Urinary bladder volume tracking using a Kalman filter

This study introduced the Kalman filter procedure for tracking urinary bladder filling from intermittent bladder volume measurements taken by an ultrasonic bladder volume monitor. The Kalman filter was based on a double integrator as a model for the bladder filling process between micturitions and included a procedure to reset the filter in the event of a micturition. The performance of the Kalman filter was evaluated experimentally using an ultrasonic bladder volume monitor on seven male urologic patients. During cystometry, saline was infused into the patient's bladder at a constant rate of 30 ml min⁻¹ until it was full, and the volume of the bladder was recorded every 30 s by the bladder volume monitor. The evaluation showed that the filter significantly improved the precision of the measured volumes in terms of mean absolute error by 4.2 ml (95% confidence interval: 0.7–7.7 ml) (p=0.025) without affecting the system accuracy, i.e slope (p=0.92) and intercept (p=0.32). Finally, the micturition reset procedure was verified using simulated data.     

Association of total plasma homocysteine with methylenetetrahydrofolate reductase genotypes 677C>T, 1298A>C, and 1793G>A and the corresponding haplotypes in Swedish children and adolescents

We studied 692 Swedish children and adolescents (aged 9-10 or 15-16 years, respectively), in order to evaluate the effect of the methylenetetrahydrofolate reductase (MTHFR) 677C>T, 1298A>C, and 1793G>A polymorphisms on total plasma homocysteine concentrations (tHcy). Genotyping was performed with Pyrosequencing technology. The MTHFR 677C>T polymorphism was associated with increased tHcy concentrations in both the children and the adolescents (P<0.001 for both age groups) in both genders. The effect of MTHFR 1298A>C was studied separately in subjects with the 677CC and 677CT genotypes, and the 1298C allele was found to be associated with higher tHcy levels both when children were stratified according to 677C>T genotypes, and when using haplotype analyses and diplotype reconstructions. The 1793A allele was in complete linkage disequilibrium with the 1298C allele. It was still possible to show that the 1793A allele was associated with lower tHcy levels, statistically significant in the adolescents. In conclusion, a haplotype-based approach was slightly superior in explaining the genetic interaction on tHcy plasma levels in children and adolescents than a simple genotype based approach (R2 adj 0.44 vs. 0.40). The major genetic impact on tHcy concentrations is attributable to the MTHFR 677C>T polymorphism. The common 1298A>C polymorphism had a minor elevating effect on tHcy, whereas the 1793G>A polymorphism had a lowering effect on tHcy.     

Sleep duration and activity levels in Estonian and Swedish children and adolescents

We aimed to examine the associations of sleep duration with time spent on sedentary, moderate and vigorous activities in children and adolescents. The sample consisted of 2,241 (53.5% girls) Estonian and Swedish children (9–10 years) and adolescents (15–16 years), from the European Youth Heart Study, in 1998–1999. Sleep duration was calculated by the difference between self-reported bedtime and time for getting up on a normal weekday. Sedentary time/physical activity was measured by accelerometry (valid data on 1,462 participants). Adolescents had lower odds than children, and Swedish higher odds than Estonian, of meeting the sleep recommendations (>9 h) (OR = 0.22, 95% CI 0.17–0.27; and 1.32, 1.07–1.61, respectively). Participants sleeping longer than 10 h spent more time on physical activities (all intensities) and less time on sedentary activities than those sleeping shorter durations (all P < 0.001). The associations with physical activity became non-significant after additional adjustment for age or sexual maturation (Tanner stages), whereas the associations with sedentary time became borderline significant (P = 0.09/0.03, for age and Tanner, respectively). In conclusion, these results do not suggest a link between sleep durations and activity in a relatively large sample of children and adolescents from two European countries. Consequently, the common assumption that physical activity is a mediator in the relationship between short sleep durations and obesity is not supported by our findings.     

Bone Graft Healing in Reconstruction of Maxillary Atrophy

Purpose: Evaluate correlations between volume change for iliac crest bone grafts in maxillary reconstruction (graft volume change [GVC]) and bone mineral density (BMD), bone volume fraction (BVF), hematologic bone metabolic factors (I), and identify indicators of implant failure (II). Material and Methods: Forty‐six consecutive patients had their edentulous atrophic maxilla reconstructed with free autogenous bone grafts from anterior iliac crest. Endosteal implants were placed 6 months after graft healing. Computer tomography was performed after 3 weeks and 6 months after grafting. Bone biopsies were taken from the internal table of donor site for calculation (BVF), and blood samples were collected. Implant stability was measured at placement with resonance frequency analysis and expressed as implant stability quotient (ISQ). Implant failure was registered. Results: GVC in onlay bone graft was 37%. The BVF in iliac crest biopsies was 32%. Serum‐IGFBP3 differed with 79% of the samples over normal range. Fifteen patients had one or more implant failures prior to loading (early failures). Forty‐two patients were followed for a minimum of 3 years after implant loading and, in addition, 6/42 patients had one or more implants removed during the follow‐up (late failures). GVC correlated to decreased BMD of lumbar vertebrae L2‐L4 (Kruskal–Wallis test, p = .017). No correlation was found between GVC and hematologic factors (Pearson correlation test) or between GVC and BVF (Kruskal–Wallis test). No correlation was found between ISQ and GVC (Pearson correlation test, p = .865). The association between implant failures and the described factors were evaluated, and no significant correlations were found (unconditional logistic regression). Conclusion: Onlay bone grafts decrease 37% during initial healing period, which correlate to BMD of lumbar vertebrae L2‐L4. No other evaluated parameters could explain GVC. The evaluated factors could not explain implant failure.     

Perception of dental fluorosis amongst Ethiopian children and their mothers

This study was conducted in three Ethiopian Rift Valley villages known for endemic fluorosis. Three-hundred-and-six adolescents (12-15 years) and 233 mothers participated. The aim was to study dental fluorosis in the youngsters and to assess the extent of agreement between clinical and self-rated discoloration and pitting of teeth, and also the level at which dental fluorosis is perceived as a problem both by children and their mothers. The children (154 M and 152 F) gave a simple self-assessment of tooth-color and quality of their teeth, and were subsequently examined for dental fluorosis. Finally, four color photographs of teeth with dental fluorosis (TF-scores 2, 3, 5, and 7) were used as references during a structured oral interview of the children, as well as their mothers. At TF score &#83 2, the prevalence of dental fluorosis on maxillary central incisors was 72% and 37% at TF score &#83 4. The mean TF score was significantly higher among boys than among girls of unemployed fathers compared to children of employed fathers. The likelihood of reporting problems with dental appearance increased with increasing individual TF scores. The child/mother pairs found teeth with TF scores 2 and 3 esthetically acceptable, while teeth with TF scores 5 and 7 were considered unacceptable. Mothers were more critical of severe fluorosis than were their children.     

Visceral fat accumulation in men is positively associated with insulin, glucose, and C-peptide levels, but negatively with testosterone levels

Twenty-three healthy men (age 25 to 50 years), covering a wide range of fatness and body fat distribution, were studied. An oral glucose tolerance test was performed and adipose tissue areas were calculated from computed tomography (CT) scans made at the level of L4/L5. Visceral fat area was associated with elevated concentrations of insulin and C-peptide and with glucose intolerance before and after the oral glucose load. Concentrations of sex-hormone-binding globulin (SHBG), as well as total and free testosterone, were negatively correlated with waist/hip circumference ratio and visceral fat area and also negatively associated with increased glucose, insulin, and C-peptide concentrations. In multiple linear regression, adjusting for age, body mass index, and visceral fat area, serum concentrations of free testosterone were still negatively correlated with glucose, insulin, and C-peptide levels. Without claiming any causality in the observed associations, we conclude that, unlike in women, abdominal fat distribution, insulin, glucose, and C-peptide levels are negatively associated with serum testosterone levels in men.     

Mobile app for treatment of stress urinary incontinence: A randomized controlled trial

Aims

To evaluate the effect of a mobile app treatment for stress urinary incontinence (SUI) in women.

Methods

Randomized controlled trial, conducted 2013‐2014 in Sweden. Community‐dwelling adult women with ≥1 SUI episode/week recruited through our website and randomized to app treatment (n = 62) or control group (postponed treatment, n = 61). One participant from each group was lost to follow‐up. Intervention was the mobile app Tät^® with a treatment program focused on pelvic floor muscle training (PFMT), and information about SUI and lifestyle factors. Primary outcomes, 3 months after randomization: symptom severity (International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form [ICIQ‐UI SF]); and condition‐specific quality of life (ICIQ Lower Urinary Tract Symptoms Quality of Life [ICIQ‐LUTSqol]).

Results

One hundred and twenty‐three women were included (mean age 44.7), with moderate/severe SUI (97.5%, 120/123), mean ICIQ‐UI SF score 11.1 (SD 2.8) and mean ICIQ‐LUTSqol score 34.4 (SD 6.1) at baseline. At follow‐up, the app group reported improvements in symptom severity (mean ICIQ‐UI SF score reduction: 3.9, 95% confidence interval 3.0‐4.7) and condition‐specific quality of life (mean ICIQ‐LUTSqol score reduction: 4.8, 3.4‐6.2) and the groups were significantly different (mean ICIQ‐UI SF score difference: ?3.2, ?4.3to ?2.1; mean ICIQ‐LUTSqol score difference: ?4.6, ?7.8 to ?1.4). In the app group, 98.4% (60/61) performed PFMT at follow‐up, and 41.0% (25/61) performed it daily.

Conclusions

The mobile app treatment was effective for women with SUI and yielded clinically relevant improvements. This app may increase access to first‐line treatment and adherence to PFMT.

     

Socio-behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort

Astrom AN, Ekback G, Ordell S, Unell L. Socio‐behavioral predictors of changes in dentition status: a prospective analysis of the 1942 Swedish birth cohort. Community Dent Oral Epidemiol 2011; 39: 300–310. © 2010 John Wiley & Sons A/S Abstract – Objectives: Using a prospective cohort design, this study assessed loss of natural teeth between ages 50 and 65. Guided by a conceptual framework grouping variables according to the life‐course stage at which they would be expected to operate, this study assessed the impacts of socio‐behavioral and disease‐related factors on tooth loss between ages 50 and 65. Methods: In 1992, all 50‐year‐olds in two counties of Sweden were invited to participate in a longitudinal questionnaire survey. Of the total population of 8888 subjects, 6346 responded (71.4%). Of the 6346 subjects who completed the 1992 questionnaire, 4143 (65%) completed postal follow‐ups at ages 55, 60 and 65. Results: For the total sample, the prevalence of having lost at least some teeth increased from 76% at age 50–85.5% at age 65. A total of 14% women and 13% men changed from having all teeth in 1992 to having tooth loss in 2007. Stepwise logistic regression analyses focused on predictors of tooth loss between 1992 and 2007. The following life‐stage predictors achieved or approached statistical significance with respect to overall tooth loss; country of birth and education (early life and young adult life stage), marital status, dental care avoidance because of high cost, smoking and reporting consistent pain (middle‐age and early‐old‐age life stage). Conclusion: Fewer substantial proportions of the 1942 cohort experienced tooth loss between ages 50 and 65. Tooth loss was highly prevalent from age 50 and increased moderately with increasing age. Oral disease‐related factors and socio‐behavioral characteristics such as refraining from dental care because of financial limitations, acting at earlier and later life‐course stages were major risk factors for having tooth loss. Early primary prevention of smoking and increased equitable access to dental care might improve tooth retention throughout the transition from middle age to early‐older age.     

The effects of auditory deprivation on morphological maturation of the ventral cochlear nucleus

Summary The volumes of the auditory brainstem nuclei and age-related auditory brainstem response (ABR) thresholds were analyzed in homozygote (je/je) and heterozygote (je/+) jerker mutant mice. Altogether 97 mice were used in the study. Je/je mice never develop any hearing. The dorsal (DCN) and ventral (VCN) cochlear nuclei were found to have stopped their growth at 56 days after birth. In je/+ mutants, ABR thresholds remained normal or nearnormal for 3–6 months, whereas VCN and DCN volumes remained unchanged at least after 56 days after birth. There is no significant difference in DCN volume in je/je and je/+ mice. However, the VCN volume and the cross-sectional area of globular cells were both significantly larger in je/+ than in je/je mice (P<0.01). These findings show that auditory deprivation during the maturation of hearing in je/je mutants causes an incomplete maturation of only the ventral cochlear nucleus.Supported by grants from the Swedish Medical Research Council (12X-7305), the National Institutes of Health (NS-19238), the Foundation Tysta Skolan (MA), the Ragnar and Torsten Söderberg Foundation (MA) and the University of Umeå