Fruit and vegetable consumption in later life.

OBJECTIVE: to assess levels of fruit and vegetable consumption in elderly people, and to examine the socio-economic, physical and psychological factors which influence this consumption. METHODS: a three-phase survey: face to face interviews; self-completed dietary diaries with a food frequency questionnaire; and follow-up face-to-face interviews. PARTICIPANTS: 445 elderly people (aged 65+) randomly selected from general practitioner lists in urban Nottingham and rural Nottinghamshire, Lincolnshire and Leicestershire. RESULTS: the recommended target of five portions of fruit and vegetables a day was achieved by less than half the respondents: 37% of those living in the urban area and 51% of those living in the rural area. Low fruit and vegetable consumption was particularly associated with being male, smoking and having low levels of social engagement. CONCLUSIONS: most elderly people consume less than the recommended levels of fruit and vegetables. Health programmes promoting fruit and vegetable consumption may not be successfully reaching elderly people and need to target those particularly at risk of low consumption.     

Coping with daily events and short-term mood changes: an unexpected failure to observe effects of coping.

This study examined the relationship between coping efforts and stress-related mood changes. Men and women with high levels of work or marital stress reported stress and coping efforts approximately once an hour for 2 days using an electronic diary. Stress episodes were identified as a stress-free time followed by a stressor at the next time point. Analyses examined how appraisals and coping influenced pre- to poststress mood change and how problem appraisals were related to coping efforts. Greater mood changes were associated with appraisals of high stress and high disruptiveness. Appraisals of high control and high desirability were associated with more planning, direct action, and fewer acceptance coping efforts. Coping failed to predict any pre- to poststressor mood changes. Possible explanations for the overall failure of coping to predict momentary mood changes are discussed.     

Colonial morphology of tumour cells and susceptibility to cytolysis by tumour necrosis factor. The role of cellular fibronectin deposition in the extracellular matrix

The tumour cell lines U937A and L929 form large, loosely packed colonies in vitro and can be killed by the cytokine tumour necrosis factor (TNF). In contrast, their TNF-resistant mutants U937A/R and L929/R form tightly packed colonies. Since cells which form loose colonies have increased metastatic potential it is important to understand the factors governing colonial morphology. To this end, we have compared the extracellular matrices (ECMs) of the 'loose' lines, U937A and L929 with their 'tight' mutants. By immunofluorescence, a polyvalent anti-U937A serum revealed a fibrillar network in the ECMs of the 'loose' lines which was absent in the 'tight'. On Western blotting of ECMs the antiserum detected an additional 300 kDa protein in the 'loose' lines which was subsequently shown to be cellular fibronectin. The four lines secreted comparable amounts of fibronectin and this was qualitatively indistinguishable between 'loose' and 'tight' cells by peptide mapping or lectin binding. It is concluded that the differences in colonial morphology are due to the 'tight' mutants' inability to incorporate fibronectin into the ECM.     

Severity of drug dependence does not predict changes in drug users’ behaviour over time

This paper examines the power of a measure of drug dependence to predict future changes in drug consumption and related outcomes such as criminality and homelessness. Data from an ongoing, longitudinal, interview study (DORIS) of 1033 new attenders at a range of Scottish drug treatment facilities were analysed, 16 months on from sample recruitment, using forward stepwise logistic regression models. Dependence was measured at baseline and in subsequent interview sweeps using the five-item Severity of Dependence Scale (SDS). In addition to drug consumption measures, a range of non-drug consumption measures were used, including those measuring housing status, employment status and criminality. Respondents’ SDS scores fell significantly over time, and SDS score at 16 months was a significant independent predictor of outcome measures such as reports of acquisitive crimes. However, SDS score at baseline was not an independent predictor of either drug consumption measures at 16 months or non-drug outcomes such as criminality at 16 months. Treatment services are increasingly designed to view drug use as a chronic condition, with dependence as its core property. However, while SDS score functions as a useful outcome measure, puzzlingly, severity of dependence does not predict future drug using careers in these data, the largest longitudinal cohort of Scottish drug users ever studied. Accordingly, the implications of these findings for the conceptualisation of drug use and for services planning and delivery are both unsettling and unclear.     

Pulmonary function in chronic renal failure patients managed by continuous ambulatory peritoneal dialysis

The influence of intraperitoneal fluid on pulmonary function was studied in 20 unselected continuous ambulatory peritoneal dialysis (CAPD) patients, all but one of whom had at least one cardiorespiratory disorder. Measurements of pulmonary function were made with the abdomen empty and following the instillation of 2 1 of dialysis fluid (full). Functional residual capacity fell with the peritoneal cavity full, due to decreases in residual volume, and expiratory reserve volume, but there was a corresponding increase in inspiratory capacity. The vital capacity remained unchanged and the total lung capacity fell only slightly. The FEV1, diffusing capacity, and distribution of ventilation were unaltered. These findings can be attributed to an increase in intra-abdominal pressure resulting in elevation of the diaphragm and increased diaphragmatic contractility. We conclude that the instillation of 21 of dialysis fluid in CAPD patients with cardiorespiratory disease does not result in a clinically significant deterioration in these aspects of pulmonary function.     

Endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis

Over a five and one half year period, four of nine patients with endstage renal failure due to polycystic kidney disease managed by continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis following intestinal perforation. Two patients had colonic perforation associated with diverticular disease, one necrosis of the terminal ileum, and one acute appendicitis. Two of the patients died subsequent to these complications. The survivors had early transfer to haemodialysis. In contrast, over the same period, only two of 125 patients with renal failure due to other causes and managed by CAPD had acute intestinal perforation. In both cases this was associated with acute appendicitis. Both patients survived. All episodes of peritonitis in CAPD patients with polycystic kidneys demand very close monitoring, cessation of CAPD, and early surgical intervention. CAPD is relatively contraindicated in such patients.