DXA-Generated Z-Scores and T-Scores May Differ Substantially and Significantly in Young Adults

Central dual-energy X-ray absorptiometry (DXA) is the gold standard for non-invasive measurement of bone mineral density (BMD). Using this value and subject demographics, DXA software calculates T-scores and Z-scores. Professional society guidelines for the management of osteoporosis are based on T-scores and Z-scores, rather than on the actual BMD value. Although one expects T-scores and Z-scores to be very similar in young men and women for any given BMD measurement, little literature exists on this issue. Our clinical experience shows that some younger adult individuals (premenopausal women and men younger than 50 yr) have larger than expected difference between their DXA T-score and Z-score. This cross-sectional study evaluates the extent of this discordance between Z-scores and T-scores in a sample of 4275 men and women aged 20–49 yr. All subjects were scanned by central DXA using equipment manufactured by GE Lunar, GE, Madison, WI, or Hologic, Inc., Bedford, MA. Significant differences between Z-scores and T-scores were seen within individuals at the lumbar spine, total hip, femoral neck, and trochanter (p value < 0.001) for both DXA systems. Although these differences were less than half a standard deviation (SD) in most instances, the magnitude of difference was substantial at times, being 1 or more SD in up to 11% of cases (range: −1.95 to +1.54 SD). The smallest differences were seen at the total hip and the largest differences were seen at the femoral neck for both technologies. This is in part because there is no single standard Z-score definition, resulting in different methods of calculation across, and even within, DXA manufacturers. Standardization of Z-score definition and method of calculation is indicated. DXA Z-scores should be interpreted with caution in men and women aged 20–50 yr.     

Changing health status and health expectancies among older adults in China: Gender differences from 1992 to 2002

Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of non-institutionalized adults in China aged 65 years and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population.     

Baraitser–Winter cerebrofrontofacial syndrome: Report of two adult siblings

Baraitser–Winter cerebrofrontofacial syndrome (BWCS) is a rare, autosomal dominant condition that is characterized by intellectual disability, distinctive craniofacial features, structural brain abnormalities, seizures, microcephaly, hearing loss, and ocular colobomas. The first three cases were described in 1988 by Baraitser and Winter and included two siblings and an unrelated third patient. Subsequently, causative missense variants in the ACTB and ACTG1 genes were identified, with de novo occurrence in patients with the condition. Herein, we describe two adult siblings who were born to unaffected parents and who were diagnosed with BWCS in their fourth and sixth decade of life following exome sequencing performed for intellectual disability. We review the literature reports of adult patients with BWCS to document the clinical features and phenotypic variability that can occur later in life. This is the first molecularly confirmed report of germline mosaicism in BWCS and one of only a few reports to describe two BWCS patients belonging to the same family.     

健康成人血液流变学与血脂相关性的实验研究

目的：研究健康成人血液流变学指标与血脂之间的相关性。方法：抽取西安市某单位健康查体人群各项检查结果齐全的资料117例，其中男性79例，女性38例，将采集的数据进行统计分析。结果：男性和女性之间，TG、HBV、LBV、HRV、LRV、CV、CY均有显著差异（P〈0.05）；女性资料中，血脂指标与血液流变学指标的相关性无统计学意义（P〉0．05）；男性资料中，血液流变学指标与血脂指标有相关性（P〈0．05）。结论：控制血液粘度和血脂水平是防止和减低心脑血管疾病发生的重要环节。     

Providing Interdisciplinary Geriatric Team Care: What Does It Really Take?

We concur with Speer and Schneider's arguments (2003 ; this issue) that more psychologists should offer mental health services to older adults and that the primary care system is a good focus of such efforts. Three issues deserve more prominence in their review. First, their argument that older adults are averse to mental health services seems incorrect, given research indicating that older adults prefer psychotherapy to medication for treatment of depression. Second, psychologists working in primary care need to be aware of new Current Procedural Terminology (CPT) codes that allow documentation of psychological work in medical settings. Third, Speer and Schneider allude to interdisciplinary team functioning, but provide little information about models of team care or issues in developing a well-functioning interdisciplinary team; this commentary expands on those topics.     

The survey of recent life experiences: A psychometric evaluation

Hitherto, various critics have claimed that the most commonly used measure for daily hassles is confounded with psychological well-being in both content and format. In order to circumvent such contamination, the Survey of Recent Life Experiences (SRLE) was developed by Kohn and MacDonald (1992). In the present study, the SRLE was psychometrically evaluated within a general sample of the Dutch population. Confirmatory factor analysis showed that, with the exception of one item, the original six-factor structure was strongly replicated. For five of six factors, internal consistency reliabilities proved satisfactory. It is argued that the rather low internal consistency reliability of the sixth factor may be improved if additional items are subjoined. In addition, yielded relationships between the SRLE and other variables were in accordance with previous research. It is therefore argued that the results are in support of cross-cultural construct validity of the SRLE. Future use within other Western European societies is recommended.     

Pineal malignant rhabdoid tumor with chondroid formation in an adult

A pineal tumour in a 27-year-old male is presented with the characteristic histological features of a pineal malignant rhabdoid tumor (MRT) with chondroid formation. Occasionally, tumor cells contained a single well-demarcated hyaline globular inclusion within the cytoplasm adjacent to the nucleus. The stroma of these tumors tends to be densely hyalinized and become chondroid. Immunohistochemical staining was positive for vimentin, epithelial membrane antigen, chromogranin A, synaptophysin, neuron-specific enolase, S-100 protein, and muscle actin. Despite surgery and radiochemotherapy, the tumor recurred in the pineal region and metastasized to the lower lobe of right lung. The patient died 2 years after the initial diagnosis. This is the second published case of central nervous system-MRT appearing in an adult. The clinical and pathological features of pineal MRT in this patient are presented.     

The relationship of age and cardiovascular fitness to cognitive and motor processes

Older and younger aerobically trained and sedentary adults participated in an S1-S2-S3 paradigm designed to elicit event-related potential (ERP) and behavioral responses to determine the influence of cardiovascular fitness on cognitive and motor processes. The paradigm provided warning (S1) as to the difficulty level of an upcoming decision task (S2). Participants had to decide the taller of two bars on presentation of S2 but hold their response until S3, to which they indicated their choice motorically. Results revealed age-related differences for ERP measures as older participants showed increased amplitude of the stimulus preceding negativity (SPN) prior to S2, and longer latencies and equipotentiality of P3 in response to S2. Fitness effects were also observed for the contingent negative variation (CNV) with decreased amplitude for fit relative to sedentary individuals. Age interacted with fitness for P3 latency to S2 as older sedentary individuals showed the longest latency followed by older fit and both younger groups. No significant group differences were observed for reaction time (RT) to S3. Therefore, physical fitness is associated with attenuation of cognitive decline in older individuals and greater economy of motor preparation for both young and older participants.     

Dietary Fiber and Its Source Are Associated with Cardiovascular Risk Factors in Korean Adults

We examined the associations of dietary fiber and its source with cardiovascular risk factors in Korean adults. This cross-sectional study involved 16,792 adults from the 2013–2018 Korea National Health and Nutrition Examination Survey data. Dietary data were obtained using a 24 h recall method and used to evaluate intakes of total dietary fiber and its source and fruit consumption. Cardiovascular risk factors included obesity, abdominal obesity, metabolic syndrome, hypercholesterolemia, hypertension, and type 2 diabetes. Multiple logistic regression was used to examine the associations of dietary fiber and its source with cardiovascular risk factors by sex. Total fiber and fruit fiber intake in men were inversely associated with metabolic syndrome (Q5 vs. Q1: odds ratios (OR) = 0.69, 95% confidence intervals (CI) = 0.53–0.92 for total fiber; Q4 vs. Q1: OR = 0.76, 95% CI = 0.61–0.93 for fruit fiber). Among women, a higher intake of fruit fiber was related to a reduced prevalence of obesity (Q4 vs. Q1: OR = 0.85, p trend = 0.029) and abdominal obesity (Q4 vs. Q1: OR = 0.82, p trend = 0.026). Total fruit and whole fruit consumption was inversely associated with obesity, abdominal obesity, and metabolic syndrome in men and hypertension in women. The amount and sources of fiber are associated with metabolic diseases in Korean adults and should be considered in the context of overall dietary quality.     

The Feasibility of Using Computrition Software for Nutrition Research—A Pilot Study

We evaluated the feasibility of using Computrition to design and implement a low vs. typical sodium meal plan intervention for older adults. Dietitians used Computrition to design a 7-day meal plan with three caloric levels (≤1750, 2000, ≥2250 kcals/day) and two sodium densities (low = 0.9 mg/kcal; n = 11 or typical = 2 mg/kcal; n = 9). Feasibility was determined by post-hoc definitions of effectiveness, sodium compliance, palatability of diet, sustainability, and safety. Given the low number of participants in one of the three calorie groups, the higher calorie groups were combined. Thus, comparisons are between low vs. typical meal plans at two calorie levels (≤1750 or ≥2000 kcals/day). Overall, regardless of the calorie group, the meal plans created with Computrition were effective in reaching the targeted sodium density and were safe for participants. Furthermore, individuals appeared to be equally compliant and reported similar palatability across meal plans. However, one of the three criteria for the sustainability definition was not met. In conclusion, we successfully used Computrition to design low and typical sodium meal plans that were effective, compliable, and safe. Future studies of older adults in similar settings should focus on improving the palatability of the meal plans and scaling this protocol to larger studies in older adults.