Search

Objective To develop a comprehensive and current description of what health informatics (HI) professionals do and what they need to know. Materials and Methods Six independent subject-matter expert panels drawn from and representative of HI professionals contributed to the development of a draft HI delineation of practice (DoP). An online survey was distributed to HI professionals to validate the draft DoP. A total of 1011 HI practitioners completed the survey. Survey respondents provided domain, task, knowledge and skill (KS) ratings, qualitative feedback on the completeness of the DoP, and detailed professional background and demographic information. Results This practice analysis resulted in a validated, comprehensive, and contemporary DoP comprising 5 domains, 74 tasks, and 144 KS statements. Discussion The HI practice analysis defined “health informatics professionals” to include practitioners with clinical (eg, dentistry, nursing, pharmacy), public health, and HI or computer science training. The affirmation of the DoP by reviewers and survey respondents reflects the emergence of a core set of tasks performed and KSs used by informaticians representing a broad spectrum of those currently practicing in the field. Conclusion The HI practice analysis represents the first time that HI professionals have been surveyed to validate a description of their practice. The resulting HI DoP is an important milestone in the maturation of HI as a profession and will inform HI certification, accreditation, and education activities.

Objective The study sought to develop a comprehensive and current description of what Clinical Informatics Subspecialty (CIS) physician diplomates do and what they need to know. Materials and Methods Three independent subject matter expert panels drawn from and representative of the 1695 CIS diplomates certified by the American Board of Preventive Medicine contributed to the development of a draft CIS delineation of practice (DoP). An online survey was distributed to all CIS diplomates in July 2018 to validate the draft DoP. A total of 316 (18.8%) diplomates completed the survey. Survey respondents provided domain, task, and knowledge and skill (KS) ratings; qualitative feedback on the completeness of the DoP; and detailed professional background and demographic information. Results This practice analysis resulted in a validated, comprehensive, and contemporary DoP comprising 5 domains, 42 tasks, and 139 KS statements. Discussion The DoP that emerged from this study differs from the 2009 CIS Core Content in 2 respects. First, the DoP reflects the growth in amount, types, and utilization of health data through the addition of a practice domain, tasks, and KS statements focused on data analytics and governance. Second, the final DoP describes CIS practice in terms of tasks in addition to identifying knowledge required for competent practice. Conclusions This study (1) articulates CIS diplomate tasks and knowledge used in practice, (2) provides data that will enable the American Board of Preventive Medicine CIS examination to align with current practice, (3) informs clinical informatics fellowship program requirements, and (4) provides insight into maintenance of certification requirements.

Summary Although treatment of non-small cell lung cancer (NSCLC) with immune checkpoint inhibitors (ICIs) can produce remarkably durable responses, most patients develop early disease progression. Furthermore, initial response assessment by conventional imaging is often unable to identify which patients will achieve durable clinical benefit (DCB). Here, we demonstrate that pre-treatment circulating tumor DNA (ctDNA) and peripheral CD8 T cell levels are independently associated with DCB. We further show that ctDNA dynamics after a single infusion can aid in identification of patients who will achieve DCB. Integrating these determinants, we developed and validated an entirely noninvasive multiparameter assay (DIREct-On, Durable Immunotherapy Response Estimation by immune profiling and ctDNA-On-treatment) that robustly predicts which patients will achieve DCB with higher accuracy than any individual feature. Taken together, these results demonstrate that integrated ctDNA and circulating immune cell profiling can provide accurate, noninvasive, and early forecasting of ultimate outcomes for NSCLC patients receiving ICIs.

To investigate the association between adherence to health recommendations and detection of advanced colorectal neoplasia (ACN) in colorectal cancer (CRC) screening.A total of 14832 women and men were invited to CRC screening, 6959 in the fecal immunochemical test arm and 7873 in the flexible sigmoidoscopy arm. These were also sent a self-reported lifestyle questionnaire to be completed prior to their first CRC screening. A lifestyle score was created to reflect current adherence to healthy behaviors in regard to smoking, body mass index, physical activity, alcohol consumption and food consumption, and ranged from zero (poorest) to six (best). Odds ratios (ORs) and 95%CIs were calculated using multivariable logistic regression to evaluate the association between the single lifestyle variables and the lifestyle score and the probability of detecting ACN.In all 6315 women and men completed the lifestyle questionnaire, 3323 (53%) in the FIT arm and 2992 (47%) in the FS arm. This was 89% of those who participated in screening. ACN was diagnosed in 311 (5%) participants of which 25 (8%) were diagnosed with CRC. For individuals with a lifestyle score of two, three, four, and five-six, the ORs (95%CI) for the probability of ACN detection were 0.82 (0.45-1.16), 0.43 (0.28-0.73), 0.41 (0.23-0.64), and 0.41 (0.22-0.73), respectively compared to individuals with a lifestyle score of zero-one. Of the single lifestyle factors, adherence to non-smoking and moderate alcohol intake were associated with a decreased probability of ACN detection compared to being a smoker or having a high alcohol intake 0.53 (0.42-0.68) and 0.63 (0.43-0.93) respectively.Adopted healthy behaviors were inversely associated with the probability of ACN detection. Lifestyle assessment might be useful for risk stratification in CRC screening.

To develop a method for quantifying risks of death and dementia in relation to vascular risk factors the Gothenburg H-70 1901-02 birth cohort was studied (n=380, was followed over 20 years, with 103 incident dementia cases). Separate vascular risk factor indices were calculated using 23 vascular risk factors to predict: (i) dementia-free-survival, and (ii) incident dementia derived from post hoc optimal separation of affected and unaffected cases. Classification of adverse outcomes (dementia/non-dementia; alive/dead) was assessed using receiver-operator characteristic (ROC) curves, and the area under the curve (AUC). Each index showed high separation between affected and unaffected cases. For dementia/non-dementia, the AUC was 0.74+/-0.02 for 10 year and 0.67+/-0.02 for 20 year; for death/survival, the AUC was 0.75+/-0.02 for 10 years and 0.79+/-0.03 for 20 years. Of note, few items were important in both indexes, and most showed reciprocal effects (e.g. decreased the risk of death but increased the risk of dementia). Our results suggest that vascular risk factor indexes can give robust estimates of dementia and life span prognoses in elderly people, but death and dementia have different risk profiles. This may be because of death being a competing risk for incident late-onset dementia.

Primary chronic cold agglutinin disease is a rare hemolytic disease mediated by monoclonal IGHV4-34-encoded cold agglutinins with a predominant specificity for the blood group antigen I. Bone marrow from 54 patients was studied to type the underlying lymphoproliferative disorder better. Bone marrow biopsies showed circumscribed intra-parenchymatous nodules with small monotonous monoclonal B cells in 40/54 patients (median infiltration: 10% of marrow cells) with a CD20(+), IgMs(+), IgDs(+), CD27(+), CD5(-/+), CD11c(-), CD23(-), CD38(-) immunophenotype. Neither plasmacytoid cytological features nor expression of plasma cell differentiation-associated transcription factors MUM1, XBP1 and BLIMP1 were noted in these B cells. However, a limited number of mature monoclonal IgM(+), IgD(-) plasma cells were present outside the lymphoid nodules and were diffusely scattered throughout the marrow. Of interest, the MYD88 L265P mutation, typical of lymphoplasmacytic lymphoma, was not detected (17/17 cases). Somatically mutated monoclonal IGHV4-34 gene rearrangement was demonstrated in eight patients with frozen samples (mean sequence homology 95.4%). However, mutations of BCL6 intron 1 were not demonstrated, except in one patient, suggesting that the lymphoma cells had not matured in the germinal center. In conclusion, cold agglutinin-associated lymphoproliferative disease displays homogeneous histological and immunophenotypic features. The absence of plasmacytoid cells, the presence of plasma cells predominantly outside the nodular lymphoid infiltrates, IGHV4-34 restriction and absence of MYD88 L265P mutation strongly suggest that cold agglutinin-associated lymphoproliferative disease is a distinct entity that is different from lymphoplasmacytic lymphoma.

The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

We present a case of a 34 year-old male diagnosed with ankylosing spondylitis. After two years of treatment with infliximab, the patient developed a clinical picture compatible with stage II thoracic sarcoidosis. These findings resulted in the interruption of infliximab therapy. The patient was not administered new treatment since respiratory function testing did not confirm harmful repercussions. After a follow-up of 1 year, the patient is asymptomatic and radiologic tests show complete resolution of pulmonary infiltrates and mediastinal and bilateral hilar lymphad- enopathy.

Patterns may explain part of the dietary variation between subjects.To create a typology of carbohydrate intake among the elderly and to analyse whether it seems valuable or not.Factor and cluster-analyses of dietary interviews from two elderly cohorts of free-living elderly people in Göteborg, Sweden.Three hundred and thirty seven women and three hundred and twenty three men aged 70-79 was studied cross-sectionally and longitudinally. The altogether 917 dietary interviews were based on the dietary history method. Cluster analysis, based on factor scores, was used to create the typology.Seven clusters were identified: 1) Small eaters (high relative intake of starch and a low energy intake), 2) Lean and green eaters (high intake of dietary fibre), 3) Fruit eaters (high intake of monosaccharides), 4) Sweet tooth eaters (high intake of sucrose), 5) Gourmands (high absolute intake of starch, dietary fibre and energy), 6) Milk drinkers (high intake of lactose) and 7) Fat eaters (high intake of fat and low intake of carbohydrates). The different patterns were associated with different food consumption, different intake of micronutrients and different social and physiological factors. There were also changes over time of the proportion of subject within the clusters.The typology found by using cluster analysis, seems to be valid and was related to all analysed dimensions. Therefore, the methods may be valuable for describing and analysing the dietary intake among elderly.

Within a larger study of social network and nutrition, we investigated measurements of nutritional status and health related quality of life.To relate a well-established questionnaire of nutritional status (MNA) to a likewise well-established questionnaire of health related quality of life (SF-36) in community dwelling, free-living and, healthy 70-75 years old persons.Before an interview, the MNA and SF-36 questionnaires were filled in by 128 participants from a sample of 262 subjects.The MNA worked well as a measurement in this sample. Many MNA aspects correlated with the SF-36 scales. The correlations between MNA total score and the eight SF-36 scales varied from .27 to .62.This correlation was partly due to the fact that MNA has questions of health but also to the fact that there is an empirical relation between nutrition and health.The MNA measurement is applicable to a healthy, free-living elderly population and parts of the MNA can be interpreted as measurements of health related quality of life. Low values of SF-36 could also be used as predictors of risk of malnutrition, although further studies are required to confirm this result.

Larger and different groups of elderly persons will meet us in the next few decades. This review describes cohort differences during a couple of decades from the gerontological and geriatric population studies in Göteborg, Sweden (H 70), regarding for example anthropometry, hearing, cognitive function, dietary habits and oral health. The sometimes great cohort differences have an obvious impact on for example planning of health care. Preventive possibilities are dealt with within the fields of nutrition and physical activity.

The mechanisms for cellular aging have yet to be elucidated, but most data are in favor of a combination of processes. Such theories include a neuroendocrine group of theories, an immunological theory, the theory with a limited number of cell divisions as a basis, and the "wear-and-tear" theories together with e.g. oxidative stress and DNA damage. New data on cardiac aging have implications for geriatric medicine. With advancing age, although body cell mass decreases, the amount of body fat is relatively unchanged, while a more marked change from age 70 entails a reduction in body water. Data on successful attempts to prolong life in man are scarce, even if life-span in animals has been manipulated.

This review deals with the elderly at home and their nutrition in health and disease. The increasing relative and absolute number of elderly in most countries and the high prevalence of disease in the higher age groups make this item a burning one. Both the ageing process per se and the effects of disease on nutritional status add difficulties to this issue. Not only disease but also factors such as impaired vision, presbyacusis, oral health, smoking, and alcohol use or misuse may complicate nutrition in the elderly. Cohort differences may have a marked impact on nutrition regarding several factors. In many countries meal habits and intake of energy and nutrients in at least "young elderly" are on average acceptable. However, variation is marked. In this review practical aspects on preventive nutrition and dietary habits in the elderly at home are also included.

The implications of aberrations in the p53 pathway for induction of apoptosis and regulation of S phase entry, and for patient survival, were investigated in 83 B-cell Non-Hodgkin's lymphomas. Eight cases had missense mutations in exons 5, 7, 8 and 9 as revealed by constant denaturant gel electrophoresis and sequencing. Fifteen cases had lost 1 TP53 allele as revealed by fluorescent in situ hybridization and comparative genomic hybridization. Ten cases expressed high levels of p53 as assessed by immunoblotting and immunohistochemistry. S phase fractions were higher, apoptotic fractions were the same and survival times were shorter in all aberration groups compared with the cases with no TP53/p53 aberrations. Since many tumors had more than one TP53/p53 aberration, the tumors were divided into groups with the following characteristics: no TP53/p53 aberrations; loss of one TP53 allele only (9 cases), TP53 point mutation (8 cases), high-level p53 expression and no TP53 mutation (3 cases). Tumors from the 3 latter groups had higher median S phase fractions (5%, 7.6%, and 5%, respectively, p0.02) than the cases without any aberrations (1.1%), and survival time for these patients was much shorter (relative risks of 5.9, 8.9, and 6.6, respectively, p0.003). Apoptotic fractions were similar in all these groups (p=0.09). Multivariate analysis showed that the presence of TP53/p53 aberrations is a strong and independent prognostic parameter in B-cell Non-Hodgkin's lymphoma.

To describe and compare anthropometric characteristics among populations of 75-year-olds in three Nordic localities and to investigate possible relationships with chronic heart disease (CHD), chronic lung disease (CLD), diabetes mellitus, arthrosis and life-style factors such as smoking and physical activity.Anthropometric data were measured in 104 men and 191 women in Jyvaskyla (Finland), 196 men and 209 women in Glostrup (Denmark) and in 127 men and 167 women in Goteborg (Sweden). Variables assessed were body height, body weight, BMI, waist/hip ratio, skinfolds from several sites and percent body fat by bioelectrical impedance. The diagnosis of diseases were made by a physician based on the individual's medical history, drugs and medical examination. Physical activity was recorded by self-rating.Men in Goteborg were taller and had a higher body weight while there was no difference in BMI among the men. Among women, those in Goteborg were tallest, while those in Jyvaskyla had the highest body weight, BMI, percent of body fat and waist/hip ratio. Biceps and triceps skinfolds were highest in men from Goteborg, while in women triceps and subscapular skinfolds were highest in those from Jyvaskyla. CHD was most common in those from Jyvaskyla, and women with CHD had a higher body weight, BMI and lean body mass in all three localities. Lean body mass was lower in men and women with CLD and women with CLD were also shorter, with a lower body weight, BMI, and percent body fat. Diabetes mellitus was associated with a higher body weight, BMI, percent body fat and lean body mass in women, but not in men. Both men and women with arthrosis had a higher BMI, while smoking was only associated with CHD in those from Jyvhskyla. In men with CHD the proportion of persons with low physical activity was higher in all three localities. The physical activity was also lower among men with CLD and diabetes mellitus in Goteborg and Glostrup.There were anthropometric differences among 75-year-olds in the three Nordic localities. CHD and CLD were associated with various anthropometric variables. These findings may reflect either cause and effect relationships between diseases and anthropometric characteristics or differences in life-style factors influencing morbidity.

To study the ability of colour naming, colour discrimination and colour preference in Alzheimer's disease (AD).Descriptive, consecutive sample.Fifty subjects65 years with AD.Testing colour discrimination, colour naming and colour preferences.Ability to detect colour differences in the yellow, red, blue and green areas, ability to assign a name to 22 colour samples, ability to rank seven colours in order of preference.Discrimination ability was significantly better in the yellow and red area and for lightness variations. Cognitive decline had a significant impact on naming mixed colours and using elaborate colour names. Severity of dementia did not affect the preference rank order of colours.Ability to discriminate is affected in AD, with most errors in the blue and green area. Naming colours shows a cognitive decline. Preferences for colour are stable despite the disease.

The aim of the present study was to investigate color discrimination, color naming and color preference in a random sample of 80-year-old men and women. Knowledge of color perception in old age can be of value when using color contrast, cues and codes in the environment to promote orientation and function. The color naming test indicated that the colors white, black, yellow, red, blue and green promoted recognition to the highest degree among all subjects. A gender-related difference, in favor of women, occurred in naming five of the mixed colors. Women also used more varied color names than men. Color discrimination was easier in the red and yellow area than in the blue and green area. This result correlates positively with visual function on far sight, and negatively with diagnosis of a cataract. The preference order for seven colors put blue, green and red at the top, and brown at the bottom, hence agreeing with earlier studies, and indicating that the preference order for colors remains relatively stable also in old age. This result should be considered when designing environments for old people.

The validity of the Swedish SF-36 Health Survey was examined, replicating techniques used in the U.S. validation. Principal components analysis was used to test the internal structure of the eight SF-36 scales in relation to hypothesized associations with the two major dimensions of health--physical and mental. Hypothesized relationships between scales and external criteria were also examined by means of clinical group contrasts. Both the principal components analysis and clinical group contrasts largely replicated U.S. findings, which supported the cross-cultural stability of the SF-36 in Sweden. As expected, the Physical Functioning and Mental Health scales were most sensitive to clinical manifestations of medical and mental health, respectively. The General Health scale was associated more with physical than mental health. However, the Social Functioning scale and particularly the Vitality scale were more related to mental health in Sweden than in the corresponding U.S. study. Cultural differences and variation in study samples and selection criteria were suggested as possible explanatory factors for these differences.

Within the framework of the gerontological and geriatric population studies in Göteborg, Sweden, 473 elderly persons were examined using pure-tone audiometry in two recent cohorts. The aim of this study was to present cross-sectionally acquired hearing data in these contemporary groups aged 70 and 75. Another objective was to compare hearing function at the same age over the last two decades (time-lag study) in three 70-year-old cohorts and three 75-year-old cohorts. The largest time-lags were 14 years (75-year-olds) and 21 years (70-year-olds). The most recently tested cohort of 70-year-olds, studied in 1992, demonstrated median pure-tone averages (PTA: 0.5, 1 and 2 kHz) of 20.2 dB HL in the left ear of men and 18.2 dB HL in women. The left median pure-tone thresholds at 4 kHz were 56.0 dB HL in men and 34.7 dB HL in women. Hearing acuity in 70-year-olds was not demonstrated to have changed in any consistent fashion over a 21-year time-lag. For the most recently evaluated 75-year-olds, the median PTA in the left ear was 27.3 dB HL in men and 21.6 dB in women. The left median 4 kHz threshold was 67.3 in the male group and 45.5 dB HL in the female group. Hearing in 75-year-olds over a time-lag of 14 years demonstrated somewhat better pure-tone thresholds predominantly in the men's better ear in the earliest cohort when compared to the cohort tested in 1990-91. However, there were no consistent differences of pure-tone thresholds between these age cohorts, except for the intermediate cohort 2, in which the men had generally worse hearing. Thus, there was no apparent evidence of changes of the auditory function in elderly of the same age over the last two decades. Gender-specific dissimilarities in annual pure-tone threshold deterioration between the ages of 70 and 75 were found and are discussed.

This article presents new weight and height data collected during three large surveys of representative middle-aged and elderly men and women from Gothenburg in 1990-93. Based on these data, weight and height tables are provided as an aid in clinical evaluation. Additionally, weights and heights collected during previous examinations in the 1970s (Läkartidningen 1981; 78: 3152-4) make it possible to describe secular changes nearly two decades later. These comparative data suggest that height and weight have increased in both men and women. However, body weight has increased more than height, resulting in an increase in mean body mass index (RMI) in most groups, with the exception of 75-year old women.

Body composition including the amount, the proportion of body weight, and the distribution of body water are of profound interest to both gerontology and geriatric medicine. In this article, methods of estimating body water, the changes with age and in disease, and clinical implications are reviewed. There are many methods to determine body water, the methods having different properties regarding e.g. feasibility and validity. Validation should for the methods used be performed in the population and age group under study. Body water decreases with age, and increases or decreases of body water are common in diseases common in old age. This has obvious clinical implications regarding e.g. geriatric pharmacotherapy, and water and electrolyte therapy. The need for methods to estimate body water and for avoiding both underhydration and overhydration is obvious both in gerontological and geriatric research and in clinical geriatric medicine.

The ability to catch scent continuously while running, which may be an essential skill for many animals of prey, requires that ambient air flows inward through the nose also during expiration. In this study on bird dogs, the direction of air flow was detected by measuring the temperature in the air inside the nostril. While resting, nose ventilation was synchronous with lung ventilation. While searching for ground scent, the dog was sniffing at a frequency of up to 200 s-1, a strategy which may create turbulence in the nasal passages and thereby enhance transport of scent molecules to the receptors in the ethmoidal cavity. When the bird dog was searching for game while running with its head high against the wind, it maintained a continuous inward air stream through the nose for up to 40s spanning at least 30 respiratory cycles. We suggest that expiratory gas flowing at high velocity from the trachea to the mouth cavity creates a lower pressure than in the nose thus causing an inward air stream through the nose during expiration by a Bernoulli effect.

Within the framework of the gerontological and geriatric population studies in Gothenburg, Sweden, the health of immigrants of non-Nordic origin was compared with that of native Swedes in a cohort of 70-year-olds born in 1922. Of the sample examined, 11.4 per cent were of non-Nordic origin, among whom the non-response rate was relatively high (48%). Although there were few differences in "objective" health criteria between the Swedish and immigrant subgroups, there were manifest differences in "subjective" criteria and quality of life. In view of the increasing proportion of elderly immigrants in the Swedish community, these findings need to be borne in mind.

The aim of this cross-national study was to describe and compare differences in functional capacity of 75-year old people in three Nordic urban localities. As the life-expectancy at the age of 75 differs between the Nordic countries, there is reason to look for similar differences in functional capacity, taking differences in socio-demography, lifestyle, living conditions and health into consideration. In 1989-1991, 400 75-year-old men and women were selected to represent 75-year-olds in a Danish, Finnish and Swedish city. They participated in examinations which focused on functional capacity and health, where identical questionnaires, tests, and equipment were employed. The methods employed were developed from the experience gathered during previous studies of epidemiology of ageing in Glostrup, Gothenburg, and Jyväskylä. Functional capacity is the dependent variable multifactorially related to age, health, living conditions, and life style. The data collection was performed with participation rates in the interviews of 85% in Glostrup, 83% in Gothenburg, and 92% in Jyväskylä. The participation rates in the laboratory examinations were 76%, 67% and 77%, respectively. Examples of differences in socio-demographic background, lifestyle and measures of health and performance in the three localities are given. The Nordic study on physical, psychological and social capacity of 75-year-olds was performed with sufficiently standardised methods to allow a comparison of the results. Similar comprehensive cross-sectional comparative studies of the elderly people have not been performed earlier. Local and cross-national results will be published in each field separately and in combination.

The ability to detect the direction of a track is of vital importance to animals of prey and is retained in many modern breeds of dogs. To study this ability, four trained German shepherd tracking dogs, equipped with head microphones to transmit sniffing activity, were video-monitored after being brought at right angles to a track where the position of each footprint was known. Three phases could be recognized in the dogs’ behaviour: (1) an initial searching phase, during which the dog tried to find the track, (2) a deciding phase, during which it tried to determine the direction of the track and (3) a tracking phase, in which it followed the track. During ten tests on 20-min-old tracks on grass, and ten tests on 3-min-old tracks on concrete, the dogs always followed the track in the correct direction (i.e. in the direction the track was leading). During the deciding phase the dogs moved at half the speed and their periods of sniffing lasted three times as long as during the other two phases. The deciding phase lasted 3–5s, while the dogs sniffed at 2–5 footprints. The dogs’ ability to determine track direction in this time must rely on accurate methods of sampling air and a remarkable sensitivity for certain substances.

A representative sample of about 1000 70-year-olds in 1971/72 was included in the longitudinal and cross-sectional population study of elderly people in Gothenburg, Sweden (H70). The objectives were to make a survey of the social and medical conditions of this population, to obtain basic data for planning the care of the elderly, to contribute to the knowledge of normal aging processes and of normal criteria within the age group, and to offer a thorough medical examination. The survivors have been examined longitudinally at ages 70, 75, 79, 81, 82, 83, 85, 88, and 90 years of age. As possible cohort effects during 5-year-periods are also an object of interest, a further two cohorts have been examined at age 70, 75, and 79, and 70, 72, and 76, respectively. Another 75-year-old cohort has also been included (the Nordic comparative study of 75-year-olds-NK75). Using mainly identical methods, but different additional examinations, three Nordic countries cooperated in a comparative study of functional aging within the framework of the gerontological and geriatric population studies during the period October 1990-May 1991. The other centers were the universities of Copenhagen and Jyväskylä. The study aimed at comparing functional ability and biological aging between elderly in the Nordic countries. On an average, 3000 to 4000 variables about aging and diseases in old age are being collected per subject.(ABSTRACT TRUNCATED AT 250 WORDS)

Two professional tracking dogs were brought in at right angles to 50-m-long tracks to try to identify the clues that the dogs used to determine the direction of the tracks. When the dogs were tested on tracks laid by a walking man, they took the direction that the track-maker had moved significantly more often than predicted by random choice regardless of whether the person had moved forwards or backwards. When tested on tracks laid by bicycling on grass or asphalt, the choice of direction was not significantly different from random, even though the dogs were always rewarded when making correct choices. When four leather strips were tied to the back tyre of the bicycle before laying the track, the one dog tested took the correct direction significantly more often than predicted by random choice. When the leather strips were smeared with sausage before laying the tracks, the dog took the wrong direction more often than predicted by random choice. However, when rewarded for making correct choices, the dog learned“ to choose the direction in which the bicycle had actually moved. We suggest that our dogs determined the direction of tracks by comparing the scents of consecutive prints and following the prints in the direction of increasing intensity.

Antler blood flow was studied in a 2 year old male reindeer during the last half of the antler growth period using an electromagnetic flow probe chronically implanted around the superficial temporal artery. Arteriovenous (a-v) differences of calcium were measured on antler blood. The blood flow increased from 60--90 ml/min when the antler was half-grown to 100--120 ml/min when fully developed. Subsequently a reduction was observed towards shedding. Positive a-v plasma calcium differences (on average 0.2 mM) were recorded during the period of active growth. Two bulls maintained positive a-v calcium differences after a 48 hour starvation period, in spite of reduced arterial calcium concentrations. Exercise to near exhaustion caused a 2 degrees C rise in the rectal temperature. Antler blood flow was decreased immediately after exercise and returned to pre-exercise values usually within 5--10 min. Since no overshoot in antler blood flow was recorded during the hyperthermia it is concluded that variations in blood perfusion of the antlers are without importance in the defence against hyperthermia during and after exercise.

Emission samples were obtained from two medium-sized power plants, one fired with oil and the other with pulverized coal. Particles obtained by a miniscale plume stack gas sampler (MIPSGAS), simulating the dilution process in the plume, were subjected to detailed physical, chemical and biological characterization. Studies by scanning electron microscopy and by Coulter counter demonstrated that the particles from the oil-fired boiler were considerably larger than the particles from the coal-fired boiler. Chemical analyses revealed more organic substances and more S, Ni, V, in the oil than in the coal particles. The latter contained a larger proportion of Al, Si, Cl, K, Ca, Ti, Mn, Fe, Se, Rb, Y, Zr, Ba and Pb. Biological testing revealed a greater acute and subacute toxicity by the intratracheal route in the hamster, a greater toxicity to alveolar macrophages and a greater lung retention of BaP coated on the particles from oil combustion than on those from coal combustion. In another sampling line, employed simultaneously with the MIPSGAS-particulate sampler, the total emissions were collected, i.e., both particle and gas phase. These samples were used for chemical analyses and Ames mutagenicity test. Analyses of specific PAHs in emissions from both plants demonstrated that concentrations were below the detection limit (less than 4 ng/m3 of benzo(a)pyrene), which is in accord with an efficient combustion of the fuel. The mutagenicity of the samples were below the detection limit of the mutagenicity assay. Images FIGURE 4. FIGURE 5.

A representative sample of 68-year-old men living in the city of Malmö, Sweden, was examined by means of psychological tests and questionnaires regarding cognitive capacity, cognitive style as an expression of personality, and life satisfaction. Reference values for these parameters are presented, and a continuous cohort increase of verbal ability could be identified in this age group. That the prevalence of cognitive reduction was found to be surprisingly high is tentatively interpreted as reflecting an underdiagnosis of these symptoms as concomitant to other diseases in the general population. Earlier results supporting the concept of terminal decline could not be replicated. The reason for this might be that the present population was somewhat younger than those earlier investigated. Contrary to expectation, life satisfaction did not correlate to either cognitive reduction or cognitive style. It had, however, a positive correlation to measures of fluid intelligence.

The objectives of this cross-sectional population study of 70-year-old people in Gothenburg, Sweden, were to make a survey of the social and medical conditions of the population, to obtain basic data for planning the care of the elderly, to contribute to the knowledge of normal ageing processes and of normal criteria within the age group, and to offer the subjects a thorough medical examination. A representative systematic sample comprised 1 148 propositi (521 males and 627 females). The study comprised a homecall part regarding basic personal data, dwelling conditions, economy, social and physical communications, previous migration, educational level, previous and any present professions, need for care, consumption of health care and drugs. Observations and measurements were done of illumination at the habitual site of reading, and a simple test of visual acuity was performed. Later on, examinations at the Out-patient Department of the Geriatric Hospital were performed, comprising in all probands general medical and ophthalmological examination, blood and urine sampling, ECG and X-ray of heart, lungs, and breasts and on subsamples, psychological, psychiatric, dental, somatometric, and audiometric examination. Furthermore, a dietary interview and a body composition examination were performed on subsamples. This first presentation deals with the design and procedure of the study, analysis of observer variation and a comparison between responders (85%) and non-responders (15%). The general design of the study, the sampling procedure, and general methods of data collection were found to be adequate. The responders were found to be representative for the population as a whole in most respects studied. The results of this study to be reported in subsequent papers will in general allow conclusions regarding the population of 70-year-olds in Gothenburg.

Summary A representative sample of 368 70-year-old males and females in Goteborg, Sweden, participated in an odontological examination and a dietary interview. The aim of the study was to relate dental state to dietary habits and, furthermore, to study the possible influence of some social factors on these relations. The degree of dental invalidity was measured with Eichner's index. There was a highly significant correlation between this index and the number of teeth and tooth contacts. Dietary interviews were performed by a dietitian according to the dietary history method. Intake of several food items was significantly inversely related to the degree of dental invalidity in males but less so in females. The proportion of probands with insufficient intake of nutrients was in one or more respects higher among the edentulous than in the dentate and highest in the female edentulous probands with only one or no denture. Insufficient intakes of some nutrients were significantly related to the degree of dental invalidity. These relations remained unchanged in males but not in females when some socio-economic factors were introduced as confounding factors in a multivariate relation analysis; which might be due to the fact that these social factors play a more important role in females than in males.

Plasma selenium and plasma glutathione peroxidase were measured in 483 68-year-old men participating in a longitudinal population study, in which the probands were representatively selected. The prevalence of cancer and coronary heart disease was assessed by a structured interview. In plasma the concentration of selenium was 1.08 +/- 0.18 mumol X l-1 and the activity of glutathione peroxidase 540 +/- 90 mumol X l-1 X min-1. Plasma selenium was correlated to glutathione peroxidase activity (r = 0.49, p less than 0.001), but not significantly to plasma albumin levels (r = 0.18). Plasma selenium and glutathione peroxidase values in subjects with cancer or angina pectoris were not significantly different from those in subjects without these diseases. Plasma selenium concentration and glutathione peroxidase activity in the subjects who died within 1 year of screening were 89% and 88%, respectively, of the values among survivors (p less than 0.01). For the subjects who died during the second year after screening, these variables did not differ significantly from the values among survivors, 97% and 99%, respectively. Since the relation of low selenium and glutathione peroxidase to mortality was observed only for the first year, it was probably due to a disturbed nutritional state prior to death, rather than to a long-term negative influence of low plasma selenium on the mortality risk. Furthermore, the data have failed to demonstrate a relationship between selenium status and cancer or angina pectoris.

In a representative sample of 621 men aged 68 years 500 (80.5%) participated in a dietary history interview, and in an interview where social network and social support characteristics, marital status, and social class were assessed. Also included was a questionnaire on alcohol consumption and smoking habits, as well as weight and height measurements and an assessment of the men's physical activities. The purpose was to describe dietary habits and to characterize men with inadequate habits according to different psychosocial characteristics. Average intake of energy and nutrients was, in general, well above the recommended. However, the variation was wide. According to the definition used, about 20% were considered to have "inadequate" dietary habits. No proportional differences in social class and marital status were found among these men. However, those with sufficient social network and social support fared better. Overweight, obesity, low physical activity and high alcohol consumption were more common among the men with inadequate diets. Low social anchorage, low physical activity and high body mass index were independent risk indicators of inadequate dietary habits in this population.

Metoprolol, a cardioselective beta-blocking agent, has been given orally to 12 geriatric patients with moderate hypertension. Drug levels of metoprolol as well as the effect of the drug on resting heart rate and BP were studied. Metoprolol was given in a dose of 20 mg, and 8 of the 12 patients also received a 50 mg dose. After the 20 mg dose the peak drug plasma concentration varied between 5 and 80 ng/ml (mean 33), and after the 50 mg dose between 14 and 212 ng/ml (mean 111). This variation is much greater than that seen in earlier studies on healthy volunteers and on a group of non-geriatric hypertensive patients. Plasma half-life of metoprolol averaged about 3.5 hours after both the 20 mg and the 50 mg dose; this does not differe from the plasma half-life in earlier studies in younger age groups. The variability observed in the study might be explained multifactorially, e.g. by different body weight, absorption and/or first-pass effect of the drug.

Twenty-nine chronically diseased patients with an average age of 84 years living in a long-term care nursing hospital were examined. Urinary nitrogen was determined in 24-hour urinary samples to estimate protein intake. The average estimated intake of protein was 47 g (range 32-63 g), corresponding to 0.87 per kg body weight (range 0.57-1.14 g). Ten patients showed an intake of less than 0.8 g per kg body weight, regarded to be a too low protein intake considering the age and chronic diseases of the patients.

Sixteen patients, five males and 11 females, (mean age 80.4 years, range 65-88 years) were studied before, during and after a changed meal environment in a long-term care ward. The dining-room was redecorated in a way similar to what was common during the 1940s. The food was served by the staff on serving-dishes, and the patients could help themselves. A 1-day dietary record was made once a week during the whole study. During the pre-experimental period the average daily intake of energy was 5.8 MJ/1379 kcal and the intake of vitamin D only 2.8 micrograms. During the experimental period the intake of energy and protein increased by 25% (p less than 0.001). No significant changes in body weight occurred which might reflect an increased physical activity. Among the blood chemistry variables blood folate, serum creatinine and retinol showed a significant increase during the experimental period. The changes in retinol might reflect a substitution of a marginal vitamin A deficiency. During the postexperimental period the decrease of serum creatinine was correlated to a decreased protein intake. The intake of energy, protein, vitamin D and thiamine decreased during the last period.

The purpose of the present study was to test the reliability and validity of a new electrical impedance method for estimating body composition in 35 healthy persons and patients in different sex and age groups, and to obtain basal data on the size of different body composition compartments in elderly individuals in health and disease. The reliability studies showed no significant differences with the new method in intraindividual comparisons before and after changing the positions of the electrodes, drinking of water, and overnight fasting, as well as at a double estimation on 2 consecutive days. The results with this method are compared to results from measurements of total body potassium and total body water, and from a four-compartment model technique using total body potassium and total body water. We conclude that the method has an acceptable reliability and validity and should be of great value not only in field studies but also in clinical practice. Data on body composition with the electrical impedance method are obtained from 147 individuals in different groups, namely healthy females, 80-81-year-old males, female patients from a nursing home, and patients of both sexes from a day care unit.

Within in the framework of the longitudinal gerontological and geriatric population study in Göteborg, Sweden, S-Magnesium (S-Mg) was examined in 55 70-year-old males and 55 70-year-old females with a as many probands without diuretic treatment. Probands with diuretic treatment had lower S-Mg than others (p smaller than 0.001). Females had higher S-Mg values than males both in those with (p smaller than 0.05) and without (p smaller than 0.01) diuretic treatment. Sixteen per cent of the males and 7 per cent of the females with diuretics had S-Mg below 0.7 mmol/l compared to none in those without. Out of 161 geriatric inpatients those 50 (17 males and 33 females) with the lowest S-Mg values took part in a double blind comparison between supplementation with a magnesium chloride and a placebo solution during three weeks. The daily dose was 12.5 mmol MgCl2. The tolerance of the solution was tested in 30 young healthy individuals and was found to be good. During treatment with magnesium chloride, S-Mg increased 0.09 plus or minus 0.08 mmol/l (p smaller than 0.001) and during treatment with placebo 0.08 plus or minus 0.09 mmol/l (p smaller than 0.01). The difference between the two groups was not significant. S-potassium, however, increased significantly more in the patients treated with magnesium chloride (p smaller than 0.01). The increase in the treatment group was 0.31 plus or minus 0.32 mmol/l compared to a decrease of 0.02 plus or minus 0.42 mmol/l in the placebo group.

Of a representative sample of 231 subjects (mean age 74.6 years) 89 women and 94 men were interviewed. The dietary history method was used and the calculated intake compared with Swedish recommendations (RDA-S). Mean intakes of energy and nutrients, except for vitamin D among women, were above the RDA-S. Intake of fat was above the RDA-S, and the proportion of energy intake from fat increased with age. Those who had three cooked meals per day had a higher nutrient density than those who ate one or two such meals. Although the RDA-S were the same for men and women, women had lower mean intakes and a higher proportion of subjects below the RDA-S for calcium, iron and vitamins C and D. More women had intakes of calcium and vitamin D simultaneously below the RDA-S. In most aspects the mean dietary intake was satisfactory according to current standards, but the RDA-S for calcium seems low. Fat intake was too extensive for both sexes and many women stood in risk of undernutrition.