Parasitologic and clinical features of bancroftian filariasis in a community in East Sepik Province, Papua New Guinea

Bancroftian filariasis has been reported in several areas of Papua New Guinea. The epidemiologic features and natural history of Wuchereria bancrofti infection in this geographic region, however, have not been well-defined. The objective of this study was to assess the parasitological and clinical features of bancroftian filariasis in a community in East Sepik Province, Papua New Guinea. In a village of 99 individuals, the overall prevalence of microfilaremia was 68%. The microfilarial carrier rate was high in those less than or equal to 10 years (62%), remained elevated in the 11-20, 21-30, and 31-40 age groups (42-55%), and peaked in subjects greater than or equal to 41 years old (90%). The geometric mean level of parasitemia in all subjects with patent infection was 3,198 microfilariae/ml blood. This value was 78 parasites/ml in the less than or equal to 10-year-old age group, increased to 1,753 in 21 to 30-year-olds and was markedly elevated in subjects greater than or equal to 41 years old (6, 792 microfilariae/ml). Acute symptoms of filariasis (lymphadenitis and lymphangitis) were initially noted in individuals between the ages of 11 and 20 years (30%). Obstructive disease, manifested as elephantiasis and hydroceles, was present in 64 and 79% of 31-40 and greater than or equal to 41-year-olds, respectively. These data suggest that intense transmission of W. bancrofti infection occurs at an early age in this area of East Sepik Province; patent infection remains high in older age groups. Irreversible lymphatic obstruction develops 20-30 years after initial infection and may be associated with either amicrofilaremia or microfilaremia.     

Analogical Reasoning Abilities of Recovering Alcoholics

This study investigated analogical reasoning abilities of alcoholics who had been abstinent from alcohol for at least 1 year. Their performance was compared to that of nonalcoholic controls matched as a group for education, age, and gender. Solution times and error rates were modeled using a regression model. Results showed a nonsignificant trend for alcoholics to be faster, but more error prone, than controls. The same componential model applied to both groups, and fit them equally well. Although differences have been found in analogical reasoning ability between controls and alcoholics immediately following detoxification, we find no evidence of differences after extended periods of sobriety.     

Clinico-epidemiological characteristics of ischemic heart disease in men of different age groups from the data of a single screening of a random population

A total of 742 men, aged 20-69 and representative of a random male population from a Leningrad district, were investigated. The incidence of coronary disease was 3.2% in subjects aged 20-29, and 33.3% in those aged 60-69. In 40-49-year-olds, coronary disease was mostly manifested in angina of effort (57.9%), whereas painless forms reflected in ECG at rest prevailed (55-58.5% in men above 50 years of age. The frequency of ischemic response to the treadmill test increases with advancing age (8.3% in subjects aged 40-49 and 28.2% at age 60-69). The results of the WHO Questionnaire on Angina of Effort demonstrate that ECG at rest and exercise tests are mutually complementary procedures for epidemiologic diagnosis of coronary disease, their combination ensuring the fullest possible identification of coronary disease in population screenings.     

Cognitive models of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease

OBJECTIVES: To investigate measures of patient cognitive abilities as predictors of physician judgments of medical treatment consent capacity (competency) in patients with Alzheimer's disease (AD). DESIGN: Predictor models of legal standards (LS) and personal competency judgments were developed for each study physician using independent neuropsychological test measures and logistic regression analyses. SETTING: A university medical center. PARTICIPANTS: Five physicians with experience assessing the competency of AD patients were recruited to make competency judgments of videotaped vignettes from 10 older controls and 21 patients with AD (10 with mild and 11 with moderate dementia). MEASUREMENTS: The 31 patient and control videotapes of performance on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI) were rated by the five physicians. The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Each study physician viewed each vignette videotape individually, made judgments of competent or incompetent under each of the LS, and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis and neuropsychological test performance. Stepwise logistic regression was conducted to identify cognitive predictors of each physician's LS and personal competency judgments for Vignette A using the full sample (n = 31). Classification logistic regression analysis was used to determine how well these cognitive predictor models classified each physician's competency judgments for Vignette A. These classification models were then cross-validated using physician's Vignette B judgments. RESULTS: Cognitive predictor models for Vignette A competency judgments differed across individual physicians, and were related to difficulty of LS and to incompetency outcome rates across LS for AD patients. Measures of semantic knowledge and receptive language predicted judgments under less difficult LS of evidencing a treatment choice (LS1) and making the reasonable treatment choice (LS2). Measures of semantic knowledge, short-term verbal recall, and simple reasoning ability predicted judgments under more difficult and clinically relevant LS of appreciating consequences of a treatment choice (LS3), providing rational reasons for a treatment choice (LS4), and understanding the treatment situation and choices (LSS). Cognitive models for physicians' personal competency judgments were virtually identical to their respective models for LS5 judgments. For AD patients, shortterm memory predictors were associated with high incompetency outcome rates (over 70%), a simple reasoning measure was associated with moderately high incompetency outcome rates (60-70%), and a semantic knowledge measure was associated with lower incompetency outcome rates (30-60%). Overall, single predictor models were relatively robust, correctly classifying an average of 83% of physician judgments for Vignette A and 80% of judgments for Vignette B. CONCLUSIONS: Multiple cognitive functions predicted physicians' LS and personal competency judgments. Declines in semantic knowledge, short-term verbal recall, and simple reasoning ability predicted physicians' judgments on the three most difficult and clinically most relevant LS (LS3-LS5), as well as their personal competency judgments. Our findings suggest that clinical assessment of competency should include evaluation of semantic knowledge, verbal recall, and simple reasoning abilities.     

Elderly online: effects of a digital inclusion program in cognitive performance

There is little empirical data about the impact of digital inclusion on cognition among older adults. This paper aimed at investigating the effects of a digital inclusion program in the cognitive performance of older individuals who participated in a computer learning workshop named “Idosos On-Line” (Elderly Online). Forty-two aged individuals participated in the research study: 22 completed the computer training workshop and 20 constituted the control group. All subjects answered a sociodemographic questionnaire and completed the Addenbrooke's cognitive examination, revised (ACE-R), which examines five cognitive domains: orientation and attention, memory, verbal fluency, language, and visuo-spatial skills. It was noted that the experimental group's cognitive performance significantly improved after the program, particularly in the language and memory domains, when compared to the control group. These findings suggest that the acquisition of new knowledge and the use of a new tool, that makes it possible to access the Internet, may bring gains to cognition.     

Componential analysis as a way to investigate age-related changes in information processing

The purpose of this paper is to alert researchers to the methods and utility of componential analysis as a means to examine age-related changes within information processing models of cognition. This analysis allows the researcher to determine which hypothesized information processing components are significant and the amount of variance shared with the dependent variable(s). Individual differences are investigated by modeling data at the individual subject level. Unstandardized regression weights are correlated with performance on a number of standardized ability tests to determine which components contribute to which abilities. The procedure combines complementary aspects of information processing analysis and psychometric analysis. Componential analysis is illustrated in this study with data from 60 individuals, aged 20 to 79, who solved verbal forced-choice analogies of the form A:B::C: (D1 or D2). Solution time and error rate data were modeled using a regression model developed by Sternberg (1977).     

Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial

The large cohort of white men (317,871) 35 to 57 years old at initial screening for possible enrollment into the Multiple Risk Factor Intervention Trial (MRFIT) was examined with regard to initial blood pressure levels and subsequent coronary heart disease (CHD), stroke, and all-cause mortality. The overall prevalence of isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) greater than or equal to 160 mm Hg and diastolic blood pressure (DBP) less than 90 mm Hg, was 0.67% among white men screened for MRFIT and increased with age (0.31% among 35- to 39-year-olds to 1.7% among 55- to 57-year-olds). The 6 year CHD and all-cause mortality rates in men over 50 were highest in those with ISH compared with both subjects with diastolic hypertension and those with normal pressure. The relative risk of death from stroke in those with ISH, compared with that in those with SBP less than 160 mm Hg and those with DBP less than 90 mm Hg, was 3.0 (95% confidence interval 1.3 to 6.8). In addition, at any level of DBP, the level of SBP appeared to be the major determinant of all-cause and CHD mortality. The determinants of ISH in individuals under 60 years of age as well as the possible efficacy of its treatment should be evaluated further.     

Componential analysis as a way to investigate age-related changes in information processing

Abstract

The purpose of this paper is to alert researchers to the methods and utility of componential analysis as a means to examine age-related changes within information processing models of cognition. This analysis allows the researcher to determine which hypothesized information processing components are significant and the amount of variance shared with the dependent variable(s). Individual differences are investigated by modeling data at the individual subject level. Unstandardized regression weights are correlated with performance on a number of standardized ability tests to determine which components contribute to which abilities. The procedure combines complementary aspects of information processing analysis and psychometric analysis. Componential analysis is illustrated in this study with data from 60 individuals, aged 20 to 79, who solved verbal forced-choice analogies of the form A: B :: C : (D1 or D2). Solution time and error rate data were modeled using a regression model developed by Sternberg (1977).     

Case definitions for chronic obstructive pulmonary disease

The objective of this study was to evaluate the definitions for classification of chronic obstructive pulmonary disease (COPD) recommended by the American Thoracic Society (ATS) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Using data from the U.S. population-based third National Health and Nutrition Examination Survey (NHANES III), we compared the number of individuals in the U.S. population who met definitions of airflow obstruction based on the fixed ratio of FEV /FVC < 0.70 criterion and on the ATS lower 95% confidence limit (lower limits of normal LLN) criterion. Further, we evaluated the definitions in the context of physician-diagnosed obstructive airways diseases and respiratory symptoms. In comparison to the FEV1/FVC < LLN and FEV1 < 100% predicted definition, the fixed ratio-based definition for mild COPD underestimates airflow obstruction by 29% in 20-49-year-olds and overestimates it by 58% in 50-80-year-olds. In comparison to the FEV1/FVC < LLN and FEV1 < LLN definition, the fixed ratio-based definition for moderate COPD underestimates airflow obstruction by 31% in 20-49-year-olds and overestimates it by 37% in 50-80 year olds. Based on our estimation, approximately 0.9 million (26%) of symptomatic individuals out of the 3.6 million U.S. adults aged 20-49 years who have airflow obstruction (FEV1/FVC < LLN and FEV1 < LLN definition) may have undiagnosed respiratory disease. In conclusion, using the FEV1/FVC < 0.70 criterion will substantially under-diagnose airway obstruction in younger individuals and substantially over-diagnose COPD in older individuals.     

Pre-experimental knowledge facilitates episodic recall in young, young-old, and old-old adults

Younger adults (mean age = 19.6), 73-year-olds and 82-year-olds were examined on free recall of verbal materials varying in datedness (i.e., names of people who attained their fame during the 1930s or the 1980s). The main result was an interaction between age and type of materials. Whereas younger adults performed better for "new" than for "old" items, both elderly groups recalled more old than new items. A highlight of these data is that activation of pre-experimental knowledge structures appears to improve episodic recall in both young-old and old-old adults.     

Monoclonal B lymphocytes with the characteristics of "indolent" chronic lymphocytic leukemia are present in 3.5% of adults with normal blood counts

Molecular and cellular markers associated with malignant disease are frequently identified in healthy individuals. The relationship between these markers and clinical disease is not clear, except where a neoplastic cell population can be identified as in myeloma/monoclonal gammopathies of undetermined significance (MGUS). We have used the distinctive phenotype of chronic lymphocytic leukemia (CLL) cells to determine whether low levels of these cells can be identified in individuals with normal complete blood counts. CLL cells were identified by 4-color flow cytometric analysis of CD19/CD5/CD79b/CD20 expression in 910 outpatients over 40 years old. These outpatients were age- and sex-matched to the general population with normal hematologic parameters and no evident history of malignant disease. CLL phenotype cells were detectable in 3.5% of individuals at low level (median, 0.013; range, 0.002- 1.458 x 10(9) cells/L), and represented a minority of B lymphocytes (median, 11%; range, 3%-95%). Monoclonality was demonstrated by immunoglobulin light-chain restriction in all cases with CLL phenotype cells present and confirmed in a subset of cases by consensus-primer IgH-polymerase chain reaction. As in clinical disease, CLL phenotype cells were detected with a higher frequency in men (male-to-female ratio, 1.9:1) and elderly individuals (2.1% of 40- to 59-year-olds versus 5.0% of 60- to 89-year-olds, P =.01). The neoplastic cells were identical to good-prognosis CLL, being CD5+23+20(wk)79b(wk)11a(-)22(wk)sIg(wk)CD38-, and where assessed had a high degree (4.8%-6.6%) of IgH somatic hypermutation. The monoclonal CLL phenotype cells present in otherwise healthy individuals may represent a very early stage of indolent CLL and should be useful in elucidating the mechanisms of leukemogenesis.     

The role of Doppler echocardiography in assessing left ventricular diastolic function. Case histories]

The aim of this study was to provide a further contribution to evaluate the alterations induced by age on a number of simple Doppler indexes of left ventricular diastolic function. A population of 48 healthy subjects aged between 15 and 78 years old was examined using pulsed Doppler analysis of the left ventricular refilling flow. Linear regression analysis revealed a significant inverse correlation between age and peak speed during rapid refilling (r = -0.80); between age and the ratio between peak speed during rapid refilling and peak during atrial systole (r = -0.92); between age and deceleration time of peak E wave speed, although on the contrary the peak speed of diastolic refilling flow during the atrial systole (r = 0.81) increased significantly with age. Variance analysis showed that indexes of left ventricular diastolic function and age continued on the contrary to be significant n the population as a whole and in both sexes. From these findings it is clear that in the different age groups (15-29, 30-49, 50-65, and over 65) the peak speed of rapid refilling flow was significantly lower in over-65-year-olds than in elderly, middle-aged and young subjects (55 +/- 0.8, 60 +/- 0.5, 65 +/- 0.7 and 75 +/- 0.6 respectively; p < 0.001). The ratio between the peak speed of rapid refilling and that during the atrial systole was lower in over-65-year-olds compared to elderly subjects, middle-aged subjects or the youngest age group (0.94 +/- 0.09, 1.05 +/- 0.13, 1.96 +/- 0.21 and 2.68 +/- 0.50 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of habitual physical activity on regulation of insulin-stimulated glucose disposal in older males

The goal of this study was to evaluate the effect of differences in habitual level of physical activity on insulin action in healthy males between 60 and 75 years of age. The study population consisted of 20 non-obese individuals with normal glucose tolerance: 13 older subjects (68 +/- 4 years) not exercising regularly and 7 older subjects (66 +/- 3 years) who exercised regularly. Measurements were made of body mass index (BMI), percentage body fat by underwater weighing, maximal O2 consumption by bicycle ergometry (VO2max), and insulin-stimulated glucose disposal by the insulin clamp technique. The results demonstrated that insulin-stimulated glucose disposal was significantly increased (P less than 0.001) in the normal older subjects who exercised regularly. Furthermore, a direct relationship (r = 0.74, P less than 0.001) existed between maximal aerobic capacity and in vivo insulin action, which was independent of either BMI or percentage body fat. These data are consistent with the view that the extensive variation previously noted in in vivo insulin-stimulated glucose disposal of older subjects is related to differences in habitual physical activity.     

Children's cognitive concepts of obesity: a developmental study

Children's thoughts about human fatness were studied in interviews with children (n = 96) of three age groups (4-5 years, 8-9 years, and 12-13 years). Using a Piagetian theoretical framework, tasks were devised to measure concepts of body identity and causes of obesity which could be compared to measures of physical conservation and physical causality. Older children demonstrated higher levels of reasoning on all tasks than did younger children, with significant differences between each age group for each of four tasks (P less than 0.001). Correlations between tasks were high across all subjects but moderate within age groups. Body identity was understood at higher levels than was physical conservation (P less than 0.0001) among only the youngest group. The levels of understanding causes of fatness and of other natural physical events were not different in the youngest group. However, physical causality was understood and at a higher level than obesity causality among both the 8- to 9-year-olds (P less than 0.0001) and 12- to 13-year-olds (P less than 0.0001). Body identity and obesity causality scores were significantly different only among 12- to 13-year-olds at which time identity scores were higher (P less than 0.003). Physical causality was understood at higher levels than physical conservation among all age groups.     

Radial and spinal bone mineral density in a patient population

Density of the radius (by single-photon absorptiometry) and the spine (by dual-photon absorptiometry) was measured in 281 normal young women and in a large heterogeneous group of 1,622 consecutive female patients. Both spinal and radial density were useful measurements when performed on patients with medical indications; spine and radius densities in these patients averaged 10-20% below those of age-matched controls. However, patients younger than 60 years of age had deficits of spine density that were twice as large as those in the radius, and twice as many of these patients had spinal osteopenia, compared with those with radial osteopenia. After age 70, loss of density in the radius approximated that in the spine and the prevalence of osteopenia was similar at both sites. The poorer sensitivity of the radius measurement reflected the fact that it did not predict spine density. The standard error of the estimate was 0.12 gm/cm2 in normal subjects and 0.15 gm/cm2 in patients. At any given radial density, the spinal density of patients averaged 0.18 gm/cm2 (15-20%) below that in normal subjects. Predictions of spinal density from body weight were as accurate as predictions from radial density. Preferential spinal osteopenia occurring without radial osteopenia precluded radial densitometry as a screening method for individuals with osteoporosis before age 60. However, measurement of the radius was more effective than body weight for defining groups at risk, even though the radius did not reliably predict individual spine density. A radius shaft density less than 0.55 gm/cm2 occurring with a body weight less than 55 kg was associated with a high prevalence of spinal osteopenia.     

A self-training program in inductive reasoning for low-education elderly: tutor-guided training vs. self-training

The main aim of this study was to compare the effectiveness of a self-training program in inductive reasoning run for elderly with low levels of education. Two different training settings were considered, i.e. tutor-guided training and self-training, to ascertain whether results obtained in both settings would be similar. A total of 25 subjects took part in this study (average age = 68.266, range = 60-85 years), all volunteers and residents of the city of Granada. A quasi-experimental design was used with random assignment to either training setting. The design was applied in four stages: pre-test, cognitive training (tutor-guided vs. self-trained inductive reasoning), post-test immediately after training and follow-up at 3 months. Results show considerable gains in inductive reasoning training both in tutor-guided and self-trained groups.     

Trends in alcohol-related harms and offences in a liberalized alcohol environment

AIM: To assess alcohol-related harms and offences in New Zealand from 1990 to 2003, a period of alcohol policy liberalization, that included the lowering of the purchase age from 20 to 18 years in 1999. DESIGN, SETTING AND PARTICIPANTS: Time trend analyses were carried out on routinely collected data for prosecutions for driving with excess alcohol; alcohol-involved vehicle crashes (all and fatal) and prosecutions for disorder offences. These were carried out separately for those aged 14-15, 16-17, 18-19, 20-24 and 25 years and over. MEASUREMENTS: Rates of: prosecutions for driving with excess alcohol (1990-2003); rates of alcohol- involved vehicle crashes (all and fatal) (1990-2003); and rates of prosecutions for disorder offences (1994-2003). FINDINGS: Effects of alcohol policy liberalization: positive trends were found in the rates of prosecutions for disorder in the 16-17, 18-19, 20-24 and 25 + age groups; with 18-19-year-olds and 16-17-year-olds having the largest rates and largest positive trend in rates. For 16-17-year-olds, there was a positive trend in the rates of prosecutions for excess breath alcohol. Negative trends in rates were found for alcohol-related crashes (all and fatal) among all age groups. Negative trends for those over 16-17 years were found for prosecutions for driving with excess breath alcohol (this was prior to the lowering of the purchase age). Effects of lowering the minimum purchase age: the lowering of minimum purchase age coincided with an increase in the trend of alcohol-related crashes for 18-19-year-olds; the next largest increase was among the 20-24-year-olds (all other age groups also increased but at a much lower rate). A similar result was found for driving with excess alcohol for those aged 18-19 (and those aged 20-24 years). An increase in the rates of prosecutions for disorder offences occurred for the 14-15-year-old group following the lowering of the purchase age. CONCLUSION: The liberalization of alcohol throughout the 1990s may have influenced younger people more, as reflected in increases in their disorder offences and drink driving. The lowering of the minimum purchase age may have led to an increase in drink-driving among the 18-19-year-olds (those directly affected by the change in purchase age).     

Cohort differences in trajectories of cognitive aging

To separate age and cohort effects on decline in normal cognitive aging, we applied growth curve models to longitudinal data from the Swedish Adoption/Twin Study of Aging. Data from up to five measurement waves covering a 16-year period were available from 806 participants (age 50 to 88 at the first wave). We divided the sample into two cohorts by birth year: 1900-1925 and 1926-1948. We generated components to tap four cognitive domains: verbal and spatial ability, memory, and speed. We tested cohort differences by using two growth models: quadratic and two linear slopes. Results indicated significant cohort differences in average performance at age 67.5 for all components except speed. When we compared linear slopes during the same age range (age 62-78), we found no cohort differences. Trajectories of change with age in these four domains were fundamentally the same in middle-old age for individuals born during the first half of the 20th century.     

Prediction model for peak expiratory flow in North Indian population

OBJECTIVE: To establish a model for predicting peak expiratory flow rate (PEFR) in North Indian healthy population. Study subjects. Eight hundred and ninety-seven healthy, non-smoker individuals (681 males and 216 females) in the age group of 10-60 years. METHODS: The study was carried out at a health exhibition organised by the Government of Uttar Pradesh, at King George's Medical University, Lucknow. Only healthy, non-smoker individuals were enrolled for the study. Age was noted in completed years and weight in kg and height in cm were taken without shoes. PEFR was measured by Mini Wrights peak flow meter in standing position after prior instructions and demonstration of technique to each individual. The test was performed three times on each subject and best of the three attempts was selected for data computation. The statistical solftware SPSS was used to fit the model and perform residual analysis. RESULTS: The highest reading for males was recorded in the age group of 20 to 24 years and for females in the age group of 25 to 29 years. Using age, height and weight, we established a regression model for predicting PEFR values for males and females separately in the age group 19-60 years. In the age group 10-18 years, the model for predicting PEFR was same for both the sexes. PEFR values were found to be more in males as compared to females. The predictive power of the model as described by explained variation was found to be 80 and 82 percent for males and females, respectively. CONCLUSIONS: Prediction model for north Indian subjects was drafted for age range 10-60 years. While separate models were required for males and females because of sex related differences in the age group 19-60 years, a common model sufficed for age group 10-18 years.