Long-term effects of nutrient intervention on markers of bone remodeling and calciotropic hormones in late-postmenopausal women

BACKGROUND: Adequate intakes of calcium and vitamin D reduce bone loss and fracture risk in the elderly. Other nutrients also affect bone health, and adequate intakes may influence bone turnover and balance. OBJECTIVE: We compared the long-term effects on bone turnover markers and calciotropic hormones of a multinutrient supplement, a calcium and vitamin D supplement, and dietary instruction aimed at increasing calcium intake through foods. DESIGN: Ninety-nine healthy postmenopausal women participated in a 3-y, randomized trial, receiving either 1) supplemental calcium (1450 mg/d) and vitamin D [10 microg (400 IU)/d], 2) calcium, vitamin D, and other nutrients (multinutrient supplement), or 3) dietary instruction (dietary control group). Data are from 83 subjects who completed the trial. RESULTS: Increases over baseline in calcium intakes and serum 25-hydroxyvitamin D concentrations were sustained over 3 y in all treatment groups. Circulating parathyroid hormone concentrations were reduced at year 1 in all treatment groups but trended toward baseline thereafter. Bone turnover markers followed a similar pattern, and none of the changes in biochemical concentrations differed significantly between groups. CONCLUSIONS: All 3 interventions offer long-term feasibility for increasing calcium intake and serum 25-hydroxyvitamin D concentrations. The dietary addition of micronutrients implicated in skeletal physiology confers no obvious bone-sparing effect in healthy postmenopausal women beyond that of calcium and vitamin D alone. The attenuation over time in suppression of parathyroid hormone and bone turnover might help explain why nutrient intervention tends to have less of a bone-sparing effect than do skeletally active medications such as estrogen or bisphosphonates.     

Assessment of personal protective equipment use among Midwestern farmers

BACKGROUND: Personal protective equipment (PPE) is readily available and widely recommended, yet usage among agricultural workers is largely unknown. METHODS: A mail survey of 2,483 farmers in six Midwestern states with telephone follow-up addressed PPE usage related to sun exposure, noise abatement, chain saw usage, welding and metal work, handling of large animals in and out of confinement facilities, feed handling, manure storage facilities, and mixing and applying chemicals. Summary statistics of survey responses were compiled. RESULTS: With the exception of welding masks, PPE usage was low. Farmers were satisfied with availability of PPE through local hardware and farm cooperatives, but the decision to use PPE was personal and influenced little by outside parties. CONCLUSION: PPE usage rates by farmers on Midwestern farms need to be increased. The desire of the individual farmer to reduce risk of personal injury or exposure should be targeted. The most effective venue will be local agricultural extension services.     

Traumatic exposure and posttraumatic stress disorder in borderline,schizotypal, avoidant,and obsessive-compulsive personality disorders: findings from the collaborative longitudinal personality disorders study

The association between trauma and personality disorders (PDs), while receiving much attention and debate, has not been comprehensively examined for multiple types of trauma and PDs. The authors examined data from a multisite study of four PD groups: schizotypal, borderline (BPD), avoidant, and obsessive-compulsive, and a major depression comparison group. Rates of traumatic exposure to specific types of trauma, age of first trauma onset, and rates of posttraumatic stress disorder are compared. Results indicate that BPD participants reported the highest rate of traumatic exposure (particularly to sexual traumas, including childhood sexual abuse), the highest rate of posttraumatic stress disorder, and youngest age of first traumatic event. Those with the more severe PDs (schizotypal, BPD) reported more types of traumatic exposure and higher rates of being physically attacked (childhood and adult) when compared to other groups. These results suggest a specific relationship between BPD and sexual trauma (childhood and adult) that does not exist among other PDs. In addition, they support an association between severity of PD and severity of traumatic exposure, as indicated by earlier trauma onset, trauma of an assaultive and personal nature, and more types of traumatic events.     

Short-term diagnostic stability of schizotypal,borderline, avoidant,and obsessive-compulsive personality disorders

OBJECTIVE: Personality disorders are defined as enduring patterns of maladaptive behaviors and traits that are stable over time. This study prospectively examined the stability of four personality disorders (schizotypal, borderline, avoidant, and obsessive-compulsive) over a 1-year follow-up period. METHOD: Subjects (N=668) were recruited from multiple clinical settings at four collaborating institutions. Subjects met criteria for one or more of the four personality disorders or were part of a comparison group of subjects with major depressive disorder and no personality disorder. Diagnoses were established by using semistructured interviews. Follow-up assessments, conducted 6 and 12 months after the baseline assessment, included monthly ratings of all criteria for the four personality disorders and weekly ratings of the course of major depressive disorder. The current report is based on 621 subjects with complete data through 12 months of the follow-up period. RESULTS: Significantly more subjects in each personality disorder group remained at diagnostic threshold throughout the 12 months of the follow-up period than did those in the major depressive disorder group. A continuous measure of number of criteria met was highly correlated across the three assessments. The majority of personality disorder subjects, however, did not consistently remain at diagnostic threshold, and the mean number of criteria met decreased significantly for each group. CONCLUSIONS: Individual differences in personality disorder features appear to be highly stable, although the number of criteria present decreases over time. Personality disorders may be characterized by stable trait constellations that fluctuate in degree of maladaptive expression.     

Pediatric central corneal thickness variation among major ethnic populations.

PURPOSE: To investigate differences in central corneal thickness (CCT) among African-American, Caucasian, and Hispanic pediatric populations with respect to race, age, and gender. SUBJECTS AND METHODS: Ultrasound pachymetry measurements were obtained on 208 eyes of 106 patients. Measurements from left eyes were used in data analysis. Analysis of variance (ANOVA) and two-tailed t-test were performed to determine the effect of race, age, and gender on CCT variation. RESULTS: Mean central corneal thickness of left eyes in each ethnic group was African-Americans, 523 +/- 40 microm; Caucasians, 563 +/- 36 microm; and Hispanics, 568 +/- 44 microm. ANOVA performed on pachymetry values showed a significant effect of race on CCT (P = 0.00002). Mean Hispanic CCT was greater than mean African-American CCT (P = 0.0003), but was not significantly different from Caucasian CCT (P = 0.56). Mean Caucasian CCT was also greater than mean African-American CCT (P = 0.0001). The difference between mean male CCT (548 +/- 41 microm) and mean female CCT (563 +/- 44 microm) did not reach statistical significance (P = 0.07). When patients were stratified into age groups (<2 years, 2 to 4 years, 5 to 9 years, 10 to 18 years), CCT did not vary with age (P = 0.16). CONCLUSIONS: Our study suggests there may be differences in CCT among different ethnic groups in the pediatric population, with African-Americans having thinner corneas than Caucasians and Hispanics.     

Treatment utilization by patients with personality disorders

OBJECTIVE: Utilization of mental health treatment was compared in patients with personality disorders and patients with major depressive disorder without personality disorder. METHOD: Semistructured interviews were used to assess diagnosis and treatment history of 664 patients in four representative personality disorder groups-schizotypal, borderline, avoidant, and obsessive-compulsive-and in a comparison group of patients with major depressive disorder. RESULTS: Patients with personality disorders had more extensive histories of psychiatric outpatient, inpatient, and psychopharmacologic treatment than patients with major depressive disorder. Compared to the depression group, patients with borderline personality disorder were significantly more likely to have received every type of psychosocial treatment except self-help groups, and patients with obsessive-compulsive personality disorder reported greater utilization of individual psychotherapy. Patients with borderline personality disorder were also more likely to have used antianxiety, antidepressant, and mood stabilizer medications, and those with borderline or schizotypal personality disorder had a greater likelihood of having received antipsychotic medications. Patients with borderline personality disorder had received greater amounts of treatment, except for family/couples therapy and self-help, than the depressed patients and patients with other personality disorders. CONCLUSIONS: These results underscore the importance of considering personality disorders in diagnosis and treatment of psychiatric patients. Borderline and schizotypal personality disorder are associated with extensive use of mental health resources, and other, less severe personality disorders may not be addressed sufficiently in treatment planning. More work is needed to determine whether patients with personality disorders are receiving adequate and appropriate mental health treatments.     

The normal development of tibial torsion

Objective: Pathological rotation of the leg is a well-known problem in paediatric orthopaedics. In this study the normal development of tibial torsion during growth was evaluated by computed tomography (CT). Design: Seventy-eight normal individuals (52 children, 26 adults) aged 3–51 years were examined with CT. In axial scans the angle between a line tangential to the posterior part of the femoral condyles and the intermalleolar line, a line through the centre of the lateral and medial malleolus, was measured. The radiation exposure was evaluated and accepted by The National Department for Radiation and the Regional Committee for Ethics in Science. Results: CT showed that the average lateral torsion of the leg at the age of 4 years was 28° with an individual variation of 20°–37°. Later the increase in tibial torsion was on average 1°/year until 10 years of age and, thereafter, 4° until maturity when the mean lateral torsion was 38° (18°–47°). Conclusion: Tibial torsion in children mainly develops during the first 4 years of life. After this the increase was of less clinical significance. Received: 13 November 2000 Revision requested: 26 February 2001 Revision received: 19 March 2001 Accepted: 18 April 2001