Validity of a single question to assess habitual physical activity of community-dwelling older people

The aim is to determine concurrent validity of a single self-report habitual physical activity (PA) question against accelerometer-based PA and mobility variables, and corresponding changes in self-reported PA and mobility. Cross-sectional and longitudinal data of the "Life-space mobility in old age" (LISPE) cohort and its substudy on PA were utilized. At baseline, 848 community-dwelling, 75- to 90-year-old people living independently in central Finland participated in home-based interviews. One and 2 years later, 816 and 761 of them were reassessed by phone, respectively. Tri-axial accelerometer data over 7 days were collected following the baseline assessments in a subsample of 174. Self-reported habitual PA was assessed based on intensity and duration using a single question with seven response options (range: mostly resting to competitive sports). Mobility variables were as follows: life-space mobility, walking difficulty over 500 m, and short physical performance battery. Statistically significant correlations were found between self-reported habitual PA and mobility (Spearman correlation coefficient Rs = 0.40-0.61) and accelerometer-based PA variables [step counts (Rs = 0.49), time in moderate (Rs = 0.49) and low intensity (Rs = 0.40) PA, and time in sedentary behavior (Rs = -0.28)]. A decline in self-reported habitual PA over time was associated with 5-10p decline in life-space mobility (PA improvement with 0-3p increase) and with developing a higher degree of walking difficulty (in 35-44% of participants). In conclusion, based on these results, the self-report question to assess habitual PA is valid and responsive to change and thus useful for epidemiological research in community-dwelling older people, also in follow-up studies.

The interaction of blood flow, insulin, and bradykinin in regulating glucose uptake in lower-body adipose tissue in lean and obese subjects

CONTEXT

Impaired adipose tissue (AT) blood flow has been implicated in the pathogenesis of insulin resistance in obesity. Insulin and bradykinin are meal-stimulated promoters of AT blood flow and glucose metabolism.

OBJECTIVE

We tested whether blood flow regulates glucose metabolism in AT, insulin and bradykinin exert additive effects on AT blood flow and metabolism, and any of these actions explains the insulin resistance observed in obese individuals.

DESIGN

Perfusion and glucose metabolism in the AT of the thighs were studied by positron emission tomography and H(2)(15)O (flow tracer) and (18)F-2-fluoro-2-deoxyglucose. Study I included five subjects in whom positron emission tomography imaging was performed in the fasting state during intraarterial infusion of bradykinin in the left leg; the right leg served as a control. Study II included seven lean and eight obese subjects in whom the imaging protocol was performed during euglycemic hyperinsulinemia.

RESULTS

Bradykinin alone doubled fasting AT blood flow without modifying glucose uptake. Hyperinsulinemia increased AT blood flow (P ≤ 0.05) similarly in lean and obese individuals. In the lean group, bradykinin increased insulin-mediated AT glucose uptake from 8.6 ± 1.6 to 12.3 ± 2.4 μmol/min · kg (P = 0.038). In the obese group, AT glucose uptake was impaired (5.0 ± 1.0 μmol/min · kg, P = 0.05 vs. the lean group), and bradykinin did not exert any metabolic action (6.0 ± 0.8 μmol/min · kg, P = 0.01 vs. the lean group).

CONCLUSION

AT blood flow is not an independent regulator of AT glucose metabolism. Insulin is a potent stimulator of AT blood flow, and bradykinin potentiates the hemodynamic and metabolic actions of insulin in lean but not in obese individuals.

Self-reported preclinical mobility limitation and fall history as predictors of future falls in older women: prospective cohort study

We studied if self-reported preclinical mobility limitation, described as modification of task performance without perception of difficulty, predicts future falls in older women with and without fall history. Our results suggest that combined measure of self-reported preclinical mobility limitation and fall history may offer one possibility for inexpensive fall-risk evaluation in clinical practice.

INTRODUCTION

We studied if self-reported preclinical mobility limitation predicts future falls in older women with and without fall history.

METHODS

The study population consisted of 428 community-living 63-76-year-old women. At baseline, those who expressed no difficulty walking 2 km but reported that it took longer than before or that they did it less often were categorized as having preclinical mobility limitation. Those reporting difficulty in 2-km walk were categorized as having manifest mobility limitation. Fall history was recalled for previous 12 months and dichotomized. The incidence of future falls over 12 months was followed up with fall calendars.

RESULTS

During the fall follow-up, a total of 440 falls were reported by 201 participants. Among those with fall history, women with preclinical mobility limitation had almost 4-fold (incidence rate ratios 3.77; 95% CI 1.02-13.92) and those with manifest mobility limitation almost 15-fold (14.66; 2.72-79.00) adjusted risk for future falls compared to those with no mobility limitation and no previous falls. Among women without fall history, preclinical and manifest mobility limitation did not predict future falls nor did fall history without mobility limitation.

CONCLUSIONS

Already, early signs of mobility decline with history of falls increase the risk of further falls and should be considered as indications for fall prevention interventions.

Reconstruction of the anterior cruciate ligament with carbon fibres: unsatisfactory results after 8 years

A total of 37 patients were operated on for anterior cruciate ligament (ACL) insufficiency between 1980 and 1989 using two types of carbon fibre ligament substitutes. The average age of the population was 23.6 years. The carbon fibre prostheses were covered with either a strip of medial joint capsule or lyophilized dura. Follow-up averaged 8.1 years (range 4-13 years), most of the operations being done from 1983 to 1985. Evaluation included a questionnaire, physical examination, Lysholm scoring, radiographs and cruciometer testing. The operated ACLs were looser than those in the contralateral healthy knees. The Lysholm scoring system gave acceptable results (excellent and good) in 43.5%, fair in 31.4% and poor in 24.1% of cases. Acceptable results provided better stability and muscle strength. During the follow-up there was an evident deterioration in stability as well as in Lysholm score. The results between the two types of ligaments did not become statistically different. Osteoarthrosis increased in all the knees examined radiographically (28/37). The results indicate that the ACL reconstructions using these types of carbon fibre prostheses lead to unacceptable results in the long-term follow-up.

Frostbite of the face and ears: epidemiological study of risk factors in Finnish conscripts

OBJECTIVE

To determine the incidence of and the risk factors for local cold injuries of the face and ears in peacetime military service.

DESIGN

Prospective, controlled epidemiological study using a questionnaire.

SETTING

Finnish defence forces, 1976-89.

SUBJECTS

913 young male conscripts with local frostbite of the head that needed medical attention and 2478 uninjured control conscripts.

MAIN OUTCOME MEASURES

Type of activity, clothing, and other risk factors at the time of cold injury. Odds ratios were used to calculate risk. Controls were handled as one group.

RESULTS

The mean annual incidence of frostbite was 1.8 per 1000 conscripts. Frostbite of the ear was most common (533 conscripts (58%)), followed by frostbite of the nose (197 (22%)) and of the cheeks and other regions of the face (183 (20%)). Most conscripts (803 (88%)) had mild or superficial frostbite. Risk factors included not wearing a hat with earflaps (odds ratio 18.5 for frostbite of the ear); not wearing a scarf (odds ratio 2.1 and 3.8 for frostbite of the ear and cheeks respectively); using protective ointments (odds ratio 3.3, 4.5, and 5.6 for frostbite of the cheeks, ear, and nose respectively); being extremely sensitive to cold and having hands and feet that sweat profusely (odds ratio 3.5 for frostbite of the nose); and being transported in the open or in open vehicles under windy conditions (odds ratio 2.2 for frostbite of the cheek).

CONCLUSIONS

Wearing warm clothing, including a scarf and a hat with earflaps, helps to prevent frostbite. Each person's sensitivity to cold may also be important. The routine use of protective ointments should not be recommended.

Neuropsychologic and cardiovascular effects of clemastine fumarate under pressure

Allergic rhinitis and mild respiratory infections have been widely accepted as temporary contraindications for fitness to dive. Nonetheless, several sport and professional divers use antihistamines to ease ear, nose, and throat (ENT) problems, especially for opening tubal ostium. Some divers know they are unfit to dive, but for a variety of reasons (e.g., money or short holiday) they try to clear their ears. Thus, the use of antihistaminic drugs (like clemastine fumarate) is common during diving. This double-blind, crossover study indicates that this special antihistamine does not increase the sedative effects of nitrogen narcosis, nor does it increase the level of cardiac arrhythmias. Liberal use of antihistamines while diving cannot be recommended because of possible complications connected with different preparations and the temporary limitations they impose on the diver.

Cardiovascular functional disorder and stress among patients having neck-shoulder symptoms

OBJECTIVES

To investigate if autonomic nervous system function, reflected in cardiovascular variables, among patients with neck-shoulder symptoms (tension neck group (T)) differed from that in a symptom free control group (C), and to establish its relation with pain and psychological stress.

METHODS

Twelve women with tension neck and nine controls in secretarial jobs were studied. They underwent an orthostatic test, deep breathing test, Valsalva manoeuvre, isometric handgrip test, and muscular endurance test. Pain was measured using visual analogue scales, and psychological stress by the Modified Somatic Perception Questionnaire (MSPQ). Plasma endothelin-1 (ET-1) was measured using high pressure liquid chromatography and radioimmunoassay.

RESULTS

Signs of psychological stress were significantly (p < 0.001) more common in group T than in group C. Mean resting heart rate in group T (77.8 (SE 2.9) beats/min; range 64-100) was significantly greater than that in group C (63.8 (3.1) beats/min; range 52-80) (p < 0.01). In the orthostatic test, the overall changes in R-R intervals during the first 40 heart beats after standing up and during seven minutes of testing differed significantly between the groups (p < 0.001, < 0.05, respectively). The increase in diastolic blood pressure in the three minute isometric handgrip test was significantly less in group T (19.4 (3.5) mm Hg; range -5 to 35) than in group C (30 (3.4) mm Hg; range 15-50) (p < 0.05). The MSPQ score in the study group (n = 21) correlated positively with resting heart rate (r = 0.462, p < 0.05) and negatively with increase in diastolic blood pressure (r = -0.514, p < 0.05). Plasma concentrations of ET-1 did not differ between the groups.

CONCLUSION

Increased sympathetic activity was found among patients having neck-shoulder symptoms. Local mechanisms may have influenced the cardiovascular changes observed during isometric testing in these patients.

Cardiovascular functional disorder and distress among patients with thoracic outlet syndrome

Cardiovascular functional stability of 11 women with thoracic outlet syndrome (TOS; mean age 34.5) and nine female controls (mean age 35.1) was studied using an orthostatic test, a deep breathing test, Valsalva manoeuvre and hand-grip test. The heart rate at rest was significantly higher in TOS patients. The TOS group showed significant accentuation in T wave vacillation in the orthostatic test. The rise in diastolic blood pressure of the TOS group during a hand-grip test was significantly less than that of the control group. TOS patients experienced significantly more distress according to the modified somatic perception questionnaire (MSPQ) than the control group. Pain was correlated with the score of MSPQ, the resting heart rate and increase in diastolic blood pressure in a hand-grip test. The results suggest that TOS patients' symptoms often reflect a wider disturbance than merely anatomical compression in the thoracic outlet. It seems possible that sympathetic tone is higher in TOS patients than in controls. In addition to possible operative treatment, it may be necessary to provide psychological help, relaxation and endurance training.

Cardiovascular functional disorder in primary fibromyalgia: a noninvasive study in 17 young men

Cardiovascular functional stability was studied in 17 young men (20-year-old conscripts) with the symptoms of primary fibromyalgia (PF). They were compared to 20 medical students of the same age. The subjects underwent an orthostatic test, deep breathing test, Valsalva maneuver, and a handgrip test. They were evaluated by an autoanamnestic questionnaire on vegetative symptoms and laboratory tests on blood chemistry. The heart rate of the PF group after 8 min of active standing was 32 +/- 15 beats/min greater than at supine rest. The corresponding figure for the controls was 23 +/- 7 beats/min (p = 0.001). Twelve conscripts with PF (71%) presented sympathicotonic cardiovascular reaction on the orthostatic test (p < 0.001). Four of these sympathicotonic conscripts and two other conscripts (total 35%) had an abnormal high index of dystonic symptoms (p = 0.01). The results suggest that young men with symptoms of PF have not only cardiovascular dystonic symptoms but also increased sympathetic nervous reactivity of the cardiovascular system.

Pleuropulmonary involvement during bromocriptine treatment

The use of bromocriptine in the treatment of Parkinson's disease is increasing. More than 20 cases of suggested drug-induced pleuropulmonary disorders during bromocriptine therapy have been reported. We describe four male parkinsonian patients taking bromocriptine in whom pleuropulmonary abnormalities were discovered in a pulmonary hospital during a one-year period. In only one case were the roentgenographic changes reversible after withdrawal of the drug. Pleural fluid from two patients was analyzed and showed lymphocyte-predominant chronic inflammatory changes. Raised erythrocyte sedimentation rate (ESR) and C-reactive protein values decreased after cessation of bromocriptine. Lung function studies demonstrated volume restriction with normal or high CO transfer coefficient. The frequency of pleuropulmonary changes during bromocriptine therapy may be greater than assumed, and such patients may initially present with nonrespiratory symptoms. Follow-up of patients during bromocriptine treatment by ESR, C-reactive protein, and chest roentgenogram is recommended.

Inhaled budesonide influences cellular and biochemical abnormalities in pulmonary sarcoidosis

In a randomized, double-blind study 19 patients with newly-detected pulmonary sarcoidosis were treated with either inhaled budesonide, 800 micrograms twice daily (n = 9), or placebo (n = 10) for 8-10 weeks. Before and after treatment, chest roentgenograms, lung function tests, bronchoalveolar lavage (BAL) and biochemical tests were performed. Angiotensin converting enzyme (ACE) activity and beta2-microglobulin (beta 2M) concentrations were measured in serum. The same tests, as well as albumin and hyaluronan were measured in the BAL-fluid. The total cell number in BAL-fluid, differential counts and lymphocyte subpopulations were determined (total T- and B-lymphocytes, T-helper/inducer (OKT-4) and T-suppressor/cytotoxic (OKT-8) lymphocytes). No significant changes in chest roentgenograms or lung function tests were observed during the short study time. However, a decrease in serum ACE (p less than 0.1) and beta 2 M (p less than 0.05) as well as in BAL-hyaluronan (p less than 0.01) was found in the budesonide-treated patients as well as a decrease in the percentage of BAL T-lymphocytes (p less than 0.05) and the T4/T8 ratio (p less than 0.1). No significant changes were seen in the placebo group. The findings suggest that treatment with inhaled budesonide influences biochemical and cellular findings in patients with early sarcoidosis in the same way as treatment with systemic corticosteroids. The results may also explain clinical effects seen in sarcoidosis patients treated with inhaled corticosteroids. However, further studies are required to determine the long-term clinical benefits of inhaled steroids in pulmonary sarcoidosis.

Reappearance of Hering-Breuer reflex after bilateral autotransplantation of the lungs

In combined heart-lung transplantation the afferent nerve pathways inevitably are transsected. In previous studies with en bloc heart-lung transplantation in dogs, we found altered regulation of breathing-abolition of Hering-Breuer reflex and response to hypercapnia inhalation stimulus consisting of augmented tidal volume with no change in respiratory rate-shortly after the operation. The long-term effects of pulmonary denervation on breathing regulation were now studied in dogs after staged bilateral pulmonary autotransplantation. Mechanical and electrical activities of the respiratory muscles were recorded during spontaneous breathing and after deflation and inflation with varying volumes of air. Five months postoperatively the duration of the respiratory cycle increased 2.5 times on inflation with 600 ml of air and occlusion of the airways, compared with tenfold prolongation in intact control dogs, indicating a partial return of the Hering-Breuer reflex after the autotransplantation. The duration of the EMG bursts in respiratory muscles increased in intact dogs and in those with bilateral lung autotransplants. In impulse frequency the response to stretching was less evident after autotransplantation. The mechanism mediating reappearance of Hering-Breuer reflex warrants further study.

Lung disease after exposure to polyvinyl chloride dust

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Combined heart and lung autotransplantation and regulation of breathing

The effects of en bloc autotransplantation of the heart and both lungs on the regulation of breathing were studied in four mongrel dogs. Tidal volume, respiratory rate, airflow, airway pressure and electromyograms from the intercostal muscles and diaphragm were recorded before and after the transplantation. The dogs breathed air or a mixture of 5% CO2 and air. Airway closure at functional residual capacity (FRC) level and after insufflation of 200 ml air was used as a mechanical stimulus. The following observations were made. 1) Stimulation by 5% CO2 after the transplantation increased the ventilatory minute volume by increasing the tidal volume while the respiratory rate remained unaltered. Before transplantation, both tidal volume and respiratory rate increased in response to CO2 stimulation. 2) After transplantation, stretching of the airways did not cause apnea (Hearing-Breuer reflex abolished) as it did preoperatively. 3) CO2 inhalation increased the efficiency of the respiratory muscles as expressed by the ratio of mechanical work (tidal volume or pressure impulse) to electrical activities of the respiratory muscles. This was most obvious in the dogs with transplant when the airways were closed at FRC level. Elimination of the afferent impulses due to en bloc transplantation of the heart and both lungs therefore modified the efferent impulses to the respiratory muscles. This effect was seen after both chemical and mechanical stimuli.

EEG and end-tidal carbon dioxide concentration in the hyperventilation syndrome

The hyperventilation syndrome (HVS) is a functional disorder with repeated involuntary hyperventilation attacks together with symptoms of respiratory alkalosis. We have studied the EEG and end-tibial pCO2 in the resting state and during hyperventilation activation in 12 HVS patients in order to find out whether there is a greater susceptibility to cerebral vasoconstriction in HVS patients than in controls, as indicated by slowing of the EEG. A surprisingly high proportion (58%) of abnormal resting EEGs was found in HVS patients, although the patients were neurologically normal. More theta and beta background activity was usually revealed in a quantitative computer analysis, especially frontally. Although the hyperventilation activation caused the same degree of hypocapnia in HVS patients and in controls, peripheral symptoms like tingling and numbness of fingers, as well as carpopedal spasms, occurred much more often in HVS patients. However, the EEG changes due to hyperventilation were similar in both HVS patients and normal controls, and it thus seems that the reason for cerebral symptoms in HVS patients is not a greater susceptibility to cerebral vasoconstriction.

[Treatment of chronic cicatricial laryngeal stenosis (author's transl)]

Eighty severe cases of chronic laryngeal stenosis in patients aged 1--78 years, where all other treatment had failed, were operated upon with laryngofissure of the front and back wall of the larynx followed by excision of the stenosis scar tissue. An endolaryngeal prosthesis was inserted and left in position for four months. The clinical result was good in 69 patients but, for various reasons, unsuccessful in eleven. The results of the treatment was also investigated by spirometry and body plethysmography. Contraindications for this operation are presented. The mean follow-up time was 6.9 years.

Exercise asthma and disodium cromoglycate

Exercise-induced asthma (defined as a fall in PEF of at least 25% of the pre-exercise value) was studied in adult patients with uncomplicated asthma. This was found to occur in 22 out of 52 patients. Pre-exercise inhalation of disodium cromoglycate reduced the mean fall in PEF after maximal exercise from 50% of the pre-exercise value to 23% (open assessment in 11 cases). After submaximal exercise for eight minutes the reduction was from 18% to 10% (double-blind crossover study in 28 cases). It is concluded that disodium cromoglycate partly inhibits the increase of airways resistance after exercise in asthmatic patients.