Chlamydial antibodies in an elderly Finnish population.

The characteristic feature of Chlamydia is its tendency to cause chronic infections. It has been hypothesized that prior exposure to C. pneumoniae may lead to chronic infection and the development of associated chronic cardiopulmonary disease. Few studies have so far addressed the occurrence of chlamydial antibodies in an elderly, unselected population. This information is important for the development of possible treatment strategies. Chlamydial antibodies were analysed from 1179 serum samples obtained from 481 men and 698 women, aged 64 y and over, who participated in an epidemiological survey carried out in a Finnish rural district. Specific IgG and IgA antibodies were measured by the microimmunofluorescence (micro-IF) test. The criterion for seropositivity was defined as a titre of > or =32 for both IgG and IgA, independently of each other. C. pneumoniae IgG antibodies occurred in 91% of the men and 75% of the women. The respective figures for C. pneumoniae IgA antibodies were 57% and 28%. The geometric mean titres (GMT) rose with increasing age and were higher in men than in women. The prevalences of C. trachomatis IgG antibodies were 13% in men and 18% in women, and for IgA antibodies, 2% and 1%, respectively. C. psittaci antibodies were rare. Only 3% of the men and women were IgG seropositive, whereas the respective figures for IgA seropositivity were 0.4% and 0.1%. C. pneumoniae antibodies indicative of recurrent or chronic infection were common in the elderly. The geometric mean titres correlated positively with age and were higher in men than in women. Other chlamydial antibodies occurred in low titres.     

Diabetes mellitus,impaired glucose tolerance and mortality among elderly men: The Finnish cohorts of the seven countries study

Summary We studied the association of glucose intolerance with total and cause-specific mortality during a 5-year follow-up of 637 elderly Finnish men aged 65 to 84 years. Total mortality was 276 per 1000 for men aged 65 to 74 years and 537 per 1000 for men aged 75 to 84 years. Five-year total mortality adjusted for age was 364 per 1000 in diabetic men, 234 per 1000 in men with impaired glucose tolerance and 209 per 1000 in men with normal glucose tolerance. The relative risk of death among diabetic men was 2.10 (95% confidence interval 1.26 to 3.49) and among men with impaired glucose tolerance 1.17 (95% confidence interval 0.71 to 1.94) times higher compared with men with normal glucose tolerance. Cardiovascular disease was the most common cause of death in every glucose tolerance group. The multivariate adjusted relative risk of cardiovascular death was increased (1.55) in diabetic patients, albeit non-significantly (95% confidence interval 0.84 to 2.85). Diabetes resulted in an increased risk of cardiovascular mortality among men aged 65–74 years but not among the 75–84-year-old men. Relative risk of death from non-cardiovascular causes was slightly increased among diabetic subjects. In conclusion, diabetes mellitus is a significant determinant of mortality among elderly Finnish men.     

Social networks and mortality in an inner-city elderly population

The authors address some of the methodological problems found in earlier investigations of the relationship between social networks and mortality. Of particular concern was the use of rudimentary measures of social interaction in previous work. Utilizing nineteen social network variables, the authors examined 155 elderly residents of midtown Manhattan single-room occupancy hotels. On three-year follow-up, twenty-eight persons had died. Discriminant function analysis indicated that ten of nineteen network variables were relatively strong discriminators between survivors and non-survivors (i.e., standardized coefficient of .20 or greater). The network variables cut across all categories of social interaction, thereby revealing why, despite the few network variables used in previous studies, nearly all had been significant.     

Nutritional status of an elderly population

Two hundred and five subjects between the ages of 61 and 97 years were examined for nutritional health. Examination included anthropometry (height, weight, triceps skinfolds, subscapular skinfolds, and mid upper arm circumference), biochemistry (serum albumin, serum vitamin B₁₂, serum folacin, hemoglobin, and hematocrit), and clinical examination. Sixty-six (32.2%) of these individuals showed signs of malnutrition. Fourteen (6.8%) showed signs of multiple deficiency. Of the specific nutrients studied (iron, zinc, folacin, vitamin B₁₂, protein/energy), nutritional deficiencies involving each of these were found in some of the subjects. Protein/energy malnutrition was the most prevalent at 13.2%. Chi-square analyses suggested an equivalent incidence of malnutrition in males versus females and institutionalized versus noninstitutionalized. A significant drop in nutritional status was observed to occur in subjects above 89 years when compared to those aged 61–89 years. The frequent prevalence of nutritional deficiencies in the elderly is likely to be of clinical and public health importance.     

Proinsulin and IGFBP-1 predicts mortality in an elderly population

Background

High IGFBP-1 in elderly subjects is related to all-cause and cardiovascular (CV) mortality. We studied the relation of IGFBP-1 to cardiometabolic risk factors and cardiovascular and all-cause mortality, and also the impact of proinsulin and insulin on this association in an unselected elderly primary health care population.

Hypothesis

Our hypothesis was that proinsulin and insulin may have an impact on the association of high IGFBP-1 levels with all-cause and CV-mortality in elderly.

Design, setting and participants

A cross-sectional and prospective study was carried out in a rural Swedish population. 851 persons aged 66–81 years were evaluated by medical history, clinical examination, electrocardiography, echocardiography, and fasting plasma samples, and were followed prospectively for up to 12 years.

Results

At baseline, in a multivariate analysis, IGFBP-1 was associated with gender, N-terminal proBNP (NT pro-BNP), blood glucose, body mass index (BMI), insulin and proinsulin, estimated glomerular filtration rate (eGFR) and haemoglobin (Hb). During the follow-up period there were 230 deaths (27%), of which 134 (16%) were due to CV mortality. When divided into tertiles there was a significant difference for CV mortality and all-cause mortality between tertiles of IGFBP-1 and proinsulin. For insulin there was a significant difference only for all-cause mortality. After adjustment for well-known risks factors, proinsulin and IGFBP-1 had significant impact on all-cause mortality but only proinsulin on CV mortality.

Conclusion

Only proinsulin is an independent predictor for both all-cause mortality and CV mortality when comparing IGFBP-1, insulin, and proinsulin as prognostic biomarkers for CV and all-cause mortality in an elderly population.     

老年男性人群高血压合并糖耐量减低与全因死亡风险的相关性

目的 探讨高血压合并糖耐量减低(IGT)对老年男性人群全因死亡风险的影响.方法 纳入2005年5月至2007年5月在解放军总医院第二医学中心行口服葡萄糖耐量试验检出的老年男性IGT患者和正常糖耐量(NGT)人群,根据基线时是否存在高血压病史和IGT分为4组:非高血压(NH)+正常糖耐量(NGT)组、高血压(H)+NGT...     

Relation between QT duration and mortality in an elderly Japanese population

The effects of prolonged QTc intervals on mortality were investigated in about 3,500 elderly Japanese patients followed for approximately 8.8 years. Prolonged QTc was found to be a marker for risk for all-cause mortality and mortality from heart disease or from coronary heart disease (CHD) after adjusting for other CHD risk factors. Even in Japanese subjects, who have a lower coronary heart disease rate than that of Caucasians, the careful observation of subjects with a prolonged QTc is believed to be necessary.     

Oral glucose tolerance and periodontal status

Summary Conventional oral glucose tolerance tests were performed for 100 systemically healthy young adult males. Half of these subjects were classified as being relatively free of periodontal involvement (GPI = 1.60), while the other half presented evidence of loss of alveolar support and, in general, could be classified es requiring periodontal treatment (GPI = 3.15). Statistical analyses sought differences in glucose responses between the two groups at all sampling intervals. No significant differences were found.These results confirm previous observations from this laboratory that glucose tolerance testing cannot be employed as an index of susceptibility to periodontal involvement in this age group.

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Zusammenfassung Es wurden konventionelle orale Glukosetoleranzproben bei 100 systemisch gesunden jungen Erwachsenen durchgefuehrt. Die Haelfte dieser Personen wurde als relativ frei von paradentialen Komplikationen klassifiziert (GPI = 1,60); die andere Haelfte zeitige Aeusserungen eines Verlustes von alveolarem Stuetzgewebe und man konnte ganz allgemein die Notwendigkeit einer Paradentium-Behandlung feststellen (GPI = 3,15). Anlaesslich jeder Entnahmezeit wurde eine statistische Analyse durchgefuehrt, um Unterschiede in der Antwort beider Gruppen auf die Glukose festzustellen; man konnte jedoch keine signifikanten Unterschiede feststellen.Diese Resultate bestaetigen vorherige Beobachtungen unseres Labors, laut welchen die Toleranz-Bestimmung gegenueber Glukose keine Praedisposition fuer Paradentium-Komplikationen in diesem Alter ausdruecken kann.

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Resumen Han sido efectuado pruebas convencionales de tolerancia a la glucosa oral en 100 machos adultos jovenes sistemicamente sanos. Mitad de estos sujetos han sido clasificados como relativamente sin complicaciones paradentales (GPI = 1,60), mientras la otra mitad presentaba manifestaciones de perdida de sosten alveolar y, en general, ha podido ser clasificada como necesitada de tratamiento paradental (GPI = 3,15). Ha sido conducido un analisis estadistico al fin de relevar diferencias de las respuestas a la glucosa entre los dos grupos en todos los tiempos de toma, pero no ha sido posible encontrar diferencias significativas.Estos resultados confirman precedentes observaciones de nuestro laboratorio, segun los cuales la determinacion de la tolerancia a la glucosa no puede expresar una tendencia a las complicaciones del paradencio en esta edad.

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Resume Les AA. ont exécuté destests de tolérance orale au glucose à 100 hommes jeunes adultes sains. La moitié de ces sujets ont été classifiés sans complications paradentales (GPI = 1,60), tandis que l'autre moitié présentait des manifestations de perte de soutien alvéolaire et, en géneral, a pu être classifié comme ayante besoin d'un traitement paradental (GPI = 3,15). Les AA. ont conduit aussi une analyse statistique à fin de relever les différentes reponses au glucose parmi les deux groupes dans tous les temps du prélèvement, mais il n'a pas été possible de noter des différences significatives.Ces résultats confirment des observations précédentes du laboratoire selon lesquelles la détermination de la tolérance au glucose ne peut exprimer une prédisposition aux complications paradentales à cet âge.

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Riassunto Sono state eseguite prove convenzionali di tolleranza al glucosio orale in 100 maschi adulti giovani sistemicamente sani. Metà di questi soggetti sono stati classificati come relativamente esenti da complicazioni paradenziali (GPI = 1,60), mentre l'altra metà presentava manifestazioni di perdita di sostegno alveolare e, in generale, ha potuto essere classificata come bisognosa di trattamento paradenziale (GPI = 3,15). E' stata condotta un'analisi statistica allo scopo di rilevare differenze delle risposte al glucosio tra i due gruppi in tutti i tempi di prelievo, ma non è stato possibile riscontrare differenze significative.Questi risultati confermano precedenti osservazioni del nostro laboratorio secondo le quali la determinazione della tolleranza al glucosio non può esprimere una predisposizione alle complicazioni del paradenzio in quest'età.

     

Predictors of high functional capacity and mortality in elderly Finnish men

Factors predicting high functional capacity in old age and 25-year mortality were studied in 1711 men aged 40 to 59 years. The study population was that of the East-West Study, i.e. the Finnish part of the Seven Countries Study. After the 25-year follow-up (in 1984) 766 men were still alive. Nonsmoking and good pulmonary function in earlier middle-age and the absence of coronary heart disease, cerebrovascular disease or emphysema in later middle-age predicted high functional capacity in old age. High systolic blood pressure, low forced vital capacity, smoking, and the presence of coronary heart disease predicted mortality in the next 10 to 25 years. Although mortality rates were higher in eastern Finland, the predictors were similar in both the eastern and the southwestern parts of the country.     

Dental status and mortality in institutionalized elderly people

Background:   Inadequate dentition for mastication is one of the major issues associated with systemic health for institutionalized elderly people, but its prognostic value and related deaths have not been fully examined.
Methods:   Four hundred and three patients aged 65 and older were recruited from nine nursing homes and were prospectively followed up for morbidity and mortality for 5 years in Japan. These patients were classified into three groups according to dental status: patients who had adequate dentition with natural teeth only or natural teeth with partial dentures (Group A); those who were edentulous but wearing full dentures (Group B); and those who had inadequate dentition without dentures (Group C).
Results:   Dental status was strongly related to age, cognitive function and activities of daily living. After allowing for confounding effects, the 2-year risk of mortality among those in Group C was 1.84 times that of Group A (95% confidence interval 1.01–3.36, P  = 0.047). Furthermore, the 5-year mortality rate in Group C was higher than that in Group A, whereas that was not significant with a hazard ratio of 1.30 (0.90–1.88, P  = 0.168). The main causes of death were respiratory infections, which explained 14.1% of all causes of death in Group A, 14.3% in Group B and 18.3% in Group C. Any associations between a specific cause of death and the different dental status did not reach a significant level.
Conclusion:   Inadequate dental status is associated with high overall mortality. Our findings suggest that systemic attention to dental status should be recommended in institutionalized elderly people.     

Prevalence of NIDDM and impaired glucose tolerance in Italy: an OGTT-based population study

Summary To provide complete prevalence data on diabetes mellitus in Italy (diagnosed and undiagnosed), a population survey was performed in the Health District of Cremona, a representative area of the Po river (north Italy). The survey is characterised by particular attention being paid to methodology, non-responders being investigated for possible selection biases affecting diagnosed and undiagnosed diabetes prevalence estimations. Out of a population aged 44 years or older from three municipalities, a random sample of 3097 subjects was selected to undergo an oral glucose tolerance test. In addition, past medical history, clinical and laboratory data were collected. A total of 1797 subjects participated (58%), and information on known diabetes status was obtained for 2618 persons (85%), also including 826 interviewed non-participating subjects. Overall rates were age-standardised according to the 1991 Italian census. Overall prevalence and 95% confidence interval of diagnosed diabetes was 8.5% (6.9–10.1) in males and 7.9% (6.7–9.3) in females over the age of 44 years; previously undiagnosed diabetes was 2.5% (1.4–3.6) in males and 3.4% (2.1–4.7) in females; glucose intolerance was 7.7% (5.7–9.7) in males and 8.9% (7.0–10.8) in females. Total diabetes prevalence above age 44 years, developed-world age, and sex standardised, was 10.7%. This study provides the first reliable prevalence estimation of impaired glucose tolerance, diagnosed and undiagnosed diabetes in Italy, according to World Health Organization criteria, and one of the few figures for Southern Europe. The role of body mass index on both prevalence of diabetes and cluster of cardiovascular risk factors is considered, with implications for prevention.Abbreviations OGTT Oral glucose tolerance test - BMI body mass index - C. I. confidence intervals     

Comparison of health status between Portuguese and Finnish elderly people

This study compares the living situation, morbidity and mortality and related factors between two different communities, one in eastern Finland (with high mortality in cardiovascular diseases) and another in Lisbon, Portugal (representing the Mediterranean area with low ischaemic heart disease but nigh cerebrovascular mortality). The representative samples of 65–74 year old population were examined using the same study protocol, and official mortality statistics were analyzed from these countries. The results show that elderly Finns have more facilities at home than elderly Portuguese. Self reported diabetes mellitus, stroke and chronic bronchitis as well as obstipation, urinary problems, leg pain and chest pain, and cough in the morning were more prevalent in Portugal but cardiac failure was more common in Finland. Reported hypertension and antihypertensive drug treatment were equally prevalent in both countries, but diastolic blood pressure level was clearly higher in Portugal. Total CVD mortality in this age group is higher in Finland among men but lower among women, stroke mortality is higher but ischaemic heart disease lower among both genders in Portugal.     

Impaired fasting glucose and impaired glucose tolerance in urban population in India.

AIMS: To study prevalence of impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) in urban Indians and their demographic and anthropometric characteristics. METHODS: Data on capillary blood glucose (OGTT), anthropometric and demography details were available in 10 025 subjects (M : F 4711 : 5314) aged > or = 20 years. Glucose tolerance was categorized as normal, isolated IFG, isolated IGT, IFG + IGT and diabetes using the fasting and 2-h blood glucose (2hBG; 75-g glucose load) values. Subjects with known diabetes were excluded. RESULTS: Age-standardized prevalences of IFG, IGT and newly detected diabetes were 8.7%, 8.1% and 13.9%, respectively. IFG was more prevalent in women (9.8%) than in men (7.4%) (chi2 = 13.62, P = 0.0002), while the gender differences in IGT (men 8.4%, women 7.9%) and diabetes (men 13.3%, women 14.3%) were not significant. Body mass index and waist circumference were higher in glucose-intolerant groups than in normal glucose tolerance (NGT). Prevalence of diabetes, IGT and IFG + IGT increased with age. Among the IFG, 4% had diabetes and 27.1% had IGT using 2hBG criteria. In IFG, the fasting and 2hBG values were not correlated. CONCLUSIONS: Prevalences of IFG and IGT were similar in urban Indians and an overlap occurred in only less than half of these subjects. IFG was more common in women. Subjects with IFG were older and had more adverse anthropometric characteristics in comparison with NGT. IFG did not show an increasing trend with age.     

Vitamin D, glucose tolerance and insulinaemia in elderly men

Summary Vitamin D status was assessed in 142 elderly Dutchmen participating in a prospective population-based study of environmental factors in the aetiology of non-insulin-dependent diabetes mellitus. Of the men aged 70–88 years examined between March and May 1990, 39 % were vitamin D depleted. After adjustment for confounding by age, BMI, physical activity, month of sampling, cigarette smoking and alcohol intake the 1-h glucose and area under the glucose curve during a standard 75-g oral glucose tolerance test (OGTT) were inversely associated with the serum concentration of 25-OH vitamin D (r = −0.23, p < 0.01; r = −0.26, p < 0.01, respectively). After excluding newly diagnosed diabetic patients total insulin concentrations during OGTT were also inversely associated with the concentration of 25-OH vitamin D (r = −0.18 to −0.23, p < 0.05). Hypovitaminosis D may be a significant risk factor for glucose intolerance. [Diabetologia (1997) 40: 344–347] Received: 3 September 1996 and in revised form: 2 January 1997     

Prevalence of NIDDM and impaired glucose tolerance in a rural and an urban population in Cameroon

Summary The adoption of Western lifestyles is known to lead to increasing prevalence of non-insulin-dependent diabetes mellitus in Africa, yet epidemiological studies using standardised methods are rare. The prevalence of diabetes and impaired glucose tolerance was determined in a rural and an urban community in Cameroon using the 75-g oral glucose tolerance test and the World Health Organization diagnostic criteria in 719 rural (292 men, 427 women) and 1048 urban (458 men, 590 women) subjects aged 24–74 years. The response rate was 95 and 91 % for the rural and urban population, respectively. The age-standardized prevalence of diabetes in the rural and urban population was respectively 0.9 % (95 % confidence interval (0.2–2.7)) and 0.8 % (0.2–1.8) for men and 0.5 % (0.1–1.6) and 1.6 % (0.7–3.1) for women, and that of impaired glucose tolerance was 5.8 % (3.3–9.4) and 1.8 % (0.9–3.2) for men, and for women, 2.2 % (1.0–4.0) and 2.0 % (0.6–4.5). Although for both men and women the body mass index was higher at all ages in the urban than in the rural area, the 2-h plasma glucose, even after adjustment for age and body mass index, was significantly higher in the rural than in the urban area (p < 0.005, p < 0.002 for men and women, respectively). There was a female excess of diabetes in the urban area and an equal sex distribution in the rural area. In the rural area 67 % (4 of 6) of diabetic subjects were unknown before the survey, compared with 57 % (8 of 14) in the urban area. These data indicate a low prevalence of diabetes in Cameroon; however, the prevalence of impaired glucose tolerance suggests an early stage of a diabetes epidemic. [Diabetologia (1997) 40: 824–829] Received: 19 November 1996 and in revised form: 10 March 1997     

Daytime sleepiness in an adult, Finnish population

Hublin C, Kaprio J, Partinen M, Heikkilä K, Koskenvuo M (Departments of Psychiatry and Neurology and the Department of Public Health (The Finnish Twin Cohort), University of Helsinki, Helsinki; and the Department of Public Health, University of Turku, Turku; Finland). Daytime sleepiness in an adult, Finnish population. J Intern Med 1996; 239: 417–23.
Objectives. To investigate the prevalence of and the factors associated with daytime sleepiness occurring every or almost every day.
Design. A cross-sectional, questionnaire survey.
Subjects. A total of 11354 adults (aged 33–60 years) representative of the Finnish population.
Main outcome measures. Frequency of daytime sleepiness, naps and sleep attacks; occurrence of emotion-associated muscle weakness, sleep debt, insomnia, sleep apnoeas and type of snoring; Beck Depression Inventory score; and the use of hypnotics and tranquillisers.
Results. A total of 11.0% of women and 6.7% of men suffered from daytime sleepiness every or almost every day. Amongst those with sleepiness ( n = 1026) 19.5% of women and 42.3% of men reported snoring 3 nights per week, 25% had scores suggesting moderate to severe depression, 11% used hypnotics or tranquilizers on more than 180 days per year, and 9% reported insufficient sleep. Insomnia at least every other day was reported by 20.7% of women and by 28.6% of men. Amongst those with sleepiness, narcolepsy was found in 0.3%, with the diagnosis confirmed in a sleep laboratory evaluation.
Conclusions. Daytime sleepiness occurring daily or almost daily is most often associated with depression, insomnia and sleep-disordered breathing. In most cases, indications of the cause of sleepiness can be obtained by using simple screening questions.