkers of suicide risk; non-suppression in the dexamethasone suppression test (DST) and low 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) have been reported to be predictors of suicide in mood disorders. The interrelation of the two systems seems to be different in suicide attempters compared with depressed inpatients who have not made a suicide attempt, indicating that the two biomarkers may be seen as independent. This investigation examined the interrelation of low CSF 5-HIAA and DST non-suppression in suicide victims with mood disorder. Fifty-eight mood disorder inpatients not receiving any treatment with antidepressants underwent lumbar puncture and the DST. Plasma cortisol levels at 8:00 a.m., 4:00 p.m. and 11:00 p.m. were analysed in relation to CSF 5-HIAA. All patients were followed up for causes of death and suicides were verified with death certificates. During follow-up (mean 21 years), 11 (19%) patients had committed suicide. In male suicide victims (n =6), the serum cortisol level at 4:00 p.m. showed a significant positive correlation with CSF 5-HIAA. Low CSF 5-HIAA predicted all early suicides (within 1 year), whereas all males who committed suicide after 1 year were DST non-suppressors. In female suicide victims (n =5), the post-DST serum cortisol did not correlate with CSF 5-HIAA. Low CSF 5-HIAA and DST non-suppression are orthogonal biologic risk factors for suicide in male mood disorder inpatients. CSF 5-HIAA is associated with short-term suicide risk; dysregulation of the hypothalamic-pituitary-adrenal axis seems to be a long-term suicide predictor. [Copyright &y& Elsevier]

Abstract: Whether different types of weight bearing loading have different effects on bone mineral accrual in young adults is not well investigated. We measured bone mineral density (BMD, g/cm2), bone mineral content (BMC, grams), and bone area (cm2) at different sites, in 46 ice hockey players, 18 badminton players and 27 controls, all 17 years of age. A follow up was conducted four years later. The gains in BMD and BMC of the femoral neck and in BMC of the humerus were significantly higher (p <0.05) in badminton players compared with controls during the follow-up time. The badminton players also gained more hip BMC and area compared with the ice hockey players (p <0.05). At the follow-up, the badminton players had higher BMD and BMC at all sites compared with controls (p <0.05). After adjustment for body weight, badminton players had higher hip BMD and BMC, femoral neck BMC, and humeral BMC compared with ice hockey players (p <0.05) at the follow-up. After adjustment for differences in age, there were no differences in BMC or BMD among fathers of badminton players, ice hockey players, or controls, suggesting an absence of selection bias. In conclusion, the novel results of the present study suggest that badminton is associated with higher gains in bone mass and size compared with ice hockey after puberty in men. These differences might be associated with higher strains on the bones from badminton play. [Copyright &y& Elsevier]

Abstract: The aim was to test the dopamine hypothesis of schizophrenia in a further analysis of D2-like dopamine binding using the radioligand [11C]raclopride and high resolution 3-dimensional (3D) PET. Eighteen drug-naive patients with schizophrenia and seventeen control subjects were examined. The D2 binding potential (BP) in the putamen, the caudate and the thalamus was calculated using the simplified reference tissue model. The volume of regions of interest was controlled for by MRI. Symptoms were rated with the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). No significant group differences were found for D2 BP in the putamen or in the caudate and there was no significant hemispheric difference for any region. In the right thalamus the D2 BP was significantly lower in patients as compared to control subjects, whereas a numerical difference did not reach statistical significance for the left thalamus. There was no significant correlation between D2 BP and total PANSS score in any region. There was a highly significant age effect in the caudate and in the putamen, but not in the thalamus. In this relatively large PET study of exclusively drug-naive schizophrenic patients, a lower D2 BP in the right thalamus was found in the patient group. This finding is in agreement with two previous studies in Sweden and in Japan using the high-affinity radioligand [11C]FLB 457 and provide further support for a role of dopamine in the thalamus related to the pathophysiology of schizophrenia. [Copyright &y& Elsevier]

It is unclear whether moderate-to-vigorous physical activity (MVPA) is associated with a lower mortality risk, over and above its contribution to total physical activity volume. 46,682 adults (mean age: 64 years) were included in a meta-analysis of nine prospective cohort studies. Each cohort generated tertiles of accelerometry-measured physical activity volume and volume-adjusted MVPA. Hazard ratios (HR, with 95% confidence intervals) for mortality were estimated separately and in joint models combining volume and MVPA. Data was collected between 2001 and 2019 and analyzed in 2023. During a mean follow-up of 9 years, 4,666 deaths were recorded. Higher physical activity volume, and a greater contribution from volume-adjusted MVPA, were each associated with lower mortality hazard in multivariable-adjusted models. Compared to the least active tertile, higher physical activity volume was associated with a lower mortality (HRs: 0.62; 0.58, 0.67 and 0.50; 0.42, 0.60 for ascending tertiles). Similarly, a greater contribution from MVPA was associated with a lower mortality (HRs: 0.94; 0.85, 1.04 and 0.88; 0.79, 0.98). In joint analysis, a lower mortality from higher volume-adjusted MVPA was only observed for the middle tertile of physical activity volume. The total volume of physical activity was associated with a lower risk of mortality to a greater extent than the contribution of MVPA to physical activity volume. Integrating any intensity of physical activity into daily life may lower mortality risk in middle-aged and older adults, with a small added benefit if the same amount of activity is performed with a higher intensity. [ABSTRACT FROM AUTHOR]

Abstract: Associations between suicide, violent behaviour and both hypocholesterolaemia and low 5-hydroxyindolacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) have been suggested. The relationships between lipids, the serotonergic system, suicidal and aggressive behaviors are complex. We explored relationships between serum cholesterol, CSF 5-HIAA, the planning subscale of suicide intent and violence of attempted suicide method in 13 medication-free male suicide attempters and eight healthy volunteers. Serum high-density lipoprotein cholesterol (HDL-C) levels were significantly lower in suicide attempters than in controls. HDL-C showed a significant positive correlation with the planning subscale of suicide intent in non-violent suicide attempters. A positive association was observed between CSF 5-HIAA and serum cholesterol in suicides. The role of cholesterol may be different in planned non-violent suicide attempts compared with violent suicide attempts. [Copyright &y& Elsevier]

Background: Real-world evidence supporting vaccination against COVID-19 in individuals who have recovered from a previous SARS-CoV-2 infection is sparse. We aimed to investigate the long-term protection from a previous infection (natural immunity) and whether natural immunity plus vaccination (hybrid immunity) was associated with additional protection.Methods: In this retrospective cohort study, we formed three cohorts using Swedish nationwide registers managed by the Public Health Agency of Sweden, the National Board of Health and Welfare, and Statistics Sweden. Cohort 1 included unvaccinated individuals with natural immunity matched pairwise on birth year and sex to unvaccinated individuals without natural immunity at baseline. Cohort 2 and cohort 3 included individuals vaccinated with one dose (one-dose hybrid immunity) or two doses (two-dose hybrid immunity) of a COVID-19 vaccine, respectively, after a previous infection, matched pairwise on birth year and sex to individuals with natural immunity at baseline. Outcomes of this study were documented SARS-CoV-2 infection from March 20, 2020, until Oct 4, 2021, and inpatient hospitalisation with COVID-19 as main diagnosis from March 30, 2020, until Sept 5, 2021.Findings: Cohort 1 was comprised of 2 039 106 individuals, cohort 2 of 962 318 individuals, and cohort 3 of 567 810 individuals. During a mean follow-up of 164 days (SD 100), 34 090 individuals with natural immunity in cohort 1 were registered as having had a SARS-CoV-2 reinfection compared with 99 168 infections in non-immune individuals; the numbers of hospitalisations were 3195 and 1976, respectively. After the first 3 months, natural immunity was associated with a 95% lower risk of SARS-CoV-2 infection (adjusted hazard ratio [aHR] 0·05 [95% CI 0·05-0·05] p<0·001) and an 87% (0·13 [0·11-0·16]; p<0·001) lower risk of COVID-19 hospitalisation for up to 20 months of follow-up. During a mean follow-up of 52 days (SD 38) in cohort 2, 639 individuals with one-dose hybrid immunity were registered with a SARS-CoV-2 reinfection, compared with 1662 individuals with natural immunity (numbers of hospitalisations were eight and 113, respectively). One-dose hybrid immunity was associated with a 58% lower risk of SARS-CoV-2 reinfection (aHR 0·42 [95% CI 0·38-0·47]; p<0·001) than natural immunity up to the first 2 months, with evidence of attenuation thereafter up to 9 months (p<0·001) of follow-up. During a mean follow-up of 66 days (SD 53) in cohort 3, 438 individuals with two-dose hybrid immunity were registered as having had a SARS-CoV-2 reinfection, compared with 808 individuals with natural immunity (numbers of hospitalisations were six and 40, respectively). Two-dose hybrid immunity was associated with a 66% lower risk of SARS-CoV-2 reinfection (aHR 0·34 [95% CI 0·31-0·39]; p<0·001) than natural immunity, with no significant attenuation up to 9 months (p=0·07). To prevent one reinfection in the natural immunity cohort during follow-up, 767 individuals needed to be vaccinated with two doses. Both one-dose (HR adjusted for age and baseline date 0·06 [95% CI 0·03-0·12]; p<0·001) and two-dose (HR adjusted for age and baseline date 0·10 [0·04-0·22]; p<0·001) hybrid immunity were associated with a lower risk of COVID-19 hospitalisation than natural immunity.Interpretation: The risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation in individuals who have survived and recovered from a previous infection remained low for up to 20 months. Vaccination seemed to further decrease the risk of both outcomes for up to 9 months, although the differences in absolute numbers, especially in hospitalisations, were small. These findings suggest that if passports are used for societal restrictions, they should acknowledge either a previous infection or vaccination as proof of immunity, as opposed to vaccination only.Funding: None. [ABSTRACT FROM AUTHOR]

Elevated T3 levels have been reported in men with antisocial behavior. The aim of the present study was to investigate the relationship between thyroid hormones and expressed adult interpersonal violence in female patients with borderline personality disorder (BPD). Furthermore, expressed adult interpersonal violence in female BPD patients was compared to healthy female controls. A total of 92 clinically euthyroid women with BPD and 57 healthy women were assessed with the Karolinska Interpersonal Violence Scales (KIVS). Baseline thyroid function was evaluated by measuring plasma free and bound triiodothyronine (FT3 and T3), thyroxine (FT4 and T4), and thyroid-stimulating hormone (TSH) with immunoassays in patients. Plasma cortisol was also measured. Among females with BPD, expressed interpersonal violence as an adult showed a significant positive correlation with the T3 levels. The mean expression of interpersonal violence as an adult was significantly higher in BPD patients as compared to healthy controls. The multiple regression model indicated that two independent predictors of KIVS expressed interpersonal violence as an adult: T3 and comorbid diagnosis of alcohol abuse. Association between T3 levels and violent/aggressive behavior earlier reported exclusively in male samples may be valid also in females with BPD. [ABSTRACT FROM AUTHOR]

Abstract: An association between low levels of serum cholesterol and violent or suicidal behaviour has frequently been reported. However the role of serum cholesterol in the cycle of violence (Widom, 1989) has not been studied. The aim of this study was to investigate association between exposure to violence during childhood and used adult violence in suicide attempters with low and high serum cholesterol levels. 81 suicide attempters were assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behaviour in childhood (between 6 and 14 years of age) and during adult life (15 years or older). We used median split to dichotomise groups below and above median serum cholesterol. In patients with serum cholesterol below median, the correlation between exposure to violence as a child and used adult violence was significant (rho=0.52, p=0.002), while in patients with serum cholesterol above median, the correlation between exposure to violence as a child and expressed violent behaviour as an adult was not significant (rho=0.25, p=0.2). Comorbid substance abuse predicted violent behaviour as an adult only in patients with serum cholesterol above median. Serum cholesterol may modify the effect of the “Cycle of Violence”. [Copyright &y& Elsevier]

Abstract: The purpose of the present study was to investigate the influence of different types of weight bearing physical activity on bone mineral density (BMD, g/cm2) and evaluate any residual benefits after the active sports career. Beginning at 17years of age, BMD was measured 5 times, during 12years, in 19 badminton players, 48 ice hockey players, and 25 controls. During the active career, badminton players gained significantly more BMD compared to ice hockey players at all sites: in their femoral neck (mean difference (Δ) 0.06g/cm2, p =0.04), humerus (Δ 0.06g/cm2, p =0.01), lumbar spine (Δ 0.08g/cm2, p =0.01), and their legs (Δ 0.05g/cm2, p =0.003), after adjusting for age at baseline, changes in weight, height, and active years. BMD gains in badminton players were higher also compared to in controls at all sites (Δ 0.06–0.17g/cm2, p <0.01 for all). Eleven badminton players and 37 ice hockey players stopped their active career a mean of 6years before the final follow-up. Both these groups lost significantly more BMD at the femoral neck and lumbar spine compared to the control group (Δ 0.05–0.12g/cm2, p <0.05 for all). At the final follow-up, badminton players had significantly higher BMD of the femoral neck, humerus, lumbar spine, and legs (Δ 0.08–0.20g/cm2, p <0.01 for all) than both ice hockey players and controls. In summary, the present study may suggest that badminton is a more osteogenic sport compared to ice hockey. The BMD benefits from previous training were partially sustained with reduced activity. [ABSTRACT FROM AUTHOR]

Abstract: Osteoporosis is associated with a general bone loss. Whether infections could contribute to osteoporosis is not known. Chlamydia pneumoniae causes chronic infections and produces potentially bone resorptive cytokines. The effect of C. pneumoniae infection was investigated in vivo in 10-week old mice (c57BL/6) and in vitro in the human osteoblast-like cell line hFOB 1.19 (hFOB). Bone mineral density (BMD) was measured before and 16 days after infection. C. pneumoniae-infected mice had decreased (p <0.05) total and subcortical BMD at the distal femur and proximal tibia compared with controls, but no body-weight gain differences. IL-6 (56 vs. 39pg/mL, p =0.02) and IL-1β (11 vs. 0pg/mL, p =0.003) levels in sera, and CD3+ T-cells (p =0.04) were higher in infected mice compared with controls. In vitro, hFOB infected with C. pneumoniae was associated with increased IL-6 (p =0.01) and RANKL (p <0.05) mRNA expression; additionally, IL-6 secretion increased in a dose-dependent manner (p <0.05). In summary, mice infected with C. pneumoniae had generalized bone loss associated with increased IL-6 and IL-1. In addition, C. pneumoniae established an infection in an osteoblast cell line in vitro with similar cytokine profiles as those in vivo, supporting a causal linkage. [Copyright &y& Elsevier]

The effect of berry polyphenols on glucose metabolism has been evaluated in several studies; however, the results are conflicting. A systematic review and meta-analysis was therefore conducted to evaluate the effect of berry polyphenol consumption on glucose metabolism in adults with impaired glucose tolerance or insulin resistance. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL (EBSCO), and Scopus were searched for randomized controlled trials published by June 2019. Of the 3240 articles found, 21 met inclusion criteria. Study-specific effects were calculated as mean differences, which were pooled using fixed-effect, inverse-variance weighting. Overall, berry polyphenol consumption did not have a clear effect on biomarkers of glucose metabolism compared with placebo or no treatment. Although some analyses showed statistically significant effects, these effects were too small to be of clinical relevance. The review protocol was registered in the PROSPERO International Prospective Register of Systematic Reviews as CRD42019130811. [ABSTRACT FROM AUTHOR]

Abstract Objective Sarcopenia has been defined as age-related loss of muscle mass and function. The aim of this randomized controlled trial was to examine the effects of a 10-week instructor-led resistance training program on functional strength and body composition in men and women aged 70 years with pre-sarcopenia. Design, Setting, and Participants Participants were randomized to either 10 weeks of a physical training regimen including optional nutritional supplementation (n = 36) or to a control group (n = 34) (ClinicalTrials.gov , no. NCT03297632). The main outcome was changes in the Short Physical Performance Battery (SPPB) score. Secondary outcomes included the Timed Up and Go test, chair sit-stand time, lean body mass, and fat mass. Results The intervention had no significant effect on SPPB in the total cohort (P =.18), when comparing changes in the intervention group with the control group. However, those given the intervention in the male subcohort increased 0.5 ± 0.4 (mean ± standard error for the difference) points in SPPB during follow-up (P =.02) compared to male controls. With respect to secondary outcomes, the intervention group decreased 0.9 ± 0.6 seconds in chair sit-stand time compared to controls (P =.01). Furthermore, the intervention resulted in significantly greater improvements for the training group than control group in all measures of body composition (P ≤.01 for all). For example, lean body mass increased by a mean of 1147 ± 282 g (P <.001), and total fat mass decreased by a mean of 553 ± 225 g (P =.003), favoring the intervention group. Conclusion/Implications The main finding of this intervention study is that an easy-to-use, functional resistance training program was effective in maintaining functional strength and increasing muscle mass in older adults with pre-sarcopenia. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to investigate the association between bisphosphonate use and the risk of new fracture in a nationwide cohort of individuals with previous hip fractures, with emphasis on individuals above 80 years of age. Design, setting, and participants From a nationwide cohort with hip fracture (2006-2012) (n = 93, 601), each individual prescribed bisphosphonates after hip fracture (n = 5845) was matched with up to three individuals not prescribed bisphosphonates, resulting in a cohort of 21,363 individuals. Main outcome measure A new hip fracture. Results During a mean follow-up period of 2.98 (range, 0.02-8) years, 4581 fractures occurred in the cohort. Before the initiation of bisphosphonate therapy, individuals later prescribed bisphosphonates had an increased risk of hip fracture (multivariable adjusted odds ratio [OR], 2.63; 95% confidence interval [CI], 2.23-3.24) compared with controls. In the period after bisphosphonate therapy initiation, individuals prescribed bisphosphonates had a lower risk of hip fracture (multivariable adjusted hazard ratio [HR], 0.76; 95% CI, 0.65-0.90) compared with controls. Similar effects were seen after the initiation of bisphosphonates in individuals aged more than 80 years (HR, 0.79; 95% CI, 0.62-0.99). In contrast, the initiation of bisphosphonate therapy did not influence the risk of injurious falls not resulting in fracture (HR, 0.95; 95% CI, 0.86-1.05). Conclusion Bisphosphonate use was associated with a decreased risk of hip fracture in this nationwide cohort of older men and women, with similar risk reductions in individuals older than 80 years. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Feasibility, acceptability, and efficacy of a Dialectical Behavioral Therapy (DBT) -based method developed in Germany were evaluated in a Swedish outpatient psychiatric context. Method: Fifty-one adults with ADHD on stable medical treatment or on no medication were randomized to the DBT-based skills training (n = 26) or a parallel loosely structured discussion group (n = 25). Self-rating scales were administered before randomization and after the treatment. Results: Feasibility and participant satisfaction were good in both groups while skills training was perceived as more logical and effective for ADHD-related problems. The analyses of the individuals who completed the treatment and remained stable with regard to medication (n = 19 in skills training; n = 18 in control group) showed a significant reduction in ADHD symptoms in the skills training group, but not in the control group. No reduction of comorbidity was observed in any of the groups. Conclusions: The treatment was feasible in an outpatient psychiatric context, well tolerated, and significantly reduced ADHD symptoms in on-treatment individuals who remained stable regarding medication status. [Copyright &y& Elsevier]

Abstract: Previous research has been inconclusive as to whether high peak bone mineral density (BMD, g/cm2) resulting from previous physical activity is retained with reduced activity later in life. The aim of this 12-year longitudinal study was to investigate the association between BMD loss and reduced physical activity (h/wk) at trabecular and cortical bone sites in men. Three groups with a mean age of 17 years at baseline were investigated: i) 51 athletes who discontinued their active careers during the follow-up period (former athletes), ii) 16 athletes who were active throughout the follow-up period (active athletes), and iii) 25 controls. BMD loss at the hip, spine, and pelvis (mainly trabecular bone) was compared to BMD loss at femur, humerus, and legs (mainly cortical bone) during a 12-year follow-up period. Across the total follow-up period in the total cohort, reduced physical activity was more strongly associated with changes at trabecular BMD sites, i.e. hip, spine, and pelvis (B =0.008–0.005 g/cm2 per weekly hour physical activity (h), p <0.001), than at cortical bone sites, i.e. humerus, legs (B =0.002–0.003 g/cm2/h, p <0.05), and femur (p >0.05). At the final follow-up, former athletes showed higher BMD than controls only at the cortical bone sites of the humerus, legs, and femur (difference 0.05–0.10 g/cm2, p <0.05). In conclusion, this study indicates that predominantly trabecular bone is lost with reduced physical activity levels in young men. Benefits were still evident at the more cortical sites eight years after the discontinuation of an active sports career. [Copyright &y& Elsevier]

Summary: The research on thyroid hormones and personality traits is quite sparse and mainly focused on male forensic psychiatric populations in which the relationship between thyroid hormones and psychopathy and aggression-related personality traits has been reported. The suicidal temperament hypothesis suggests that certain personality traits such as aggression, anxiety proneness, impulsivity, and low socialization may render an individual vulnerable to the risk of suicide. The aim of this study was to investigate personality traits assessed by the Karolinska Scales of Personality (KSP) in relation to hormones in the hypothalamic–pituitary–thyroid (HPT) axis in 100 euthyroid suicide attempters. Standard multiple regression analyses were performed with TSH, T3, T4, and the T3/T4 ratio, respectively, as the dependent variable and KSP factors (Anxiety Proneness, Aggressiveness, and Impulsivity) and subscales (Detachment, Social Desirability, and Socialization) as independent variables. In men, but not in women, the regression model of the T3/T4 ratio was significant and the results suggested that high scores on Aggressiveness and low ones on Detachment were associated with a low T3/T4 ratio. These results indicate that HPT function may be related to Aggressiveness and Detachment in male suicide attempters. [Copyright &y& Elsevier]

Abstract: The aim of the present study was to explore the effects of the menstrual cycle phases on 5-HT1A receptor and 5-HTT binding potentials (BPs) in healthy women by using positron emission tomography (PET). Women were investigated in the follicular and luteal phase of the menstrual cycle with radioligands [11C]WAY10035 (n =13) and [11C]MADAM (n =8) to study 5-HT1A and 5-HTT BPs. The BPs values were quantified using the simplified reference tissue model. The phases of the menstrual cycle were characterized by transvaginal ultrasound (TSV) and plasma levels of hormones estradiol (E2), progesterone (P4), follicle stimulating hormone (FSH) and luteinizing hormone (LH).The 5-HT1A receptor and 5-HTT BPs did not significantly differ between follicular and luteal phases in any of the investigated regions. There were no significant correlations between the change in E2 or P4 values with the change in 5-HT1A receptor or 5-HTT BPs. The results provide principally a new in vivo finding in human female biology, suggesting the absence of influence of menstrual cycle phase on 5-HT1A receptors or 5-HTT. The finding however does not preclude that gonadal hormones differentially influence central serotonin system inwomen and men, which might contribute to gender differences in serotonin-associated disorders. [Copyright &y& Elsevier]

Abstract: Most prospective studies of HPA axis have found that non-suppressors in the dexamethasone suppression test (DST) are more likely to commit suicide during the follow-up. Attempted suicide is a strong clinical predictor of suicide. The aim of this study was to assess the predictive value of DST for suicide in a group of depressed inpatients with and without an index suicide attempt. Historical cohort of 382 psychiatric inpatients with mood disorder admitted to the department of Psychiatry at the Karolinska University Hospital between 1980 and 2000 were submitted to the DST and followed up for causes of death. During the follow-up (mean 18 years), 36 suicides (9.4%) occurred, 20 of these were non-suppressors and 16 were suppressors. There was no statistically significant difference in suicide risk between the suppressors and non-suppressors for the sample as a whole. An index suicide attempt predicted suicide. In suicide attempters with mood disorder, the non-suppressor status was significantly associated with suicide indicating that HPA axis hyperactivity is a risk factor for suicide in this group. The dexamethasone suppression test may be a useful predictor within this population. [Copyright &y& Elsevier]

Abstract: The cause of premenstrual dysphoric disorder (PMDD) is largely unknown. It has been hypothesized that normal ovarian function triggers PMDD-related biochemical events within the brain and that serotonin plays an important role. In the present study, positron emission tomography (PET) and [carbonyl-11C]WAY-100635 were used to examine serotonin 5-HT1A receptors in a control group of women and in a group of women with PMDD. Two PET examinations were performed in each subject, one before (follicular phase) and one after ovulation (luteal phase). Each subject''s menstrual cycle was confirmed by ultrasonography of the ovaries as well as with hormone levels in blood and urine. The 5-HT1A binding potential was measured in six regions of interest and calculated according to the simplified reference tissue model. In the raphe nuclei, the 5-HT1A binding potential changed from the follicular to the luteal phase of the menstrual cycle in asymptomatic controls. In women with PMDD, the observed change between phases was significantly smaller. The results are in concordance with previously reported challenge studies of 5-HT1A receptor-mediated effects indicating different serotonergic responses between women with PMDD and controls. The study principally provides new support, in vivo, for a serotonergic dysregulation in women with PMDD. [Copyright &y& Elsevier]

To compare 30-day mortality in long-term care facility (LTCF) residents with and without COVID-19 and to investigate the impact of 31 potential risk factors for mortality in COVID-19 cases. Retrospective cohort study. All residents of LTCFs registered in Senior Alert, a Swedish national database of health examinations in older adults, during 2019-2020. We selected residents with confirmed COVID-19 until September 15, 2020, along with time-dependent propensity score–matched controls without COVID-19. Exposures were COVID-19, age, sex, comorbidities, medications, and other patient characteristics. The outcome was all-cause 30-day mortality. A total of 3731 residents (median age 87 years, 64.5% female) with COVID-19 were matched to 3731 controls without COVID-19. Thirty-day mortality was 39.9% in COVID-19 cases and 5.7% in controls [relative risk 7.05, 95% confidence interval (CI) 6.10-8.14]. In COVID-19 cases, the odds ratio (OR) for 30-day mortality was 2.44 (95% CI 1.57-3.81) in cases aged 80-84 years, 2.99 (95% CI 1.93-4.65) in cases aged 85-89 years, and 3.28 (95% CI 2.11-5.10) in cases aged ≥90 years, as compared with cases aged <70 years. Other risk factors for mortality among COVID-19 cases included male sex (OR, 2.60, 95% CI 2.22-3.05), neuropsychological conditions (OR, 2.18; 95% CI 1.76-2.71), impaired walking ability (OR, 1.45, 95% CI 1.17-1.78), urinary and bowel incontinence (OR 1.51, 95% CI 1.22-1.85), diabetes (OR 1.36, 95% CI 1.14-1.62), chronic kidney disease (OR 1.37, 95% CI 1.11-1.68) and previous pneumonia (OR 1.57, 95% CI 1.32-1.85). Nutritional factors, cardiovascular diseases, and antihypertensive medications were not significantly associated with mortality. In Swedish LTCFs, COVID-19 was associated with a large excess in mortality after controlling for an extensive number of risk factors. Beyond older age and male sex, several prevalent clinical risk factors independently contributed to higher mortality. These findings suggest that reducing transmission of COVID-19 in LTCFs will likely prevent a considerable number of deaths. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effects of geriatric rehabilitation on short-term risk of death and readmission after a hip fracture were investigated in a nationwide cohort. In addition, the association of discharge location (nursing home or patient's home) with the short-term risk of death was assessed. Design, Setting, and Participants The cohort consisted of 89,301 individuals at least 50 years of age, with a first hip fracture registered in the Swedish quality register RIKSHÖFT, the years 2004–2012. Measures Short-term risk of death and readmission to hospital after discharge was compared at 8 hospitals, where most patients received inpatient care in geriatric wards, and those treated at 71 regular hospitals. Results The risks of death within 30 days of admission were 7.1% in patients admitted to geriatric ward hospitals and 7.4% in those treated at regular hospitals (multivariable-adjusted hazard ratio [HR] 0.91, 95% CI 0.85–0.97), whereas the odds of readmission within 30 days of discharge were 8.7% and 9.8%, respectively (multivariable-adjusted odds ratio 0.86, 95% CI 0.81–0.91). The risk of death was influenced by discharge location and inpatient length of stay (LOS). Thus, for patients discharged to short-term nursing homes with a LOS of at most 10 days, each additional day of LOS reduction increased the risk of death within 30 days of discharge by 13% (HR 1.13, 95% CI 1.08–1.18). This association was reduced in patients discharged to permanent nursing homes (HR 1.04, 95% CI 1.02–1.07), and not significant in those discharged to their own home (OR 1.00, 95% CI 0.91–1.10). Conclusion The risks of death and readmission were lower in patients with hip fracture who received care in hospitals with geriatric wards. The risk of death after discharge increased with shorter LOS, especially in patients discharged to short-term nursing homes. [ABSTRACT FROM AUTHOR]