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In a consecutive series of 51 one-stroke hemiplegics some aspects of sexuality were investigated using structured interviews. Findings were related to treatment with anti-hypertensive drugs. In most subjects the site of brain lesion was visualized by X-ray methods. Moreover, in a sub-sample of 15 consecutive males LH, FSH and prolactin were assessed using standard clinical radioimmunoassay techniques. Serum testosterone including response to HCG-stimulation was also measured. Both in males and females frequency of intercourse and durations of foreplay and of intercourse were markedly reduced. For the males erectile problems were rare before but occurred for the majority after stroke. For the females, but not for the males, orgastic dysfunction was relatively common pre-stroke. After the stroke such dysfunction occurred for 75% of the females and 64% of the males. Partnership sexual drive also decreased. Each of the 15 males hormonally screened had values within the predicted normal and responses to HCG-stimulation were also adequate. Moreover, actual levels of hormones were associated neither with change in sexual function nor with the sexual function per se at the time of the investigation. Thus, in this sample hormonal disarrangement did not appear to be the cause of sexual dysfunction. Surprisingly, no association between erectile dysfunction and use of anti-hypertensive drugs occurred. We believe that sexual dysfunctions in hemiplegics may rather be explained in terms of coping than by endocrine deficits or by anti-hypertensive treatment.

Aspects of sexual function, partnership responsiveness and fulfilment after stroke were, together with sexually performance orientated and stigmatic attitudes, investigated in 51 subjects. Erectile and orgastic spectatoring were frequent after stroke and were in the males significantly associated. Retarded ejaculation occurred for no males before but for 15% after the stroke. Marked decreases in different kinds of caressive behaviour were followed by discontentment and up to and about half the subjects felt that sexual partnership responsiveness had deteriorated. After the stroke the commonly occurring reduction in general sexual satisfaction was significantly associated with symptoms of increased sexual dysfunction, disturbed partnership responsiveness and reduced sexual fulfilment. The high prevalence of sexual maladjustment in stroke victims appears mostly to be psychogenic. Important precipitating factors are performance orientation and sexual stigmatism. Moreover, lack of sexual information and counselling may contribute to deterioration of partnership sexuality.

In 283 students in various branches of the health profession commonly involved in physical medicine and rehabilitation, experiences of sexual life were investigated together with parameters of sexual function and of sexual performance-orientation. The findings were related to attitudes towards sexuality of disabled subjects. Results indicate that sexual performance-orientation, frustration and dysfunction are common features for the students. Sexual performance-orientation was associated with alienation towards the sexuality and the sexual counselling needs of the disabled. It is therefore recommended that the curriculae of these students should include sexual education and possibilities for sexual counselling.

Background In the light of the growing number of refugees that the world has faced during the last years it is reasonable to suggest that the number with both physiological and mental health needs will raise and result in increased public health challenges. Physical activity with its well documented positive impact on both mental and physical health might be one way for refugees to promote health. The importance of investigating participation in physical activity in this group and the impact it might have on their health and wellbeing cannot be underestimated. Few studies exists in the field and therefore, this study aimed to investigate physical activity in relation to mental well-being, vitality, stress and sleep quality among newly arrived refugees in Sweden. Methods The study was based on the results from a survey, conducted in 2015 - 2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39,5%). Results We found a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees. Conclusions Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so. Key messages There is a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees. Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, and supported in their attempts to do so.

Background As there is incontrovertible evidence of the essential prerequisite of regular physical activity it is also important to understand how different life change events may impact individual's participation in physical activity. Pregnancy and the transition to parenthood have been found to be life change events associated with decreased physical activity among women however, the examination of changes of physical activity in the male parent during this major life change event has been largely neglected in scientific literature and a significant research gap can be found. In the light of this, this longitudinal study aimed to follow changing physical activity patterns among women and med during pregnancy and eight months postpartum compared to pre-pregnancy. Methods The study involved 123 women and 112 men (partners of the women) from the municipality of Karlskrona, Sweden. We measured the self-reported amount of physical activity performed outdoors and indoors before pregnancy (calculated from one month before pregnancy), throughout the entire pregnancy, and eight months postpartum. Results We found similar trends among both women and men in decreasing frequency of physical activity during pregnancy and eight months postpartum as compared to pre-pregnancy, however, overall physical activity levels did not change. Conclusions Our findings contribute new knowledge about changes in men's physical activity patterns from pre-pregnancy to pregnancy and postpartum and is an important contribution in research, as the area is very limited. As couples seem to change activity patterns similarly, it is important to promote family-based physical activity initiatives and encourage couples to be active together during pregnancy and postpartum. Key messages Couples seem to change physical activity patterns similarly during pregnancy and postpartum. as compared to pre-pregnancy. It is important to promote family-based physical activity initiatives and encourage couples to be active together during pregnancy and postpartum.

We aimed to investigate resource use and its association to cognitive impairment, activities of daily living and neuropsychiatric symptoms in residents of Swedish nursing homes. Data was collected in 2014 from a Swedish national sample of nursing home residents (n=4 831) by proxies. The sample consists of all nursing homes in 35 of 290 randomly selected Swedish municipalities. Mean age was 85 years and 67% were women. Cognitive impairment was associated with a 23 hour per week increase in total resource use versus cognitively intact persons. This was also the case for being dependent in activities of daily living. Being dependent increased the amount of resource use by twenty-five hours per week. The sex of a resident did not influence the resource use. Cognitive impairment and functional dependency increases resource use significantly in nursing homes implying possibilities for differentiation of costs in institutional settings.

Objectives: Follow changing physical activity (PA) patterns among women and men during pregnancy compared to before pregnancy. Study design: Longitudinal study. Methods: The study involved 280 indi ...

The aim of the present investigation was to evaluate the effect of sugar-free chewing gums containing fluoride (F) and urea in an intra-oral experimental caries model. Placebo chewing gums (without any active ingredient) and no gum served as controls. Fifteen subjects participated in a cross-over, single-blind study. Demineralised enamel and dentine blocks were embedded in circular plastic discs and bonded to the buccal surfaces of the lower canines and first premolars. The discs were removed and analysed using transversal microradiography after each of the six 4-week periods during which the subjects used either test or placebo products or no product. The results revealed that frequent use of sugar-free chewing gum is sufficient to inhibit further demineralisation of previously demineralised enamel and dentine specimens in the oral cavity. Comparing F, urea and placebo gums, the data showed that there was little or no difference between the products, except for an inhibitory effect on the chewing side of the dentition after using F chewing gums. Copyright (C) 2002 S. KargerAG, Basel.

This paper reviews current ideas relating to oral fluoride retention after topical applications of various fluoride preparations. The oral fluoride reservoirs, which serve as a store for fluoride, gradually releasing its content into saliva, will be discussed. The present paper also deals with fluoride kinetics in the oral cavity. The answer to the title of the paper has, however, not yet been found but remains a goal for researchers studying caries prophylaxis worldwide in the search for possible ways of increasing and improving oral fluoride retention.

Growth hormone (GH) is important for skeletal growth as well as for a normal bone metabolism in adults. The skeletal growth and adult bone metabolism was studied in mice with an inactivated growth hormone receptor (GHR) gene. The lengths of femur, tibia, and crown-rump were, as expected, decreased in GHR-/- mice. Unexpectedly, GHR-/- mice displayed disproportional skeletal growth reflected by decreased femur/crown-rump and femur/tibia ratios. GHR-/- mice demonstrated decreased width of the growth plates in the long bones and disturbed ossification of the proximal tibial epiphysis. Furthermore, the area bone mineral density (BMD) as well as the bone mineral content (BMC)/body weight were markedly decreased in GHR-/- mice. The decrease in BMC in GHR-/- mice was not due to decreased trabecular volumetric BMD but to a decreased cross-sectional cortical bone area In conclusion, GHR-/- mice demonstrate disproportional skeletal growth and markedly decreased bone mineral content.

This investigation was done to determine the bioavailability of fluoride (F) after toothbrushing associated with different water rinsing procedures. Eight adult subjects participated in four experiments, conducted with a randomised, crossover design: (A) 2 min brushing with an F dentifrice, followed by three quick (3 x 2 s) rinses, each with 10 ml of water; (B) brushing as in A followed by one long-lasting (1 min) rinse with 5 ml of water combined with the toothpaste-saliva mixture; (C) brushing as in A followed by expectoration but without any water rinse afterwards; and (D) ingestion of the toothpaste as a slurry with 100 ml of de-ionized water. Blood samples were collected before and frequently for 6 h after each experiment and analyzed for F content. The area under the plasma F concentration vs. time curves (AUC) was calculated and the degree of F absorption estimated. AUC values obtained in experiment D were assumed to represent 100% F bioavailability. The plasma values recorded during experiment A were not significantly greater than the baseline values, indicating almost no F absorption when 3 quick water rinses were performed after toothbrushing. The degrees of F absorption after one long-lasting water rinse (B) were 7.6 +/- 4.2% and with no water rinse after toothbrushing (C) 23.8 +/- 13.5%, respectively. The results showed that the degree of F absorption after toothbrushing using an F toothpaste is strongly related to the mode of water rinsing.

The study consisted of eight experiments, divided into three series, aimed at investigating the effect on the salivary fluoride (F) concentration of three post-brushing regimes: (1) rinsing once or twice with water, (2) rinsing either with a slurry of the toothpaste foam and water or with an 0.05% NaF solution, or a single NaF mouthrinse with no prior brushing, and (3) chewing and drinking ('eating') for 2 min. Brushing was done with 1.5 g of an 0.32% NaF dentifrice. The concentration of F in whole saliva was determined in 15 subjects at various time points up to 45 min after completing each experimental procedure. Results showed that the initial (0 min post-brushing) F concentration in saliva decreased about 1-2 times after a single, and 4-5 times after a double post-brushing water-rinse, as compared with no rinsing at all (p < 0.001). Brushing followed by a mouthrinse with an 0.05% NaF solution elevated the F concentration more than brushing alone (p < 0.001). Rinsing with the slurry of toothpaste foam and water gave only a somewhat (but not significantly) lower concentration of F in saliva than just rinsing with the 0.05% NaF solution. Eating immediately after brushing reduced the salivary F level about 12-15 times (p < 0.001) compared with brushing alone.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the present investigation was to study the brushing and toothpaste technique employed by caries-active and caries-inactive patients in a toothbrushing population. The study consisted of 47 patients at a public dental clinic in the County of Bohuslan, Sweden; 23 with low (group L) and 24 with high caries activity (group H). They were asked to brush their teeth with a fluoride dentifrice at the clinic using an identical technique to that which they employed at home. Various factors, such as brushing time, amount of dentifrice, water consumption and mouthrinsing habits after brushing, were carefully registered. Saliva samples for fluoride analyses were collected up to 45 min after brushing. The members of group L used less rinsing water (0.7 +/- 0.6 dl; mean +/- SD) than those of group H (1.9 +/- 1.0 dl, p < 0.001). Comparing the mouthrinsings with water after the brushing, a significantly higher frequency was observed in group H (3.6 +/- 1.9 rinsings) than in group L (1.5 +/- 0.7 rinsings; p < 0.001). There were no differences between the two groups regarding the amount of dentifrice used and the total brushing time. When the salivary fluoride concentration was plotted vs. time and the area under the curve (AUC) calculated, a significantly higher mean value was found in group L than in group H (p < 0.01). Calculation of the correlation coefficient (r) between the AUC value and the amount of water used gave r = 0.53 (p < 0.001) and between the AUC and the frequency of mouthrinsing r = 0.46 (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Objective The objective of this study was to compare the prevalence of dementia using different diagnostic systems, and to investigate the influence of the different diagnostic components (memory impairment, personality changes, definition of other intellectual functions) on the prevalence. Methods A general population sample of 1,019 elderly living in Gothenburg, Sweden was investigated by using the Comprehensive Psychopathological Rating Scale as well as specific assessments relevant for dementia diagnoses. Diagnoses were given according to the 9th and 10th version of the International Classification of Diseases (ICD-9, ICD-10) as well as the 3rd revised and 4th edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM–III–R , DSM–IV ). Further, "historical" criteria for dementia were applied as had been used in older studies. Results DSM–IV dementia occurred most frequently (9.6%), followed by dementia according to "historical" criteria (7.4%), DSM–III–R (6.3%), ICD-10 (3.1%), and ICD-9 (1.2%). The kappa values for the agreement between the diagnostic systems were between 0.166 and 0.810. The requirement of both long-term and short-term memory impairment in DSM–III–R and personality changes in ICD-10 explained most of the differences. When these requirements were held constant, DSM–III–R , DSM–IV , ICD-10 and "historical" criteria identified predominantly the same persons as demented (kappa: 0.810–1.000). Conclusion Prevalence of dementia varied widely depending on diagnostic classification system used. For DSM–III–R , DSM–IV , ICD-10, and "historical" criteria, the definitions of personality changes and combinations of memory impairment lead to differing prevalence rates, whereas the definitions of other intellectual functions have little impact.

Normal cognitive function depends on sufficient supply and efficient utilization of oxygen in the brain. Prospective studies on respiratory function and dementia are lacking. This study investigated the relationship between midlife respiratory function and incidence of dementia in a population-based sample of 1291 women followed from 1974 to 2003. Respiratory function was measured by peak expiratory flow in 1974, and forced vital capacity and forced expiratory volume in 1980. Dementia diagnoses were based on information from neuropsychiatric examinations, informant interviews, hospital records and registry data. Better respiratory function in midlife was associated with a lower late-life risk of developing dementia and Alzheimer's disease (AD). Per 1 standard deviation increase in peak expiratory flow, forced vital capacity and forced expiratory volume, hazard ratios (95% confidence intervals) for dementia were 0.77 (0.65-0.91), 0.72 (0.57-0.92) and 0.75 (0.59-0.95), respectively, and for AD 0.76 (0.62-0.94), 0.71 (0.54-0.95) and 0.74 (0.56-0.98), respectively, after adjustment for potential confounders. These data reinforce the advantages of maintaining good respiratory function in midlife, even though causation cannot be established.

The aim of the present investigation was to map the presence of prophylactic measures in organized Swedish dental health care systems, focusing on personnel working with children and adolescents. The study was conducted by sending a questionnaire to all public dental clinics in Sweden (830 clinics in all). The results showed that collectively – performed prophylactic measures were given at 66% of the child health centers/ child day care centers and at 63% of the pre-schools. 51% of all clinics replied that they performed some kind of fluoride administration collectively (mainly fluoride varnish application or fluoride mouthrinses). 34% of all clinics used fluoride varnishes at the ages from 6 to 12 years, and collectively-performed fluoride mouthrinsing in schools at these ages was carried out by 16% of the clinics. 26% of all the clinics answered that they aimed at increasing the time spent on prophylactic measures compared to only 2% that were planning to decrease this time. The remaining 12% aimed at maintaining the time spent at the present. Prophylactic measures were performed individually by 49% of the clinics, whereas 50% of the clinics preferred a combination of individually and collectively performed measures. It can be concluded that the preventive measures against dental caries in Swedish public dental care is mainly focused on individually performed prophylaxis.

The aim was to study the salivary fluoride (F) concentration and plaque pH recovery on the chewing and the non-chewing side of the dentition during and after chewing 1 piece of chewing gum containing 0.25 mg F as NaF. Ten subjects refrained from toothbrushing for 3 days. On the fourth day, they rinsed for 1 min with 10 ml of a 10% sucrose solution. When plaque pH had reached a low value, they started to chew for either 5, 10, 15, 20, 30 or 45 min. Measurements of F concentration in saliva and of pH of approximal plaque were carried out at 2 contralateral sites for up to 60 min. In each individual, the chewing and non-chewing side were registered. Two to 3 times higher salivary F concentrations (expressed as area under the curve, AUC) were found on the chewing than on the non-chewing side (p < 0.05 or p < 0.01). The most pronounced recovery of plaque pH after the sucrose rinse was also registered for the chewing side, but the difference between the chewing and the non-chewing side was not so obvious as for the salivary F concentration. Significantly higher values of plaque pH (expressed as AUC) were found during prolonged chewing (p < 0.05 or p < 0.01), while only small numerical differences in salivary F concentration were noted between short and long chewing times. Thus, this study showed: (1) that the F concentrations in saliva after chewing a F-containing chewing gum were highest on the chewing side, and (2) that a prolonged chewing time increased the plaque pH recovery after a sucrose rinse, but had only a minor effect on the salivary F concentration.

The aim of the present investigation was to study two post-brushing water rinsing procedures: (1) on fluoride (F) accumulation in approximal dental plaque, and (2) on F clearance in the interdental area. Twenty subjects participated first in the accumulation study, including three experimental periods (A, B and C), each lasting for 7 days. During period A, they brushed with a 0.32% NaF dentifrice for 2 min, followed by a 1-min active mouth rinse with the toothpaste foam combined with 5 ml of water. During period B, the 2-min brushing was followed by three quick water rinses with 15 ml each. During period C, toothbrushing, which was carried out without any toothpaste, was followed by a 2-min active mouthrinse with 10 ml of a 0.05% NaF solution. All three procedures were performed in the morning (after breakfast) and in the evening (just before bedtime). The results showed that the accumulation of F in pooled approximal plaque after 7 days reached on average 2.7 times higher values after procedure A than B (p0.001). Procedure C also resulted in more F in plaque than B (p0.001). The same 20 subjects participated in the clearance study on a separate occasion. When measuring the F concentration in the interdental area at 3 h after the application, procedure A resulted in a significantly higher F concentration than both toothbrushing B and mouth rinse C; the AUC was 2.2 times larger for A than for B (p0.001). Thus, both the accumulation of F in approximal plaque and the clearance of F in the interdental area are related to the mode of water rinsing after toothbrushing.

A 3-year, double-blind caries trial was conducted to evaluate the caries-reducing effect of a modified technique to use toothpaste. At the outset, 369 children, 4 years of age, were randomly assigned to four groups. At the end of the study, when the children were 7 years old, 281 (76%) had completed the trial. Two of the groups (test groups, n = 131) were given the following instructions regarding 'toothpaste technique': (1) to spread the paste evenly on the teeth prior to brushing, (2) not to expectorate more than necessary during brushing, (3) to filter the remaining dentifrice foam in the dentition, together with a sip of water, by active cheek movements for 1 min before expectorating, and (4) not to carry out any further water rinsings afterwards, and not to eat or drink for 2 h after brushing. The children in the other two groups (control groups, n = 150) were not given any instruction how to use the dentifrice and how to rinse after the brushing, but were, as the children in the test groups, encouraged to use the test dentifrice and to brush their teeth twice daily. Two commercial fluoride dentifrices (A and B) were compared: one of the test groups and one of the control groups used each product. Approximal carious lesions were scored on bite-wing radiographs at baseline and at the end of the study on the distal surface of the first and on the mesial surface of the second primary molars. No difference in caries increment was found between toothpastes A and B. The children in the two test groups developed a mean of 1.14 new dfs during the 3 years compared to 1.55 in the two control groups (p0.05). Thus, the results indicate that the modified toothpaste technique reduced approximal caries in preschool children by an average of 26%.

The aim was to study the effect of two different water rinsing procedures after tootbrushing with an NaF-containing dentifrice on the degree of de- or remineralization of enamel and dentine at approximal and buccal sites. Seven adults, wearing complete dentures, participated in two experimental periods (A and B) in a randomised order. During period A, they blushed with the dentifrice for 2 min, followed by 1-min active mouthrinse with the toothpaste-foam combined with 10 ml of water. No more water was used after the slurry had been spat out. During period B, the brushing was followed by 3 thorough rinsings of approximately 15 ml water each. These two procedures were carried out twice daily, i.e. in the morning (after breakfast) and in the evening (just before bedtime), during 3 months. Demineralized enamel and dentine samples were mounted at two locations - approximally and buccally - in the first molar region of the upper prostheses. Quantitative microradiography (TMR) was used to assess the lesion depth (Id) and the mineral loss (Delta Z). The results showed that the approximally located samples continued to lose mineral during both periods A and B. However, the Id and Delta Z values for enamel (p

The aim of the investigations was to evaluate the cariostatic effects of a modified toothpaste technique using fluoride (F) toothpaste. The modification consisted of an active mouthrinse with the toothpaste slurry and a sip of water for one minute after brushing. Toothpaste technique and salivary F concentration after toothbrushing were recorded in a caries active and a caries inactive group. The level of F in whole saliva, the concentration of F in plasma, the effect on demineralised enamel and dentine samples, and the accumulation of F in interdental plaque when using the modified toothpaste technique were studied. In a 3-year clinical trial, 4-year old children were trained in the toothpaste technique. The results showed that in the caries active group, the water rinsing was more thorough and more water was used compared to a caries inactive group. Rinsing with water and eating immediately after toothbrushing decreased the F level in whole saliva. Mouthrinsing with either a NaF solution or a slurry of toothpaste foam and water increased the F concentration in saliva compared to when a single or double water rinse was performed. The degree of F absorption in plasma, the accumulation of F in approximal plaque and the interdental clearance after toothbrushing were strongly related to the mode of water rinsing. The degree of demineralisation of enamel and dentine at approximal sites was also related to the mode of water rinsing. The clinical study showed that the cariostatic effect of the modified toothpaste technique resulted in 26% less approximal caries in the test group. It is concluded that a toothpaste technique where a slurry rinse was carried out after brushing increased the efficacy of F toothpaste.

High resolution spatial details of the distribution of activity in three dimensions is required to evaluate the localization and dosimetric properties of radiolabelled monoclonal antibodies in tumors and normal tissues. Planar imaging of small animals with a resolution of 5-10 mm is usually the imaging modality of choice. The authors investigated high resolution single-photon emission computed tomographic (SPECT) imaging, based on a rotating pinhole scintillation camera. Although the sensitivity of the pinhole collimator is low, several radionuclides offer suitable decay properties to perform pinhole SPECT, especially in conjunction with high activity levels used in radioimmunotherapy.Transverse, sagittal, and coronal sections were reconstructed using a three-dimensional cone-beam algorithm, which is a generalization of the two-dimensional fan-beam filtered backprojection algorithm. Before reconstruction, the pinhole projections were corrected for the decay of the radionuclide, geometric and intrinsic efficiency variations of the camera system, and center of rotation shift.The spatial resolution at 50 mm from the pinhole collimator with 3.3 mm aperture was 3.4 mm, and the sensitivity 7.2 c/s microCi for technetium-99m. With the 2 mm collimator the resolution was 2.2 mm, and the sensitivity was 2.6 c/s/microCi. To show the spatial resolution in vivo, a rat was injected with 185 MBq of technetium-99m-methylene diphosphonate or with 5 mCi technetium-99m-hexamethylpropylene amine oxime. The bone structures were well delineated in the methylene diphosphonate image, and in the hexamethylpropylene amine oxime image, the brain was nicely shown. For comparison a magnetic resonance image for the same section was done.High resolution SPECT imaging with the pinhole collimator provides mapping of the activity in three-dimensions, needed for more detailed biodistribution data and to perform more accurate dosimetry.

The aim of the present investigation was to compare the clearance pattern in saliva and the salivary stimulating effect of a new fluoride (F) chewing gum (Fluorette) with three other F products used in Scandinavia for many years for caries prevention. Concentration of F was determined in whole saliva in three groups of subjects: 1) children, 10-12 yr of age (n = 20), 2) adults (n = 20), and 3) dry mouth patients (n = 15), after a single intake of the two tablets, Dentan and Fludent, and the two chewing gums, Fluomin and Fluorette, all containing 0.25 mg F as NaF. Sucking was allowed until the tablets had been completely dissolved in the mouth. The chewing gums were used for 15 min. Saliva samples were collected from subjects expectorating 0.3-0.5 ml at nine different time intervals up to 45 min after the intake. There were some significant differences in the maximum F concentration, the area under the salivary fluoride concentration curve (AUC) when plotted against time, and the salivary stimulating effect among the four products, but as a whole they were small and probably of minor clinical importance. Among the various groups, the dry mouth patients showed the highest salivary F concentration. Thus, the main conclusion from this study is that the F tablets and chewing gums studied, including the new product Fluorette, had approximately the same clearance pattern in saliva and the same salivary stimulating effect. However, there were great variations among the different subjects.