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Purpose: To study the effects of a perindopril-based regimen on cardiovascular (CV) outcomes in patients with vascular disease in relation to background statin therapy. Methods: A pooled analysis of the randomized ADVANCE, EUROPA, and PROGRESS trials was performed to evaluate CV outcomes in 29,463 patients with vascular disease treated with perindopril-based regimens versus placebo. The primary endpoint was a composite of CV mortality, nonfatal myocardial infarction, and stroke. Multivariable Cox regression analyses were performed to assess the effects of a perindopril-based regimen versus placebo in relation to statin use. Results: At randomization, 39.5% of the overall combined study population used statins. After a mean follow-up of 4.0 years (SD 1.0), the cumulative event-free survival was highest in the statin/perindopril group and lowest in the no statin/placebo group (91.2% vs. 85.6%, respectively, log-rank p < 0.001). In statin users (adjusted hazard ratio [aHR] 0.87, 95% confidence interval [CI] 0.77–0.98) and non-statin users (aHR 0.80, 95% CI 0.74–0.87), a perindopril-based regimen was associated with a significantly lower risk of the primary endpoint when compared to placebo. The additional treatment effect appeared numerically greater in non-statin users, but the observed difference was statistically nonsignificant. Conclusion: Our data suggest that the treatment benefits of a perindopril-based regimen in patients with vascular disease are independent of statin use. [ABSTRACT FROM AUTHOR]

There are nearly 65 million people with chronic heart failure (CHF) globally, with no treatment directed at the pathologic cause of the disease, the loss of functioning cardiomyocytes. We have an allogeneic cardiac patch comprised of cardiomyocytes and human fibroblasts on a bioresorbable matrix. This patch increases blood flow to the damaged heart and improves left ventricular (LV) function in an immune competent rat model of ischemic CHF. After 6 months of treatment in an immune competent Yucatan mini swine ischemic CHF model, this patch restores LV contractility without constrictive physiology, partially reversing maladaptive LV and right ventricular remodeling, increases exercise tolerance, without inducing any cardiac arrhythmias or a change in myocardial oxygen consumption. Digital spatial profiling in mice with patch placement 3 weeks after a myocardial infarction shows that the patch induces a CD45pos immune cell response that results in an infiltration of dendritic cells and macrophages with high expression of macrophages polarization to the anti-inflammatory reparative M2 phenotype. Leveraging the host native immune system allows for the potential use of immunomodulatory therapies for treatment of chronic inflammatory diseases not limited to ischemic CHF. Biologic epicardial patch induces macrophage mediated pathophysiologic repair in chronically infarcted mice and swine hearts shows an immune cell response that results in an infiltration of M2 macrophages [ABSTRACT FROM AUTHOR]

Objectives: To estimate productivity loss and associated indirect costs in high-risk patients treated for hyperlipidemia who experience cardiovascular (CV) events.Methods: Retrospective population-based cohort study conducted using Swedish medical records linked to national registers. Patients were included based on prescriptions of lipid-lowering therapy between 1 January 2006 and 31 December 2011 and followed until 31 December 2012 for identification of CV events and estimation of work productivity loss (sick leave and disability pension) and indirect costs. Patients were stratified into two cohorts based on CV risk level: history of major cardiovascular disease (CVD) and coronary heart disease (CHD) risk equivalent. Propensity score matching was applied to compare patients with new events (cases) to patients without new events (controls). The incremental effect of CV events was estimated using a difference-in-differences design, comparing productivity loss among cases and controls during the year before and the year after the cases' event.Results: The incremental effect on indirect costs was largest in the CHD risk equivalent cohort (n = 2946) at €3119 (P value <0.01). The corresponding figure in the major CVD history cohort (n = 4508) was €2210 (P value <0.01). There was substantial variation in productivity loss depending on the type of event. Transient ischemic attack and revascularization had no significant effect on indirect costs. Myocardial infarction (€3465), unstable angina (€2733) and, most notably, ischemic stroke (€6784) yielded substantial incremental cost estimates (P values <0.01).Conclusions: Indirect costs related to work productivity losses of CV events are substantial in Swedish high-risk patients treated for hyperlipidemia and vary considerably by type of event. [ABSTRACT FROM AUTHOR]

Objectives: To estimate healthcare costs of new cardiovascular (CV) events (myocardial infarction, unstable angina, revascularization, ischemic stroke, transient ischemic attack, heart failure) in patients with hyperlipidemia or prior CV events.Methods: A retrospective population-based cohort study was conducted using Swedish national registers and electronic medical records. Patients with hyperlipidemia or prior CV events were stratified into three cohorts based on CV risk level: history of major cardiovascular disease (CVD), coronary heart disease (CHD) risk-equivalent, and low/unknown risk. Propensity score matching was applied to compare patients with new events to patients without new events for estimation of incremental costs of any event and by event type.Results: A CV event resulted in increased costs over 3 years of follow-up, with the majority of costs occurring in the 1st year following the event. The mean incremental cost of patients with a history of major CVD (n = 6881) was €8588 during the 1st year following the event. This was similar to that of CHD risk-equivalent patients (n = 3226; €6663) and patients at low/unknown risk (n = 2497; €8346). Ischemic stroke resulted in the highest 1st-year cost for patients with a history of major CVD and CHD risk-equivalent patients (€10,194 and €9823, respectively); transient ischemic attack in the lowest (€3917 and €4140). Incremental costs remained elevated in all cohorts during all three follow-up years, with costs being highest in the major CVD history cohort.Conclusions: Healthcare costs of CV events are substantial and vary considerably by event type. Incremental costs remain elevated for several years after an event. [ABSTRACT FROM AUTHOR]

Bone fractures are one of the most commonly occurring injuries of the musculoskeletal system. A highly complex physiological process, fracture healing has been studied extensively. Data from in vivo, in vitro and clinical studies, have shown pulsed electromagnetic fields (PEMFs) to be highly influential in the fracture repair process. Whilst the underlying mechanisms acting to either inhibit or advance the physiological processes are yet to be defined conclusively, several non-invasive point of use devices have been developed for the clinical treatment of fractures. With the complexity of the repair process, involving many components acting at different time steps, it has been a challenge to determine which PEMF exposure parameters (i.e., frequency of field, intensity of field and dose) will produce the most optimal repair. In addition, the development of an evidence-backed device comes with challenges of its own, with many elements (including process of exposure, construct materials and tissue densities) being highly influential to the field exposed. The objective of this review is to provide a broad recount of the applications of PEMFs in bone fracture repair and to then demonstrate what is further required for enhanced therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Introduction: In everyday practice, angiotensin converting enzyme inhibitors and beta-blockers are cornerstone treatments in patients with (cardio-)vascular disease. Clear data that evaluate the effects of the combination of these agents on morbidity and mortality are lacking. Methods: In this retrospective pooled analysis of three large perindopril outcome trials (ADVANCE, EUROPA, PROGRESS), clinical outcomes were evaluated in 29,463 patients with vascular disease. Multivariate Cox regression analyses were performed in patients randomized to a perindopril-based regimen or placebo (treatment effect), and data were stratified according to background beta-blocker treatment. The primary endpoint was a composite of cardiovascular mortality, non-fatal myocardial infarction, and stroke. Results: The cumulative incidence of the primary endpoint over mean follow-up of 4.0 years (Sd 1.0) was significantly lower in the beta-blocker/perindopril group (9.6%; 545/5700 patients) as compared to beta-blocker/placebo (11.8%; 676/5718 patients) ( p < 0.01). Adding perindopril to existing beta-blocker treatment reduced the relative risk of the primary endpoint by 20% (hazard ratio (HR) 0.80; 95% confidence interval (CI) 0.71-0.90), non-fatal myocardial infarction by 23% (HR 0.77; 95% CI 0.65-0.91), and all-cause mortality by 22% (HR 0.78; 95% CI 0.68-0.88) as compared to placebo. Significant treatment benefit was not observed for stroke (HR 0.93; 95% CI 0.75-1.15). Significance was maintained for the primary endpoint and cardiovascular endpoints when data were further stratified by baseline hypertension. However, the mortality benefit was only observed in patients with hypertension with background beta-blocker use. Conclusions: These data suggest that the beneficial cardioprotective effects of perindopril treatment are additive to the background beta-blockers use. [ABSTRACT FROM AUTHOR]

Summary: This qualitative study explored the acceptability of high-impact physical activity for increasing bone strength in later life. Thematic analysis established the barriers and facilitators to this physical activity. They prioritised joint over skeletal health, of which they had little concept. Interventions need to clearly communicate the rationale and benefits. Introduction: The aim of this study was to explore the acceptability of doing high-impact physical activity in later life. Methods: This qualitative study was embedded within a large-scale observational study and was designed to address specific objectives and feed into a subsequent intervention. Five focus groups with physically active men and women (over 50 years) were used to develop an interview topic guide to explore the acceptability of high-impact physical activity in older men and women (over 65 years) in South West England. A total of 28 semi-structured interviews with 31 participants were then conducted and transcripts analysed thematically. Results: Three main barriers emerged: conceptualising bone, damage to joints and falling/safety concerns. Two main facilitators were also identified: the need to understand clear tangible benefits and incorporation of activity into everyday habits. Older adults were interested how high-impact physical activity would help to maintain their mobility, independence or social relationships. Some participants wanted tangible feedback from accelerometers, health care professionals and/or bone scans in order to develop a more intimate knowledge of their bone health. Conclusions: Interventions incorporating high-impact physical activity for older adults need to communicate how this activity can impact more broadly on health and lives; that physical activity will be safe, beneficial and not damaging to their joints will need to be clearly conveyed. Ways in which high-impact physical activity can be habitualised into everyday activities, be fun and interactive may help facilitate longer term adoption. [ABSTRACT FROM AUTHOR]

Summary: We explored the cardiac safety of the osteoporosis treatment strontium ranelate in the UK Clinical Practice Research Datalink. While known cardiovascular risk factors like obesity and smoking were associated with increased cardiac risk, use of strontium ranelate was not associated with any increase in myocardial infarction or cardiovascular death. Introduction: It has been suggested that strontium ranelate may increase risk for cardiac events in postmenopausal osteoporosis. We set out to explore the cardiac safety of strontium ranelate in the Clinical Practice Research Datalink (CPRD) and linked datasets. Methods: We performed a nested case-control study. Primary outcomes were first definite myocardial infarction, hospitalisation with myocardial infarction, and cardiovascular death. Cases and matched controls were nested in a cohort of women treated for osteoporosis. The association with exposure to strontium ranelate was analysed by multivariate conditional logistic regression. Results: Of the 112,445 women with treated postmenopausal osteoporosis, 6,487 received strontium ranelate. Annual incidence rates for first definite myocardial infarction (1,352 cases), myocardial infarction with hospitalisation (1,465 cases), and cardiovascular death (3,619 cases) were 3.24, 6.13, and 14.66 per 1,000 patient-years, respectively. Obesity, smoking, and cardiovascular treatments were associated with significant increases in risk for cardiac events. Current or past use of strontium ranelate was not associated with increased risk for first definite myocardial infarction (odds ratio [OR] 1.05, 95 % confidence interval [CI] 0.68-1.61 and OR 1.12, 95 % CI 0.79-1.58, respectively), hospitalisation with myocardial infarction (OR 0.84, 95 % CI 0.54-1.30 and OR 1.17, 95 % CI 0.83-1.66), or cardiovascular death (OR 0.96, 95 % CI 0.76-1.21 and OR 1.16, 95 % CI 0.94-1.43) versus patients who had never used strontium ranelate. Conclusions: Analysis in the CPRD did not find evidence for a higher risk for cardiac events associated with the use of strontium ranelate in postmenopausal osteoporosis. [ABSTRACT FROM AUTHOR]

Objective To evaluate the ability of apex locators as a tool in determining working length in comparison to traditional working length radiographs in general dental practice.Design Randomised controlled clinical trial.Setting General dental practices in the North West of England.Subjects Adults requiring root canal treatment of at least one tooth with minimal or moderate difficulty.Intervention Root canal treatment was carried out with the working length determined by apex locator in the treatment group (AL), and periapical radiograph in the control group (PA).Outcome measure The acceptability of the master cone gutta percha measured from a radiograph before obturation was used as the primary outcome.Results Twenty-one of 23 fillings in the AL group were judged as acceptable, compared to 17 of 23 fillings in the PA group. This difference was not statistically significant.Conclusion In general dental practice, no significant difference was found in working length determined using apex locator combined with a master cone GP radiograph or using the conventional method. There is a need for larger trials to investigate these methods further. [ABSTRACT FROM AUTHOR]

Objective:To describe abdominal adipose tissue distribution in a large sample of contemporary British children; to determine the influence of gender, stage of maturation and body mass index (BMI) on abdominal adipose tissue distribution; and to compare the ability of BMI and waist circumference to predict abdominal adipose tissue.Subjects and methods:A total of 74 boys (mean age 13.4±0.4 years) and 96 girls (mean age 13.5±0.5 years) were selected from volunteer children enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). Height, weight and waist circumference were measured and BMI calculated. Stage of sexual maturation was available for 113 children using a self-report questionnaire based on Tanner's criteria. Magnetic resonance imaging was used to assess subcutaneous abdominal adipose tissue (SAAT) and intra-abdominal adipose tissue (IAAT) volumes and patterning.Results:Boys had lower levels of IAAT (P=0.036) and SAAT (P=0.003) than girls. IAAT and SAAT were higher in overweight and obese boys and girls when compared with normal weight children (P<0.0001). This pattern was also reflected in waist circumference groups. Boys had higher IAAT/SAAT ratios than girls, indicating proportionately more adipose tissue deposited intra-abdominally (P=0.002). However, both boys and girls deposited less than 10% of their abdominal fat as internal adipose tissue. WC predicted 67.4% of the variance in IAAT (P<0.001), and BMI predicted 84.8% of the variance in SAAT (P<0.001). However, BMI as the best single predictor explained only 8.4% of the variance in the IAAT/SAAT ratio (P<0.001).Conclusions:At this age and stage of sexual maturation, the amount of IAAT remains relatively small. WC and BMI offer a feasible alternative to the MRI estimation of IAAT and SAAT, respectively, in a population-based sample of boys and girls.International Journal of Obesity (2008) 32, 91–99; doi:10.1038/sj.ijo.0803780; published online 27 November 2007 [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence of tobacco smoking, alcohol and drug use among UK vocational dental practitioners (VDPs) in 2005, and compare these with prevalence in 2000. Design: Cross-sectional survey using an anonymous self-report questionnaire. Subjects and Methods: All 767 VDPs who started practice in the summer of 2004 were sent a questionnaire in order to obtain data on the frequency and amount of tobacco, alcohol, cannabis and other illicit drugs used before and during vocational training (VT). The same survey had been conducted on VDPs five years earlier. The analysis was based on 502 subjects who responded and completed the questionnaire in 2005 and 534 subjects in 2000. Results: Regular tobacco use (10+ cigarettes per day) was reported by 5.4% of males and 4.0% of females in 2005. This is lower than reported in 2000 (9%) and a statistically significant reduction in males. Eighty-two percent of males and 81% of females reported alcohol use; a statistically significant reduction from 2000 (89% males and 88% females). Reported 'binge drinking' remained high with 44% of males and 39% of females drinking at least half the recommended weekly units of alcohol in one session, similar to those levels seen in 2000. Thirty-eight percent of males and 26% of females reported cannabis use during their VT, similar to levels seen in 2000. Reported use of illicit drugs other than cannabis was less than in 2000. Reported illicit drug use was associated with alcohol drinking, and particularly with tobacco use. Conclusion: This study has found the level of alcohol, tobacco and illicit drug use (excluding cannabis) among VDPs decreasing since 2000, but levels of binge drinking and cannabis use remaining similar. [ABSTRACT FROM AUTHOR]

Objectives To ascertain the requirements in restorative dentistry that undergraduate dental students have to fulfil in order to sit the finals examinations in dental schools in the UK and Ireland and to compare those requirements with the competencies stipulated by the GDC in The first five years.Methods Fifteen anonymised questionnaires, of open and closed question design, were sent by post to academics in the university departments of restorative dentistry in each of the undergraduate dental schools in the UK and Ireland. The first section concerned numerical information regarding total numbers of procedures that were required to be completed in undergraduate restorative dentistry. The second section was designed to ascertain information as to how decisions are made with respect to an undergraduate's readiness to sit the finals examination in restorative dentistry (such as continual assessment and/or competency assessments).Results A total of 15 replies were received for analysis, a 100% response rate. Several institutions emphasised that they do not have 'requirements', but provide guidelines as to what should be achieved. Six institutions did not have set numerical requirements for direct placement restorations or bridges. The number of direct placement restorations required at the other nine institutions ranged from 50 to 160. Five institutions did not have numerical requirements for dentures; four institutions did not set numerical targets for crowns, veneers, inlays/onlays or endodontics. In institutions where numerical requirements were not used, forms of competency assessments were completed. The requirements across all institutions for periodontology, integrated treatment planning and completed cases were ill-defined.Conclusions This study shows that there is a wide disparity amongst institutions in the UK and Ireland with regards to finals requirements in restorative dentistry. Ideally, such requirements should be similar between institutions and should be closely mapped to the GDC's required learning outcomes (The first five years) for the UK institutions. [ABSTRACT FROM AUTHOR]

Objective:To examine the prevalence of childhood and adolescent obesity in Taiwan and investigate the association between excess weight and physical fitness and blood pressure.Design:Cross-sectional study.Subjects:A total of 13 935 children and adolescents aged 6–18 years (boys: 7031, girls: 6904) were involved in the 1999 survey and 24 586 (boys: 12 367, girls: 12 219) were available in the 2001 survey.Measurements:Weight, height, systolic and diastolic blood pressures, and health-related fitness tests (bent-leg curl-ups, sit-and-reach test and step test) were measured.Results:The overall prevalence of obesity (including overweight) in boys was 19.8% in 1999 and 26.8% in 2001. It was lower in girls with 15.2% in 1999 and 16.5% in 2001. The normal weight group performed better (P<0.05) than the overweight/obese group in all fitness tests except in the 2001 sit-and-reach test where there were no differences between the two groups. The risk of hypertension increased nearly two times for the overweight/obese-fit group and nearly three times for the overweight/obese-unfit group compared to the normal weight-fit group (adjusted odds ratio (AOR)=1.93, 95%CI=1.514–2.451 and AOR=2.93, 95%CI=2.493–3.454, respectively).Conclusion:Overall, the findings demonstrated that there is an increasing trend in overweight/obesity prevalence for Taiwanese youth even in a 2-year period. The overweight/obese youngsters tend to have poorer muscular strength and cardiovascular endurance than the normal weight group. The overweight/obese and unfit group had a greater risk of hypertension than other groups. However, this risk was significantly lower if obese/overweight children had a higher than average level of cardiovascular fitness.European Journal of Clinical Nutrition (2006) 60, 1367–1375. doi:10.1038/sj.ejcn.1602466; published online 14 June 2006 [ABSTRACT FROM AUTHOR]

Aims To compare the views of new vocational dental practitioners (VDPs) and their trainers regarding how undergraduate dental education has prepared them for their vocational training (VT) in England. This study also aims to identify areas of relative weakness in dental undergraduate education that could influence the future training needs of vocational trainees.Method Structured postal questionnaires were completed by VDPs and trainers from five Deaneries in England. The usable response rate was 71% (n = 186 VDPs and 186 trainers).Results The vast majority of VDPs and trainers perceived the undergraduate training in history taking, diagnosis and treatment planning for general practice to have been covered 'well' or even 'very well'. Undergraduate training in routine restorative dentistry, oral pathology and paediatric dentistry was also perceived to have been covered well. However, a large proportion of VDPs and trainers reported that they felt that undergraduate training in orthodontics, molar endodontics, surgical endodontics and surgical extraction of teeth had not adequately prepared them for VT.Conclusions Newly qualified dentists appear to lack certain competencies recommended by the General Dental Council in The First Five Years. This has implications for dental undergraduate education, but also highlights current training needs during VT. [ABSTRACT FROM AUTHOR]

Background:The study of the relationship between anthropometry and visceral adipose tissue (VAT) is of great interest because VAT is associated with many risk factors for noncommunicable diseases and anthropometry is easy to perform in clinical practice. The studies hitherto available for children have, however, been performed on small sample sizes.Design:Pooling of the data of studies published from 1992 to 2004 as indexed on Medline.Aims:To assess the relationship between anthropometry and VAT and subcutaneous adipose tissue (SAT) as measured by magnetic resonance imaging (MRI) in children and to analyze the effect of age, gender, pubertal status and ethnicity.Subjects and methods:Eligible subjects were 7–16 year-old, with availability of VAT and SAT, gender, ethnicity, body mass index (BMI) and waist circumference (WC). A total of 497 subjects were collected from seven different investigators and 407 of them (178 Caucasians and 229 Hispanics) were analyzed.Results:Despite ethnic differences in MRI data, BMI, WC and age, no difference in VAT was found between Caucasians and Hispanics after correction for SAT and BMI. Univariate regression analysis identified WC as the best single predictor of VAT (64.8% of variance) and BMI of SAT (88.9% of variance). The contribution of ethnicity and gender to the unexplained variance of the VAT–WC relationship was low (3%) but significant (P0.002). The different laboratories explained a low (4.8%) but significant (P<0.0001) portion of the unexplained variance of the VAT–WC and SAT–BMI relationships. Prediction equations for VAT (VAT (cm2)=1.1 × WC (cm)−52.9) and SAT (SAT (cm2)=23.2 × BMI (kg/m2)−329) were developed on a randomly chosen half of the population and crossvalidated in the remaining half. The pure error of the estimate was 13 cm2 for VAT and 57 cm2 for SAT.Conclusions:WC can be considered a good predictor of VAT as well as BMI of SAT. The importance of ethnicity and gender on VAT estimation is not negligible.International Journal of Obesity (2006) 30, 23–30. doi:10.1038/sj.ijo.0803163 [ABSTRACT FROM AUTHOR]

Objective: This study was designed to investigate the prevalence of alcohol and drug use in vocational dental practitioners (VDPs). Design: Anonymous self-report questionnaire. Subjects and Methods: All UK vocational dental practitioners (n = 719) who started practice in the summer of 1999 were questioned on their use of alcohol, tobacco, cannabis and other illicit drugs whilst a VDP and before graduation. Results: Eighty-nine per cent of males and 88% of females reported alcohol use. Of these, 35% of males and 36% of females drank above sensible levels (up to 21 units per week for males, 14 units for females), with 48% of males and 52% of females "binge drinking". Thirty-three per cent of respondents reported cannabis use whilst a VDP. Regular drug use (use at least once a month) other than cannabis whilst a VDP was found to be highest among males, with regular ecstasy use reported by 4% and regular cocaine use reported by 2%. Regular tobacco use (ten or more cigarettes per day) was reported by 9% of VDPs. Regular tobacco users were found to be six times more likely to use cannabis on a regular basis, three times more likely to use ecstasy on a regular basis and four times more likely to use cocaine on a regular basis than those VDPs who reported non regular tobacco use. Conclusion: VDPs are drinking above sensible limits, binge drinking, using tobacco and indulging in illicit drug use to a degree that will cause health problems. However, use of all substances had reduced since qualification. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the patterns of change and the best anthropometric indicators of intra-abdominal fat deposition in young adolescents from ages 11-13 y. SUBJECTS: Subjects were 25 boys (mean age 13.7±0.32 y) and 17 girls (mean age of 13.7±0.23 y) who had taken part in a similar study 2 y earlier at ages 11.5±0.33 y and 11.5±0.27 y, respectively. METHODS: Intra-abdominal (IA) and subcutaneous adipose (SA) tissue areas and IA/SA ratio were determined through four tranverse magnetic resonance imaging scans on two occasions. Differences were investigated using t-tests and ANOVA. Skinfolds, girths and circumferences, body mass index and hydrostatic weighing were also recorded. Pearson correlation coefficients and regression equations were calculated to determine the best anthropometric indicators of intra-abdominal fat deposition. RESULTS: Intra-abdominal fat and subcutaneous fat areas had significantly increased in boys and girls by the second measure. Boys had deposited greater amounts of fat in intra-abdominal depots so that their intra-abdominal/subcutaneous ratio had increased significantly from 0.31 to 0.39. This had reduced in girls from 0.39 to 0.35. However, patterns of change were variable within sexes. Truncal skinfold sites (r=0.54-0.70) emerged as the best field indicators of intra-abdominal fat deposition. CONCLUSIONS: Patterns of intra-abdominal and subcutaneous fat distribution are identifiable in pubescent children using magnetic resonance imaging. An acceptable indication is provided by truncal skinfolds. [ABSTRACT FROM AUTHOR]

: The aim of this study was to determine whether both types of hip fracture, femoral neck and intertrochanteric, have similar risk factors. A prospective cohort study was carried out on community-dwelling elderly women in four areas of the United States: Baltimore, MD; Pittsburgh, PA; Minneapolis, MN and Portland, OR. The participants were 9704 Caucasian women, 65 years and older, of whom 279 had fractured their femoral neck and 222 had fractured their trochanteric region of the proximal femur. The predictors used were the bone mass of the calcaneus and proximal femur, anthropometry, history of fracture (family and personal), medication use, functional status, physical activity and visual function. The main outcome measures were femoral neck and intertrochanteric fractures occurring during an average of 8 years of follow-up. In multivariate proportional hazards models, several risk factors increased the risk of both types of hip fracture; including femoral neck bone density and increased functional difficulty. In hazard regression models that directly compared risk factors for the two types of hip fracture, calcaneal bone mineral density (BMD) predicted femoral neck fractures more strongly than intertrochanteric fractures (OR = 1.16; 95% CI = 1.02–1.31). Steroid use and impaired functional status also predicted femoral neck fractures instead of intertrochanteric fractures. Poor health status (OR = 0.74; 95% CI = 0.55–1.00) predicted intertrochanteric fractures more strongly than femoral neck fractures. We conclude that femoral neck fractures are largely predicted by BMD and poor functional ability while aging and poor health status predispose to intertrochanteric fractures. [ABSTRACT FROM AUTHOR]

Objective: This study was designed to investigate the prevalence of alcohol and drug use.Design: Anonymous self-report questionnaire.Setting: A UK dental school in May 1998.Subjects and Methods: 1st-5th year dental undergraduates (n = 264) were questioned on their use of alcohol and tobacco, cannabis and other illicit drugs whilst at dental school, and before entry.Results: Eighty two per cent of male and 90% of female undergraduates reported drinking alcohol. Of those drinking, 63% of males and 42% of females drank in excess of sensible weekly limits (14 units for females, 21 units for males), with 56% of males and 58.5% of females 'binge drinking'. Regular tobacco smoking (10 or more cigarettes a day) was found to have a statistically significant association with year of study, 4th-5th year undergraduates being eight times more likely to regularly smoke than their junior colleagues. Fifty five per cent of undergraduates reported cannabis use at least once or twice since starting dental school, with 8% of males and 6% of females reporting current regular use at least once a week.Conclusion: Dental undergraduates are drinking above sensible weekly limits of alcohol, binge drinking and indulging in illicit drug use. Dental Schools should designate a teacher responsible for education of undergraduates regarding alcohol and substance abuse. [ABSTRACT FROM AUTHOR]

Calcium/calmodulin kinase type II (CaMKII) is a major postsynaptic density protein. CaMKII is postulated to act as a 'molecular switch', which, when triggered by a transient rise in calcium influx, becomes active for prolonged periods because of its ability to autophosphorylate. We studied experience-dependent plasticity in the barrel cortex of mice carrying a point mutation of the α-CaMKII gene (T286A), which abolishes this enzyme's ability to autophosphorylate. Plasticity was prevented in adult and adolescent mice homozygous for the mutation, but was normal in heterozygotes and wild-type littermates. These results provide evidence that the molecular switch hypothesis is valid for neocortical experience-dependent plasticity. [ABSTRACT FROM AUTHOR]

: Few studies of bone loss have assessed the amount of loss directly after a hip fracture. The present prospective study was conducted to determine changes in bone mineral density (BMD) and muscle mass shortly after fracture and through 1 year to assess short-term loss and related factors. The setting was two acute care teaching hospitals in Baltimore, Maryland, and subjects were 205 community-dwelling women with a new fracture of the proximal femur between 1992 and 1995. Bone density of the nonfractured hip and whole-body and body composition were measured by dual-energy X-ray absorptiometry at 3 and 10 days and 2, 6 and 12 months after admission. Mean BMD of the femoral neck was 0.546 ± 0.007 g/cm2 at baseline. Average loss of femoral neck BMD from baseline was 2.1% at 2 months, 2.5% at 6 months and 4.6% at 12 months. The average loss of BMD in the intertrochanteric region was 2.1% at 12 months. Total lean body mass decreased by 6% while fat mass increased by 3.6% by 1 year after the fracture. These findings indicate that significant loss in BMD and lean body mass occur shortly after hip fracture while body fat increases. Continued loss was evident throughout the 1 year of follow-up. This loss of both bone density and muscle mass may lead to new fractures. [ABSTRACT FROM AUTHOR]

Presents a set of papers featured in the December 1999 issue of "Culture, Medicine and Psychiatry," which analyzed narratives of caregivers of elders with dementia in Boston, Massachusetts. Methods shared across the papers; Multidimensional framework for ethnicity; Directions for future research.

This pilot study uses an anthropological gaze to analyze transcripts of extended in-home interviews among a set of ten caregivers of African-American elders with dementia. How are race and ethnicity made to matter in the recognition of, the meaning-making around and the responses to dementing illness among a sample of African-American caregivers? The essay contrasts prevailing cultural representations of African-American caregiver burden with caregiver interview data. What we find is that current constructs which consistently demonstrate "lesser burden" among African-American caregivers compared with Whites may not adequately capture these caregivers' experiences. Interpretations of experiences, meanings of "burden" and the logic of symptoms in the illness narratives generated by these African-American caregivers of elders with dementia require attention to the embodiment of large scale sociopolitical and historical forces like residential, educational and occupational segregation, institutional racism, and economic exploitation over the life course. [ABSTRACT FROM AUTHOR]

AIM: Young people are often seen as an important target for prevention of overweight, but we know little about the factors which are important for their weight management decisions. This study aimed to evaluate the extent to which elements of body composition and dimensions were implicated in their decisions to change their weight. PARTICIPANTS: Participants were 116 male and 126 female volunteers from a tertiary college in the south-west of England with a mean age of 17.90 (s.d.=1.90) y. MEASURES: Body composition measures included height (m), weight (kg), waist and hip circumferences (mm), shoulder and hip girths (mm) and skinfold thicknesses (triceps, calf and subscapular, mm). Students also provided self-reported information on dietary practices they had undertaken in the last year. RESULTS: More females reported attempting weight loss in the last year compared to males (51.5 vs 17.6%), although more males reported attempting weight gain (19.3 vs 2.3%). Reported dietary strategies for both males and females centred around eating less fatty foods, eating less than usual and exercising more. However, a significant proportion of females also reported excessive strategies, such as self-induced vomiting and regular crash dieting. Results indicated that females who desired to lose weight were significantly (P<0.05) heavier, and bigger in terms of circumferences and skeletal breadths, compared to females who did not wish to change their weight. For males, the ‘weight loss’ group were significantly (P<0.05) bigger, heavier and fatter compared to the ‘no change’ and ‘weight gain’ group. For females only, the previously significant main effect for body dimensions across weight management groups (Pillais F14,188=3.81, P<0.001) was extinguished when controlling for bone dimensions (Pillais F12,198=1.68, P=0.074). CONCLUSION: These results indicate that frame size, particularly in the lower trunk, is a more... [ABSTRACT FROM AUTHOR]

Objective: There is a current debate whether multicentric osteosarcoma represents synchronous multiple primary osteosarcomas or metastatic disease. The purpose of this report is to evaluate the etiology, presentation, and classification of this entity.Design and Patients: Six patients ranging in age from 7 to 29 years were studied. The clinical, radiographic, and pathologic findings are reported. In addition, a review of the literature was undertaken.Results: The clinical courses of our six patients as well as a review of the literature suggest that multicentric osteosarcoma represent one extreme of a continuous scale of metastatic osteosarcoma rather than multiple synchronous primary tumors. The presentation is unusual and the clinical behavior distinctive, but the mechanism of spread remains the same: blood-borne and lymphatic-borne.Conclusions: Our experience with these six patients supports the concept in the recent literature that synchronous osteosarcoma is one extreme of the spectrum of metastatic osteosarcoma. Its unique features are: (1) multiple radiodense lesions that present simultaneously with or without pulmonary metastases; (2) a single "dominant" lesion with multiple smaller lesions; and (3) a uniformly rapid, fatal prognosis. Osteosarcoma should be regarded as a metastatic disease, even when only a single primary lesion is found at the initial presentation. [ABSTRACT FROM AUTHOR]

The nature of spontaneous unitary activity of rat neocortex was investigated during slow wave sleep and urethane anaesthesia. Neurones in layer IV and V locations fired in a burst-pause pattern at a low burst repetition rate (0.5-4 per second) during both stage 3/4 sleep and urethane anaesthesia. Occasionally an alternative mode of firing (spindle clusters), associated with focal spindle wave activity, was also found to occur in both states. Using dual microelectrode implants it was found that the onset times of bursts (but not spindle clusters), coincided in the same and opposing cortices, whether in functionally similar or disparate areas. The highest probability was that burst onsets occurred simultaneously (resolution =2.56 ms, interquartile range=40 ms). Spontaneous unitary activity was investigated in the thalamus for temporal correlation with spontaneous unitary activity in neocortex under urethane anaesthesia. Neurones of the anterior intralaminar group (aIL) consistently fired in a burst-pause pattern such that each aIL burst showed a strong tendency to precede a cortical burst. Unilateral electrical stimulation of the aIL nuclei evoked widespread bilateral entrainment of cortical bursts. In contrast stimulation of VP1, or cutaneous sites, evoked only short duration spike responses together with burst abolition in the appropriate restricted Sm1 area. Ionophoresis of NMDA (N-Methyl D-Aspartate) onto Sm1 neurones increased the probability of cortical burst responses to aIL stimulation in addition to decreasing the latency by 20-40 ms (n=11). lonophoresis of 2APV (2-amino 5-phosphono valeric acid) caused simultaneous abolition of spontaneous cortical bursts and bursts evoked by aIL stimulation. Short latency responses to cutaneous and VP1 stimulation were unaffected by ionophoresis of 2APV sufficient to cause burst elimination, suggesting that this pathway does not operate via a 2APV sensitive receptor mechanism. Anatomical features of the aIL nuclei and their overall cortical projection pattern are discussed in relationship to these findings. The activation of cortical NMDA/APV sensitive receptors by aIL afferents in the 'spontaneous' generation of bursts in cortical cells is discussed. [ABSTRACT FROM AUTHOR]

Spontaneous activity of single neurones in neocortex was sampled using pairs of microelectrodes in rats anaesthetised with urethane. In confirmation of previous studies, many cells recorded from middle layers characteristically fired in bursts, the onset times of which were synchronous both unilaterally and bilaterally. Iontophoresis of 2APV onto such cells either caused an abolition of bursts or a reduction in spikes per burst. In the latter case action potentials which occurred later in the burst were preferentially abolished. Iontophoresis of NMDA onto the same cells caused a prolongation of bursts with minimal effect on intraburst interspike interval. In interactive trials with the two drugs the effect of NMDA could be abolished by 2APV, and NMDA counteracted the effect of 2APV. It is concluded that spontaneous burst generation in neocortex during urethane anaesthesia is generated through a cortical NMDA/2APV-sensitive receptor mechanism. [ABSTRACT FROM AUTHOR]

This longitudinal study was undertaken to ascertain the rate of bone loss and to identify aging, cohort and/or time effects on bone loss in male participants of the Baltimore Longitudinal Study of Aging. Hand-wrist radiographs were obtained from 1958-1981 and were evaluated for total width, medullary width, and length of the second metacarpal. Data were analyzed using an age-time matrix with 8-year intervals for three epochs and nine age groups. The bone measurements were analyzed in three perspectives (cross-sectional, longitudinal and time-series). The results demonstrate that there is both a cross-sectional and longitudinal loss of cortical bone with age in the second metacarpal. Furthermore, the results show that males lose approximately 14% of their cortical bone, at a rate of about 2% per decade, over the adult lifespan. The majority of this loss occurs between the ages of 45 and 69 and is due primarily to aging and is not an artifact of cohort differences or secular change. [ABSTRACT FROM AUTHOR]

A study of 258 suicide attempters presenting themselves at Yale-New Haven Hospital Emergency Room during a six-month period revealed that the majority of attempts were by pill ingestion. A comparison made with attempt methods revealed that attempts by pill overdose (N= 205) were the most impulsive, had the least intent to kill, and were motivated towards obtaining attention from significant others. Attempts by violent methods (N=53), such as wrist-cutting, shooting or hanging, were more planned, had higher intent to kill, and these attempters expressed more self-directed hostility. While the patients taking overdoses had the least intent to kill themselves, the medical effects of their attempts were most serious. The treatment disposition indicated that the pill ingestors more often had medical consequences of the attempt and less often were considered serious psychiatric problems, while the opposite was true of the attempters using other methods. Education about the potential hazards of the medications and the effects of combining medications is seriously needed. [ABSTRACT FROM AUTHOR]

The importance of family history of fractures as a risk factor for fractures is unclear. The aim of this study was to test the hypothesis that family history of fracture increased a woman's risk of hip, wrist and other osteoporotic fracture and determine whether the influence of family history is independent of low bone density. We tested this hypothesis in a prospective study of 9704 Caucasian women, age 65 years or older, by assessing family history and bone density of the radius and calcaneus at baseline; 7963 women had femoral bone density measurements two years later. Fractures occurring during an average of 7.1 years of follow-up since baseline and 5.2 years since the second examination were confirmed by radiographic report. After adjusting for age, risk of hip fracture was increased in those with a maternal (1.48; 95% CI = 1.03–2.11); sister's (1.83; 1.20–2.80) or brother's history of hip fracture (2.26; 1.16–4.42). Risk of wrist fracture was increased by maternal (1.52; 1.10–2.11) and paternal (2.41; 1.14–5.07) history of wrist fracture. Adjustment for bone density did not consistently and substantially affect the strength of the associations. Family history of hip fracture was not associated with an increased risk of wrist fracture and family history of wrist fracture did not increase the risk of hip fracture. We conclude that family history is an important risk factor for fracture that may act, at least in part, through means besides bone density. Furthermore, the effect of family history is not a general but site-specific predisposition to fracture. [ABSTRACT FROM AUTHOR]

Infection of inflorescence stalks by the mycoherbistat Rhynchosporium alismatis caused significant reductions in seed weight and viability in the rice weed Damasonium minus. Seed weight was reduced by 49% when 80% of the stalk was infected. Numbers of nodes and florets per plant were not affected. The fungus was seedborne at low levels. [ABSTRACT FROM AUTHOR]

Reports that the dark-rearing of kittens delays the loss of N-methyl-D-aspartate (NMDA) receptor function in the visual cortex. This supports the view that they play an important part in neuronal development and plasticity.

Presents a reply to a letter to the editor that focused on mortality after hip fracture.

Objective To estimate the prevalence of tobacco, alcohol and drug use among dental undergraduates at one English university in 2008, and compare these with prevalence in 1998.Design Cross-sectional survey using an anonymous self-report questionnaire.Subjects and methods In 2008 all 384 dental undergraduates at one English university were sent a questionnaire in order to obtain data on the frequency and amount of tobacco, alcohol, cannabis and other illicit drugs used before and during their time as a dental undergraduate. The same survey had been conducted on dental undergraduates at the university 10 years earlier.Results Tobacco smoking was reported by 27% of males and 13.5% of females, a reduction from 1998 (42% of males and 32% of females) being significant among females. 63% of males and 69.5% of females reported drinking alcohol: significantly fewer than in 1998 (82% males and 90% females). Binge drinking was reported by 69.5% of males compared to 56% in 1998. In females 66% binged compared to 58.5% in 1998. The increase in males was significant. 62% of males and 68% of females had never used cannabis compared to 38% in males and 50.5% of females in 1998, a significant reduction. A significant reduction in amphetamine use was reported among both male and female undergraduates in 2008 compared to 1998 and a significant increase in amyl nitrate use was reported by females. Reported illicit drug use was associated with alcohol drinking, and particularly with tobacco use.Conclusion Dental undergraduates at one English university in 2008 when compared to those in 1998 are reported to be significantly less likely to drink alcohol, use cannabis and amphetamines. If female, they are significantly less likely to smoke tobacco and overestimate the number of units of alcohol they can safely consume in a week, but more likely to use amyl nitrate. If male, those who drink alcohol are significantly less likely to drink at a level of increased risk, but more likely to binge drink. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about the evaluation of left ventricular function for patients being considered for, or receiving Trastuzumab therapy.

Objective To compare the alcohol and drug use of dental and law undergraduates.Design Anonymous self-report questionnaire.Subjects and methods All dental undergraduates (n = 263) and a randomly selected group of law undergraduates (n = 180) from the same university were questioned on their use of alcohol, tobacco and illicit drugs.Results Current tobacco use was reported by 7% of dental students and 19% of law students. Alcohol use was reported by 86% of dental students and 88% of law students, with 44% of dental students and 52% of law students estimating they drank above recommended safe limits (14 units for females, 21 units for men). Binge drinking was reported by 71% of dental students and 75% of law students, with weekly binge drinking reported by 27% and 34% of dental and law students respectively. Cannabis experience was reported by 44% of dental students and 52% of law students, with current use reported by 12% and 25% of dental and law students respectively. A small proportion of dental and law students reported using other Class A and B drugs including ecstasy, amphetamines and cocaine.Conclusions Dental students appear to be indulging in similar levels of alcohol and illicit drug use when compared to students of a different, non-medical faculty. Binge drinking may be more prevalent than previously thought, with potential risks to health, patient safety and professional status. [ABSTRACT FROM AUTHOR]

ObjectiveThis study was designed to investigate the prevalence of alcohol and drug use in vocational dental practitioners (VDPs).DesignAnonymous self-report questionnaire.Subjects and methodsAll UK vocational dental practitioners (n = 719) who started practice in the summer of 1999 were questioned on their use of alcohol, tobacco, cannabis and other illicit drugs whilst a VDP and before graduation.ResultsEighty-nine per cent of males and 88% of females reported alcohol use. Of these, 35% of males and 36% of females drank above sensible levels (up to 21 units per week for males, 14 units for females), with 48% of males and 52% of females 'binge drinking'. Thirty-three per cent of respondents reported cannabis use whilst a VDP. Regular drug use (use at least once a month) other than cannabis whilst a VDP was found to be highest among males, with regular ecstasy use reported by 4% and regular cocaine use reported by 2%. Regular tobacco use (ten or more cigarettes per day) was reported by 9% of VDPs. Regular tobacco users were found to be six times more likely to use cannabis on a regular basis, three times more likely to use ecstasy on a regular basis and four times more likely to use cocaine on a regular basis than those VDPs who reported non regular tobacco use.ConclusionVDPs are drinking above sensible limits, binge drinking, using tobacco and indulging in illicit drug use to a degree that will cause health problems. However, use of all substances had reduced since qualification. [ABSTRACT FROM AUTHOR]