Aligned or misaligned: Are public funding models for speech-language pathology reflecting recommended evidence? An exploratory survey of Australian speech-language pathologists

Government subsidised funding arrangements serve as an essential medium for families to access private speech-language pathology (SLP) services in Australia. This study aimed to investigate whether, from a provider perspective, contemporary public funding models (PFMs) align with best-available scientific evidence for management of children and young persons with swallowing and communication disorders within Australian private-practice settings. This exploratory study was distributed to paediatric speech-language pathologists throughout Australia via an online survey. A total of 121 valid surveys were completed by Australian speech-language pathologists with divergent career experiences. In comparing three familiar PFMs using mixed effects logistic regression models to estimate odds ratios, results indicated that perceived congruence with recommended scientific evidence for SLP management varied across PFMs: the odds of failing to align with scientific evidence was 4.92 times higher for Medicare's Chronic Disease Management Plan (MBS_CDMP) than for the National Disability Insurance Scheme; and 7.40 times higher in comparison to Medicare's Helping Children with Autism initiative. This study is the first to report on (in)congruence between PFMs that provide access to independent Australian SLP services for children and young persons and best available scientific evidence to inform clinical practice. Participants identified that: (a) four out of seven contemporary PFMs were unfamiliar to speech-language pathologists; and (b) MBS_CDMP initiative failed to align with the evidence-base for best scientific SLP management.

Fission Product Yield Measurements from Neutron-Induced Fission of 235,238 U and 239Pu

Fission product yields (FPY) are one of the most fundamental quantities that can be measured for a fissioning nucleus and are important for basic and applied nuclear physics. Recent measurements using mono-energetic and pulsed neutron beams generated using Triangle Universities Nuclear Laboratory’s tandem accelerator and employing a dual fission chamber setup have produced self-consistent, high-precision data critical for testing fission models for the neutron-induced fission of 235,238U and 239Pu between neutron energies of 0.5 to 15.0 MeV. These data have elucidated a low-energy dependence of FPY for several fission products using irradiations of varying lengths and neutron energies. This paper will discuss new measurements just beginning utilizing a RApid Belt-driven Irradiated Target Transfer System (RABITTS) to measure shorterlived fission products and the time dependence of fission yields, expanding the measurements from cumulative towards independent fission yields. The uniqueness of these FPY data and the impact on the development of fission theory will be discussed.

Multidimensional severity assessment in bronchiectasis: an analysis of seven European cohorts

INTRODUCTION

Bronchiectasis is a multidimensional disease associated with substantial morbidity and mortality. Two disease-specific clinical prediction tools have been developed, the Bronchiectasis Severity Index (BSI) and the FACED score, both of which stratify patients into severity risk categories to predict the probability of mortality.

METHODS

We aimed to compare the predictive utility of BSI and FACED in assessing clinically relevant disease outcomes across seven European cohorts independent of their original validation studies.

RESULTS

The combined cohorts totalled 1612. Pooled analysis showed that both scores had a good discriminatory predictive value for mortality (pooled area under the curve (AUC) 0.76, 95% CI 0.74 to 0.78 for both scores) with the BSI demonstrating a higher sensitivity (65% vs 28%) but lower specificity (70% vs 93%) compared with the FACED score. Calibration analysis suggested that the BSI performed consistently well across all cohorts, while FACED consistently overestimated mortality in 'severe' patients (pooled OR 0.33 (0.23 to 0.48), p<0.0001). The BSI accurately predicted hospitalisations (pooled AUC 0.82, 95% CI 0.78 to 0.84), exacerbations, quality of life (QoL) and respiratory symptoms across all risk categories. FACED had poor discrimination for hospital admissions (pooled AUC 0.65, 95% CI 0.63 to 0.67) with low sensitivity at 16% and did not consistently predict future risk of exacerbations, QoL or respiratory symptoms. No association was observed with FACED and 6 min walk distance (6MWD) or lung function decline.

CONCLUSION

The BSI accurately predicts mortality, hospital admissions, exacerbations, QoL, respiratory symptoms, 6MWD and lung function decline in bronchiectasis, providing a clinically relevant evaluation of disease severity.

High sodium and low potassium intake in patients with Type 2 diabetes

AIMS

To document dietary sodium and potassium intake and adherence to the Australian National Heart Foundation (NHF) guidelines in patients with Type 2 diabetes mellitus attending an Australian tertiary referral and university teaching hospital.

METHODS

In a longitudinal study, 24h urinary sodium (uNa), potassium (uK), creatinine (uCr), urea (uUrea) and glucose (uGlu) excretions, urine volume (uVol) and body mass index were recorded in 122 regular attenders over an 8 year period (2001-2008; mean of 1.9 samples/patient/year). In a cross-sectional study, the same measurements were recorded in patients providing urine samples in the month of June from 2001 to 2009 (782 patients, averaging 87/year).

RESULTS

In the longitudinal study, uNa (mmol/24 h) was 170 ± 53 (mean ± SD) in males and 142 ± 51 in females, whereas uK (mmol/24 h) was 75 ± 22 in males and 62 ± 18 in females. Once adjusted for insensible losses, only 3% of males and 14% of females met the NHF dietary sodium intake guidelines, and 14% of males and 3% of female patients met the NHF dietary potassium guidelines. Body mass index, uUrea, uVol and uGlu were independent predictors of uNa (adjusted r(2) =0.57, P<0.0001). The mean intra-individual coefficient of variation of the corrected uNa was 21 ± 1%. The cross-sectional study confirmed these findings, and no temporal trends were observed. There was no correlation with glycated haemoglobin to suggest natriuresis with hyperglycaemia.

CONCLUSIONS

Most patients with Type 2 diabetes mellitus do not meet NHF sodium or potassium intake guidelines. A diet high in sodium and low in potassium may contribute to the development of hypertension and to resistance to blood-pressure-lowering therapies.

Leaf color used by cabbage root flies to distinguish among host plants

In experiments in which spectrophotometric reflectance patterns of real leaves were mimicked with mixtures of artists' pigments, leaf color was shown to be a character used by cabbage root flies, before landing on leaves, to discriminate among the host plant cultivars radish, green cabbage, and red cabbage. It may be possible to take advantage of factors that affect leaf color, such as epicuticular bloom, pubescence, and masking of chlorophyll by other pigments, to decrease the attraction of certain pest insects to plants.

Salt supplementation blunts the blood pressure response to telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes

AIMS/HYPOTHESIS

We assessed the effects of sodium chloride (NaCl) supplementation on the blood pressure response to treatment with telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes and habitually high (HDS, sodium excretion >200 mmol/24 h on two out of three consecutive occasions) or low (LDS, sodium excretion <100 mmol/24 h on two out of three consecutive occasions) salt intake.

METHODS

Patients received 4 weeks of telmisartan followed by 4 weeks of telmisartan plus hydrochlorothiazide. In a double-blind randomised fashion, patients received sodium chloride (NaCl, 100 mmol/24 h) or placebo capsules in addition to their habitual salt intake during the last 2 weeks of telmisartan and telmisartan plus hydrochlorothiazide therapy. The protocol was repeated with NaCl and placebo capsules administered in reverse order to allow each participant to act as his or her own control. At 0, 4, 8, 14, 18 and 22 weeks, 24 h ambulatory blood pressure (ABP) and 24 h urine collections were performed.

RESULTS

No statistically significant differences were seen in the ABP response in the LDS vs HDS groups to any of the interventions (p = 0.58). NaCl supplementation reduced the effect of telmisartan with or without hydrochlorothiazide on systolic BP by approximately 50% (-5.8 mmHg during NaCl supplementation vs -11.3 mmHg during placebo, mean difference 5.6 mmHg [95% CI 1.7-9.4 mmHg], p = 0.005), irrespective of habitual salt intake. By contrast, addition of hydrochlorothiazide increased the antihypertensive effect of telmisartan on systolic BP by approximately 35% (p = 0.048) in both groups of patients.

CONCLUSIONS/INTERPRETATION

NaCl supplementation blunts the effectiveness of telmisartan with or without hydrochlorothiazide in hypertensive patients with type 2 diabetes, independently of habitual low or high salt intake.

The Ukrainian-American study of leukemia and related disorders among Chornobyl cleanup workers from Ukraine: I. Study methods

There are relatively few data on the risk of leukemia among those exposed to external radiation during cleanup operations after the Chornobyl nuclear accident, and results have not been consistent. To investigate this further, we assembled a cohort of 110,645 male cleanup workers from Ukraine and identified cases of leukemia occurring during the period 1986 to 2000. Detailed interviews were conducted and individual bone marrow doses estimated using a new time-and-motion method known as RADRUE described in companion paper II. For the initial analyses we used a nested case-control approach with a minimum of five controls per case, matched for year of birth, oblast (region) of registration, and residence. All identified cases were reviewed by an international panel of experts; 87 of 111 were confirmed. The dose-response analysis and results are given in companion paper III. As background, we describe herein the design, procedures, outcome of case finding and confirmation, control selection, dose estimation and interviewing of subjects.

Nutritional characteristics of people with impaired mental capacity from a nationally representative survey of British people aged 65 years and over

BACKGROUND

Mentally impaired older people are frequently excluded from population surveys for practical reasons; thus their nutritional characteristics are poorly delineated.

OBJECTIVE

To describe the nutritional characteristics of those who, through mental impairment, were considered to require proxy consent and/or proxy information-givers, within a National Diet and Nutrition Survey (NDNS) of people aged 65 years and over, in the UK.

DESIGN AND METHODS

2043 participants in the NDNS in mainland Britain during 1994-95 were studied. Proxy consent and/or proxy information was provided by the next-of-kin or a carer for 3% of people living in the community and for 35% of people in institutions. A four-day weighed diet estimate and a single blood sample for nutritional status and clinical chemistry indices were obtained.

RESULTS

Inclusion of people requiring proxy consent and/or information was acceptable to NHS local research ethics committees. These participants differed in certain food choices, nutrient intakes and biochemical status indices, from those not requiring a proxy. They ate more sugary and milky foods. They had lower blood concentrations of haemoglobin, retinol, cholesterol; and higher plasma levels of urea and creatinine.

CONCLUSIONS

Older people who require proxy consent or information-givers can be studied in population surveys. They are nutritionally vulnerable and may need special assistance to ensure acceptable nutritional intake and status.

A confidence interval analysis of three studies using the Alzheimer's disease knowledge test

It has been suggested that community awareness of Alzheimer's disease (AD) has increased over recent years. This claim has been difficult to evaluate given the lack of systematic research in this area however, despite some recent attempts at monitoring changes in knowledge about AD. To address the question of change in awareness about AD, the present study compared results from three studies that have investigated the level of AD knowledge among undergraduate students, using confidence intervals. Consistent with previous findings, the results of this study suggest that more recent cohorts of undergraduate students are more knowledgeable about some aspects of AD, although to an extent that is much less marked than previously thought. Importantly, there are also a number of areas in which there appears to have been little or no change in community awareness about AD, and these are highlighted as issues that may need to be specifically addressed as part of future career education programs.

Pest insect control in organically-produced crops of field vegetables

In the UK, the demand for organic vegetable and salad crops is increasing, mainly as a result of the requirements of the multiple retailers. However, approximately 85% of the organic fruit and vegetable produce sold in the UK is imported. A major constraint to growing field vegetable crops, and particularly organically-produced crops, is the reduction in crop yield and quality caused by pest insects. This paper will consider the control techniques currently available to organic growers and other techniques that may become available in the future. Growing plant varieties with complete or even partial resistance to pest insects can be an effective way of reducing crop damage. There are already varieties of carrot, with resistance to carrot fly, and lettuce, with resistance to certain pest aphid species, which are available commercially. Cultural techniques to exclude, deter or avoid pest insects are also being used by some organic growers. Although isolating new crops from sources of infestation can be a highly effective control strategy, many organic growers cannot use it, as the land converted for organic production is still limited. Various crop covers can be used to prevent pest insects from damaging field crops, but to be effective such covers have to be in place before the pests enter the crop. Several researchers have tried to develop techniques to prevent pest insects from finding their host-plants. No technique involving semiochemicals has been sufficiently successful to be used in field vegetable production in the UK. Other studies have shown that the numbers of pest insects found on crop plants are reduced considerably when the crop is allowed to become weedy, is intercropped with another plant species, or is undersown with a living mulch. Hence, work is now needed to select background plant species that will both reduce pest insect numbers and cause the least reduction in yield to the harvested crop plants. There is also a need to obtain a better understanding of "companion planting", a practice used frequently by organic growers. To date, microbial control is the only biological technique that has been used successfully in field vegetable crops in the UK. However, only the toxicant produced by one microbial agent, the bacterium Bacillus thuringiensis, has so far been registered for use. The use of bacteria, fungi and viruses to control pests of field vegetable crops certainly has possibilities. However, in many cases there are still problems to be overcome to select pathogens that are compatible with, or can still be effective in, the wide fluctuations in temperature, humidity and soil moisture that occur under field conditions. Attempts are now being made to use entomopathogenic nematodes and predatory arthropods to control one major pest insect, the cabbage root fly. Techniques developed to improve the timing of application of various crop protection procedures in systems of conventional vegetable production apply equally well to organic production, despite the choice of control options being more limited. In particular, models to forecast the timing of pest insect attacks could be used to great effect, to indicate the best times to plant, protect and harvest a specific crop to minimise pest insect damage.

The relationship between oral health status and Body Mass Index among older people: a national survey of older people in Great Britain

AIMS

To assess the relationship between oral health status and Body Mass Index.

MATERIAL AND METHODS

This paper relates to the free-living sample (participants who lived in their own home, rather than an institution) of the National Diet and Nutrition Survey: people aged 65 years and older.

SUBJECTS

629 adults.

DATA COLLECTION

A probability random national sample of adults who had a dental examination, an interview and an anthropometric examination.

DATA ANALYSIS

Fisher's exact test and multivariate logistic modeling.

FINDINGS

Being underweight was relatively uncommon in this population. People without teeth were significantly (P=0.05) more likely to be underweight than those with 11 or more teeth; 12.3% and 2.9%. A highly statistically significant (P=0.001) difference was observed in BMI between dentate people with 1-10 teeth and with more than 10 teeth; 24% and 2.9% were underweight. Dentate people with less than 21 natural teeth were on average more than 3 times more likely to be obese than those with 21-32 teeth (P=0.036). There was no significant difference in both the proportion of overweight and obese adults between those who were edentulous and dentate with 21 or more teeth. A similar pattern was observed when the number of posterior occluding pairs was compared with BMI categories. Results of multiple logistic regression were adjusted for the confounding effects of age, social class, region of origin and partial denture wearing.

CONCLUSIONS

Older people in Britain with more than 20 teeth are more likely to have a normal Body Mass Index.

Geographical variations in nutrition-related vascular risk factors in the UK: National Diet and Nutrition Survey of People Aged 65 Years and Over

BACKGROUND

There is a strong north-south gradient of vascular disease in Britain, whose aetiology is not fully understood.

OBJECTIVE

To test the hypothesis, in a cross-sectional survey of older people, that intakes and status indices for protective micronutrients, particularly those for which fruit and vegetables are rich sources, also vary on a north-south axis.

DESIGN

The 1994-5 National Diet and Nutrition Survey of People Aged 65 Years and Over has provided a uniquely appropriate data-set for this purpose. The analysis, confined to free-living participants, compared nutrient intakes and status between people living in the north of Britain, from Scotland to Humberside, with those living south of the Wash, excluding the Midlands and Wales.

RESULTS

Highly significant north-south differences, especially for vitamin C, but also to a significant extent for B-vitamins and carotenoids, indicated a more vitamin-rich diet, with more frequent use of vitamin supplements, in the south. Vitamin D status and fibre intakes were also higher in the south; sodium intake was greater in the north. Blood lipid indices did not, however, differ between north and south. North-south differences in the likelihood of receiving income support, of having manual socio-economic status and of smoking habit, appeared to be significant underlying socio-demographic factors.

CONCLUSION

These findings are consistent with the hypothesis that for older British people, differences in nutrient intake and status indices between the north and south of Britain run parallel with, and may contribute to, the north-south axis of vascular disease risk.

JunB negatively regulates AP-1 activity and cell proliferation of malignant mouse keratinocytes

OBJECTIVE

Previously we have shown that a malignant mouse keratinocyte cell line, 10Gy5, has elevated AP-1 transactivation and reduced JunB protein levels compared to its parental benign cell line, 308, and that the tumorigenicity in the 10Gy5 cells could be blocked by a dominant negative c-Jun mutant protein. We wished to determine whether the change in JunB protein levels could account for the elevated AP-1 activity and whether re-expression of JunB in malignant 10Gy5 cells altered their proliferative capacity.

DESIGN

In the current study, we reduced JunB expression in benign 308 cells with antisense oligonucleotides and increased JunB expression in malignant 10Gy5 cells by stable transfection of a JunB expression vector.

RESULTS

Increased AP-1 activity was detected after treatment of the benign 308 cell line with JunB antisense oligonucleotides that reduced JunB protein levels. Stably JunB-transfected clones of malignant 10Gy5 cells showed decreased AP-1 activity, slowed in vitro cell proliferation and reduced tumor growth when xenografted to athymic nude mice.

CONCLUSION

These findings suggest that expression of JunB protein has a negative effect on malignant tumor cell proliferation in part through its ability to inhibit AP-1 transactivation.

Prevalence of impacts of dental and oral disorders and their effects on eating among older people; a national survey in Great Britain

OBJECTIVE

The objective was to assess the prevalence, in a British population aged 65 years and older, of oral health related impacts and the effects they had on the quality of daily life and in particular on eating.

METHODS

753 free living and 202 institutionalised subjects aged 65 years and over, participating in the oral health survey of the British National Diet and Nutrition Survey (NDNS), had a dental examination and interview. Data on the impact of dental and oral disorders on the activities of daily living based upon the modified Oral Impacts on Daily Performance (OIDP) indicator were collected.

RESULTS

17% of the free living edentate participants reported that their mouth affected their pattern of daily living on a regular basis. Oral impacts levels were lowest in dentate subjects with the greatest number of teeth. For the dentate, the most common oral impacts were on eating and speaking. Impacts relating to emotional stability, sleeping, relaxing, carrying out physical activity and social contact were very infrequent, but were severe when they did occur. Among those with an impact on eating, 25% said it was severe and 42% had the impact nearly every day or in a spell of 3 or more months. Oral impacts were more prevalent among the institution sample, particularly the dentate. The impacts were associated with the inability or difficulty to eat a range of 16 common foods.

CONCLUSION

This survey has shown that the oral status of older people fairly frequently affects the quality of life of older people, and in particular, the ability to eat several common types of foods.

The relationship among dental status, nutrient intake, and nutritional status in older people

Dental health status may influence nutrition. The objective of this part of the National Diet and Nutrition Survey was to assess if there is a relationship between dental status in people 65 years and older and intake of certain nutrients and any link between dental status and blood-derived values of key nutrients. Random national samples of independently living subjects and those living in institutions had dental examinations, interviews, four-day food diaries, and blood and urine analyzed. In the sample living independently, intakes of most nutrients were lower in edentate than dentate subjects. Intake of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C was significantly lower in edentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly of non-starch polysaccharide. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and plasma retinol were the only analytes significantly associated with dental status.

Cabbage root fly control using non-organophosphorus insecticides

The need to find non-organophosphorus insecticides to control the cabbage root fly has never been so urgent. Of the six non-OP insecticides tested, fipronil was the most effective but spinosad, diflubenzuron and cyromazine also showed considerable promise. As expected, the transplant drenches (34 mg active ingredient (a.i./plant) were more effective than the module drenches (5 mg a.i./plant), which in turn were more effective than the film-coated seed treatments (0.001 mg a.i./plant), simply because of the different amounts of insecticide applied per plant. One remaining major problem is that, even if effective non-OP insecticides can be found, the manufacturers may still not support their insecticides being applied to minor crops such as field vegetables.

Longitudinally foretelling drug use in the late twenties: adolescent personality and social-environmental antecedents

This research focuses on the interrelation of the parent-child attachment, unconventionality, friends' drug use, and the young adult's use of drugs. Data were collected from participants at 4 points in time: early adolescence, late adolescence, early 20s, and late 20s. Data were collected from mothers at the 3 points in time that corresponded with the first 3 collections of data from their children. Both the youths and their mothers were individually interviewed. The findings indicated that the effect of parent-child mutual attachment was mediated through early adolescent personality attributes of greater responsibility, less rebelliousness, and intolerance of deviance. These non-drug-prone personality and behavioral attitudes, in turn, insulated the young adult from affiliating with drug-using peers, and these attitudes were related to less drug use in the early 20s and ultimately in the late 20s. The results suggest that interventions focused on enhancing parent-child mutual attachment should result in a reduction of the risk factors conducive to drug use during the late 20s. The fact that these findings cover a decade and a half, from early adolescence to the late 20s, underscores the significance of placing drug use in a perspective that includes familial and behavioral aspects.

Visual acuity measurements in a national sample of British elderly people

BACKGROUND

Despite the fact that visual function has an important role in the quality of life in later years, very few studies have measured visual acuity in population based nationwide samples of British elderly people. Such measurements were carried out in the context of the national diet and nutrition survey of people aged 65 years or over (NDNS).

METHODS

NDNS participants, who were living in 80 different randomly selected postcode areas of mainland Britain, were visited at their home by a nurse who measured visual acuity at 3 metres, using the Glasgow acuity card (GAC) method. In addition, a brief questionnaire related to ocular health was administered.

RESULTS

Visual acuity was measured in 1362 NDNS participants who were not classified as mentally impaired. Visual impairment (using the WHO low vision criteria) was measured in 195 (14.3%) subjects. Prevalence of visual impairment increased significantly with age (65-74 years 3.1%; 75-84 years 11.6%; 85+ years 35.5%, p<0.001 for trend). Impaired vision was more common in subjects living in a nursing home (odds ratio adjusted for age 2.59 (95% CI 2.23 to 2. 96)) and in women (odds ratio adjusted for age 1.55 (95% CI 1.21 to 1.89)). 132 (9.7%) subjects had previously undergone cataract surgery and another 157 (11.5%) had been told that they currently had cataract. Vision improved 0.2 log units or more (at least one Snellen line) with the aid of a pinhole occluder in 289 subjects (21. 2%).

CONCLUSION

Results of this nationwide, community based study confirm that problems with poor distance visual acuity exist in a substantial part of the elderly community, particularly in women and people living in nursing homes.

Gender differences in food and nutrient intakes and status indices from the National Diet and Nutrition Survey of people aged 65 years and over

OBJECTIVES

To determine the patterns and possible explanations for gender differences in food choices, nutrient intakes and status indices, especially for micronutrients, in a representative sample of older people living in Britain, who participated in the National Diet and Nutrition Survey of people aged 65 y and over during 1994-95.

DESIGN

The Survey procedures included a health-and-lifestyle interview, a four-day weighed diet record, anthropometric measurements and a fasting blood sample for biochemical indices.

SETTING

Eighty randomly-selected postcode sectors from mainland Britain.

SUBJECTS

Of 1556 older people not living in institutions who were interviewed, 80% agreed to provide a complete four-day diet record and 63% agreed to give a blood sample for status index measurements.

INTERVENTIONS

None.

MAIN RESULT

The most highly significant gender differences in food choices were that women ate more butter, full-fat milk and certain beverages, cakes, apples, pears and bananas, whereas men ate more eggs, sugar, certain meat products and drank more alcoholic drinks, especially beer and lager. When adjusted for energy intakes, the younger women (65-79 y) had higher intakes than the younger men, of fat, retinol, vitamin C and calcium. The older women (80+ y) had higher intakes than older men, of fat and vitamin E, but lower intakes of protein, zinc and beta-carotene. The younger women had better status indices than the younger men: for alpha- and beta-carotenes, beta-cryptoxanthin and vitamin C. Women had higher plasma concentrations of cholesterol and HDL cholesterol, phosphate and copper, but lower indices of iron and vitamin D status, than men. These gender differences in status were not altered by inclusion of the corresponding nutrient intakes in the model.

CONCLUSIONS

There are gender differences in food choices, in energy and nutrient intakes and in nutritional blood status indices in older British people, especially those aged 65-79 y. Some of the status differences are attenuated in the age group of 80 y and older, whereas others are enhanced. The relationships between the quantity and type of foods or nutrients consumed, and nutrient status, are complex. With respect to suspected risk and protective factors for vascular disease, women aged 65-79 y had significantly better status for plasma alpha- and beta-carotene, ascorbate, HDL-cholesterol and homocysteine; but, in contrast, they had lower blood haemoglobin concentrations and higher concentrations of total and non-HDL-cholesterol.

The impact of oral health on stated ability to eat certain foods; findings from the National Diet and Nutrition Survey of Older People in Great Britain

OBJECTIVES

To assess how the dental status of older people's mouths affected their stated ability to eat common foods.

DESIGN

Cross sectional study.

SUBJECTS

Survey was part of the oral health component of the nationwide British National Diet and Nutrition Survey: people aged 65 years and older. Two separate representative samples aged 65 and over: a free-living and an institutional sample. 881 free-living and 275 institution subjects had a dental exam and were interviewed about ability to eat key foods.

RESULTS

Significant percentages of free-living people had difficulty or could not eat at least 4 of 16 foods, and about 1 in 5 dentate stated they had difficulty eating or could not eat raw carrots, apples, well-done steak or nuts. More of the edentate subjects stated that they had difficulty eating than the dentate. Perceived chewing ability increased with increasing numbers of natural teeth and pairs of opposing posterior teeth. Subjects reporting a sociodental impact were more likely to consider that they were unable to eat foods that required more chewing. Associations remained valid after correction for the effects of age, sex, social class and denture wearing status and region. Perceived dryness did not affect significantly the stated ease of eating most foods. There were more dietary restrictions reported by the institution sample. Some foods, such as nuts, apples and raw carrots could not be eaten easily by over half of edentate people in the institution sample.

CONCLUSIONS

The stated selection of foods are substantially affected by numbers of teeth and occluding pairs of posterior teeth and presence of full dentures in significant percentages of older people.

Micronutrients: highlights and research challenges from the 1994-5 National Diet and Nutrition Survey of people aged 65 years and over

The aims of the National Diet and Nutrition Survey series are summarized, and the new National Diet and Nutrition Survey of people aged 65 years and over is explored, with particular emphasis on micronutrient intakes and status indices. Mean nutrient intakes were generally satisfactory for most micronutrients, but intakes of vitamin D, Mg, K and Cu were low. Intakes of vitamin D were far below the reference nutrient intake for people aged 65 years and over, and there was also biochemical evidence of vitamin D deficiency, for 8% of free-living and 37% of institution participants, attributed partly to limited exposure to sunlight. A substantial proportion of people living in institutions had inadequate biochemical status indices, notably for vitamin C, Fe and folate. Relationships between intake and status were close for vitamins. Mineral intakes did not correlate well with currently used status indices. Some intakes and indices, especially those of vitamin C, carotenoids, Na and K, were strongly correlated with socio-economic status and with north-south gradients in Britain. Future research challenges should address the functional and health significance of low intakes and sub-optimal biochemical indices for certain micronutrients, especially for people living in institutions; the shortcomings of mineral status indices especially as indicators of mineral intake; the social and geographical inequalities of micronutrient intakes and status, and why micronutrient status deteriorates with increasing age. The answers to these questions will help to define the characteristics of nutritional risk for older people in Britain, and to clarify future needs for education and intervention.

Plasma pyridoxal phosphate and pyridoxic acid and their relationship to plasma homocysteine in a representative sample of British men and women aged 65 years and over

Concentrations of pyridoxal phosphate and pyridoxic acid were measured in fasting plasma samples from British men and women aged 65 years and over, participating in a National Diet and Nutrition Survey during 1994-5, selected to be representative of the population of mainland Britain. In this population, the concentration of pyridoxal phosphate declined, whereas pyridoxic acid rose, with increasing age and frailty; however, both status indicators were strongly and directly (with a positive coefficient) correlated with estimates of vitamin B6 intake. This was little affected by the inclusion of food energy and protein intakes in the model. Forty-eight percent of the participants living in the community and 75% of those living in institutions had plasma pyridoxal phosphate concentrations below a range considered normal from other studies. In a univariate regression model, plasma pyridoxal phosphate concentrations were inversely correlated with plasma homocysteine concentrations, consistent with the hypothesis that vitamin B6 status may influence plasma homocysteine levels, and hence vascular disease risk. However, this relationship was partly attenuated in a multiple regression model including age, sex, domicile and biochemical status indices, including those of folate and vitamin B12. There was evidence that plasma pyridoxal phosphate was sensitive to metabolic conditions associated with inflammation and the acute-phase reaction, and that plasma pyridoxic acid was sensitive to renal function. Thus, neither index is an ideal predictor of vitamin B6 status in older people, unless these confounding factors are allowed for. Since poor vitamin B6 status may have health implications, e.g. for immune function, cognition, and for essential intermediary metabolic pathways in older people, it needs to be investigated as a possible public health problem.

Use of medicines by older people in a large British national survey, and their relation to vitamin status indices

OBJECTIVE

To describe the extent of use of medicines by older people living in Britain, and to explore relationships with vitamin status indices.

DESIGN

The National Diet and Nutrition Survey of people aged 65 years and over collected data from a British sample during 1994-95. The present study has made novel use of it, to relate medicine use with biochemical indices of vitamin status.

SETTING

Eighty postcode areas, selected randomly from mainland Britain.

SUBJECTS

1506 people, 65 years and over gave information about use of medication, and a 4-day weighed food record. Three-quarters gave blood for status indices.

RESULTS

78% of those living in the community and 93% of those in institutions were using medication. Certain vitamin status indices: plasma retinol, erythrocyte folate and riboflavin, paradoxically suggested better status in users than in non-users of antihypertensive, gastrointestinal, central nervous system, corticosteroid or diabetic drugs. There was evidence of a link with renal insufficiency, especially for plasma retinol, but neither this nor increased nutrient intake, acute phase effects or haemoconcentration could explain the paradoxical associations.

CONCLUSIONS

Caution is needed in interpreting certain vitamin status indices, especially in older people who are extensively using medicines. New vitamin indices are needed, to avoid confounding interferences.

Estimation of the use of dietary supplements in the National Diet and Nutrition Survey: people aged 65 years and Over. An observed paradox and a recommendation

OBJECTIVE

To compare the evidence derived from blood biochemical status indices with the evidence from a questionnaire and from a 4-day weighed dietary record of micronutrient supplement use in the British National Diet and Nutrition Survey (NDNS) of People Aged 65 Years and Over; to resolve some apparent incompatibility between nutrient intake and status estimates, and to recommend an approach towards supplement recording that should improve accuracy.

DESIGN

The survey procedures described in the National Diet and Nutrition Survey Report (1998) included a health-and-lifestyle questionnaire, a 4-day weighed diet record, and fasting blood and urine sample for biochemical indices, including a wide range of micronutrients.

SETTING

Eighty randomly selected postcode sectors from mainland Britain during 1994-1995.

SUBJECTS

Of 2060 people interviewed, 1467 provided a blood sample and 1217 provided both a blood sample, and a complete 4-day diet record. About 20% were living in institutions such as nursing homes, and the remainder were living in private households.

RESULTS

After assigning the subjects to four categories by the use of dietary supplements (A, those not taking supplements (by questionnaire or by the 4-day record); B, those taking supplements (excluding prescribed ones) by questionnaire only; C, those taking supplements by 4-day record only; and D, those taking supplements by both questionnaire and 4-day record), these categories were then compared with respect to estimated total nutrient intakes and blood biochemical indices. Those in category B had estimated (4-day) nutrient intakes (from foods and supplements) that were indistinguishable from those in category A, but had biochemical indices that indicated significantly higher dietary intakes of several vitamins. CONCLUSIONS AND RECOMMENDATION: The 4-day weighed intake record may not have identified all of the subjects who were regularly taking micronutrient supplements in amounts sufficient to improve their biochemical status. Because survey respondents may use supplements irregularly or change their usual patterns of supplement use during a period of intensive diet-recording, it is important to design a dietary instrument that will minimise this potential source of inaccuracy. We therefore recommend that population surveys in which an accurate estimate of micronutrient intakes is required, from supplements as well as from food, should record supplement use for a period longer than 4-days. It is likely that a better estimate of long-term intakes can be achieved by combining a 4-day weighed diet record with a structured recall or several weeks of diary records, which focus specifically on the use of supplements.

Mutual attachment, personality, and drug use: pathways from childhood to young adulthood

Young adult drug use stemming from childhood aggression, the parent-child mutual attachment relationship, and the effect of unconventionality were studied. Youngsters and their mothers were interviewed when the former were early adolescents, late adolescents, and young adults. Additional data were collected from the mothers when their youngsters were children. The analysis was conducted on youngsters who had complete data at all 4 points in time. The findings were in accord with the family interactional model; that is, the parent-child mutual attachment relationship affects unconventionality in the youngster, which, in turn, affects young adult drug use. The results indicate that the parent-child mutual attachment relationship does so through (a) the stability of the attachment relationship from childhood to young adulthood, (b) the stability of unconventional personality and behavioral attributes from early adolescence to young adulthood, and (c) the stability of drug use from early adolescence to young adulthood. The findings imply that (a) early intervention with respect to aggression, (b) interventions that focus on strengthening the parent-child bond and conventional behavior, and (c) interventions aimed at early drug use should be most effective in reducing young adult drug use.

Does vitamin C reduce blood pressure? Results of a large study of people aged 65 or older

OBJECTIVE

To characterize relationships among blood pressure, pulse rate, vitamin C status and other protective and risk factors for older British people, from a national survey.

DESIGN

A cross-sectional analysis of survey data.

SETTING

A population study, representative of mainland Britain.

SUBJECTS

Among 914 people of both sexes living in the community, 373 were taking blood-pressure-lowering drugs and were therefore excluded from the analyses.

INTERVENTIONS

Completion of an interview on health, lifestyle and dietary habits, recording of a 4-day dietary record, anthropometry and taking of a blood sample to determine haematological and biochemical status.

MAIN OUTCOME MEASURES

Systolic and diastolic blood pressures, pulse rate, indices of micronutrient status including plasma ascorbate concentration, nutrient intake and haematology.

RESULTS

Plasma ascorbate concentration was inversely correlated to systolic and diastolic blood pressures and pulse rate. Other covariates of blood pressure included age, sex, domicile, plasma retinol, fibrinogen and gamma-tocopherol concentrations, erythrocyte count, prothrombin time and urine sodium: creatinine ratio. Covariates of pulse rate included sex, domicile, plasma fibrinogen and platelet count. Blood pressure was also correlated to intake of vitamin C.

CONCLUSIONS

Plasma ascorbate concentration and intake of vitamin C are covariates of blood pressure in older people living in Britain. New intervention studies are now needed, to test for possible causalities.

Plasma total homocysteine in a representative sample of 972 British men and women aged 65 and over

OBJECTIVES

To provide a reference range for plasma total homocysteine (tHcy), an independent risk factor for vascular disease, and to explore relationships with nutritional indices for people aged 65 y and over, in the UK National Diet and Nutrition Survey (NDNS).

DESIGN

The survey procedures described in the National Diet and Nutrition Survey Report (1997) included a health-and-lifestyle interview, a four-day weighed diet record, anthropometric and blood pressure measurements and a fasting blood sample for biochemical indices, including tHcy.

SETTING

Eighty randomly selected postcode sectors from mainland Britain during 1995-1996.

SUBJECTS

Of 2060 people interviewed, 1527 were visited by the nurse, 1276 gave a blood sample and 972 had tHcy measured. About 80% were in their own homes and the remainder were in nursing homes or similar institutions.

RESULTS

Significant cross-sectional relationships, both univariate and multivariate were found between tHcy and index concentrations of folate and vitamin B12 (P < 0.0001), and between tHcy and plasma creatinine, urea, calcium, zinc, alpha 1-antichymotrypsin, lutein and cysteine (P = 0.013 to < 0.0001). Dietary nutrient analyses showed an association with folate intake. tHcy was also correlated with age and with domicile (free-living or institution), with history of vascular disease and with use of four classes of drugs, two of which are prescribed for vascular diseases. There was a north-south gradient in tHcy (P = 0.005), and also in food choices, blood micronutrient indices and vascular disease prevalence.

CONCLUSIONS

The concentrations of tHcy found in this study provide a reference range for people aged 65 y and over, in mainland Britain. tHcy is a valuable functional index of micronutrient status and intakes for British people aged 65 y and over, which can assist the development of health-promotion strategies.

Aggression, intrapsychic distress, and drug use: antecedent and intervening processes

OBJECTIVE

To explore the interrelation of childhood aggression, early and late adolescent intrapsychic distress, unconventionality, and drug use.

METHOD

Data were obtained from the subjects when they were 5 to 10 years old. Follow-up interviews were conducted when the subjects were between 13 and 18 years old and again when they were 15 to 20 years old.

RESULTS

A LISREL analysis indicated that childhood aggression was related to later intrapsychic distress, unconventionality, and drug use. There were significant pathways from childhood aggression to drug use at 15 to 20 years of age, with mediation through intrapsychic distress and unconventionality, and during adolescence there was a pathway from intrapsychic distress to unconventionality, leading to legal and subsequently illegal drug use. There was also considerable stability in intrapsychic distress, unconventionality, and drug use.

CONCLUSION

Intrapsychic distress and unconventionality are important mediators of childhood aggression and adult drug use.

Role of mutual attachment in drug use: a longitudinal study

OBJECTIVE

This study examines childhood aggression, mutual attachment and later drug use.

METHOD

Data on 397 children and adolescents at three points in time were collected and analyzed. Mothers and their children were individually interviewed.

RESULTS

A weak parent-child mutual attachment in girls can be viewed as a consequence of childhood aggression. Moreover, mutual parent-child attachment affects later drug use through three stabilities: (1) the stability of attachment during adolescence, (2) the stability of unconventionality during adolescence, and (3) the stability of drug use during adolescence.

CONCLUSION

The multiple pathway perspective on drug use poses a number of ways in which to think about interventional approaches. First, interventions may be targeted toward those risk factors showing the strongest relations with later drug use. A second mode of orientation to intervention would deal with the amenability of the target to particular interventional agents. Interventions may be geared to intraindividual characteristics or may focus more attention on familial characteristics. A third way of considering interventions, as suggested by the developmental pathways to drug use, seeks to address the temporal order of risk factors leading to drug use.

Childhood aggression, adolescent delinquency, and drug use: a longitudinal study

The interrelation of childhood aggression, early and late adolescent delinquency, and drug use was explored. Data were obtained for the subjects when they were 5-10 years old. Follow-up interviews were conducted when the subjects were between 13-18 years old and again when they were 15-20 years old. A LISREL analysis of the three waves of data indicated that childhood aggression is a precursor of adolescent drug use and delinquency, and that early adolescent drug use is correlated with contemporaneous delinquency as well as with later drug use and delinquency.